Claims Representative - Glendale, AZ
Claim specialist job in Glendale, AZ
Who is Federated Insurance?
At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own.
Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values.
What Will You Do?
Customer-focused, source of knowledge and comfort, desire to help, professional - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss.
No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients.
This is an in-office position that will work out of our Glendale, AZ office, located at 5701 W. Talavi Blvd. A work from home option is not available.
Responsibilities
Work with policyholders, physicians, attorneys, contractors and others to ensure claims are resolved in a prompt, fair and courteous way.
Explain policy coverage to policyholders and third parties.
Complete thorough investigations and document facts relating to claims.
Determine the value of damaged items or accurately pay medical and wage loss benefits.
Negotiate settlements with policyholders and third parties.
Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars.
Minimum Qualifications
Current pursuing, or have obtained a four-year degree
Experience in a customer service role in industries such as retail, hospitality, logistics, banking, automotive dealerships, vehicle rental, sales or similar fields
Ability to make confident decisions based on available information
Strong analytical, computer, and time management skills
Excellent written and verbal communication skills
Leadership experience is a plus
Salary Range: $61,700 - $75,400
Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. More information can be discussed with a with a member of the Recruiting team.
What We Offer
We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You.
Employment Practices
All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization.
If California Resident, please review Federated's enhanced Privacy Policy.
Auto-ApplyPatient Claims Specialist
Claim specialist job in Phoenix, AZ
ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine!
Your Role:
* Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections
* Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates
* Input and update patient account information and document calls into the Practice Management system
* Special Projects: Other duties as required to support and enhance our customer/patient-facing activities
Skills & Requirements:
* High School Diploma or GED required
* Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST
* Minimum of 1-2 years of previous healthcare administration or related experience required
* Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs)
* Manage/ field 60+ inbound calls per day
* Bilingual a plus (Spanish & English)
* Proficient knowledge of business software applications such as Excel, Word, and PowerPoint
* Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone
* Ability and openness to learn new things
* Ability to work effectively within a team in order to create a positive environment
* Ability to remain calm in a demanding call center environment
* Professional demeanor required
* Ability to effectively manage time and competing priorities
#LI-SM2
Auto-ApplyP&C Claims Specialist
Claim specialist job in Scottsdale, AZ
Company Details
Berkley Risk is a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.
Responsibilities
We are looking for an outstanding and collaborative candidate to work within our small, dynamic team. Responsible for adjusting claims as assigned, to perform all claim duties associated with the investigation, evaluation and resolution of all claims assigned.
Understands and can apply coverage for the claims assigned. Issues appropriate RORs and disclaimers.
Conducts the necessary investigation, either by phone, or through independent adjusters, to determine coverage, liability and damages.
Evaluates, negotiates, and settles assigned claims within authority granted, or seeks authority for those claims in excess of authority.
Identifies subrogation/contribution/deductible recovery opportunities and effectively pursues recovery when appropriate.
Assigns and actively directs independent adjusters as well as defense attorneys. Complies with litigation management guidelines.
Keeps claim files maintained in a consistent and organized manner, diaries are kept current, and reserves are constantly assessed for adequacy throughout the life of the claim.
Complies with reinsurance and client reporting guidelines.
Issues loss and expense payments properly and on a timely basis.
May perform other functions as assigned.
Qualifications
2+ years claim experience required.
AIC, CPCU, or other industry coursework preferred.
Complies with state adjuster licensing where applicable.
Prior claim experience required.
Strong organizational skills.
Good human relations skills and communications skills.
Education
College degree or relevant claim handling experience
Additional Company Details The Company is an equal employment opportunity employer.
We do not accept unsolicited resumes from third party recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary
• Benefits include Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans
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.
Auto-ApplyRisk Claims Supervisor
Claim specialist job in Phoenix, AZ
As a key member of the Risk Operations team, you#ll lead and support our Risk Specialists while overseeing the management of complex claims data. In this role, you#ll guide investigations and coordinate liability, Workers# Compensation, and property claims to help protect Valleywise Health and the communities we serve. # You#ll work closely with leaders across the organization to ensure effective remediation plans are in place, supervise the collection and analysis of claims data, and play a critical role in insurance renewals and the actuarial process. Because information is often incomplete or difficult to obtain, this position requires strong problem-solving, research, and decision-making skills. # Reporting to the Risk Operations Manager, you#ll bring structure and clarity to complex issues while empowering your team to deliver accurate insights and effective solutions that shape our risk management strategies. # Annual Salary Range: $79,913.60 - $117,873.60 # Qualifications Education: Requires a bachelor#s degree in insurance, Risk Management, Public Administration, Business Administration, Finance, Management, or a closely related field, or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work. Experience: Must have three (3) years of Claim Supervisor experience. Preference given for technical training in claims or insurance policies and demonstrated supervisory experience. Knowledge, Skills, and Abilities: Must possess demonstrated experience and expertise in liability and property claims adjusting or auditing. Strong supervisory, organizational, and critical thinking skills, as well as a highly professional attitude and demeanor. Must be self-directed with good time management skills and strong interpersonal skills that will result in working effectively with diverse individuals and groups. Must have the ability to exercise sound judgment and initiative within established guidelines, meet deadlines, and simultaneously handle numerous projects. Will need to be able to work independently and as a team member to attain goals and resolutions through collaboration and negotiation. Must continually strive to improve processes, assigned functions, and functions performed by assigned staff. Requires the ability to read, write and speak effectively in English. #CRP
As a key member of the Risk Operations team, you'll lead and support our Risk Specialists while overseeing the management of complex claims data. In this role, you'll guide investigations and coordinate liability, Workers' Compensation, and property claims to help protect Valleywise Health and the communities we serve.
You'll work closely with leaders across the organization to ensure effective remediation plans are in place, supervise the collection and analysis of claims data, and play a critical role in insurance renewals and the actuarial process. Because information is often incomplete or difficult to obtain, this position requires strong problem-solving, research, and decision-making skills.
Reporting to the Risk Operations Manager, you'll bring structure and clarity to complex issues while empowering your team to deliver accurate insights and effective solutions that shape our risk management strategies.
Annual Salary Range: $79,913.60 - $117,873.60
Qualifications
Education:
* Requires a bachelor's degree in insurance, Risk Management, Public Administration, Business Administration, Finance, Management, or a closely related field, or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work.
Experience:
* Must have three (3) years of Claim Supervisor experience.
* Preference given for technical training in claims or insurance policies and demonstrated supervisory experience.
Knowledge, Skills, and Abilities:
* Must possess demonstrated experience and expertise in liability and property claims adjusting or auditing.
* Strong supervisory, organizational, and critical thinking skills, as well as a highly professional attitude and demeanor.
* Must be self-directed with good time management skills and strong interpersonal skills that will result in working effectively with diverse individuals and groups.
* Must have the ability to exercise sound judgment and initiative within established guidelines, meet deadlines, and simultaneously handle numerous projects.
* Will need to be able to work independently and as a team member to attain goals and resolutions through collaboration and negotiation.
* Must continually strive to improve processes, assigned functions, and functions performed by assigned staff.
* Requires the ability to read, write and speak effectively in English.
#CRP
US Retail Markets Claims Specialist Development Program-(January, June 2026)
Claim specialist job in Chandler, AZ
Advance your career at Liberty Mutual - A Fortune 100 Company! Manages, investigates and resolves claims assigned and assists in providing service to policyholders. Responsibilities: * Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
* Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
* Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.
* Ensures adequacy of reserves.
* Accountable for security of financial processing of claims, as well as security information contained in claims files.
* Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or co-defendants. Arranges for expert inspections involving third party or potential fraud actions as needed.
* Updates files and provides comprehensive reports as required
Qualifications
Qualifications:
* Strong written and oral communications skills required.
* Good interpersonal, analytical, investigative, and negotiation skills required.
* Customer service experience preferred.
* Basic knowledge of legal liability, general insurance policy coverage and State Tort Law.
* Bachelor's degree is required.
* Ability to obtain proper licensing as required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco
Auto-ApplyClaims Specialist
Claim specialist job in Tempe, AZ
Requirements
What You Bring to the Team by Way of Skills and Experience:
Bachelor's degree required in Business, Risk Management, or related field.
Minimum 5+ years of experience in auto estimating and claims management.
Valid driver's license and current auto insurance preferred.
Professional appraisal or adjuster licenses preferred.
Strong knowledge of auto damage estimating, freight/cargo claims processes, and insurance policy structures.
Knowledge of FMCSA/DOT regulations, multi-jurisdictional claims practices, Carmack Amendment principles, and carrier liability standards.
Exceptional interpersonal, negotiation, communication, and organizational skills.
Proven ability to work independently, prioritize competing demands, and resolve complex issues within deadlines.
Strong business acumen and collaborative approach to working cross-functionally with internal teams and external vendors.
Experience managing full claims lifecycle, coordinating with insurers and TPAs, and analyzing claims trends.
Strong communication skills, integrity, and sound judgment with experience handling sensitive information and conducting investigations.
Proficient in Microsoft Office Suite (Word, Excel, Outlook) and claims management systems/tools.
Service-oriented mindset with a positive, proactive attitude.
Travel Requirements:
Occasional travel (
What is in it for You and Why you Should Apply:
Market-competitive pay based on education, experience, and location.
Highly competitive medical, dental, vision, Life w/ AD&D, Short-Term Disability insurance, Long-Term Disability insurance, pet insurance, identity theft protection, and a 401(k) retirement savings plan.
Employee wellness program.
Employee rewards, discounts, and recognition programs.
Generous company-paid holidays (12 per year), vacation, and sick time.
Paid paternity/maternity leave.
Monthly connectivity/home office stipend if working from home 5 days a week.
A supportive and positive space for you to grow and expand your career.
Pay Range Disclosure:
The advertised range represents the expected pay range for this position at the time of posting based on education, experience, skills, location, and other factors.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
RunBuggy is an equal-opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination, harassment, and retaliation on the basis of race, color, religion, sex (including gender identity and sexual orientation), pregnancy, parental status, national origin, age, disability, genetic information, or any other status protected under federal, state, or local law.
Salary Description $65k - $85k, DOE and location
Bodily Injury Claims Specialist
Claim specialist job in Mesa, AZ
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative in AZ, UT, or ID. The position requires the person to:
Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss.
Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage.
Follow claims handling procedures and participate in claim negotiations and settlements.
Deliver a high level of customer service to our agents, insureds, and others.
Devise alternative approaches to provide appropriate service, dependent upon the circumstances.
Meet with people involved with claims, sometimes outside of our office environment.
Handle investigations by telephone, email, mail, and on-site investigations.
Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute.
Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials.
Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule.
Assist in the evaluation and selection of outside counsel.
Maintain punctual attendance according to an assigned work schedule at a Company approved work location.
Desired Skills & Experience
A minimum of three years of insurance claims related experience.
The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision.
The ability to effectively understand, interpret and communicate policy language.
The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues.
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-DNI
Auto-ApplyClaims Processing Expert
Claim specialist job in Phoenix, AZ
Join Our Team as a Claims Processing Expert!
Are you a data-driven marketer who thrives on turning insights into impactful strategies? We are looking for a Claims Processing Expert to analyze key performance metrics, optimize marketing campaigns, and drive data-backed decision-making.
Why You'll Love This Role:
📊 Data-Driven Impact - Play a critical role in shaping marketing strategies through analytics.
🚀 Career Growth - Access professional development and leadership opportunities.
⏰ Work-Life Balance - Enjoy a flexible schedule with full-time opportunities.
💰 Competitive Compensation - Earn a stable income with performance-based incentives.
Your Responsibilities:
Analyze marketing campaign performance, customer behavior, and market trends.
Develop and track key performance indicators (KPIs) to measure marketing effectiveness.
Provide data-driven insights and recommendations to optimize marketing strategies.
Work with cross-functional teams to ensure data accuracy and consistency.
Utilize analytics tools (Google Analytics, Tableau, etc.) to generate reports and dashboards.
A/B test campaigns and refine strategies based on data insights.
What We're Looking For:
Proven experience in marketing analytics, data analysis, or a related field.
Proficiency in analytics tools such as Google Analytics, Tableau, or SQL.
Strong analytical and problem-solving skills.
Ability to translate complex data into actionable marketing strategies.
Experience with digital marketing metrics, reporting, and performance optimization.
Perks & Benefits:
Professional development and continuous learning opportunities.
Health insurance and retirement plans.
Performance-based bonuses and recognition programs.
Leadership growth and career advancement opportunities.
🚀 Ready to Turn Data into Growth?
If you're passionate about leveraging data to drive marketing success, apply today! Join us and help shape data-driven marketing strategies that make an impact.
Your journey as a Claims Processing Expert starts here-let's optimize for success together!
Auto-ApplyHomeowners Property Claims Specialist
Claim specialist job in Scottsdale, AZ
The Claims department within IAT has an immediate opening for a Homeowner's Claims Specialist that can be located in one of the following locations:
Raleigh, North Carolina
Scottsdale, Arizona
Alpharetta, Georgia
Spring, Texas
Virginia Beach, Virginia
Omaha, Nebraska
This role works a hybrid schedule from an IAT Office in Scottsdale, AZ, or Alpharetta, GA, or Raleigh, NC, or Spring, Texas or Virginia Beach, Virginia, or Omaha, NE. The hybrid schedule reflects our values (thinking and acting like an owner, collaboration, and teamwork) as it requires working from the office with colleagues and other disciplines Monday through Wednesday, with the option of working Thursday and Friday remotely.
Responsibilities:
Handles claims, moderate to severe in scope, relative to homeowner's property based on Claim Guidelines.
Perform CAT duty as needed that will require occasionally working weekend hours, overnight hours, holiday hours (Federal and religious), etc.
Follows standard practices and procedures in analyzing situations or data where answers can be readily obtained.
Verifies/analyzes applicable coverage for the reported loss.
Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file.
Investigates each claim by gathering information, conducting interviews, taking statements, conducting website research as needed, reviewing and analyzing reports and related bills.
Identifies and addresses subrogation/contribution/SIU opportunities.
Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines.
Evaluates, negotiates, and authorizes settlements with all stakeholders within designated authority.
Selects, directs and manages Vendors/Counsel including approval of defense budgets.
Negotiates directly with claimants and claimant attorneys upon receipt of critical information.
Drafts correspondence, including but not limited to, coverage letters to stakeholders as required.
Maintains resident/nonresident adjuster licenses as required.
Works on problems of limited scope.
Follows standard practices and procedures in analyzing situations or data from which answers can be readily obtained.
Perform other duties as needed
Qualifications: Must-Have:
HS degree/GED with 5+ years of relevant claims experience.
Must be able to understand fire loss.
Must be able to identify and investigate subrogation potential of a claims.
Must have the ability draft appropriate and professional correspondence.
Must have good estimating skills and be proficient with Xactimate.
Must have or be able to obtain licensure as required by respective state(s).
Excellent oral and written communication skills.
Ability to analyze date, utilize sound judgment to draw conclusion and make supported decisions.
Knowledge of various property insurance coverages and forms.
To qualify, applicants must be authorized to work in the United States and must not require VISA sponsorship, now or in the future, for employment purposes.
Preferred to Have:
Associate/Bachelors Degree
CPCU and other insurance related studies
Field adjusting experience
Proficiency Cotality platform
Our Culture IAT is the largest private, family-owned property and casualty insurer in the U.S. I
nsurance
A
nswers
T
ogether
is how we define IAT, in letter and in spirit. We work together to provide solutions for people and businesses. We collaborate internally and with our partners to provide the best possible insurance and surety options for our customers.
At IAT, we're committed to driving and building an open and supportive culture for all. Our employees propel IAT forward - driving innovation, stable partnerships and growth. That's why we continue to build an engaging workplace culture to attract and retain the best talent.
We offer comprehensive benefits like:
26 PTO Days (Entry Level) + 12 Company Holidays = 38 Paid Days Off
7% 401(k) Company Match and additional Profit Sharing
Hybrid work environment
Numerous training and development opportunities to assist you in furthering your career
Healthcare and Wellness Programs
Opportunity to earn performance-based bonuses
College Loan Assistance Support Plan
Educational Assistance Program
Mentorship Program
Dress for Your Day Policy
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We maintain a drug-free workplace and participate in E-Verify.
Complex Claims Specialist - Cyber, Technology, Media & Crime
Claim specialist job in Scottsdale, AZ
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 Claims Specialist!
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 Claims Specialists 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 Claims Specialist 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 Claims Specialist:
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 $140,000 - $155,000 (Boston, Manhattan, West Hartford)
Salary range $125,000-$135,000 (Chicago, Atlanta)
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-AJ1
Work with amazing people and be part of a unique culture
Auto-ApplyPharmacy Claims Adjudication Specialist
Claim specialist job in Scottsdale, AZ
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Scottsdale, AZ. This will be a Full-Time position. This is a remote hybrid opportunity, after onsite training period. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $23.00 an hour and up Sign-On Bonus: $5,000 for employees starting before January 1, 2026. We offer a variety of benefits including:
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Document and submit requests for Patient Refunds when appropriate.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law
Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
Insurance Claims Adjuster- Litigation
Claim specialist job in Phoenix, AZ
At American Express, our culture is built on a 175-year history of innovation, shared values and Leadership Behaviors, and an unwavering commitment to back our customers, communities, and colleagues. As part of Team Amex, you'll experience this powerful backing with comprehensive support for your holistic well-being and many opportunities to learn new skills, develop as a leader, and grow your career.
Here, your voice and ideas matter, your work makes an impact, and together, you will help us define the future of American Express.
How will you make an impact in this role?
AMEX Assurance Company provides insurance protection for American Express Card Members through implicit card benefits, and fee/add-on insurance products to both Card Members and non-Card Members. This role will reside in the Claim and Servicing Operations department of AAC, whose primary responsibilities include enrollment, servicing, and adjudication of insurance policies and claims; this role provides an exciting opportunity in handling Litigated Claims for all claims within the AMEX Assurance Company Insurance portfolio, Including but not limited to Travel and Medical claims within the highly complex suite of Specialty Lines products.
Duties include but not limited to:
* Investigation/research by using tools available and making outbound calls to settle claims
* Communication via written and/or direct phone interaction with the customer, to ensure timely decisions
* Communication and partnership with our legal teams and leadership
* Decision making of claims for these products
* Contract and policy interpretation
* Maintaining state compliance
To be considered for this position you must reside in Arizona. This is a hybrid position and will require the successful candidate to be in office a minimum of 3 days per week.
Minimum Qualifications:
* 2 years of Customer Service experience
* 2 years Insurance experience, preferably in claims
* Customer First Principles demonstrated through excellent verbal, written and interpersonal communication skills
* Passion for exceptional service
* Strong phone skills
* Ability to adapt to multiple demands, shifting priorities and rapid changes in workflow
* Ability to demonstrate initiative with minimal supervision to drive results
* Strong problem-solving skills, time management and organizational skills
* Superior level of accuracy and attention to detail.
* Strong proficiency in PC skills, including MS Word and Excel
Preferred Qualifications:
* Travel and Medical Claims experience
* Auto Insurance Experience
* Litigation claims handling experience
* Insurance or Travel Industry experience
A current Claims Adjuster License
If a license is not currently held, the applicant must be able to obtain the necessary license during the time frame allowed prior to training. Upon hiring, candidate will have 2 attempts to pass the Arizona Licensing exam. If the exam, to obtain your license, cannot be passed within 2 attempts, employment will be terminated.
Salary Range: $26.20 to $43.87 hourly + bonus + benefits
The above represents the expected hourly pay range for this job requisition. Ultimately, in determining your pay, we'll consider your location, experience, and other job-related factors.
We back you with benefits that support your holistic well-being so you can be and deliver your best. This means caring for you and your loved ones' physical, financial, and mental health, as well as providing the flexibility you need to thrive personally and professionally:
* Competitive base salaries
* Bonus incentives
* 6% Company Match on retirement savings plan
* Free financial coaching and financial well-being support
* Comprehensive medical, dental, vision, life insurance, and disability benefits
* Flexible working model with hybrid, onsite or virtual arrangements depending on role and business need
* 20+ weeks paid parental leave for all parents, regardless of gender, offered for pregnancy, adoption or surrogacy
* Free access to global on-site wellness centers staffed with nurses and doctors (depending on location)
* Free and confidential counseling support through our Healthy Minds program
* Career development and training opportunities
For a full list of Team Amex benefits, visit our Colleague Benefits Site.
American Express is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law. American Express will consider for employment all qualified applicants, including those with arrest or conviction records, in accordance with the requirements of applicable state and local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance for Employers, and the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance. For positions covered by federal and/or state banking regulations, American Express will comply with such regulations as it relates to the consideration of applicants with criminal convictions.
We back our colleagues with the support they need to thrive, professionally and personally. That's why we have Amex Flex, our enterprise working model that provides greater flexibility to colleagues while ensuring we preserve the important aspects of our unique in-person culture. Depending on role and business needs, colleagues will either work onsite, in a hybrid model (combination of in-office and virtual days) or fully virtually.
US Job Seekers - Click to view the "Know Your Rights" poster. If the link does not work, you may access the poster by copying and pasting the following URL in a new browser window: ***************************
Employment eligibility to work with American Express in the U.S. is required as the company will not pursue visa sponsorship for these positions.
US Retail Markets Claims Specialist Development Program-(January, June 2026)
Claim specialist job in Chandler, AZ
Description Advance your career at Liberty Mutual - A Fortune 100 Company! Manages, investigates and resolves claims assigned and assists in providing service to policyholders. Responsibilities:
Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.
Ensures adequacy of reserves.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or co-defendants. Arranges for expert inspections involving third party or potential fraud actions as needed.
Updates files and provides comprehensive reports as required
Qualifications Qualifications:
Strong written and oral communications skills required.
Good interpersonal, analytical, investigative, and negotiation skills required.
Customer service experience preferred.
Basic knowledge of legal liability, general insurance policy coverage and State Tort Law.
Bachelor's degree is required.
Ability to obtain proper licensing as required.
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Auto-ApplyClaims Representative CO & AZ
Claim specialist job in Phoenix, AZ
Job DescriptionJob Profile Job Title: Claims RepresentativeLocation: Remote anywhere in the US with CO & AZ experience Hire Type: Contingent Pay Range: $40 - $44/hr. Work Model: RemoteWork Shift: Monday-Friday 8 am - 4:30 pm Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305 Nature & Scope:Positional OverviewWe are seeking an experienced Workers' Compensation Claims Representative to handle and adjudicate low-level workers' compensation claims. The ideal candidate will have at least 2 years of direct WC claim-handling experience, with proficiency in Colorado jurisdiction and Arizona licensure or certification preferred. This position involves determining compensability, administering benefits, managing return-to-work efforts, and ensuring compliance with company standards and state regulations-all while delivering high-quality customer service to claimants and clients.Role & Responsibility:Tasks That Will Lead to Your Success
Process and manage low-level workers' compensation claims, determining compensability and benefits due.
Monitor reserve accuracy and file required documentation with state agencies.
Develop and coordinate claim action plans focused on resolution and return-to-work outcomes.
Approve and issue claim payments within established authority levels.
Handle subrogation of claims and negotiate settlements as appropriate.
Communicate effectively with claimants, clients, and internal partners regarding claim actions and updates.
Maintain accurate and compliant claim documentation and coding.
Process lifetime and/or defined-period medical claims, including state filings and utilization review decisions.
Foster and maintain positive client and claimant relationships.
Support the organization's quality programs and continuous improvement efforts.
Skills & ExperienceQualifications That Will Help You Thrive
High School Diploma or GED required; bachelor's degree preferred.
Colorado WC jurisdiction proficiency required; Arizona license/certification a plus.
Minimum 2 years of direct workers' compensation claim-handling experience, or equivalent combination of education and experience.
Prior experience managing indemnity and medical-only claims preferred.
Working knowledge of state-specific workers' compensation laws and procedures.
Strong analytical, interpretive, and problem-solving skills.
Excellent written and verbal communication skills.
Proficient in Microsoft Office Suite and claims management systems.
Strong organizational and interpersonal abilities.
Ability to work independently and collaboratively to meet performance standards.
Pharmacy Claims Representative 2
Claim specialist job in Mesa, AZ
Essential Functions
Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent's performance objectives as outlined by the incumbent's immediate supervisor or manager.
1. Assist pharmacies with real-time and retrospective claims adjudication. Adjust and correct authorizations in dispensing and PBM systems to ensure timely claims submission. Research and resolve rejected claims by contacting hospices for approvals or updated authorizations.
2. Maintain accuracy of patient profiles, involving authorization status and relatedness indicators.
3. Evaluate and process compound medication claims, ensuring accuracy in ingredients, quantities, and pricing.
4. Research pharmacy invoices and hospice billing issues, reconciling discrepancies as needed.
5. Collaborate with the Customer Service team on complex claims research and resolution.
6. Understand Enclara Pharmacia's standard and custom formularies and differentiate between Per Diem (PD) and Fee-for-Service (FFS) billing models across hospice partners.
7. Contact facilities and pharmacies to verify and collect necessary information for onboarding spreadsheets. Coordinate PBM and billing system verification with facility pharmacies. Maintain and update facility-pharmacy tracking spreadsheets and communicate status with implementation teams.
8. Educate facility pharmacies on billing procedures and contacts for rejected claims.
9. Collect and verify missing or incomplete facility information reported by the Call Center team. Ensure all facilities are correctly linked to their respective hospices in internal systems. Assist with Confirmation Fax reports to validate and update facility-pharmacy relationships and demographics.
10. Complete tasks and special projects assigned by Pharmacy Claims Team Leaders on Pharmacy Claims (Support Services) Manager.
11. Support Call Center leadership in initiatives to streamline processes and improve service outcomes.
Marginal or Additional Functions
1. Performs other duties as assigned or apparent.
Supervisory and Managerial Responsibility
• Supervisory/managerial responsibility is not applicable
Knowledge, Skills & Abilities
Education, Licensure or Certification:
• High school diploma or equivalent required
• CPhT or EXCPT certification required
Work Experience or Related Experience:
• Minimum of six (6) months of pharmacy technician experience.
• Experience with pharmacy claims adjudication is required.
Specialized Knowledge, Skills & Abilities:
• PBM or billing platform experience preferred
• Proficient in Microsoft Office Suite, especially Excel, Word, Outlook, and Access
• Comfortable navigating multiple software systems, including pharmacy dispensing and PBM platforms
• Excellent verbal and written communication skills
• Ability to learn proprietary systems used for claims management and facility tracking.
Equipment
• Working knowledge of a PC, business and communications software (MS Office) and web-based tools are required
Travel Requirements and Conditions
• Travel is not required
Work Environment, Conditions and Demands
• Work is generally performed in a climate-controlled, smoke-free office environment.
Physical Requirements and Demands
• May sit, stand, walk, stoop, or bend intermittently throughout the day.
• May be required to sit for extended periods (7-10 hours/day).
• Occasional lifting of up to 25 pounds may be required.
• Requires manual dexterity to operate office equipment.
• Visual acuity to read fine print and digital screens; must be able to hear and respond to verbal communication.
Additional Position Information
• No additional information is applicable
Trucking Claims Specialist
Claim specialist job in Scottsdale, AZ
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
Competitive compensation
Healthcare benefits package that begins on first day of employment
401K retirement plan with company match
Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
Up to 6 weeks of parental and bonding leave
Hybrid work schedule (3 days in the office, 2 days from home)
Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
Tuition reimbursement after 6 months of employment
Numerous opportunities for continued training and career advancement
And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Qualifications
Minimum of 3 years of trucking industry experience.
Experience with bodily injury and/or cargo exposures.
Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
Strong analytical and negotiation skills, with the ability to manage multiple priorities.
Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
Possession of applicable state adjuster licenses.
Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplyClaims Processing Specialist
Claim specialist job in Scottsdale, AZ
Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America.
We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands.
Job Summary:
Pets Best is seeking a Claims Processing Specialist who will report to the Manager, Claims. Claims Processing Specialists are responsible for reviewing invoices and pet medical documents and determining coverage in compliance with the current Underwriter's policy.
Job Location: Remote - USA
Main Responsibilities:
Review individual policies to make an eligibility determination with high degree of accuracy
Contact with internal departments as well as veterinarians and clinic staff
Ensure compliance guidelines are met with both internal policies and procedures and contractual commitments
Work independently and with others on a virtual team
Drive a “Great Place to Work” culture, attend and participate in team meetings as well as engagement events
Use PC based programs to enter data into claims system, communicate with leaders and teammates, and organize information
Create and issue claim decisions to pet parents using proper spelling, grammar, and punctuation in line with the policy terms
Calculate invoice totals, discounts, and tax rates
Perform other duties and/or special projects as assigned
Basic Qualifications:
High school diploma or equivalent
3+ years recent clinical veterinary experience (dog and cat) as a veterinary assistant, veterinary technician or veterinarian
Knowledge of veterinary terms, abbreviations and conditions.
Knowledge of medical conditions and associated symptoms, procedures, treatments, secondary conditions and pharmaceuticals used in veterinary medicine
Knowledge of canine and feline breeds, anatomy and associated predispositions to illness.
Ability to read and interpret medical diagnoses via medical records review both written and digital.
Ability to work cross functionally with our internal and external resources
Ability to handle multiple projects concurrently
Ability to navigate Windows OS, Google Chrome, and corresponding applications
Demonstrable Microsoft Office proficiency: Word, PowerPoint, Excel, Outlook, Teams
Strong writing skills: organization, spelling, grammar and punctuation
Strong mathematical and problem-solving skills
#LI-Remote
#LI-PetsBest
All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following:
Comprehensive full medical, dental and vision Insurance
Basic Life Insurance at no cost to the employee
Company paid short-term and long-term disability
12 weeks of 100% paid Parental Leave
Health Savings Account (HSA)
Flexible Spending Accounts (FSA)
Retirement savings plan
Personal Paid Time Off
Paid holidays and company-wide Wellness Day off
Paid time off to volunteer at nonprofit organizations
Pet friendly office environment
Commuter Benefits
Group Pet Insurance
On the job training and skills development
Employee Assistance Program (EAP)
Auto-ApplyMedical Claims Analyst/Negotiator
Claim specialist job in Scottsdale, AZ
Rapidly growing healthcare technology company is looking for outgoing, energetic, and motivated individuals to join our team of Claim Analysts. If you possess these qualities and want to be part of a passionate team on a mission to drive change in healthcare, then Green Light could be a great fit for you. Ideal candidates will share our core values, be a team player, possess a strong work ethic, be a problem solver, have professional integrity and a sense of humor!
JOB SUMMARY:
The Claims Analyst position is responsible for collaborating with out-of-network healthcare providers (telephonically, in most cases) to finalize allowed amounts on out-of-network claims. Our health plan clients have implemented various controls to establish out-of-network allowances and to ensure that non-contracted providers are paid fairly according to market data, for services provided to their health plan members. The Claims Analyst role facilitates any exceptions for higher out-of-network allowances on behalf of the health plan, in cases where patient balance billing can be eliminated, while also ensuring that out-of-network allowances adhere to the overall provisions of the health plan.
RESPONSIBILITIES:
Foster and maintain relationships with the Provider community to facilitate current and future claim settlements with professionalism.
Verbally and accurately communicate the various out-of-network pricing methodologies used by our health plan clients for establishing allowances on out-of-network claims.
Generate settlement agreements based on written and verbal communication with the Provider, throughout the settlement process.
Work with internal stakeholders, such as Client Services, to coordinate the necessary flow of information required to successfully obtain settlement of out-of-network healthcare claims.
Meet and maintain individual and departmental performance metrics.
Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and settling claims.
Initiate provider telephone calls with respect to settlement proposals, mediate objections and apply effective telephone communication skills to reach successful resolution on out-of-network claims.
Address any counter offers and present proposals for resolution while adhering to client guidelines and department goals.
Collaborate, coordinate, and communicate across the organization, as is necessary to obtain successful settlement of claims.
Ensure compliance with HIPAA protocol.
QUALIFICATIONS:
3-5 years customer service experience
High school diploma or equivalent
Excellent verbal and written skills
Ability to multi-task and thrive in fast paced work environment
Willingness to perform high volume of outbound calls to healthcare providers
General knowledge of healthcare claims processing and medical terminology
Healthcare billing and/or coding background is a PLUS
Complex Liability Adjuster - CGL & BOP Specialist
Claim specialist job in Scottsdale, AZ
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
* Competitive compensation
* Healthcare benefits package that begins on first day of employment
* 401K retirement plan with company match
* Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
* Up to 6 weeks of parental and bonding leave
* Hybrid work schedule (3 days in the office, 2 days from home)
* Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
* Tuition reimbursement after 6 months of employment
* Numerous opportunities for continued training and career advancement
* And much more!
Responsibilities
Are you an experienced professional with a sharp eye for detail and a strong background in litigation? Join our team as a Complex Liability Adjuster, where you'll play a crucial role in managing Commercial General Liability (CGL) and Business Owners Policy (BOP) claims with precision and expertise. We're looking for someone who thrives in high-stakes environments, communicates with confidence, and knows how to navigate the legal landscape with precision.
Key Responsibilities:
* Conduct thorough investigations of losses, identifying coverage issues and ensuring accurate assessments.
* Review and analyze evidence, reports, and medical records to establish damages and reserves.
* Interview insureds, claimants, and witnesses to gather essential information and build strong cases.
* Collaborate with legal teams to navigate complex litigation processes and defend our insureds effectively.
* Manage litigated claims involving CGL and BOP policies, including coordination with defense counsel, litigation strategy development, and resolution planning.
* Process payments efficiently, ensuring timely resolution of claims.
Qualifications
* Prior experience adjusting Commercial General Liability claims with a proven track record in litigation is required.
* Juris Doctorate (JD) preferred, reflecting the value we place on strong legal acumen in managing complex liability claims.
* Licensing: Active TX All Lines License, or willingness to obtain one at company's expense.
* Exceptional written and verbal communication skills.
* Strong organizational and computer skills.
* Excellent time management skills with the ability to prioritize tasks effectively.
Auto-ApplyExecutive Claims Examiner- Executive Liability
Claim specialist job in Scottsdale, AZ
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
This position will be an acknowledged technical expert and be responsible for the resolution of high complexity and high exposure Public Company D&O and Financial Institutions D&O and E&O claims. The position will have significant responsibility for decision making and work autonomously within their authority.
Job Duties:
* Confirms coverage of claims by reviewing policies and documents submitted in support of claims
* Analyzes coverage and communicates coverage positions
* Conducts, coordinates, and directs investigation into loss facts and extent of damages
* Directs and monitors assignments to experts and outside counsel
* Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
* Sets timely reserves within authority or makes claim recommendations concerning reserve changes to supervisor
* Negotiates and settles claims either directly or indirectly
* Prepares reports by collecting and summarizing information
* Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives
* Assists in training and mentoring of examiners
* Serves as technical resource to subordinates and others in the organization.
* Reviews and approves correspondence,s reports and authority requests as directed by supervisor
* Participates in special projects or assists other team members as requested
* Travel to meditations, trials, and conferences as required
Education
* Bachelor's degree or equivalent work experience
* JD , advanced degree, or focused technical degree a plus
Certification
* Must have or be eligible to receive claims adjuster license.
* Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU, RPLU) or
* I-Lead or other Management Training
Work Experience
* Public Company D&O, Financial Institutions D&O and E&O, Financial Advisors, and/or Management Liability Claims handling experience preferred.
* Minimum of 10 years of claims handling experience or equivalent combination of education and experience
Skill Sets
* Excellent written and oral communication skills
* Strong analytical and problem solving skills
* Strong organization and time management skills
* Ability to deliver outstanding customer service
* Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
* Ability to work in a team environment
* Strong desire for continuous improvement
US Work Authorization
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.
Pay information:
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The national average salary for the Executive Claims Specialist - Executive Liability is $97,520 - $134,090 with 25% bonus potential.
Who we are:
Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.
We're all about people | We win together | We strive for better
We enjoy the everyday | We think further
What's in it for you:
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
* We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
* All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
* We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
Are you ready to play your part?
Choose 'Apply Now' to fill out our short application, so that we can find out more about you.
Caution: Employment scams
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
* All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.
* All legitimate communications with Markel recruiters will come from Markel.com email addresses.
We would also ask that you please report any job employment scams related to Markel to ***********************.
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.
Should you require any accommodation through the application process, please send an e-mail to the ***********************.
No agencies please.
Auto-Apply