To be considered, please apply through the link here.
We are seeking an experienced and independent Insurance ClaimsSpecialist with 7+ years of multi-line claims experience to manage and resolve claims across Marine Cargo, Property & Casualty, Automobile, Workers' Compensation, and Liability/Litigation.
The role also supports contract reviews by assessing insurance-related provisions to ensure alignment with policy coverage and claims protocols. The ideal candidate will also provide support to the Insurance Manager and General Manager on special insurance projects as needed, contributing to broader departmental goals and demonstrating flexibility beyond core claims duties.
ESSENTIAL JOB DUTIES:
Manage the end-to-end claims process for:
-Marine cargo/inland transit
-Commercial property and general liability
-Automobile (fleet and HNOA)
-Workers' Compensation (“WC”)
-Litigated liability claims, including bodily injury and third-party property damage
Handle end-to-end claims for marine, property, liability, auto (fleet/HNOA), WC, and litigated matters including bodily injury and third-party property damage.
Review policies to assess coverage, exclusions, deductibles, and retentions
Coordinate with brokers, carriers, adjusters, and Internal legal counsel
Support contract review by evaluating insurance clauses (limits, AI, Waiver of Subrogation) and identifying potential risk/coverage gaps
Draft claim notifications and ensure compliance with policy timelines
Provide loss history, reserve, and claim summaries to assist with renewal preparation
Collaborate with Legal, MGC, and MAC BU Operations to resolve claims
Participate in claim reviews and strategic discussions in recovery efforts
Support the GM and Insurance Manager with special insurance-related projects as needed, and demonstrate flexibility in cross-functional assignments.
MINIMUM EDUCATION REQUIREMENTS:
Bachelor's degree in insurance or business-related fields or equivalent experience.
MINIMUM EXPERIENCE AND CAPABILITY REQUIREMENTS:
7+ years of insurance claims experience across multiple P&C lines, including marine and litigated claims.
Strong working knowledge of insurance policy language, ISO forms, and manuscript policies.
Familiarity with contractual risk transfer principles and ability to analyze insurance-related clauses.
Experience coordinating with external counsel and adjusters on complex/litigated claims.
Proficiency in claims systems, Microsoft Word and Excel, and document management platforms.
Technically skilled in both claims handling and policy interpretation.
Detail-oriented with excellent judgment and risk awareness.
Confident in reviewing contract language from an insurance perspective.
Collaborative and able to communicate effectively with both technical and non-technical stakeholders.
Able to manage competing priorities and operate independently.
Must have the ability to work with deadlines and work in a fast-paced and dynamic work environment.
Requires excellent written and verbal communication skills.
Must be able to work in a multi-cultural business environment.
JOB-RELATED CERTIFICATION:
CPCU, ARM, or AIC designation preferred
$46k-71k yearly est. 1d ago
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Claims Adjuster
Network Adjusters, Inc. 4.1
Claim specialist job in Farmingdale, NY
Network Adjusters is seeking experienced General Liability and/or Construction Defect Claims Adjusters to join our third-party administrative insurance handling team. This role supports the investigation, evaluation, negotiation, and resolution of third-party construction defect claims, including property damage and liability exposures, while delivering consistent, high-quality claims management in alignment with industry best practices.
This position offers the opportunity to work within a trusted organization committed to integrity, reliability, and professional development through ongoing training and growth opportunities.
About the Role
Construction Defect Claims Adjusters are responsible for managing complex third-party claims related to construction projects from inception through closure. Claims may include third-party property damage, bodily injury, and other specialized construction-related exposures of varying complexity and severity. In this role, you will investigate losses, analyze policy language, evaluate damages, determine coverage, negotiate settlements, and handle litigated matters as needed while maintaining clear, professional communication with all involved parties.
Adjusters routinely conduct site inspections, gather statements from claimants, witnesses, and contractors, coordinate with external experts, and ensure all claim activity complies with state-specific regulations and Network Adjusters' Best Claims Practices. This is a desk-based role.
Responsibilities
Apply in-depth knowledge of General Liability and Construction Defect claims to manage complex third-party property damage, bodily injury, and related losses
Deliver high-quality customer service to insureds, claimants, carrier clients, and internal stakeholders
Review and analyze coverage by applying policy conditions, provisions, exclusions, and endorsements, and address jurisdictional considerations such as negligence laws, immunity, and financial responsibility limits
Investigate claims to determine liability and potential sources of recovery by contacting, interviewing, and coordinating with appropriate parties and external experts
Effectively manage litigated claims, including coordination with defense and coverage counsel
Establish, document, and maintain appropriate claim and expense reserves in a timely manner
Develop and execute plans of action for claim resolution, including diary management and timely follow-up
Determine settlement values using independent judgment, applicable limits, and deductibles, and negotiate settlements within assigned authority
Draft denial letters, reservation of rights, tenders, and other routine or complex claim correspondence
Identify and pursue subrogation opportunities when applicable
Prepare client-specific reports and detailed claim analyses, and consult with senior technical staff to ensure proper file handling
Document all claim activity in accordance with established procedures and Best Practices
Ensure compliance with all state-specific regulatory requirements and quality standards
Manage multiple competing priorities to ensure timely payments, follow-up, and claim resolution
Qualifications
2-5 years of claims handling experience, preferably in third-party General Liability and/or Construction Defect
College or technical degree, or equivalent relevant business experience
Ability to obtain and maintain required adjuster licenses, including completion of continuing education
Strong analytical, investigative, decision-making, and negotiation skills, with the ability to manage conflict effectively
Excellent verbal and written communication skills, with a customer-focused and empathetic approach
Strong organizational and time management skills with the ability to multitask in a fast-paced environment
High attention to detail, accuracy, confidentiality, and sound judgment
Proficiency in MS Word, Outlook, Excel, and standard business software
Bilingual proficiency preferred but not required
Compensation & Benefits
Salary: $75,000-$100,000 annually (based on licensure, certifications, and experience)
Training, development, and career growth opportunities
401(k) with company match and retirement planning
Paid time off and company-paid holidays
Comprehensive medical, dental, and vision insurance
Flexible Spending Account (FSA)
Company-paid life insurance and long-term disability
Supplemental life insurance and optional short-term disability
Strong work/family and employee assistance programs
Employee referral program
Location
📍 Farmingdale, NY (On-site)
Remote opportunities may be available for experienced candidates who meet all required criteria.
About Network Adjusters
Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver, and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.
$75k-100k yearly 3d ago
Complex Claim Specialist - New York Labor Law
Amtrust Financial 4.9
Claim specialist job in New York, NY
Requisition ID 2026-19759 Category Claims - General Liability Type Regular Full-Time
Amtrust Financial Services, a fast-growing commercial insurance company, is seeking a Complex General Liability ClaimsSpecialist. The successful candidate will evaluate coverage issues and risk transfer opportunities as well as ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed. This position reports to a line of business executive.
Responsibilities
Identifying potential risks and managing timely reserves effectively
Evaluating coverage issues and risk transfer opportunities
Ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed.
Effectively communicate exposures both internally and externally
Overall responsibility for formulating proper resolution strategy to ensure best total outcome.
Position may require periodic travel to attend meditations, trials and / or other related meetings
Perform other duties as assigned
Qualifications
Bachelor's degree or equivalent experience in insurance claims management or related field.
Minimum of seven (7) years' experience in the handling or litigating of complex commercial general liability claims.
Strong experience in handling New York Labor Law claims highly preferred.
Strong experience in handling Employers Liability/Workers Compensation 1B claims highly preferred.
Proficient computer skills required to navigate our paperless claim file system.
Possesses a high level of technical claim and legal knowledge and skills.
Excellent communication skills both written and oral.
Ability to professionally interact at a high level with parties both internal and external to AmTrust.
Easily adapts to changing situations requirements or priorities.
Ability to effectively influence others without damaging relationships.
Skillful negotiator.
Home designated home state adjuster license preferred.
CPCU designation/AIC certification preferred.
The expected salary range for this role is $126K-$155K/year.
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
#LI-BL1
#AmTrust
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Connect With Us!
Not ready to apply? Connect with us for general consideration.
$126k-155k yearly 5d ago
Claims Court Representative (Court Liaison)
GNY Insurance Companies
Claim specialist job in New York, NY
An Insurance Claims Court Representative role involves overseeing litigated claims, analyzing legal/medical data, collaborating with claims and trial lawyers, requiring strong analytical, negotiation, and communication skills to resolve high-stakes cases efficiently for optimal outcomes and cost control, often involving court appearances including conferences, mediations, and trials. Position requires the candidate to be the face of GNY in the NYC, Long Island and Westchester courts, working closely with defense counsel.
Essential Duties and Responsibilities:
Monitoring the legal defense of claims and coordinating with claims examiners and claims management.
Reviewing claims files, reviewing medical records/police reports, evaluating policy coverage, and assessing damages.
Working with defense attorneys.
Analyzing claim data for trends, providing status reports to management, and ensuring accurate record-keeping.
Negotiating settlements and presenting cases at claim committee meetings or mediations.
Occasionally making settlement calls.
Document file notes in ImageRight.
Participates in special projects and performs additional duties as required.
QualificationsEducation and Experience:
Bachelors degree required; J.D. would be a plus.
Minimum of 5 years' related experience.
Strong analytical, negotiation, and communication (written/verbal) skills.
Highly skilled in trial preparation.
Proficiency with claims management software, databases, and MS Office.
Understanding of relevant insurance laws and regulations.
Experience in claims adjusting.
Good knowledge of the law, settlement values, judges, adversaries, defense firms, venues.
Knowledge of New York State Insurance Department regulations including fair claim standards.
Other Requirements:
Ability to travel back and forth between office and court.
The salary range for this role is $74,600 - $136,100. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.
$40k-62k yearly est. 3d ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in New York, NY
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.
$29k-36k yearly est. 2d ago
Claims Specialist, APH
Swiss Re 4.8
Claim specialist job in Armonk, NY
Imagine a role where you can directly influence the profitability of a business, steer a diverse portfolio of claims, and build lasting relationships with clients. If you're a self-motivated individual who thrives on collaboration and career growth, this challenge is for you! If this sounds interesting, join us at Swiss Re, where we believe in fostering an environment that sparks the best ideas, maintaining a sensible work-life balance, and producing outstanding results through engaged employees. Together, we can help make the world more resilient.
About the Role
As a Reinsurance ClaimsSpecialist at Swiss Re, you'll manage a portfolio of asbestos, pollution, and health hazard (APH) reinsurance claims across various lines of business for both active and runoff portfolios. This role offers a unique opportunity to collaborate across functions, develop broad knowledge about the insurance and reinsurance industry, and help steer the business through data-driven insights and strong client partnerships.
Key activities of the role include:
* Steer a diverse portfolio of multi-line reinsurance claims, ensuring strategic performance through data analysis and industry insight.
* Analyze contractual obligations, establish and monitor reserves, and approve payments within authority to ensure timely, effective resolution.
* Apply advanced data analytics and reporting tools to manage the portfolio and identify emerging trends.
* Collaborate with Underwriting, Actuarial, and other teams to provide portfolio insights that inform business strategy and decision-making.
* Formulate, develop, and implement account management, including building and supporting client relationships.
* Participate in client meetings and audits to review claims, assess claims-handling practices, and support collaborative problem-solving.
* Deliver high-quality claims and client service, sharing industry knowledge and contributing to continuous improvement initiatives.
* Support internal stakeholders with research on claim topics, loss development, and contract wording issues, while ensuring compliance with governance, legal, and reporting requirements.
About the Team
You'll join a team of APH claims professionals known for deep technical expertise, collaborative spirit, and innovative problem-solving. We work closely with clients and internal partners to deliver exceptional claims management, identify potential exposures, and provide meaningful insights that shape our business. If you're curious, analytical, and motivated by teamwork and impact, this is the place for you.
About You
You excel in a dynamic environment, adept at juggling multiple priorities while maintaining professionalism. With strong interpersonal skills, you're confident communicating with clients, legal counsel, and senior management, and you bring curiosity and strategic thinking to every challenge.
Additional requirements include:
* Bachelor's degree required.
* At least 2-5 years of experience in claims, underwriting, insurance, reinsurance, or insurance-related legal work, including handling latent direct insurance claims.
* General understanding of and/or exposure to other insurance disciplines i.e., contract wording, accounting, underwriting.
* Ability and passion to manage a complex portfolio with critical analysis and innovative strategic thought.
* Confirmed ability to meet deliverables, implement plans, and conduct analysis.
* Excellent writing skills and proficiency in MS Office tools, claims systems and the ability and willingness to learn new systems.
* Excellent organizational and data analytics skills with openness for continued growth.
* Ability and willingness to learn new claims handling systems.
* Some business travel required.
The estimated base salary range for this position in Kansas City, MO is $84,000 to $140,000; for Armonk, NY is $90,000 to $150,000. The specific salary offered for this or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.
About Swiss Re
Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.
Keywords:
Reference Code: 136396
Nearest Major Market: White Plains
Nearest Secondary Market: New York City
Job Segment: Claims, Compliance, Data Analyst, Accounting, Actuarial, Insurance, Legal, Data, Finance
$90k-150k yearly 31d ago
Claims Specialist - Auto
Philadelphia Insurance Companies 4.8
Claim specialist job in Melville, NY
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a ClaimsSpecialist - Auto to join our team.
JOB SUMMARY
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
Communicates with all relevant parties and documents communication as well as results of investigation.
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
Travel is required to attend customer service calls, mediations, and other legal proceedings.
JOB REQUIREMENTS
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
• National Range : $82,800.00 - $97,300.00
• Ultimate salary offered will be based on factors such as applicant experience and geographic location.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
$82.8k-97.3k yearly Auto-Apply 60d+ ago
Billing/Claims Specialist
P4P
Claim specialist job in New York, NY
Location: Brooklyn, NY Salary: $52K-$80K The Billing and ClaimsSpecialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials. Key Responsibilities for Billing/ClaimsSpecialist:
Billing & Claims Processing
Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance
Review authorizations, service hours, and eligibility prior to billing
Ensure accurate coding and claim data in accordance with payer guidelines
Process electronic and paper claims as required by payers
Claims Follow-Up & Reconciliation
Monitor claim status and follow up on unpaid, denied, or underpaid claims
Investigate and resolve billing discrepancies and denials
Submit corrected or resubmitted claims as needed
Post payments, adjustments, and denials accurately into billing systems
Reconcile remittance advice (EOBs/ERAs) with billed claims
Authorization & Compliance
Track MLTC authorizations, service limits, and expiration dates
Ensure billing aligns with approved care plans and service authorizations
Maintain compliance with Medicaid, MLTC, and insurance regulations
Stay current on payer rule changes and billing requirements
Qualifications for Billing/ClaimsSpecialist:
Required
Minimum 2-3 years of billing and claims experience in home care, healthcare, or related setting
Hands-on experience with MLTC billing and insurance claims
Strong knowledge of Medicaid and managed care billing processes
Proficiency with home care billing software and clearinghouses
Excellent attention to detail and organizational skills
$52k-80k yearly 6d ago
Complex Claims Specialist - Cyber, Technology, Media & Crime
Hiscox
Claim specialist job in New York, NY
Job Type:
Permanent
Build a brilliant future with Hiscox
Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex ClaimsSpecialist!
Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations:
West Hartford, CT (preferred)
Atlanta, GA
Boston, MA
Chicago, IL
Los Angeles, CA
Manhattan, NY
About the Hiscox Claims team:
The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex ClaimsSpecialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners.
The Role:
The primary role of a Complex ClaimsSpecialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible.
What you'll be doing as the Complex ClaimsSpecialist:
Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to:
Reviewing and analyzing claim documentation and legal filings
Drafting coverage analyses for tech E&O, first and third party cyber claims
Strategizing and maximizing early resolution opportunities
Monitoring litigation and managing local defense and breach counsel
Attending mediations and/or settlement conferences, either in person or by phone as appropriate
Smartly managing and tracking third-party vendor and service provider spend
Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
Liaising directly on daily basis with insureds and brokers
Maintaining timely and accurate file documentation/information in our claims management system
Our Must-Haves:
5+ years of professional lines claims handling experience
A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience
A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required
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
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred
What Hiscox USA Offers:
Competitive salary and bonus (based on personal & company performance)
Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care)
Company paid group term life, short-term disability and long-term disability coverage
401(k) with competitive company matching
24 Paid time off days with 2 Hiscox Days
10 Paid Holidays plus 1 paid floating holiday
Ability to purchase 5 additional 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
Recipient of 2024 Cigna's Well-Being Award 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.
Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. 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: $125,000- $160,000
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
$43k-77k yearly est. Auto-Apply 7d ago
Transactional Risk Claims Specialist
Hyperiongrp
Claim specialist job in New York, NY
Who are we?
Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
Classification: Exempt/Full-time
Reports to: Head of Claims for Transactional Risk
Travel: 0-15%
Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk ClaimsSpecialist for the Claims team.
The Transactional Risk ClaimsSpecialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
Assist with entering claim data into operational systems.
Assist with quality control and performance management, to ensure high-quality claim handling.
Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
Perform other duties as assigned.
Key requirements
Bachelor's degree required and law degree preferred.
Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
Ability to manage multiple competing priorities.
Ability to adapt to evolving regulatory and legal environments.
Complete assigned tasks correctly, on time and able to learn quickly.
Self-motivated and demonstrating attention to detail.
Be able to work independently for extended periods.
Excellent written and verbal communication skills as well as general business understanding.
Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
Our successes have all come from someone brave enough to try something new
We support each other in the small everyday moments and the bigger challenges
We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
*Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
$43k-77k yearly est. Auto-Apply 43d ago
Claims Specialist
Sourcepro Search
Claim specialist job in New York, NY
SourceProSearch is seeking a ClaimsSpecialist with 1-2 years of experience to work in our New York office. The ideal candidate should be comfortable with technology and platforms. This position requires at least 2 days per week in the office.
Job Responsibilities:
Format documents and communications for clients.
Liaise between third-party vendors and the firm.
Review documents (release/document verification) for production to defense counsel for quality control.
Calendaring and entry of case info into the database.
Perform intake and initial filtering of client inquiries.
Preparation of submissions involving large volumes of individual claims.
Run and analyze client data reports.
Organize documents and communications with clients.
Ensure that case documents accurately reflect a client's individual information.
Keep track of communications or developments relating to client cases and deadlines that may be applicable to individual clients.
Prepare and send client communications.
Communicate with clients telephonically, on occasion.
Work with attorneys to plan data gathering and settlement update workflows.
Analyze and summarize client inquiries to identify trends and patterns requiring further action.
Assist with the development of processes and technological systems for addressing large volumes of client interactions.
Skills/Requirements:
Proficient in the use of Microsoft Word and Excel.
Familiarity with Filesite preferred.
Familiarity with client management systems or databases preferred.
Strong technical skills and ability to quickly learn new litigation support software.
Strong written and oral communication skills and strong interpersonal skills.
Must possess great attention to detail.
Must possess analytical and critical thinking skills.
Strong organizational and time-management skills.
Ability to work independently while understanding the importance of teamwork.
Ability to manage workload consisting of multiple tasks.
The work shift for this position is 9:30 am-5:30 pm, five days a week, but the applicant must be willing and available to work overtime, both evening and weekends, when necessary.
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$43k-77k yearly est. 60d+ ago
Insurance Claims Specialist
Ultimate Care Assisted Living Management
Claim specialist job in Ronkonkoma, NY
Job Description
The Insurance ClaimsSpecialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.
DUTIES AND KEY RESPONSIBILITIES:
Claims Management and Oversight
Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
Respond to inquiries and concerns regarding new and existing claims
Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
Compliance and Reporting
Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
Monitor claim trends and identify risk mitigation opportunities.
Financial Coordination and Invoicing
Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
Work with finance team to place and monitor appropriate reserves and allocate funds.
Data Analytics and Reporting
Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
Collaboration and Communication
Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
Provide regular updates to management on claims status, strategic initiatives, and risk trends.
Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.
QUALIFICATIONS:
3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
Associate's degree required.
Excellent customer service skills
Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
Exceptional interpersonal, verbal, and written communication skills
Proven customer relationship and conflict resolution skills
Ability to develop and maintain strong working relationships with internal and external parties
Strong attention to detail and accuracy in data entry and record keeping
Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.
$43k-76k yearly est. 22d ago
Claims Specialist 3- Staffing
Circet USA
Claim specialist job in Englewood Cliffs, NJ
Job Description
Circet USA is the leading provider of Network Services in North America, and we're looking for talented professionals to join our team. We specialize in engineering and construction services delivering comprehensive solutions across Inside Plant, Outside Plant, and Wireless networks to meet the evolving infrastructure needs of our customers.
With nearly 50 years of industry experience, we work with major telecom service providers, MSOs, cloud service providers, and utilities. At Circet USA, you'll have the opportunity to make an impact by helping to create customized solutions that address our clients' unique challenges. If you're passionate about innovation and thrive in a dynamic environment, we'd love to hear from you.
Circet USA's benefits package includes the following:
Medical, Dental, and Vision insurance
Digital Health & Wellness Support
Critical Illness, Accident, & Hospital Insurance
Short-term & Long-term disability
Group term & Voluntary life insurance
Flexible Spending and Health Savings Accounts
Paid Time Off & 401K
Company Discount Website
Responsibilities
We are seeking a highly skilled and experienced ClaimsSpecialist 3 to fulfill a staff augmentation role with Circet USA's customer. The primary objective of the ClaimsSpecialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the ClaimsSpecialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable.
ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties may be assigned:
Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators.
Generate daily/weekly/monthly reports, with analysis and recommendations
Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics
Ensure that all projects have required documentation as they move through the project tollgates
Communicate to Product Liability leadership on project status and escalation/decision points
Works cross functionally with HQ teams in Korea (occasional evening conference call) and SEA operations to manage all possible risks.
Pending Claim Management, KPI & TAT Management - Claim registration to closure
Product Verification
Liability Assessment by reviewing diagnosis results
Reporting on high-profile claims to the leadership
Qualifications
Bachelor's Degree (or equivalent experience)
3-5 years of hands-on claims management & customer care experience
Expertise in MS, Excel, and PPT
Proven capability to analyze data and develop a course of action
Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution
Process, procedure, strategic planning and project development experience
Experience working with and influencing cross-functional teams.
Experience working within the insurance and/or home appliance industry a plus
Experience with product development or testing a plus
Experience working in a complex and wide organization and department
Claims Adjuster License a plus
Takes project ownership and possess leadership qualities with an entrepreneurial approach
Circet USA is an Equal Opportunity Employer - Veteran/Disabled. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by law.
$44k-79k yearly est. 22d ago
Claims Adjuster
Network Adjusters, Inc. 4.1
Claim specialist job in Farmingdale, NY
Network Adjusters is seeking skilled Bodily Injury and Property Claims Adjusters to join our third-party administrative claims handling team. This role focuses on the investigation, evaluation, negotiation, and resolution of complex commercial bodily injury and property damage claims while delivering consistent, high-quality claims management in alignment with industry best practices.
This position offers the opportunity to work within a trusted organization committed to integrity, reliability, and professional development through ongoing training and growth opportunities.
About the Role
Bodily Injury and/or Property Claims Adjusters are responsible for managing commercial bodily injury and/or property damage claims from inception through closure. Claims may include complex commercial auto and general liability exposures with higher severity and specialization. In this role, you will investigate losses, analyze policy language, evaluate damages, negotiate settlements, and handle litigated matters while exercising a high level of independent judgment.
Adjusters routinely take statements, review medical records and police reports, collaborate with legal counsel when necessary, and ensure all claim activity complies with state-specific regulations and Network Adjusters' quality standards and Best Claims Practices. This is a desk-based role.
Responsibilities
Handle complex Commercial Auto and General Liability bodily injury and/or property damage claims from inception to closure
Investigate, evaluate, negotiate, and manage claims involving higher severity and exposure
Provide superior customer service to insureds, claimants, carrier clients, and internal stakeholders
Conduct comprehensive interviews, secure statements, and gather evidence from claimants, witnesses, medical providers, and law enforcement agencies
Analyze insurance contracts and policy language to determine coverage applicability
Review medical records, police reports, and related documentation to evaluate injuries and liability
Establish, monitor, and adjust reserve requirements throughout the life of the claim
Determine settlement values using independent judgment, applicable limits, deductibles, and collaboration with legal counsel when necessary
Handle litigated matters and negotiate settlements within assigned authority
Prepare professional written correspondence summarizing coverage analysis and claim decisions
Communicate claim decisions and sensitive developments with clarity, confidence, and empathy
Maintain accurate, up-to-date claim files, diaries, and documentation
Ensure compliance with applicable regulations and Network Adjusters' quality standards and Best Claims Practices
Qualifications
Minimum 3 years of claims handling experience in either bodily injury or property damage claims
Strong verbal and written communication skills
Proficiency in MS Word, Outlook, Excel, and standard business software
Strong customer service skills with demonstrated empathy
Advanced analytical, investigative, negotiation, and decision-making abilities
Excellent organizational and time management skills with the ability to manage complex workloads
High attention to detail and commitment to accuracy
Ability to maintain confidentiality
College or technical degree, or equivalent business experience preferred
Ability to obtain and maintain required adjuster licenses, including continuing education
Knowledge of the security industry and/or rideshare industry is beneficial
Bilingual proficiency preferred but not required
Compensation & Benefits
Salary: Starting from $70,000+ annually (based on licensure, certifications, and experience)
Training, development, and career growth opportunities
401(k) with company match and retirement planning
Paid time off and company-paid holidays
Comprehensive medical, dental, and vision insurance
Flexible Spending Account (FSA)
Company-paid life insurance and long-term disability
Supplemental life insurance and optional short-term disability
Strong work/family and employee assistance programs
Employee referral program
Location
📍 Farmingdale, NY
This role is on-site only; remote or hybrid arrangements are not available.
About Network Adjusters
Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver, and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.
$70k yearly 3d ago
Claim Specialist
Amtrust Financial 4.9
Claim specialist job in Jersey City, NJ
Requisition ID JR1005075 Category Claims - Specialty Lines Type Regular Full-Time
AmTrust Financial Services, a fast-growing commercial insurance company, is seeking an experienced ClaimsSpecialist. This position can be located in one of our claims offices, with the possibility of working remotely. The successful candidate will directly handle both litigated and non-litigated commercial general liability claims. The successful candidate will also exhibit a strong proficiency in insurance coverage analysis and risk transfer.
Responsibilities
Managing an inventory of commercial general liability claims with moderate complexity by following company guidelines to manage all aspects of the claim handling, including coverage determinations, investigations, and strategic resolution plans which may include pursuit of risk transfer, negotiations, and litigation management.
Recognizing potential exposures and ensuring reserving is appropriate and timely.
Evaluating coverage issues and risk transfer opportunities.
Ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed.
Provide outstanding customer service and effectively communicate with our internal and external business partners.
Formulate proper resolution strategies to ensure the best total claim outcome.
Mentors less experienced Claim Professionals and may be asked to assist with special projects as needed.
Position may require periodic travel to attend meditations, trials and/or other related meetings.
Qualifications
Minimum of five years of experience in the handling of litigated and non-litigated commercial general liability claims.
Bachelor's degree or equivalent work experience.
Strong contractual analysis skills to include the analysis of insurance contracts for coverage analysis and other contracts for risk transfer obligations/opportunities.
Investigative mindset with critical thinking skills.
Strong work ethic with organizational skills and the ability to work independently in a fast-paced environment.
Knowledge of Microsoft Office and ability to learn business-related software.
Excellent verbal and written communication skills with the ability to articulate claim facts, analysis and recommendations to leadership, business partners, and customers.
Ability to partner with internal resources and oversee/manage outside counsel.
Experience in leading negotiations, as well as developing and implementing strategic resolution plans.
Adjuster licensing as required, with preference for Texas and/or Florida.
The expected salary range for this role is $106k-$127k/year
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
#LI-EF1
#LI-Hybrid
#AmTrust
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Connect With Us!
Not ready to apply? Connect with us for general consideration.
$106k-127k yearly 2d ago
Liability Claims Examiner (Trial Prep Unit)
GNY Insurance Companies
Claim specialist job in New York, NY
To examine, adjust, defend, claims and lawsuits against our insureds. Entails reviewing policies to determine coverage, resolving questions of coverage, investigating and making liability determinations, and evaluating damages such as property damage or medical records.
Essential Duties and Responsibilities:
Review and verify coverage for each claim, includes policy review and comparing to allegations made by the claimant. Issue timely coverage position letters.
Conduct factual investigation directly or with the assistance of investigators.
Review and analyze various documents such as contracts, leases, condo/co-op governing documents, the insured's business records, public records, medical records, property damage scopes, etc.
Setting proper reserves timely; making a fair and prompt settlement determination
Negotiate settlements.
Follow all company and departmental protocols
Direct defense counsel, monitor/review discovery.
Make certain that all discovery, expert/IME, and motions are made timely and in accordance with the established defense strategy.
Coordinate and assist defense counsel as requested.
Maintain accurate and complete file notes.
Maintain current and meaningful diary system.
Participates in special projects and performs additional duties as required.
QualificationsEducation and Experience:
A bachelors degree required.
CPCU, AIC, SCLA and other insurance professional designations preferred.
5+ years of experience handing premises liability claims required.
4+ years handling litigated files required.
4+ plus years experience and an understanding of NY Labor Law (if handling NYclaims) required.
Minimum 2 years experience in handling other complex claims such as wrongful death, mold, drownings, negligent security, etc. required.
Must be well versed in handling litigated file in the state(s) they will be assigned to handle and must be able to direct defense counsel and think independently.
Must be able to develop defense tactics and strategies.
Familiarity with ImageRight and Guidewire a plus.
Skills:
Strong written and verbal communication skills required as well as good interpersonal, analytical and negotiation skills.
Intellectual curiosity.
A strong sense of urgency.
Ability to establish relationships and rapport with insured's brokers, attorneys, etc.
To be able to empathize with unrepresented claimants
Other Requirements:
Ability to travel occasionally, generally locally.
Attain/maintain any licenses in states that require them if assigned to those states.
The salary range for this role is $77,400-$141,400. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.
$38k-72k yearly est. 2d ago
Associate, Wage and Hour - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in New York, NY
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.
$38k-44k yearly est. 2d ago
Complex Claims Specialist-MPL
Hiscox
Claim specialist job in New York, NY
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 ClaimsSpecialist 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.
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Work with amazing people and be part of a unique culture
$43k-77k yearly est. Auto-Apply 6d ago
Claim Specialist, E&S
Amtrust Financial 4.9
Claim specialist job in New York, NY
Requisition ID JR1005284 Category Claims - General Liability Type Regular Full-Time
AmTrust Financial Services, a fast-growing commercial insurance company, is seeking an experienced ClaimsSpecialist for a role in Excess and Surplus Lines (E&S) General Liability. This position can be located in one of our claims offices, with the possibility of working remotely. The successful candidate will directly handle both litigated and non-litigated commercial general liability claims. The successful candidate will also exhibit a strong proficiency in insurance coverage analysis and risk transfer.
Responsibilities
Recognizing exposures and ensuring reserving is appropriate and timely.
Evaluating coverage issues and risk transfer opportunities.
Ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, and proper negotiation strategy is employed.
Provide outstanding customer service and effectively communicate with our internal and external business partners.
Formulate proper resolution strategies to ensure the best total claim outcome.
Position may require periodic travel to attend meditations, trials and/or other related meetings.
Qualifications
Minimum of five (5) years of experience in the handling of litigated and non-litigated commercial general liability claims, with a preference for bodily injury and property damage claims in California and the Western United States.
Bachelor's degree or equivalent work experience.
Strong contractual analysis skills to include the analysis of insurance contracts for coverage analysis and other contracts for risk transfer obligations/opportunities.
Proficient computer skills required to navigate our paperless claim file system.
Possesses a high level of technical claim and legal knowledge and skills.
Excellent communication skills both written and oral.
Ability to professionally interact at a high level with parties both internal and external to AmTrust.
Ability to effectively influence others without damaging relationships.
Skillful negotiator.
Adjuster licensing as required, with preference for California, Texas and/or Florida.
CPCU designation/AIC certification preferred.
The expected salary range for this role is $92K-114K/year.
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
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#AmTrust
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Connect With Us!
Not ready to apply? Connect with us for general consideration.
$92k-114k yearly 2d ago
Custom Liability Claims Examiner
GNY Insurance Companies
Claim specialist job in New York, NY
To handle claims associated with GNY Custom book and other select accounts from inception to closure. To assure that there are accurate reserve and expense controls are implemented. To focus on the early and fair disposition of cases. To coordinate with defense counsel to make sure that all cases are properly prepared for a potential trial. To assist underwriting and loss control in account reviews. Interact with insured and broker as often as may be required.
Essential Duties and Responsibilities:
Inception to closure claim handling of claims on assigned special accounts, including multi-state claim handling.
Review and verify coverage for each claim, includes policy review and comparing to allegations made by the claimant. Issue timely coverage position letters.
Conduct factual investigation directly or with the assistance of investigators.
Review and analyze various documents such as contracts, leases, condo/co-op governing documents, the insured's business records, public records, medical records, property damage scopes, etc.
Setting proper reserves timely; making a fair and prompt settlement determination.
Negotiate settlements.
Follow all company and departmental protocols.
Direct defense counsel, monitor/review discovery.
Maintain accurate and complete file notes.
Maintain current and meaningful diary system.
Participates in special projects and performs additional duties as required.
QualificationsEducation and Experience:
Bachelor's degree required.
CPCU, AIC, SCLA and other insurance professional designations preferred.
4+ years of experience handing premises liability claims required.
Advanced knowledge and understanding of NY Labor Law required. 2 years experience handling labor law claims preferred.
Must have experience in handling other complex claims such as wrongful death, mold, drownings, negligent security, etc.
Must be able to direct defense counsel and think independently.
Must be able to develop defense tactics and strategies.
Familiarity with ImageRight and Guidewire a plus.
Skills:
Strong written and verbal communication skills required as well as good interpersonal, analytical and negotiation skills.
Strong customer focus skills with the ability to handle complex accounts.
Intellectual curiosity.
Strong sense of urgency
Ability to establish relationships and rapport with insured's brokers, attorneys, etc.
Ability to empathize with unrepresented claimants.
Other Requirements:
Ability to travel occasionally, generally locally
Attain/maintain any licenses in states that require them if assigned to those states.
The salary range for this role is $77,500-$141,400. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.
How much does a claim specialist earn in Levittown, NY?
The average claim specialist in Levittown, NY earns between $33,000 and $99,000 annually. This compares to the national average claim specialist range of $27,000 to $67,000.
Average claim specialist salary in Levittown, NY
$58,000
What are the biggest employers of Claim Specialists in Levittown, NY?
The biggest employers of Claim Specialists in Levittown, NY are: