Claim specialist jobs in Buffalo, NY - 33 jobs

Full-time Description We're looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you'll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise. Key Responsibilities Accurately process claims within established timelines Review and complete claim adjustment requests Research claim reversal requests to determine approval or denial Manage debit card dispute workflows, including fraudulent or disputed transactions Provide clear and professional responses to routine phone and written inquiries related to claim processing Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules Adjudicate transactions that fail auto-review and determine whether additional documentation is needed Requirements High School Diploma or equivalent Knowledge of ERISA guidelines preferred Strong written and verbal communication skills with excellent attention to detail Ability to manage multiple priorities using strong organizational and time-management skills Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally Self-starter who can work independently in a fast-paced environment with critical deadlines An Equal Opportunity Employer. Salary Description 16.00 - 18.00

Job Type: Permanent Build a brilliant future with Hiscox Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required. Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations: Manhattan, NY West Hartford, CT Atlanta, GA Chicago, IL Boston, MA The Role: The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also: Adjusts and resolves complex to severe claims that includes all phases of litigation With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters Reviews and analyses claim documentation and legal filings Drives litigation best practices to lead defense strategy on litigated files Mentors Claim Examiners Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions Identifies emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with special investigations unit Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities Develops content and conducts training for claims team and underwriters as requested The Team: The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling. Requirements: 8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.) Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation Advanced knowledge of coverage within the team's specialty or focus Advanced knowledge of litigation process and negotiation skills Experience in mentoring and training other claims examiners Excellent verbal and written communication skills Advanced analytical skills B.A./B.S degree from an accredited College or University preferred Additional Factors Considered: Ability to act a subject matter expert within team Demonstrated ability to work with minimal oversight Experience attending and leading mediations, arbitrations and trials Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars. What Hiscox USA offers: 401(k) with competitive company matching Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) Company paid group term life, short- term disability and long-term disability coverage 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days Paid parental leave 4-week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing 2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox USA: Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. Diversity and flexible working at Hiscox: At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range: $125,000-$155,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-RM1 Work with amazing people and be part of a unique culture

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency. Responsibilities Include: * Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans * Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations. * Manages the inventory of claims against standard service level agreements (SLA's) * Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement. * Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics * Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance * Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems * Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance * Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades * Performs other duties as deemed essential and necessary Qualifications: Required Skills and Abilities: * Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims. * Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team. * Analytical Skills: Ability to analyze claims data and make informed decisions based on findings. * Experience: Previous experience in claims processing or a related field, including supervisory experience. * Understands health insurance benefit administration in a Self-Funded environment * Ability to read and understand various forms, documentation, files, and information with the department. Education and Experience: * Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment * Candidate must have at least 3 years of experience supervising a claims team * Candidates must have prior experience with a highly automated and integrated claim adjudication system * Experience working with HealthRules Payer * Understanding of health insurance benefits administration in a self-funded environment Preferred Qualifications: * Past Training Experience * Experience working at TPA * Experience with self-funded plans Work Location: * An ideal candidate would be assigned to the Buffalo Office with ability to work from home. * If not in the Buffalo area, the opportunity can be remote. Leadership Skills & Behaviors: ● Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward. ● Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function. ● Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically. ● Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps. ● Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know. ● Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding. ● Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development. ● Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network. ● Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.

Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Buffalo, New York. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $55,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $62,000 - $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.

At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose. When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers. Multi-line Adjuster Trainee -New York City, NY, Buffalo, NY, Syracuse, NY Rochester, NY, Albany, NY Salary: "*Starting pay rate varies based upon position and location. Ask your Recruiter for details!" We are looking for a highly motivated and service-oriented individual to join our Multi-line Damage team as a Multi-line Property Damage Trainee! As an ambassador for GEICO's renowned customer service, you will work in a dynamic environment that may include repair shops, salvage yards, a customer's home or in a virtual estimating environment. You will be responsible for inspecting damage, estimating cost of repairs, negotiating settlements, issuing payments, and providing excellent customer service. This position primarily will include servicing boat, motorcycle, RV and other specialty claims. Our industry-leading, paid training, which includes 3-weeks of required hands-on experience at our Ashburn, VA training facility will teach you the ins and outs of physical damage adjusting. We will provide the resources and training so you can directly assist our customers after accidents or major disasters. We're looking for those who are equally as motivated as they are compassionate. Your unique skillset, along with the latest adjusting tools and tech, will help you. Qualifications & Skills: Valid driver's license (must meet company underwriting guidelines for at least the past 3 consecutive years) and the ability to maintain applicable state and federal certifications and permits Willingness to be flexible with primary work location - position may require either remote or field work Solid computer, mechanical aptitude, and multi-tasking skills Effective attention to detail and decision-making skills Ability to effectively communicate, verbally and in writing, and willingness to expand on these abilities Minimum of high school diploma or equivalent, college degree or currently pursuing preferred Annual Salary $25.44 - $45.28 The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations. At this time, GEICO will not sponsor a new applicant for employment authorization for this position. The GEICO Pledge: Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs. We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives. Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels. Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose. As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers. Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future. * Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being. * Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance. * Access to additional benefits like mental healthcare as well as fertility and adoption assistance. * Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year. The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled. GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR rXzZkqANop

SUMMARY DESCRIPTION: The Residential Field Adjuster is responsible for investigating, inspecting, negotiating, and bringing to final resolution property claims of all named-peril losses. For claims where the damage is less severe, the Property Field Adjuster may be assigned tasks, such as verification of damage. The role's primary duties include reviewing coverage, inspecting damaged property, and estimating repair/replacement costs in accordance with the client's and RENFROE's guidelines. The Property Field Adjuster is also responsible for documenting all activity, submitting proper claims paperwork, handling renters and personal property policies, meeting with contractors, effectively communicating with the client and all stakeholders, and ensuring compliance with legal and contractual obligations. REPORTS TO: Assigned RENFROE Manager ESSENTIAL JOB FUNCTIONS: Follows RENFROE and clients' policies and procedures to handle all assigned property claims Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills Completes assigned property adjustments, such as property or contents inspections, verification of loss, and updates claims as new information becomes available using XactAnalysis, Xactimate, or other estimating platforms Manages the progression of claims/tasks and claim inventories assigned to the them Travels to the loss location to inspect the property, which could include climbing the roof, inspecting the attic, or other inspection points, to establish the cause and scope of the loss Works with contractors or another representative to reach an agreement on the scope of loss Reviews the insurance policy and endorsement details to confirm coverage Contacts and interacts with the insured to obtain documents such as property deeds, purchase receipts, warranties, photographs, or other documents to establish the existence, ownership, and value of the items claimed lost Assists the client and claims examiner in determining coverage and amounts for additional living expenses such as rental housing, travel, meals, etc. Writes closing reports, including recommendations for repair and/or replacement, the pursuit of subrogation, and salvage potential Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE Does not handle claims for which they do not have client authorization or for which they are not licensed Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes Makes suggestions on ways to improve process efficiency Participates in special projects and completes other duties as assigned Non-Authorized Activities: Field adjusters should not: Communicate training requirements to client staff adjusters and non-affiliated firms Communicate training requirements to any claim handler who is not deployed with RENFROE Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind EXPERIENCE/QUALIFICATIONS: Minimum of 1 year of property claims experience is preferred Participation in technical insurance coursework is preferred, such as CPCU Experience using various claims processing systems is preferred Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others Strong analytical skills and consistent attention to detail Knowledge of ISO forms, and client policy coverage, procedures, and systems Communicates clearly and effectively, both verbally and in writing Strong customer service orientation and good rapport with the insured Well-organized and hard-working, with the ability to thrive in a fast-paced work environment Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact Computer skills, including but not limited to practical knowledge of Word and Excel PHYSICAL DEMANDS: Ability to operate an automobile and have a valid driver's license with a safe driving record Ability to travel by automobile or airplane Must be able to lift, carry, unfold/extend, and climb a ladder (which may exceed 50 lbs. in weight) that is approved by the appropriate regulatory agency or complies with legislative or regulatory occupational health and safety requirements Must be able to complete measurements of roofs and inspect interior as necessary, including attics, basements, and crawl spaces for residential and commercial structures Must be able to do the following while conducting an inspection: climb, bend, crawl, stoop, walk, reach, kneel, squat, and carry/lift objects (typically weighing less than 50 lbs.) Must be able to work outdoors in all types of weather Ability to operate a telephone and a computer for extended periods of time Must be able to work extended and varying work schedules, including working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays Ability to work in a fast-paced, changing, and multi-tasking environment

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Responsibilities & Duties:Claims Processing and Assessment: * Evaluate incoming claims to determine eligibility, coverage, and validity. * Conduct thorough investigations, including reviewing medical records and other relevant documentation. * Analyze policy provisions and contractual agreements to assess claim validity. * Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: * Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. * Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. * Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: * Ensure compliance with company policies, procedures, and regulatory requirements. * Maintain accurate records and documentation related to claims activities. * Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: * Identify opportunities for process improvement and efficiency within the claims department. * Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. * Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: * Generate reports and provide data analysis on claims trends, processing times, and outcomes. * Contribute to the development of management reports and presentations regarding claims operations.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Contents Adjuster **PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies and other records to determine insurance coverage. + Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. + Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance. + Estimates cost of repair, replacement, or compensation. + Prepares report of findings and negotiates settlement with claimant. + Recommends litigation by legal department when settlement cannot be negotiated. + Attends litigation hearings. + Revises case reserves in assigned claims files to cover probable costs. + Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Obtain IIA-AIC designation within 12 to 18 months. Appropriate state adjuster license is required. **Experience** None. **Skills & Knowledge** + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Demonstrated commitment to timely reporting + Strong customer service skills + Strong interpersonal skills + Attention to detail and accuracy + Good time management and organizational skills + Ability to work independently or in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** : Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** : + Must be able to stand and/or walk for long periods of time. + Must be able to kneel, squat or bend. + Must be able to work outdoors in hot and/or cold weather conditions. + Have the ability to climb, crawl, stoop, kneel, reaching/working overhead + Be able to lift/carry up to 50 pounds + Be able to push/pull up to 100 pounds + Be able to drive up to 4 hours per day. + Must have continual use of manual dexterity. **Auditory/Visual** : Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($50,000 - $70,000). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a medical claims representative trainee, you'll be instrumental in keeping the medical claims process efficient and supportive for our customers. Focusing on personal injury protection (PIP) medical coverage, you'll analyze accident details, medical records and terminology. You'll also adjust claims while maintaining solid relationships with customers. Bring your passion for helping others and we'll teach you the insurance stuff - allowing you to be confident when speaking with customers. This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like. Duties & responsibilities after training * Research policy contract, regulation and cause of injury to make coverage decisions * Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions * Identify and research wage loss expenses and documentation for payment consideration * Review and interpret policy language when subrogation demands are received Must-have qualifications * Three years of work experience OR * Bachelor's degree OR * Two years work experience and an associate degree Schedule * Monday - Friday 8:00 AM - 4:30 PM during Onboarding Compensation * Once you complete training (which means passing any necessary training requirements) your salary will be $60,500 - $63,000. However, during training, you will be paid an hourly rate based on your salary. * Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Benefits * 401(k) with dollar-for-dollar company match up to 6% * Medical, dental & vision, including free preventative care * Wellness & mental health programs * Health care flexible spending accounts, health savings accounts, & life insurance * Paid time off, including volunteer time off * Paid & unpaid sick leave where applicable, as well as short & long-term disability * Parental & family leave; military leave & pay * Diverse, inclusive & welcoming culture with Employee Resource Groups * Career development & tuition assistance Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership. Equal Opportunity Employer Applicants must be authorized to work for any employer in the U.S. without the need or potential need, of current or future sponsorship for employment. Progressive does not hire candidates with (e.g., F-1 CPT, OPT, or STEM OPT, H-1B, O-1, E-3, TN) statuses for this role. For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************** Share: Email X Facebook LinkedIn Apply Now

Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Buffalo, NY. Work Hours: Monday-Friday shifts available; some weekends as needed. **Starting salary at $22/HR and up** We also offer quarterly incentive bonuses. Sign-On Bonus: $5,000 for employees starting before March 1, 2026. We offer a variety of benefits including: Medical, Dental & Vision insurance 401k with a match Paid Time Off and Paid Holidays Tuition Reimbursement Paid Volunteer Day Floating Holiday Referral Incentive Paid Life, and short & long-term disability insurance Pharmacy Benefit Verification Summary The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders. Pharmacy Benefit Verification Specialist Major Responsibilities: Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests. Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information. Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information. Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile. Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy. Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims. Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws Contributes to team effort by accomplishing related tasks as needed and other duties as assigned. Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. Pharmacy Benefit Verification Specialist Qualifications: Education/Learning Experience Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience Work Experience Required: 1+ years pharmacy or benefit verification experience Desired: 3+ years pharmacy or benefit verification experience Skills/Knowledge: Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Behavior Competencies Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skill Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists. - Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- New York Independent Adjuster License- Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- 18+ months of medical claim processing experience- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement. The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency. Responsibilities Include: · Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans · Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations. · Manages the inventory of claims against standard service level agreements (SLA's) · Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement. · Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics · Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance · Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems · Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance · Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades · Performs other duties as deemed essential and necessary Qualifications: Required Skills and Abilities: Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims. Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team. Analytical Skills: Ability to analyze claims data and make informed decisions based on findings. Experience: Previous experience in claims processing or a related field, including supervisory experience. Understands health insurance benefit administration in a Self-Funded environment Ability to read and understand various forms, documentation, files, and information with the department. Education and Experience: · Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment · Candidate must have at least 3 years of experience supervising a claims team · Candidates must have prior experience with a highly automated and integrated claim adjudication system · Experience working with HealthRules Payer · Understanding of health insurance benefits administration in a self-funded environment Preferred Qualifications: · Past Training Experience · Experience working at TPA · Experience with self-funded plans Work Location: An ideal candidate would be assigned to the Buffalo Office with ability to work from home. If not in the Buffalo area, the opportunity can be remote. Leadership Skills & Behaviors: ● Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward. ● Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function. ● Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically. ● Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps. ● Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know. ● Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding. ● Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development. ● Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network. ● Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them. Who we are: Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com. Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.

Job Type: Permanent Build a brilliant future with Hiscox Join our dynamic and forward-thinking Claims team! Here, you'll be part of an energetic and innovative group, with the chance to help shape insurance products and collaborate with business leaders throughout the organization. Please note that this position is hybrid and requires working in office a minimum of two (2) days per week. Position can be based in the following locations: Atlanta, GA Boston, MA Chicago, IL Manhattan, NY West Hartford, CT Our Senior Complex Claims Specialist-Professional Liability role is an individual contributor responsible for the handling of high-severity primary Professional Lines including Miscellaneous Professional Liability, A&E, Allied Health, and Media claims for the organization from inception to resolution. This role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required. In addition to handling assigned claims, this role also provides technical support to the overall claims team. This role also: With minimal supervision, adjusts to resolution the highest severity claims and drafts the most complex technical coverage analysis and letters required in the given claim department Acts as subject matter expert within the team Models gold standard for litigation best practices and file integrity Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions, including identifying appropriate matters for trial Identifies and provides potential solutions for emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with special investigations unit Accurately documents claim files with all relevant correspondence and notes in compliance with company policies and applicable regulatory authorities Mentors other team members, including providing formalized training, as needed. Develops content and conducts training for claims team and underwriters as requested The Team: The US Claims team at Hiscox is a growing group of professionals working collaboratively to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority in order to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling. Requirements: 10+ years of Professional Liability and/or Specialty claims handling experience. A JD from an ABA accredited law school may be considered as a supplement to claims handling experience Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation Ability to work in a fast-paced and changing environment Expert knowledge of coverage within the team's specialty or focus Expert knowledge of litigation process and negotiation skills Proven track record of mentoring others Excellent verbal and written communication skills Advanced analytical skills B.A./B.S Degree required, JD optimal Adjuster licensing required or ability to obtain within 90 days of employment Additional Factors Considered: Subject matter expertise or technical leadership in other lines of business and/or claim types Demonstrates ability to work with minimal oversight Demonstrates ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects across teams of lines of business Demonstrates courage and confidence in addressing and solving difficult or severity matters with insureds, attorneys, and brokers What Hiscox USA offers 401(k) with competitive company matching Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care) Company paid group term life, short- term disability and long-term disability coverage 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days Paid parental leave 4-week paid sabbatical after every 5 years of service Financial Adoption Assistance and Medical Travel Reimbursement Programs Annual reimbursement up to $600 for health club membership or fees associated with any fitness program Company paid subscription to Headspace to support employees' mental health and wellbeing 2024 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program Dynamic, creative and values-driven culture Modern and open office spaces, complimentary drinks Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation About Hiscox US Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) Salary range $140,000-$170,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. #LI-RM1 Work with amazing people and be part of a unique culture

Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.