Michigan Homeowners Claim Representative II - AAA The Auto Club Group Reports to: Claim Manager IWhat you will do:
Work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units, resolve coverage questions, take statements, and establish clear evaluation and resolution plans for claims.
Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim, and initiate documentation in the claim handling system.
Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve payments for the appropriate parties accordingly.
Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.
Employees assigned to the Homeowner/CAT claim unit will handle claims generally valued between $5,000 and $25,000 (for the inside desk role) and up to $100,000 (for field role). Investigate claims requiring coverage analysis. When handling claims in the field, prepare damage estimates using claims software. Review estimates for accuracy. May monitor contractor repair status and update.
Supervisory Responsibilities:
None
How you will benefit:
A competitive annual salary between $64,000 - $72,000
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, and rewards and much more
We're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify) Education:
Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience in property adjusting
In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states
A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
Experience:
One year of experience or equivalent training in the following:
Negotiating claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:
Advance knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Knowledge of building construction and repair techniques
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guidelines
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Research, analyze, and interpret subrogation laws in various states
Strong negotiating skills
Ability to work outside normal business hours as needed
Preferred Qualifications:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Xactimate software experience/training or experience in an equivalent software
Claims adjuster experience specifically in home/property claims preferred
Experience working within a customer service setting
Call center experience or experience handling high volume calls preferred, but not required
Excellent communication skills both oral and written
Experience working within an insurance or claims-based role for one year or more
Full claims cycle experience preferred
Work Environment
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit ***********
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
$25k-29k yearly est. 2d ago
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Claims Specialist, Professional Liability (Medical Malpractice)
Sedgwick 4.4
Claim specialist job in Bismarck, ND
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
ClaimsSpecialist, Professional Liability (Medical Malpractice)
**PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
+ Negotiates claim settlement up to designated authority level.
+ Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
+ Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
+ Represents Company in depositions, mediations, and trial monitoring as needed.
+ Communicates claim activity and processing with the client; maintains professional client relationships.
+ Ensures claim files are properly documented and claims coding is correct.
+ Refers cases as appropriate to supervisor and management.
+ Delegates work and mentors assigned staff.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
**Experience**
Six (6) years of claims management experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent negotiation skills
+ Good interpersonal skills
+ Ability to work in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** **:** Computer keyboarding, travel as required
**Auditory/Visual** **:** Hearing, vision and talking
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$117,000 - $125,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$26k-31k yearly est. 10d ago
Claims Examiner
Harriscomputer
Claim specialist job in North Dakota
Responsibilities & Duties:Claims Processing and Assessment:
Evaluate incoming claims to determine eligibility, coverage, and validity.
Conduct thorough investigations, including reviewing medical records and other relevant documentation.
Analyze policy provisions and contractual agreements to assess claim validity.
Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
Ensure compliance with company policies, procedures, and regulatory requirements.
Maintain accurate records and documentation related to claims activities.
Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
Identify opportunities for process improvement and efficiency within the claims department.
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
Generate reports and provide data analysis on claims trends, processing times, and outcomes.
Contribute to the development of management reports and presentations regarding claims operations.
$25k-39k yearly est. Auto-Apply 35d ago
Senior Claim Benefit Specialist
CVS Health 4.6
Claim specialist job in North Dakota
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
**Position Summary**
Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.
**Additional Responsibilities:**
Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
- Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.
- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.
- Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.
- Identifies and reports possible claim overpayments, underpayments and any other irregularities.
- Performs claim rework calculations.
- Distributes work assignment daily to junior staff.
- Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration.
**Required Qualifications**
- New York Independent Adjuster License
- Experience in a production environment.
- Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
**Preferred Qualifications**
- 18+ months of medical claim processing experience
- Self-Funding experience
- DG system knowledge
**Education**
**-** High School Diploma required
- Preferred Associates degree or equivalent work experience.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$18.50 - $42.35
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit *****************************************
We anticipate the application window for this opening will close on: 02/27/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
$18.5-42.4 hourly 7d ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claim specialist job in North Dakota
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at **********************
Overview:
Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution.
Key Responsibilities:
- Planning and organizing daily workload to process claims and conduct inspections
- Investigating insurance claims, including interviewing claimants and witnesses
- Handling property claims involving damage to buildings, structures, contents and/or property damage
- Conducting thorough property damage assessments and verifying coverage
- Evaluating damages to determine appropriate settlement
- Negotiating settlements
- Uploading completed reports, photos, and documents using our specialized software systems
Requirements:
- Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces
- Strong interpersonal communication, organizational, and analytical skills
- Proficiency in computer software programs such as Microsoft Office and claims management systems
- Self-motivated with the ability to work independently and prioritize tasks effectively
- High school diploma or equivalent required
- Previous experience in insurance claims or related field is a plus but not required
Next Steps:
If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps.
Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.
$43k-51k yearly est. Auto-Apply 1d ago
Independent Insurance Claims Adjuster in Bismarck, North Dakota
Milehigh Adjusters Houston
Claim specialist job in Bismarck, ND
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.
$42k-50k yearly est. Auto-Apply 60d+ ago
Crop Insurance Adjuster - Southwest North Dakota
Farmers Mutual Hail 4.3
Claim specialist job in North Dakota
Crop Insurance Adjuster
At Farmers Mutual Hail (FMH), our mission is simple: protect the livelihoods and legacies of America's farmers through the complete farm insurance solutions we offer. As America's Crop Insurance Companyâ„¢, we are headquartered in the U.S. and have been owned by the farmers we insure for over 125 years.
As a full-time Crop Insurance Adjuster at FMH, you'll complete field inspections, read maps and aerial photos, measure fields, climb storage bins, and discuss findings of crop losses with producers to enable America's farmers to clothe, feed, and fuel the world. Due to the required travel, the potential candidate will need to be located in Southwest North Dakota to be successful in this role.
BENEFITS:
Our employees appreciate our family-oriented culture, and we make sure their benefits reflect that. In addition to a competitive salary and bonuses, medical/dental/vision plan, 401(k) plan with a generous company match, you will be eligible for benefits such as:
Paid Parental leave and Caregiver leave
This position will receive a vehicle, cell phone, and paid expenses for travel
Employee appreciation events
Employee Assistance Program (EAP) for support when you and your family need it
REQUIREMENTS:
To be considered for this role, you will need the following:
Experience: A minimum of 1 to 5 years of crop insurance adjusting experience or an agriculture background is preferred.
Education: High school diploma or general education degree (GED) required; Associates and/or Bachelor's degree in business or an ag-related field preferred.
Skills: Must possess basic computer skills: Ability to use a computer, printer, scanner, Internet and Microsoft Office Products.
Additional Requirements: Must be available to attend all Company-mandated training events and conferences and be able to travel for work-related reasons for periods of time exceeding twenty-four (24) hours. Must be able to physically climb heights in excess or ten (10) feet, walk distances over ¼ mile over uneven terrain, and stand without rest for periods of time greater than one hour. Must maintain a valid driver's license, clean MVR, and own a vehicle.
RESPONSIBILITIES:
Understands and is able to work claims for all major crops, policy/plan types, in all stages of growth.
Effectively and clearly communicates regulations and interpretations to producers, agents, and Company staff regarding claims processes.
Stays current with RMA-requirements and maintains CAPP certification if working multi-peril crop insurance (MPCI) claims.
Maintains a State Adjuster License where required.
Does this sound like a good fit for you? Apply today through our website!
This position is not eligible for sponsorship for work authorization by Farmers Mutual Hail Insurance Company of Iowa. Therefore, if you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time.
Farmers Mutual Hail Insurance Company does not discriminate in employment (EOE). All qualified applicants are encouraged to apply. #LIDNP
$43k-55k yearly est. Auto-Apply 13d ago
Surveillance / Claims Investigator - Part-Time
Allied Universal Compliance and Investigations
Claim specialist job in Fargo, ND
Overview
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Surveillance / Claims Investigator. Surveillance / Claims Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation.
No office to go to - travel daily to cases in the field!
Must possess a valid driver's license with at least one year of driving experience
Will require Claims and Surveillance investigations as needed to ensure a full schedule
RESPONSIBILITIES:
Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations
Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation
Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters
Run appropriate database indices if necessary and verify the accuracy of results found
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
Ability to be properly licensed as a Private Investigator as required by the states in which you work
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims
Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
Proficient in utilizing laptop computers and cell phones
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
One or more of the following professional industry certifications
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID
2025-1500467
$41k-50k yearly est. 28d ago
Surveillance / Claims Investigator - Part-Time
Security Director In San Diego, California
Claim specialist job in Fargo, ND
Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal is hiring a Surveillance / Claims Investigator. Surveillance / Claims Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation.
No office to go to - travel daily to cases in the field!
Must possess a valid driver's license with at least one year of driving experience
Will require Claims and Surveillance investigations as needed to ensure a full schedule
RESPONSIBILITIES:
Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations
Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation
Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters
Run appropriate database indices if necessary and verify the accuracy of results found
QUALIFICATIONS (MUST HAVE):
Must possess one or more of the following:
Bachelor's degree in Criminal Justice
Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims
Ability to be properly licensed as a Private Investigator as required by the states in which you work
Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims
Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country
Special Investigative Unit (SIU) Compliance knowledge
Ability to type 40+ words per minute with minimum error
Flexibility to work varied and irregular hours and days including weekends and holidays
Proficient in utilizing laptop computers and cell phones
PREFERRED QUALIFICATIONS (NICE TO HAVE):
Military experience
Law enforcement
Insurance administration experience
One or more of the following professional industry certifications
Certified Fraud Investigator (CFE)
Certified Insurance Fraud Investigator (CIFI)
Fraud Claim Law Associate (FCLA)
Fraud Claim Law Specialist (FCLS)
Certified Protection Professional (CPP)
Associate in Claims (AIC)
Chartered Property Casualty Underwriter (CPCU)
BENEFITS:
Medical, dental, vision, basic life, AD&D, and disability insurance
Enrollment in our company's 401(k)plan, subject to eligibility requirements
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.
Closing
Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: ***********
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: ***********/offices.
Requisition ID 2025-1500467
$41k-50k yearly est. Auto-Apply 28d ago
Property Claims Representative
Nodak Insurance Company 3.7
Claim specialist job in Fargo, ND
Summary: Investigate, negotiate, and settle claims of a more serious nature within personal settlement authority under general supervision. Render prompt claim service and establish the best possible relationship with all persons involved.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
May be responsible for the set-up of claims, including taking loss reports, establishing a claim file either through automated or manual systems, and obtaining policy information through the use of computer or direct contact with agents or company personnel.
Performs a thorough investigation of the loss, including securing recorded or signed statements, medical records and reports, proof of loss, police reports, diagrams, photographs, or testimony from technical experts.
Investigation may be tedious and involve exploring less accessible sources.
Secure assistance of specialists or outside vendors where personal judgment dictates the cost effectiveness and need for these services.
Interprets coverage and liability issues on the majority of cases, seeking advice on only the most involved cases or those with dollar values exceeding personal authorization. This includes reviewing policy language and endorsements as well as using reference materials to determine legal precedent. On claims where investigation warrants denial, prepares denial materials including documentation, and communicates the decision to the affected parties.
Evaluates and appraises losses and applies deductibles, betterment, and depreciation principles in arriving at a settlement amount. This may include writing estimates and acquiring agreed-upon prices for property damage as well as assessing bodily injury and related awards for personal injury cases.
Reviews all bills and estimates prior to making a settlement or seeking a settlement authority to determine applicability for payment under policy provisions.
Prepares drafts, negotiates settlements, and performs all tasks required to close a case and effect efficient and fair settlement of claims. This may include the proper handling of subrogation and disposal of salvage or property owned by the Company to reduce paid loss amounts.
Prepares all worksheets, forms, documentation, and reporting duties to create a file that is capable of being used by others to monitor progress or continue efficient handling of a claim.
Responsible for providing an acceptable work space to work out of their home and comply with the Company's Telecommuting Agreement.
Qualifications
Education and/or Experience: Bachelor's Degree or equivalent. Experience at the claim representative level with the ability to handle more complex cases with only general supervision. Generally acquired at about 3 years of experience.
Promotional potential and organizational progressions: Sr. Claim Representative
Certificates, Licenses, Registrations: AIC, Agents Property and Casualty License (by state).
Required Knowledge and Skills:
Must be able to readily interpret policy language, liability, and negligence law on more involved cases and perform research when required. Work is varied and complex in nature.
Must have knowledge of claim values and establish the value of the majority of assigned cases. Must have knowledge of claim procedures and legal requirements for proper claim handling. Access and enter information accurately into the CRT.
Prepare written worksheets, forms, and other documentation to enable efficient claim handling.
Record numerous reports, letters, and file documentation for transcription by appropriate staff.
Maintain acceptable attendance as defined in the company personnel policy.
Special Relationships to other people, internally and externally, cost control, etc.): Has broader personal settlement authority subject to normal supervisory review. Generally can work independently with normal supervision and accountability for the results. Has considerable contact by telephone or in person with claimants, insureds, agents, attorneys, Company personnel, and the general public. Must continually be aware of being a Company representative and projecting a favorable image.
Physical Requirements: While performing the duties of this job, the employee is occasionally required to stand, walk, sit, use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
The noise level in the work environment is usually moderate.
FOR OUTSIDE CLAIM REPRESENTATIVES ONLY
Visually and physically inspect accident and/or loss scenes. Conduct in-person meetings with claimants, insureds, agents, and the public in a variety of locations away from the home office. Visually and physically inspect the damages claimed. Work outdoors in all types of weather for a limited time period while inspecting damages or a loss scene. Photographically record damages, accidents, and/or loss scenes. While performing the duties of this job, the employee is occasionally required to stand; walk considerable distances in all types of weather, terrain and conditions; sit; use hands to finger, handle, measure, or feel; reach with hands and arms; transport, setup and climb ladders to inspect roofs including dwellings, barns, bins, grain systems, and other structures, or balance; stoop, kneel, crouch, or crawl in or under structures and equipment. The employee must regularly lift and/or move items weighing at least 50 pounds.
Nodak Insurance Company complies fully with all federal, state, and local employment laws and shall provide equal employment and advancement opportunities for all persons regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, the presence of any mental or physical disability, status with regard to public assistance or marriage, or any other category protected by local, state or federal law.
$29k-34k yearly est. 11d ago
Claims Examiner
Harris Computer Systems 4.4
Claim specialist job in Michigan City, ND
Responsibilities & Duties:Claims Processing and Assessment: * Evaluate incoming claims to determine eligibility, coverage, and validity. * Conduct thorough investigations, including reviewing medical records and other relevant documentation. * Analyze policy provisions and contractual agreements to assess claim validity.
* Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
* Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
* Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
* Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
* Ensure compliance with company policies, procedures, and regulatory requirements.
* Maintain accurate records and documentation related to claims activities.
* Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
* Identify opportunities for process improvement and efficiency within the claims department.
* Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
* Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
* Generate reports and provide data analysis on claims trends, processing times, and outcomes.
* Contribute to the development of management reports and presentations regarding claims operations.
$40k-53k yearly est. Auto-Apply 32d ago
Adjudicator, Provider Claims-On the phone
Molina Healthcare Inc. 4.4
Claim specialist job in Michigan City, ND
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution.
* Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues.
* Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions.
* Assists in reviews of state and federal complaints related to claims.
* Collaborates with other internal departments to determine appropriate resolution of claims issues.
* Researches claims tracers, adjustments, and resubmissions of claims.
* Adjudicates or readjudicates high volumes of claims in a timely manner.
* Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership.
* Meets claims department quality and production standards.
* Supports claims department initiatives to improve overall claims function efficiency.
* Completes basic claims projects as assigned.
Required Qualifications
* At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience.
* Research and data analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Customer service experience.
* Effective verbal and written communication skills.
* Microsoft Office suite and applicable software programs proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.65 - $38.37 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 27d ago
Crop Claims Seasonal Adjuster
Great American Insurance Group (DBA 4.7
Claim specialist job in Michigan City, ND
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.
The Crop Division of Great American has been helping generations of farmers take control of their risks since 1915. The Division is also one of a select few private companies authorized by the United States Department of Agriculture Risk Management Agency (USDA RMA) to write MPCI policies. With six regional offices throughout the U.S., the teams provide tremendous expertise in the specific needs of farmers and crops.
**********************************
Great American is currently seeking Seasonal Crop Adjusters. These positions are seasonal and may not be eligible for full-time or part-time benefits. Qualified candidates will cover territory in one of the following states:
* Alabama
* Arkansas
* California
* Colorado
* Florida
* Georgia
* Idaho
* Illinois
* Indiana
* Iowa
* Kansas
* Kentucky
* Louisiana
* Michigan
* Minnesota
* Mississippi
* Missouri
* Montana
* Nebraska
* New York
* North Carolina
* North Dakota
* Ohio
* Oklahoma
* Oregon
* Pennsylvania
* South Carolina
* South Dakota
* Tennessee
* Texas
* Washington
* Wisconsin
* Wyoming
Schedule: Seasonal part-time. Hours fluctuate based on seasonal needs.
As a Crop Adjuster, you will:
* Understand and can work claims for all major crops, policy/plan types, in all stages of growth.
* Complete field inspections, reviews, and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company Crop insurance policies.
* Review and evaluates coverage and/or liability.
* Secure and analyze necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims.
* Ensure compliant and cost effective application of Crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements.
* Accurately document, process and transmit loss information to determine potential.
* Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions, or trials as necessary.
* May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
* Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
* Ensures that claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
* Follow regulatory and company rules, policies, and procedures.
* Performs other duties as assigned.
Physical Requirements for employees in the Crop Business Unit/Crop Claims General Adjuster
* Requires continuous and prolonged walking and standing.
* Requires frequent lifting, carrying, pushing and pulling of objects up to 50 lbs.
* Requires frequent climbing grain bins, bending, twisting, stooping, kneeling and crawling.
* Requires overhead reaching and grabbing.
* Requires regular and predictable attendance.
* Requires ability to conduct visual inspections.
* Requires work outdoors, in inclement weather conditions.
* Requires frequent travel.
* May require ability to operate a motor vehicle.
Business Unit:
Crop
Salary Range:
$0.00 -$0.00
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
$43k-50k yearly est. Auto-Apply 60d+ ago
Claims Representative (IAP) - Workers Compensation Training Program
Sedgwick 4.4
Claim specialist job in Bismarck, ND
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative (IAP) - Workers Compensation Training Program
Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
+ A stable and consistent work environment in an office setting.
+ A training program to learn how to help employees and customers from some of the world's most reputable brands.
+ An assigned mentor and manager who will guide you on your career journey.
+ Career development and promotional growth opportunities through increasing responsibilities.
+ A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs.
**PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due.
**ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field.
**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**
+ Attendance and completion of designated classroom claims professional training program.
+ Performs on-the-job training activities including:
+ Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims.
+ Adjusting low and mid-level liability and/or physical damage claims under close supervision.
+ Processing disability claims of minimal disability duration under close supervision.
+ Documenting claims files and properly coding claim activity.
+ Communicating claim action/processing with claimant and client.
+ Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
+ Participates in rotational assignments to provide temporary support for office needs.
**QUALIFICATIONS**
Bachelor's or Associate's degree from an accredited college or university preferred.
**EXPERIENCE**
Prior education, experience, or knowledge of:
- Customer Service
- Data Entry
- Medical Terminology (preferred)
- Computer Recordkeeping programs (preferred)
- Prior claims experience (preferred)
Additional helpful experience:
- State license if required (SIP, Property and Liability, Disability, etc.)
- WCCA/WCCP or similar designations
- For internal colleagues, completion of the Sedgwick Claims Progression Program
**TAKING CARE OF YOU**
+ Entry-level colleagues are offered a world class training program with a comprehensive curriculum
+ An assigned mentor and manager that will support and guide you on your career journey
+ Career development and promotional growth opportunities
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$27k-33k yearly est. 29d ago
Independent Insurance Claims Adjuster in Grand Forks, North Dakota
Milehigh Adjusters Houston
Claim specialist job in Grand Forks, ND
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.
$42k-50k yearly est. Auto-Apply 60d+ ago
Analyst, Claims Research
Molina Healthcare Inc. 4.4
Claim specialist job in Michigan City, ND
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
* Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
* Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
* Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
* Assists with reducing rework by identifying and remediating claims processing issues.
* Locates and interprets claims-related regulatory and contractual requirements.
* Tailors existing reports and/or available data to meet the needs of claims projects.
* Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
* Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
* Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
* Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
* Works collaboratively with internal/external stakeholders to define claims requirements.
* Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
* Fields claims questions from the operations team.
* Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
* Appropriately conveys claims-related information and tailors communication based on targeted audiences.
* Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
* Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
* Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
* At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
* Medical claims processing experience across multiple states, markets, and claim types.
* Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
* Data research and analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Ability to work cross-collaboratively in a highly matrixed organization.
* Customer service skills.
* Effective verbal and written communication skills.
* Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
* Health care claims analysis experience.
* Project management experience.
* QNXT, Salesforce and basic SQL
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $21.65 - $46.42 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$25k-31k yearly est. 6d ago
Senior Claim Benefit Specialist
CVS Health 4.6
Claim specialist job in Michigan City, ND
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.
And we do it all with heart, each and every day.
Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.
Acts as a subject matter expert by providing training, coaching, or responding to complex issues.
May handle customer service inquiries and problems.
Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
- Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment.
measures to assist in the claim adjudication process.
- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.
- Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.
- Identifies and reports possible claim overpayments, underpayments and any other irregularities.
- Performs claim rework calculations.
- Distributes work assignment daily to junior staff.
- Trains and mentors claim benefit specialists.
- Makes outbound calls to obtain required information for claim or reconsideration.
Required Qualifications- New York Independent Adjuster License- Experience in a production environment.
- Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Preferred Qualifications- 18+ months of medical claim processing experience- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience.
Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18.
50 - $42.
35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.
The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future.
Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be.
In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit *************
cvshealth.
com/us/en/benefits We anticipate the application window for this opening will close on: 02/27/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
$18 hourly 13d ago
Independent Insurance Claims Adjuster in Fargo, North Dakota
Milehigh Adjusters Houston
Claim specialist job in Fargo, ND
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.
$42k-50k yearly est. Auto-Apply 60d+ ago
Rec Marine Adjuster
Sedgwick 4.4
Claim specialist job in Fargo, ND
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Rec Marine Adjuster
**PRIMARY PURPOSE** **:** To investigate and process marine claims adjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement.
+ Receives and reviews new claims and maintains data integrity in the claims system.
+ Reviews survey reports and insurance policies to determine insurance coverage.
+ Prepares settlement documents and requests payment for the claim and expenses.
+ Assists in preparing loss experience report to help determine profitability and calculates adequate future rates.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required.
**Experience**
3 years or more of Marine Adjusting preferred.
**Skills & Knowledge**
+ Strong oral and written communication skills
+ PC literate, including Microsoft Office products
+ Good customer service skills
+ Good organizational skills
+ Demonstrated commitment to timely reporting
+ Ability to work independently and in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** **:**
+ Must be able to stand and/or walk for long periods of time.
+ Must be able to kneel, squat or bend.
+ Must be able to work outdoors in hot and/or cold weather conditions.
+ Have the ability to climb, crawl, stoop, kneel, reaching/working overhead
+ Be able to lift/carry up to 50 pounds
+ Be able to push/pull up to 100 pounds
+ Be able to drive up to 4 hours per day.
+ Must have continual use of manual dexterity
**Auditory/Visual** **:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$50k yearly 43d ago
Analyst, Claims Research
Molina Healthcare Inc. 4.4
Claim specialist job in Michigan City, ND
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution.
Essential Job Duties
* Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects.
* Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams.
* Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests.
* Assists with reducing rework by identifying and remediating claims processing issues.
* Locates and interprets claims-related regulatory and contractual requirements.
* Tailors existing reports and/or available data to meet the needs of claims projects.
* Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors.
* Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes.
* Seeks to improve overall claims performance, and ensure claims are processed accurately and timely.
* Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance.
* Works collaboratively with internal/external stakeholders to define claims requirements.
* Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing.
* Fields claims questions from the operations team.
* Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims.
* Appropriately conveys claims-related information and tailors communication based on targeted audiences.
* Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members.
* Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance.
* Supports claims department initiatives to improve overall claims function efficiency.
Required Qualifications
* At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience.
* Medical claims processing experience across multiple states, markets, and claim types.
* Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs.
* Data research and analysis skills.
* Organizational skills and attention to detail.
* Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
* Ability to work cross-collaboratively in a highly matrixed organization.
* Customer service skills.
* Effective verbal and written communication skills.
* Microsoft Office suite (including Excel), and applicable software programs proficiency.
Preferred Qualifications
* Health care claims analysis experience.
* Project management experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $22.81 - $46.42 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.