Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in San Diego, CA
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$35k-43k yearly est. 2d ago
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Claims Examiner Trainee
Berkshire Hathaway 4.8
Claim specialist job in San Diego, CA
WHAT WE'RE LOOKING FORAre you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster.
Upon successful completion of the Claims Training program, the Claims Examiner Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity. RESPONSIBILITIES
Completes classroom training introducing workers' compensation claims handling strategies, medical terminology, and legal concepts.
Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
Develops and updates a plan of action for the successful resolution of each claim.
Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
Reduces fraud through early identification and escalation.
Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.
WHAT YOU'D BRING TO THE ROLE
Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred
Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred
Exceptional interpersonal and customer service skills
Ability to manage and prioritize multiple assignments in a fast-paced environment
Strong organization skills to ensure tasks are completed within hard deadlines
Basic mathematical skills to calculate monetary reserves
Knowledge of Microsoft Word, Powerpoint, Excel, Outlook
WHY YOU SHOULD APPLY
Unparalleled financial strength and stability
Fantastic growth and advancement opportunities
WFH Hybrid schedule
Free gym in building
Generous Paid Time Off and Holidays
Excellent Benefits (Medical, Dental, Vision, 401k, etc)
Health and Wellness Reimbursement
Tuition Assistance Reimbursement
Discounts across companies such as GEICO, See's Candies, etc.
In accordance with the California Equal Pay Act, the starting hourly wage for this job is $30.2885. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.
$30.3 hourly Auto-Apply 13d ago
Claims Supervisor, Workers' Compensation (CA Expertise Required)
Cannon Cochran Management 4.0
Claim specialist job in San Diego, CA
Workers' Compensation Claim Supervisor
Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 adjusters
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking a Workers' Compensation Claim Supervisor with California jurisdiction expertise to remotely lead a team of adjusters out of our Las Vegas, NV branch. This role is critical in ensuring claims are handled accurately, efficiently, and in compliance with client and regulatory requirements. You'll provide clear guidance and direction throughout the lifecycle of each claim, while mentoring and developing your team for long-term success.
Responsibilities
• Oversee proper handling of WC claims to protect the interests of the adjuster, client, and carrier
• Review claim files regularly and provide direction on complex or litigated matters
• Assist with reserve accuracy and compliance with client handling instructions
• Participate in claim reviews and ensure adherence to jurisdictional laws and best practices
• Recruit, train, and mentor staff; conduct performance reviews and manage PIPs
• Address personnel issues and manage administrative responsibilities
• Ensure compliance with carrier/state reporting requirements
Qualifications
What You'll Bring
Required:
• 10+ years of WC claims experience (California jurisdiction)
• Prior experience adjusting WC claims from start to resolution
• CA SIP designation or CAClaims Certificate (or ability to obtain within 60 days)
• Strong leadership, communication, and organizational skills
Preferred:
• 3+ years of supervisory experience
• Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required.
• Proficiency in Microsoft Office and claims systems
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote
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$98k-110k yearly Auto-Apply 37d ago
Supervisor Claims
Insurance Company of The West
Claim specialist job in San Diego, CA
Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!
PURPOSE OF THE JOB
The purpose of this job is to ensure efficient, effective activity within technical units assigned to produce professional and optimal claim results through aggressive claim management. This position exists to oversee, lead, and guide a unit of Claims staff while working in compliance with Company philosophies, practices, and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Establishes and maintains a high degree of the Company's philosophy and technical practices throughout the claims operation.
Conducts periodic audits of staff assignments to ensure operational workflow.
Collaborates in the preparation and delivery of Workers' Compensation education and training programs.
Manages control and direction of reported claims within the authority level established by management.
Participates in different Department projects as assigned by upper Management.
Approves, reserves and makes payments within designated limitations of authority.
Approves reserves and payments within designated limitations of authority.
Executes claims with a reserve authority of no greater than $175,000.
Recommends claim settlements on those exceeding authority, to ensure reserve adequacy on each claim within the unit.
Develops, coaches, leads and mentors a team of claims personnel to ensure claims are processed promptly, professionally and economically.
Communicates Mission, Values and other organization operating principles to staff.
Establishes and maintains the overall work cadence and ensures performance and outcomes strive for excellence in delivery and customer experience. Ensures that the entire team is engaged and that leadership practices in the department encourage development, recognition and retention.
Establishes hiring criteria, on-boarding and training requirements for incoming staff.
Oversees the performance management and development process for the department and performs performance management duties, development planning and coaching for direct reports.
Ensures adherence to all Company policies and procedures and compliance responsibilities.
SUPERVISORY RESPONSIBILITIES
Directly supervises a unit of employees within the Claims team and carries out supervisory responsibilities in accordance with company policies and applicable laws. These responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; conducting performance and salary reviews; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures.
EDUCATION AND EXPERIENCE
High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum 4-6 years of related examining experience required.
CERTIFICATES, LICENSES, REGISTRATIONS
IEA Certificate, WCCP Accreditation preferred.
KNOWLEDGE AND SKILLS
Strong understanding of Workers' Compensation claims principles and application. Strong foundation of business acumen. Basic understanding of personnel and performance strategies. Excellent verbal and written communication skills, time management, and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Ability to effectively present information to top management and/or public groups Ability to apply principles of logic to a wide range of intellectual and practical problems.
PHYSICAL REQUIREMENTS
Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
WORK ENVIRONMENT
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
We are currently not offering employment sponsorship for this opportunity
#LI-ET1 #LI-Hybrid
The current range for this position is
$90,559.93 - $152,723.07
This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
WHY JOIN ICW GROUP?
Challenging work and the ability to make a difference
You will have a voice and feel a sense of belonging
We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
Bonus potential for all positions
Paid Time Off
Paid holidays throughout the calendar year
Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.
___________________
Job Category
Claims
$90.6k-152.7k yearly Auto-Apply 6d ago
Supervisor, Liability Claims
Alliant 4.1
Claim specialist job in San Diego, CA
SUMMARY Responsible for managing, reporting and monitoring liability claims files. Provides coverage/policy interpretation for liability claims, as well as guidance on liability coverage and claims issues. Provides proactive oversight, guidance, and professional development to a team of liability Claims Adjusters.
ESSENTIAL DUTIES AND RESPONSIBILITIES Partners proactively with management to inform, analyze, educate and mitigate potential future liability claims; identifies high frequency and/or severity trends for immediate action;
Resolves complex exposure claims, using high service oriented file handling working closely with clients to resolve conflicts, settle disputes, resolve grievances;
Presents potentially problematic and high value cases to management for review and settlement boundary approval;
Manages and maintains information regarding claims and requests for documents from employees and others, and monitors claims;
Maintains claims information for regular quarterly review, and carrier notifications. Files all notices and reports of claims to all carriers;
Reviews/acts on reported litigated claims; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties;
Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization;
Proactively addresses cases involving a legal inquiry or dispute and develops a strategy to bring a case to satisfactory resolution;
Supervises staff including; motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate;
Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information);
Other duties as assigned.
QUALIFICATIONS
EDUCATION / EXPERIENCEBachelor's Degree or equivalent combination of education and experience
Eight (8) or more years related work experience
Valid Insurance License
SKILLSExcellent verbal and written communication skills
Good leadership, problem solving, and time management skills
Good planning, organizational, and prioritization skills
Ability and motivation to work independently
Ability to interface with executive - internally and externally
Proficient in Microsoft Office products
Frequent travel required (35%+)#LI-DM1
$77k-114k yearly est. 14d ago
Complex Commercial Construction Defect Claim Representative
The Travelers Companies 4.4
Claim specialist job in San Diego, CA
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. 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. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$94,400.00 - $155,800.00
Target Openings
1
What Is the Opportunity?
This role is eligible for a sign-on bonus of up to $20,000.
This position is hybrid (3 days in office, 2 days remote).
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.
What Will You Do?
* Directly handles assigned severity claims.
* Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
* Consults with Manager on use of Claim Coverage Counsel as needed.
* Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
* Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
* Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
* Maintains claim files and documents claim file activities in accordance with established procedures.
* Utilizes evaluation documentation tools in accordance with department guidelines.
* Proactively creates Claim File Analysis (CFA) by adhering to quality standards.
* Utilizes diary management system to ensure that all claims are handled timely.
* At required time intervals, evaluate liability & damages exposure.
* Establishes and maintains proper indemnity and expense reserves.
* Recommends appropriate cases for discussion at roundtable.
* Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
* Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
* Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance.
* Develops and employ creative resolution strategies.
* Responsible for prompt and proper disposition of all claims within delegated authority.
* Negotiates disposition of claims with insureds and claimants or their legal representatives.
* Recognizes and implements alternate means of resolution.
* Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
* Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy,
* Tracks and controls legal expenses to assure cost-effective resolution.
* Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
* Perform other duties as assigned.
What Will Our Ideal Candidate Have?
* Bachelor's Degree.
* 5 years equivalent business experience.
* Advanced level knowledge and skill in claim and litigation.
* Basic working level knowledge and skill in various business line products.
* Strong negotiation and customer service skills.
* Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
* Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims.
* Able to make independent decisions on most assigned cases without involvement of supervisor.
* Openness to the ideas and expertise of others actively solicits input and shares ideas.
* Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
* Demonstrated coaching, influence and persuasion skills.
* Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
* Can adapt to and support cultural change.
* Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
* Analytical Thinking - Advanced.
* Judgment/Decision Making - Advanced.
* Communication - Advanced.
* Negotiation - Advanced.
* Insurance Contract.
* Knowledge - Advanced.
* Principles of Investigation - Advanced.
* Value Determination - Advanced.
* Settlement Techniques - Advanced.
* Legal Knowledge - Advanced.
* Medical Knowledge - Intermediate.
What is a Must Have?
* High School Degree or GED.
* 3 years of liability claim handling experience and/or comparable litigation claim experience.
* In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
* Generally, license(s) are required to be obtained within three months of starting the job.
What Is in It for You?
* Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
* Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
* Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
* Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
* Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
$41k-54k yearly est. 41d ago
Daily Claims Adjuster - San Diego, CA
Cenco Claims 3.8
Claim specialist job in San Diego, CA
CENCO is a well-established provider of property claims solutions, partnering with top insurance carriers to deliver prompt, accurate, and reliable adjusting services. We are currently seeking experienced Daily Property Claims Adjusters to support residential and commercial claims throughout San Diego and the greater Southern California area. This role is ideal for independent adjusters looking for consistent work and the freedom of field-based assignments.
Key Responsibilities:
Conduct in-person inspections of property damage from wind, water, fire, and other covered events.
Capture thorough documentation, including detailed reports and high-quality photos.
Develop accurate estimates using Xactimate or Symbility.
Maintain clear, professional communication with policyholders, contractors, and carriers.
Efficiently manage each claim from inspection through submission, ensuring deadlines are met.
What You'll Need:
Licensing: Active California adjuster license required.
Software: Experience with Xactimate or Symbility is preferred.
Tools: Reliable transportation, ladder, laptop, and basic field equipment.
Work Style: Independent, detail-oriented, and self-motivated.
Responsiveness: Ability to quickly accept assignments and complete them on time.
Why Join CENCO?
Steady claim volume throughout the San Diego region
Competitive compensation with fast, dependable payments
Strong back-office support and streamlined claims processes
If you're a qualified adjuster looking for dependable daily work and the chance to grow with a respected industry partner, we'd love to hear from you!
$53k-65k yearly est. Auto-Apply 60d+ ago
Auto Bodily Injury Claim Representative - San Diego, CA
Msccn
Claim specialist job in San Diego, CA
ATTENTION MILITARY AFFILIATED JOB SEEKERS
- Our organization works with partner companies to source qualified talent for their open roles. The following position is available to
Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers
. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. 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. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$67,000.00 - $110,600.00
What Is the Opportunity?
This role is eligible for a sign-on bonus.
Be the Hero in Someone's Story
When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most.
As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner.
In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process
What Will You Do?
Provide quality claim handling of auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations.
Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates.
Determine claim eligibility, coverage, liability, and settlement amounts.
Ensure accurate and complete documentation of claim files and transactions.
Identify and escalate potential fraud or complex claims for further investigation.
Coordinate with internal teams such as investigators, legal, and customer service, as needed
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
Bachelor's Degree.
Three years of experience in insurance claims, preferably auto claims.
Experience with claims management and software systems.
Strong understanding of insurance principles, terminology with the ability to understand and articulate policies.
Strong analytical and problem-solving skills.
Proven ability to handle complex claims and negotiate settlements.
Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants
What is a Must Have?
High School Degree or GED with a minimum of one year bodily injury liability claim handling experience or successful completion of Travelers Claim Representative training program is required.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
$36k-50k yearly est. 28d ago
Claims Investigator - Experienced
Command Investigations
Claim specialist job in San Diego, CA
Job DescriptionCLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also 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 highly needed.
Must have reliable transportation, along with own digital recorder and 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:
W/C and P&C 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)
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$43k-59k yearly est. 19d ago
Independent Insurance Claims Adjuster in San Ysidro, California
Milehigh Adjusters Houston
Claim specialist job in San Diego, CA
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.
$52k-65k yearly est. Auto-Apply 60d+ ago
Senior Claim Resolution Specialist, Property
Liberty Mutual 4.5
Claim specialist job in San Diego, CA
Manages, investigates and resolves assigned high severity Property Loss claims under limited supervision. Provides policyholders with exceptional customer service. May assist Customer Claims Representatives with in-person inspection/policyholder contact where necessary.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory
Responsibilities:
* Investigates, determines coverage of loss and adjusts all elements of Property Loss claims of high severity.
* Conducts inspections of loss sites, writes appraisals for dwelling repairs and issues payment to policyholders where possible.
* May work with a Liberty network contractor in the appraisal process.
* Ability to independently scope high severity losses and/or large losses.
* Works with Liberty network contractor in the appraisal process of claims and participates in re-inspection of Liberty referred contractors.
* Explains coverage of loss, assists policyholders with itemization of damages, emergency repairs and additional living arrangements.
* Works with and may coordinate a number of vendor services such as contractors, emergency repair, cleaning services and various replacement services.
* Identifies suspicious losses.
* Recommends referral to SIU where appropriate and may assist the SIU in their investigation and settling of the claim.
* May be called upon for catastrophe duty, may assist in management of catastrophe operation, Quality Control of Independents used and may trouble shoot problem and high profile cases.
* For Catastrophe (CAT) roles, investigative fieldwork includes a high amount of travel to claim location.
* Assists in the training of property personnel and serves as a technical resource to the office. May assist in the absence of the Claims Team Manager.
Qualifications
* Requires knowledge of coverages provided within various homeowner policies.
* Demonstrated ability to handle claims of the highest complexity and exposure.
* Effective negotiation skills.
* Ability to effectively and independently manage workload while exhibiting good judgment.
* Proven ability to provide exceptional customer service.
* Strong written/oral communication and interpersonal skills.
* Computer skills with the ability to work with multi-faceted systems, and analytical skills.
* The capabilities, skills and knowledge required is normally acquired through Bachelor's Degree or equivalent experience and at least 5 years of directly related experience.
* Completion of advanced property training required.
* Ability to obtain proper licensing as required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco
$42k-58k yearly est. Auto-Apply 28d ago
Claims Examiner
Imagine Staffing Technology 4.1
Claim specialist job in San Diego, CA
Job DescriptionJob ProfileJob TitleWorkers Compensation Claims Examiner (1360552) LocationRemote/Hybrid in San Diego CAHire TypeContingentHourlyopenWork ModelMonday - FridayContact Phone(443)-345-3305 Contact Emailsean@marykraft.com Nature & Scope:Positional Overview
Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices, service expectations, and specific client requirements. The examiner will also identify subrogation opportunities and negotiate settlements to achieve cost-effective resolutions.Role & Responsibility:Tasks That Will Lead To Your Success
Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
Manage claims through well-developed action plans, ensuring timely and appropriate resolutions.
Negotiate settlement of claims within designated authority limits.
Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness.
Prepare necessary state filings within statutory limits.
Oversee the litigation process to ensure timely and cost-effective resolution of claims.
Coordinate vendor referrals for additional investigation or litigation management.
Implement cost-containment strategies, including partnerships with vendors, to reduce overall claim costs.
Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
Report claims to excess carriers and respond to their inquiries in a timely and professional manner.
Maintain communication with claimants and clients, fostering professional relationships.
Ensure claims files are properly documented, with accurate coding.
Refer complex cases to supervisors or management as needed.
Skills & Experience:Qualifications That Will Help You Thrive
Bachelor's degree from an accredited college or university preferred.
Professional certifications relevant to workers' compensation claims are preferred.
Five (5) years of claims management experience or an equivalent combination of education and experience required.
Minimum of 3 years of California workers' compensation claims handling experience is mandatory.
Self-Insurance Plan (SIP) certification is preferred but not mandatory.
Expertise in insurance principles and laws, claim and disability duration, and medical management practices.
Strong knowledge of Social Security, Medicare application procedures, and recovery processes.
Excellent communication skills, both oral and written, including presentation abilities.
Proficiency in Microsoft Office and general PC literacy.
Strong analytical, interpretive, and problem-solving skills.
Strong organizational skills and the ability to manage multiple priorities effectively.
Excellent negotiation skills.
Ability to work collaboratively in a team environment and meet or exceed service expectations.
$26k-32k yearly est. 11d ago
Worker Compensation Adjuster -Glendale, CA
Avonrisk
Claim specialist job in San Diego, CA
Job DescriptionWorker Compensation Claims Adjuster Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Glendale, CA We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations.
Our Mission:
To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives.
Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes.
Our Goal:
To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients.
Your Impact:
Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance
Ensure all claims are handled in accordance with relevant statutes and company guidelines
Address personnel issues promptly and decisively, keeping management informed of corrective action
Foster a collaborative and productive team environment focused on excellence in claim resolution
Our Offer:
Competitive salary and benefits package, including medical, dental, vision, and 401(k)
Opportunity for professional growth and advancement in a dynamic organization
Collaborative work environment with a team dedicated to workers' compensation excellence
Interested? Get in Touch:
To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following:
Apply to this posting
Call me directly at ************
Email ************************
We look forward to hearing from you!
“Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.”
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$53k-72k yearly est. Easy Apply 29d ago
Medical Claims/Billing Specialist (Entry -Level)
Revel Staffing
Claim specialist job in San Diego, CA
Join a fast -moving revenue cycle team supporting clinicians by converting services rendered into accurate claims and ensuring timely reimbursement. You'll learn the full claim lifecycle-from charge entry through payment posting and denials-while working with experienced mentors.
What you'll do
Translate clinical services into standardized codes (ICD -10 -CM, CPT, HCPCS) with high accuracy.
Prepare, submit, and track claims to commercial, Medicare, and Medicaid payers.
Verify benefits, obtain basic authorizations, and resolve eligibility issues.
Post payments/adjustments from EOBs/ERAs; research underpayments and short pays.
Work aging reports; investigate and resolve denials using payer portals.
Maintain strict confidentiality and data integrity across all systems and documents.
Collaborate with clinicians, front office, and finance to prevent rework and improve first -pass yield.
Must -have qualifications
MediClear (or equivalent HIPAA compliance certification) - required.
Working knowledge of medical billing software and MS Office (Excel/Outlook).
Familiarity with medical terminology and the basics of ICD -10/CPT/HCPCS coding.
Strong numeracy, attention to detail, and clear written/verbal communication.
High integrity and professionalism handling PHI in accordance with HIPAA.
Nice to have
Exposure to clearinghouses and payer portals (Availity, Optum, etc.).
Experience reading EOBs/ERAs and basic denial reason codes.
AAPC or AHIMA entry -level credential (e.g., CPB, CPC -A, CCS -P) or completion of a billing/coding program.
What we offer
Training and mentorship with clear advancement paths in RCM.
Collaborative culture, modern tools, and meaningful work that impacts patient care.
Competitive pay with benefits (details provided during interview).
Associate, Wage and Hour - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in San Diego, CA
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
Associate - DCI (Disputes, Claims & Investigations), Wage & Hour
Stout is seeking an Associate with 2-5 years of experience to join our Disputes, Claims & Investigations (DCI) Wage and Hour practice. This is a full-time role offering comprehensive benefits, a 401(k), and eligibility for annual bonuses.
Stout brings deep expertise supporting clients in high-stakes business litigation and economic consulting matters. Associates work closely with experienced professionals and subject-matter experts to analyze complex data and deliver independent, thoughtful analyses.
Impact You'll Make
This role plays a critical part in delivering high-quality analytical support on complex wage and hour matters. Your work will directly contribute to successful client outcomes and the effectiveness of project teams.
Execute and support complex data analyses related to wage and hour disputes and investigations.
Contribute to the development of sound methodologies and analytical approaches that support defensible conclusions.
Help ensure projects are completed on time, within scope, and with a high standard of quality.
Build strong working relationships across project teams to drive collaboration and efficiency.
Support client-facing deliverables that clearly communicate findings and insights.
What You'll Do
These responsibilities reflect the day-to-day work required to support engagements and achieve project objectives.
Review, organize, and analyze large and complex datasets to support litigation and consulting engagements.
Support multiple concurrent projects, anticipating scope, timing, and budget considerations.
Assist in developing work plans, methodologies, and resource needs to optimize project outcomes.
Collaborate closely with team members to meet deadlines and manage competing client expectations.
Support written analyses, reports, and presentations prepared for clients and other stakeholders.
Apply creative problem-solving techniques to manage risks and address analytical challenges.
What You Bring
This section outlines the qualifications and technical skills needed to succeed in the role.
Bachelor's degree from an accredited college or university, preferably in Economics, Mathematics, or a related field.
2-5 years of experience in wage and hour consulting or a closely related field.
Working knowledge of advanced data management and analytical tools such as SAS, SQL, STATA, R, or similar platforms.
Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Access.
Strong written and verbal communication skills with the ability to present complex information clearly.
Demonstrated ability to manage multiple projects simultaneously and work effectively with cross-functional teams.
How You'll Thrive
These competencies and behaviors will help you excel and grow within Stout's collaborative culture.
Maintain flexibility and adaptability in response to changing project requirements and timelines.
Demonstrate strong organizational skills and rigorous attention to detail.
Exhibit intellectual curiosity, self-motivation, and a commitment to quality control.
Collaborate effectively with colleagues while managing competing priorities.
Uphold Stout's core values and deliver Relentless Excellence in both client service and internal teamwork.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $74,000.00 - $135,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$40k-47k yearly est. 2d ago
Claims Supervisor, Workers' Compensation (CA Expertise Required)
Cannon Cochran Management 4.0
Claim specialist job in San Diego, CA
Workers' Compensation Claim Supervisor
Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking an experienced Workers' Compensation Claim Supervisor with deep California jurisdiction expertise to lead a team of 3-6 adjusters supporting a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch.
This is a hands-on leadership role for a supervisor who understands the full California workers' compensation lifecycle-from intake through resolution-and can coach adjusters through complex, fast-paced claims while ensuring strict compliance with regulatory and client-specific requirements. You'll guide claim strategy, mentor your team, and partner closely with clients to deliver consistent, high-quality outcomes.
Responsibilities
When we hire claim supervisors at CCMSI, we look for leaders who believe strong teams create strong outcomes-leaders who own results, develop people, and treat every claim with purpose and care.
Supervise and guide a team of 3-6 California Workers' Compensation adjusters handling cradle-to-grave claims
Ensure claims are investigated, evaluated, and resolved accurately, timely, and in compliance with California WC laws
Review claim files regularly, providing direction on complex, litigated, or high-exposure matters
Oversee reserve accuracy and compliance with client handling instructions
Participate in claim reviews, audits, and quality initiatives
Partner with internal teams, clients, and vendors to resolve issues and maintain service standards
Recruit, onboard, train, and mentor staff; conduct performance evaluations and manage development plans
Address personnel and administrative matters with professionalism and consistency
Ensure compliance with carrier/state reporting requirements
Qualifications
What You'll Bring
Required:
• 10+ years of WC claims experience (California jurisdiction)
• Proven experience adjusting CA WC claims from intake through resolution
• CA SIP designation or CAClaims Certificate (or ability to obtain within 60 days)
• Demonstrated leadership, coaching, and communication skills
Preferred:
• 3+ years of supervisory experience
• Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required.
• Experience supporting PEO and/or staffing accounts
• Proficiency in Microsoft Office and claims systems
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote
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$98k-110k yearly Auto-Apply 33d ago
Complex Commercial Construction Defect Claim Representative
Travelers Insurance Company 4.4
Claim specialist job in San Diego, CA
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. 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. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$94,400.00 - $155,800.00
**Target Openings**
1
**What Is the Opportunity?**
This role is eligible for a sign-on bonus of up to $20,000.
This position is hybrid (3 days in office, 2 days remote).
Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff.
**What Will You Do?**
+ Directly handles assigned severity claims.
+ Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
+ Consults with Manager on use of Claim Coverage Counsel as needed.
+ Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate.
+ Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts.
+ Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation.
+ Maintains claim files and documents claim file activities in accordance with established procedures.
+ Utilizes evaluation documentation tools in accordance with department guidelines.
+ Proactively creates Claim File Analysis (CFA) by adhering to quality standards.
+ Utilizes diary management system to ensure that all claims are handled timely.
+ At required time intervals, evaluate liability & damages exposure.
+ Establishes and maintains proper indemnity and expense reserves.
+ Recommends appropriate cases for discussion at roundtable.
+ Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
+ Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others.
+ Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance.
+ Develops and employ creative resolution strategies.
+ Responsible for prompt and proper disposition of all claims within delegated authority.
+ Negotiates disposition of claims with insureds and claimants or their legal representatives.
+ Recognizes and implements alternate means of resolution.
+ Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
+ Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy,
+ Tracks and controls legal expenses to assure cost-effective resolution.
+ Effectively and efficiently manage both allocated and unallocated loss adjustment expenses.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree.
+ 5 years equivalent business experience.
+ Advanced level knowledge and skill in claim and litigation.
+ Basic working level knowledge and skill in various business line products.
+ Strong negotiation and customer service skills.
+ Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills.
+ Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims.
+ Able to make independent decisions on most assigned cases without involvement of supervisor.
+ Openness to the ideas and expertise of others actively solicits input and shares ideas.
+ Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices.
+ Demonstrated coaching, influence and persuasion skills.
+ Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.
+ Can adapt to and support cultural change.
+ Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information.
+ Analytical Thinking - Advanced.
+ Judgment/Decision Making - Advanced.
+ Communication - Advanced.
+ Negotiation - Advanced.
+ Insurance Contract.
+ Knowledge - Advanced.
+ Principles of Investigation - Advanced.
+ Value Determination - Advanced.
+ Settlement Techniques - Advanced.
+ Legal Knowledge - Advanced.
+ Medical Knowledge - Intermediate.
**What is a Must Have?**
+ High School Degree or GED.
+ 3 years of liability claim handling experience and/or comparable litigation claim experience.
+ In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
+ Generally, license(s) are required to be obtained within three months of starting the job.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
$41k-54k yearly est. 41d ago
Claims Investigator - Experienced
Command Investigations
Claim specialist job in San Diego, CA
CLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also 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 highly needed.
Must have reliable transportation, along with own digital recorder and 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:
W/C and P&C 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)
$43k-59k yearly est. Auto-Apply 60d+ ago
Senior Claim Resolution Specialist, Property
Liberty Mutual 4.5
Claim specialist job in San Diego, CA
Manages, investigates and resolves assigned high severity Property Loss claims under limited supervision. Provides policyholders with exceptional customer service. May assist Customer Claims Representatives with in-person inspection/policyholder contact where necessary.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory
Responsibilities:
Investigates, determines coverage of loss and adjusts all elements of Property Loss claims of high severity.
Conducts inspections of loss sites, writes appraisals for dwelling repairs and issues payment to policyholders where possible.
May work with a Liberty network contractor in the appraisal process.
Ability to independently scope high severity losses and/or large losses.
Works with Liberty network contractor in the appraisal process of claims and participates in re-inspection of Liberty referred contractors.
Explains coverage of loss, assists policyholders with itemization of damages, emergency repairs and additional living arrangements.
Works with and may coordinate a number of vendor services such as contractors, emergency repair, cleaning services and various replacement services.
Identifies suspicious losses.
Recommends referral to SIU where appropriate and may assist the SIU in their investigation and settling of the claim.
May be called upon for catastrophe duty, may assist in management of catastrophe operation, Quality Control of Independents used and may trouble shoot problem and high profile cases.
For Catastrophe (CAT) roles, investigative fieldwork includes a high amount of travel to claim location.
Assists in the training of property personnel and serves as a technical resource to the office. May assist in the absence of the Claims Team Manager.
Qualifications
Requires knowledge of coverages provided within various homeowner policies.
Demonstrated ability to handle claims of the highest complexity and exposure.
Effective negotiation skills.
Ability to effectively and independently manage workload while exhibiting good judgment.
Proven ability to provide exceptional customer service.
Strong written/oral communication and interpersonal skills.
Computer skills with the ability to work with multi-faceted systems, and analytical skills.
The capabilities, skills and knowledge required is normally acquired through Bachelor's Degree or equivalent experience and at least 5 years of directly related experience.
Completion of advanced property training required.
Ability to obtain proper licensing as required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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How much does a claim specialist earn in La Mesa, CA?
The average claim specialist in La Mesa, CA earns between $30,000 and $83,000 annually. This compares to the national average claim specialist range of $27,000 to $67,000.
Average claim specialist salary in La Mesa, CA
$50,000
What are the biggest employers of Claim Specialists in La Mesa, CA?
The biggest employers of Claim Specialists in La Mesa, CA are: