Claim specialist jobs in Rhode Island - 24 jobs

Your Next Career Move Starts Here - Join Us! Content Claims Specialist - Field - Level I (Hybrid: Work from Home + Driving Role) What We're Looking For: Adjuster experience preferred, not required Open to candidates with restoration, roofing, customer service, or retail experience ️ Strong communication and problem-solving skills Ability to work independently and travel for inspections

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.

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Responsibilities: * Provides voice to voice contact within 24 hours of first report. * Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel. * Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements. * Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. * Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals. * Utilizes evaluation documentation tools in accordance with department guidelines. * Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. * Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution. * Maintains and document claim file activities in accordance with established procedures. * Attends depositions and mediations and all other legal proceedings, as needed. * Protects organization's value by keeping information confidential. * Maintains compliance with Claim Department's Best Practices. * Provides quality customer service and ensures file quality * Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs. * Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner. * Participates in special projects as assigned. * Some overnight travel maybe required. * Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. Qualifications: * Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. * Adjuster Licensure required. * One to three years of experience processing claims; property and casualty segment preferred. * Experience with Xactware products preferred. * Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. * Proficiency with Microsoft Office products required; internet research tools preferred. * Demonstrated customer service focus / superior customer service skills. * Excellent communication skills and ability to interact on a professional level with internal and external personnel * Results driven with strong problem solving and analytical skills. * Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. * Detail-oriented and exceptionally organized * Collaborative partner; ability to contribute to a positive work environment. General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

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.

Rhode Island Claims 10 Amica Center Blvd, Lincoln, RI 02865 Thank you for considering Amica as part of your career journey, where your future is our business. At Amica, we pride ourselves on being an inclusive and supportive environment. We all work together to accomplish the common goal of providing the best experience for our customers. We believe in trust and fostering lasting relationships for our customers and employees! We're focused on creating a workplace that works for all. We'll continue to provide training, guidance, and resources to make Amica a true place of belonging for all employees. Want to learn more about our commitment to diversity, equity, and inclusion? Visit our DEI page to read about it! As a mutual company, our people are our priority. We seek differences of opinion, life experience and perspective to represent the diversity of our policyholders and achieve the best possible outcomes. Our office located in Lincoln, RI is seeking an Associate PIP Claims Representative to join the team! Job Overview: The job duties include but are not limited to handling personal lines Personal Injury Protection and Medical Payments insurance claims. Substantial customer contact via the telephone and correspondence is required. Responsibilities include working in an electronic claim file environment, taking claim telephone reports, investigating, negotiating and settling claims and general office functions. Candidates will be required to obtain a state insurance license and meet continuing education requirements. Responsibilities: * Handling personal lines Personal Injury Protection and Medical Payments Insurance Claims * Substantial customer contact via the telephone and correspondence is required * Working in an electronic claim file environment, taking claim telephone reports, investigating, negotiating, and settling claims and general office functions * Candidates will be required to obtain a state insurance license and meet continuing education requirements Total Rewards: * Medical, dental, vision coverage, short- and long-term disability, and life insurance * Paid Vacation - you will receive at least 13 vacation days in the first 12 months, amounts could be greater depending on the role. While able to use prior to accrual, vacation time will accrue monthly. * Holidays - 14 paid holidays observed * Sick time - 6 days sick time at hire, 6 additional days sick time at 90 days of employment * Generous 401k with company match and immediate vesting. Additionally, annual 3% non-elective employer contribution * Annual Success Sharing Plan - Paid to eligible employees if company meets or exceeds combined ratio, growth and/or service goals * Generous leave programs, including paid parental bonding leave * Student Loan Repayment and Tuition Reimbursement programs * Generous fitness and wellness reimbursement * Employee community involvement * Strong relationships, lifelong friendships * Opportunities for advancement in a successful and growing company Qualifications * High School Diploma or equivalent education required * Maintain state insurance license * Excellent written and verbal communication skills * Knowledge of Microsoft Excel, Word, and Outlook * Previous insurance, claims, and customer service experience preferred Amica conducts background checks which includes a review of criminal, educational, employment and social media histories, and if the role involves use of a company vehicle, a motor vehicle or driving history report. The background check will not be initiated until after a conditional offer of employment is made and the candidate accepts the offer. Qualified applicants with arrest or conviction records will be considered for employment. The safety and security of our employees and our customers is a top priority. Employees may have access to employees' and customers' personal and financial information in order to perform their job duties. Candidates with a criminal history that imposes a direct or indirect threat to our employees' or customers' physical, mental or financial well-being may result in the withdrawal of the conditional offer of employment. About Amica Amica Mutual Insurance Company is America's oldest mutual insurer of automobiles. A direct national writer, Amica also offers home, marine and umbrella insurance. Amica Life Insurance Company, a wholly owned subsidiary, provides life insurance and retirement solutions. Amica was founded on the principles of creating peace of mind and building enduring relationships for and with our exceptionally loyal policyholders, a mission that thousands of employees in offices nationwide share and support Equal Opportunity Policy: All qualified applicants who are authorized to work in the United States will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, family status, ethnicity, age, national origin, ancestry, physical and/or mental disability, mental condition, military status, genetic information or any other class protected by law. The Age Discrimination in Employment Act prohibits discrimination on the basis of age with respect to individuals who are 40 years of age or older. Employees are subject to the provisions of the Workers' Compensation Act. Amica Mutual Insurance Company is committed to protecting job seekers from recruitment fraud. We never request sensitive personal information or payment during the interview process. All legitimate job opportunities are listed on our official careers site: ************************** Learn more in the "Is Amica hiring?" section of our FAQ. rp

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.

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

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 Specialty Loss Adjuster **Embark on an Exciting Career Journey with Sedgwick Specialty** **Job Location** **: USA, Mexico, Brazil and strategic locations globally** **Job Type** **: Permanent** **Remuneration** **: Salaries can range from** **_$40,000.00USD to $250,000.00USD_** **taking into account skills, experience and qualifications.** **We have a number of fantastic opportunities for Specialty Loss Adjusters across the US, Mexico and Brazil and a number of key locations** We are looking for a variety of skill sets at all levels. Whether you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your skills and grow with a company that values innovation, excellence, and employee satisfaction. Are you ready to be a part of providing a differentiated and best of class proposition to clients whilst working with like-minded colleagues? Sedgwick Specialty is thrilled to announce that we are investing in growth across Natural Resources, Property, Casualty, Technical and Special Risks and Marine. As we expand our operations, we are seeking individuals who are passionate about making a difference to the Adjusting industry. **As a member of the Specialty platform, you will have the opportunity to:** + Work with a wide range of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team of professionals who are dedicated to delivering exceptional results + Utilise state-of-the-art technology and resources to streamline processes and enhance efficiency + Receive ongoing training and development opportunities to further enhance your skills and knowledge in the marine industry + Enjoy a flexible work arrangement that allows you to maintain a healthy work-life balance while contributing to our global success **The skills you will have when you apply:** + **Qualified** : it is important to us that you are either accredited, on your way to be accredited or qualified by experience + **Insurance claims experience:** it is imperative that you have experience working on insurance claims within you respective field. Full claims life cycle experience is a must + **Great communicator:** you will be constantly working with policy holders, brokers, carriers and various third parties, so being able to communicate accurately important. Providing an excellent customer service with our clients in mind. Able to approach issues empathetically + **Commercially minded:** An understanding of how the industry operates and where the role of a Loss Adjuster fits in. Being able to negotiate. Understanding how to market your services is a big advantage **What we'll give you for this role:** 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 annual salaries can range from _$40,000.00 to $250,000.00USD._ Bonus eligible role. 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. Always Accepting Applications. **This isn't just a position, it's a pivotal role in shaping our industry** At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education. Together, we're not only reshaping the insurance landscape, we're building a legacy of talent. Come and be a catalyst for change within our industry. **Next steps for you:** **Think we'd be a great match? Apply now -** ** we want to hear from you.** As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation. After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person). \#LI-HYBRID 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**

Job Title: Public Adjuster Job Summary: We are seeking a skilled and experienced Public Adjuster to advocate for policyholders in the negotiation and settlement of property insurance claims. The ideal candidate will possess a strong understanding of insurance policies, claim procedures, and damage assessments. They will work closely with clients, insurance companies, and contractors to ensure fair and equitable claim resolutions. Key Responsibilities: Review and analyze insurance policies to determine coverage and benefits for clients. Inspect and document property damage to assess the extent of loss. Prepare and submit detailed claims, including estimates, reports, and supporting documentation. Negotiate settlements with insurance companies on behalf of clients. Communicate regularly with policyholders, adjusters, and contractors to facilitate the claims process. Advocate for the best possible settlement for clients within the scope of their policy coverage. Stay up to date with industry regulations, insurance laws, and best practices. Maintain accurate records and documentation throughout the claims process. Qualifications: Valid Public Adjuster license in the applicable state(s) or the ability to obtain one. Proven experience in public adjusting, insurance claims, or a related field. Strong knowledge of insurance policies, construction, and damage assessment. Excellent negotiation and communication skills. Ability to manage multiple claims and deadlines effectively. Proficiency in claim management software and Microsoft Office Suite. High ethical standards and commitment to client advocacy. Preferred Qualifications: Experience working with property damage claims, including fire, water, wind, and hail damage. Background in construction, restoration, or insurance claims handling. Bilingual skills (Spanish preferred but not required). Compensation: Competitive salary and/or commission-based earnings. Performance-based bonuses and incentives. Opportunities for professional growth and continuing education. If you are a detail-oriented professional with a passion for helping policyholders navigate the complexities of insurance claims, we encourage you to apply for this rewarding opportunity as a Public Adjuster.

HealthDrive is seeking a full-time Medical and Dental Claims Denial Resolution Specialist to join our team! The Medical and Dental Claims Denial Resolution Specialist is responsible for daily review and resolution of insurance claim denials and/or unpaid/incorrectly paid claims with the primary goal to increase cash collections and minimize bad debt write-offs. This individual must have extensive experience working with claim denial resolution for all insurance plan types; Medicare Part B, Medicare Advantage, Medicaid, Medicaid MCO, Private Insurance and BCBS, including but not limited to: Aetna Medicare, AARP Medicare, AmeriHealth Caritas, BCSBS Federal, BCBS MA, BSBS Medex, BCBS RI, Cigna Medicare, Commonwealth Care Alliance, Delta Dental of MA, Dentaquest, Element Care, Envolve Vision, EPIC Hearing, EyeMed, Fallon, Harvard Pilgrim, Health New England, Humana Medicare, Medicaid MA,, Medicare MA Part B, MetLife Dental, NHP of RI, NHP East Boston Neighborhood PACE, Senior Whole Health, Spectera, Tricare for Life, Tufts, Well Sense MA and NH, United HealthCare (UHC), VSP (Vision Service Plan) and VA Community Network. The hourly pay range for this position is $22.00 - $27.00 per hour. We are conveniently located off Route 9 in Framingham, MA, close to routes 90 and 495 in a spacious modern office with a workout center available right in the building! What's in it for you: PPO Medical, Dental, and Vision Insurance, 401(k) + Company match, Paid Time Off, hybrid schedule opportunity, Verizon Wireless, Dell, and other employee discounts, profit sharing, and employee referral bonuses. HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence. Responsibilities • Identify, investigate, and follow-up with insurance plans daily to expedite resolution of denied, incorrectly paid, or unpaid claims. • Submit corrected claims and appeals online to obtain payment within the insurance plan timely filing and appeal limits. • Obtain and verify new/corrected insurance information using clearinghouse or insurance websites prior to rebilling claims to new/updated insurances. • Document and communicate ongoing denial or incorrect payment issues for a specific insurance plan which require assistance from manager and/or director to help resolve. • Become the expert on the billing and claim requirements for assigned insurance plans. • Utilize insurance plan website(s) to check eligibility, claim status, submit online appeals, or provide Explanation of Benefits (EOB's) / Explanation of Payments (EOP's) required for processing secondary/tertiary claims. • Review and resolve overpayments, submit requests for insurance to retract their payment, and as needed request refund through automated process in billing system. • Identify and communicate payment posting issues to cash application team. • Meet or exceed daily productivity objectives for all assigned duties. • Respond to email inquiries or teams chat messages regarding questions/issues with your assigned AR plans within 24 hours. • Work professionally and cooperatively with facilities, responsible parties, insurance carriers, and all internal and external customers. • Assist with development of training materials/cheat sheets for assigned insurance plans and actively participate in training of other employees on as needed basis. • Other duties and tasks assigned or necessary to meet business needs/objectives. Qualifications • Prefer minimum of 5 years; experience in professional physician multispecialty group specifically managing medical and dental claims denial resolution. • Extensive knowledge of third-party billing practices and regulations for insurances in New England (Medicare Part B, Medicare Advantage, Medicare Supplemental, BCBS, Private Insurance, Medicaid, and Medicaid Managed Care plans. • Knowledgeable of the claim adjustment (CARC) and the remark reason codes (RARC) from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of Benefits (EOB's)/Explanation of Payments (EOP's), CPT, and ICD10 codes. • Highly organized, with excellent attention to detail and exceptional/persistent follow-up, problem-solving and analytical skills. • Must have strong ability to self-direct and work independently in a high-volume, deadline-driven role. • Demonstrates proficiency in computer skills including Microsoft Office Applications (Excel, Outlook, Word and Teams), medical billing software, insurance plan websites, and provider manuals. • Excellent interpersonal and communication skills with professional demeanor and positive attitude who readily adapts to change and effectively and appropriately communicates both verbally and in writing. • Collaborator with ability to establish priorities, effectively multitask to meet objectives and deadlines. • Strong time management and organizational skills; demonstrated ability to independently prioritize. • Knowledge of HIPAA regulations and patient privacy rules.

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

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

in Providence, RI location. This entry-level position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, and claims resolution and negotiation strategies of lower complexity claims in compliance with established company technical and customer service best practices. Under moderate supervision, works within specific limits and authority to resolve claims with well-defined procedures. Job Duties Communicate and interact with a variety of individuals including insureds and claimants. Verify and explain benefits, coverages, fault, and claims process either verbally or in writing which complies with regulatory and statutory requirements. Conduct investigations to determine liability and damages and differentiate between allegations and facts. Identify and obtain statements from insureds, claimants, and witnesses. Evaluate and negotiate within settlement authority with insureds and claimants to resolve first and third-party claims in multiple markets. Demonstrate proficiency with estimate review, material damage, liability, analysis of claims, claims technology, and tool usage. Coordinate with internal and external departments as required. Respond quickly to customer needs and inquiries. Overtime and holiday hours may be required. Qualifications Bachelors Equivalent combination of education and experience Preferred No prior claims experience required. Knowledge of Microsoft Office suite and general computer software. Organization and planning recognition skills required. Oral and written communication skills required. Interpersonal skills required. May be required to obtain an Adjuster license as applicable in accordance with state law. within 60 Days Travel Requirements Occasional travel to off-site business meetings or conferences. (5% proficiency) The starting pay range for this position is $50,600 - $67,400 per year. Additionally, you will be eligible to participate in our incentive program based upon your team and individual performance. Remarkable benefits: • Health coverage for medical, dental, vision • 401(K) saving plan with company match AND Pension • Tuition assistance • PTO for community volunteer programs • Wellness program • Employee discounts (membership, insurance, travel, entertainment, services and more!) Auto Club Enterprises is the largest federation of AAA clubs in the nation. We have 14,000 employees in 21 states helping 17 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity - we win. All of Us! With our national brand recognition, long-standing reputation since 1902, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team. "Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.” AAA is an Equal Opportunity Employer

Global Operations (Global Ops) focuses on creating positive experiences for MetLife customers and helping the company make the best use of its global resources. We're looking for unique talent with fresh perspectives that can propel innovation. In this role you will provide exemplary customer service by facilitating Multi-State Paid Family Leave (PFL) benefits, Family Medical leave Act (FMLA) and Americans with Disabilities Act (ADA) claim adjudication in a timely and accurate manner. Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR, West Des Moines, IA office Once a month in office for meetings How You'll Help Us Build a Confident Future (Key Responsibilities) * Coaches, coordinates, and develops Multi-State PFL, FML and ADA Claims Specialists. * Acts as resources for claim-related and technical issues. * Monitors case managers' work queues to ensure claims team is meeting expectations and applicable performance guarantees. * Conducts exceeds authority reviews daily, weekly quality audits; resolves escalated phone calls. * Analyzes trending opportunities to provide ongoing trainings. * Provides real time coaching to Claims Specialists. * Provides feedback to Unit Leaders on individuals' and overall team performance. * Daily and weekly reporting to ensure compliance measures are met. * Performs other related duties as assigned or required. What You Need to Succeed (Required Qualifications) * Positive mindset and willingness to learn. * 1+ years of Disability Insurance experience. * Must be able to communicate clearly and effectively, both written and verbal. * Ability to work with autonomy, minimal direction. * Strong computer skills (word, excel, manipulating reports, spreadsheets, etc…). * High School Diploma. What Can Give You an Edge (Additional Skills) * 1+ years of Paid Family Leave experience. * 5+ years of Disability Insurance experience. * Excellent analytical, decision making and problem-solving skills. * Highly self-motivated. The expected salary range for this position is $41,600 - $61,500. This role may also be eligible for annual short-term incentive compensation. All incentives and benefits are subject to the applicable plan terms. Benefits We Offer Our U.S. benefits address holistic well-being with programs for physical and mental health, financial wellness, and support for families. We offer a comprehensive health plan that includes medical/prescription drug and vision, dental insurance, and no-cost short- and long-term disability. We also provide company-paid life insurance and legal services, a retirement pension funded entirely by MetLife and 401(k) with employer matching, group discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance, as well as Employee Assistance Program (EAP) and digital mental health programs, parental leave, volunteer time off, tuition assistance and much more! About MetLife Recognized on Fortune magazine's list of the "World's Most Admired Companies", Fortune World's 25 Best Workplaces, as well as the Fortune 100 Best Companies to Work For, MetLife, through its subsidiaries and affiliates, is one of the world's leading financial services companies; providing insurance, annuities, employee benefits and asset management to individual and institutional customers. With operations in more than 40 markets, we hold leading positions in the United States, Latin America, Asia, Europe, and the Middle East. Our purpose is simple - to help our colleagues, customers, communities, and the world at large create a more confident future. United by purpose and guided by our core values - Win Together, Do the Right Thing, Deliver Impact Over Activity, and Think Ahead - we're inspired to transform the next century in financial services. At MetLife, it's #AllTogetherPossible. Join us! MetLife is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law ("protected characteristics"). If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug-free workplace. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities. $41,600 - $61,500

Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals. Education: High school graduate or GED required. Associate#s level degree preferred. Experience: Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment. Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals. Education: High school graduate or GED required. Associate's level degree preferred. Experience: Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment.

Job DescriptionBenefits: Competitive salary Paid time off Training & development Benefits/Perks: Competitive Pay Professional Development Job Stability in a growing industry What Youll Do: Engage in telemarketing and phone sales to generate leads and close deals. If you're a people person and like to chat, you may be a good fit! Grow your customer base by building lasting relationships. Develop referral partners in our local community through networking. Proactively contact potential customers to discuss their insurance needs. Provide tailored solutions for auto, home, and other personal lines insurance products. Follow up on leads, referrals, and quotes to maximize sales opportunities. Build rapport with clients and maintain long-term relationships. Collaborate with our team to meet and exceed sales goals. What Were Looking For: Proven experience in telemarketing or phone sales (insurance sales experience preferred). A high-energy, goal-oriented attitude with a desire to win. Excellent communication skillsboth verbal and written. Strong organizational skills and the ability to multitask. Property & Casualty insurance license (or willingness to obtain). A commitment to providing exceptional customer service. What We Offer: Competitive base salary plus uncapped commission potential. Comprehensive training and ongoing support. Opportunities for growth and advancement within the agency. A positive, team-oriented work environment. The satisfaction of helping clients protect what matters most. If youre a sales rockstar ready to take your career to the next level, we want to hear from you! Apply now to join our team of professionals dedicated to success. Qualifications: Hold the insurance license required by your state by start date. Prior Licensed Applicants will have preference but will train the right person. Possess a valid drivers license and a source of reliable transportation. Demonstrate ability to learn the knowledge of insurance products and usages, rating procedures, underwriting procedures, coverages, and industry operations needed to effectively secure new business and maintain existing client base. Possess strong presentation, persuasion, and negotiation skills with the ability to close sales. Be people-oriented, customer-focused, and professionally assertive in developing new client relationships and servicing existing clients. Possess outstanding organizational skills with an ability to complete difficult assignments without supervision, sound business judgment, strong decision-making and superior written and verbal communication skills. Have excellent time management skills, thrive in a team environment and Technology and Computer proficiency including agency management systems.

SUMMARY: Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct. Review claim forms for all required data fields depending on the specific 3rd party requirements. Review patient account for demographic accuracy. Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data. Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer's contracts or Federal reimbursement methods. Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment. Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language. Continually maintains knowledge of payer specific updates via payer's listservs, provider updates, webinars, meetings and websites. Review payer's settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer's policies and each individual related contract. Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors. Understands and maintains compliance with HIPAA guidelines when handling patient information Initiate adjustments to payer's as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials. Submits appeals to payers as appropriate to recover denied revenue Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials. Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown. Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies. Answer telephone inquiries from 3rd parties and interdepartmental calls. Refer all unusual requests to supervisor. Retrieve appropriate medical records documentation based on third party requests. Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations. Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations. Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures. Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates. Perform other related duties as required. WORK LOCATIONS/EXPECTIONS: After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.. Full time schedule worked in office Full time schedule worked in a dedicated space in the home Part time schedule in office and in a dedicated space within the home Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Equivalent to a high school graduate Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form Demonstrated skills in critical thinking, diplomacy and relationship-building Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies. EXPERIENCE: One to three years of relevant experience in medical collections or professional/hospital billing preferred INDEPENDENT ACTION: Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action. SUPERVISORY RESPONSIBILITY: None Pay Range: $19.58-$32.31 EEO Statement: Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor. Location: Corporate Headquarters - 167 Point Street Providence, Rhode Island 02903 Work Type: Monday-Friday 7am-330pm Work Shift: Day Daily Hours: 8 hours Driving Required: No

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**

Location: Must live within a commutable distance of the Oriskany, NY, Tampa, FL, Bloomfield, CT Cary, NC, Aurora, IL, Bridgewater, NJ, Omaha, NE, Warwick, RI, Clark Summit, PA, San Juan, PR, West Des Moines, IA office Once a month in office for meetings How You'll Help Us Build a Confident Future (Key Responsibilities) * Coaches, coordinates, and develops Multi-State PFL, FML and ADA Claims Specialists. * Acts as resources for claim-related and technical issues. * Monitors case managers' work queues to ensure claims team is meeting expectations and applicable performance guarantees. * Conducts exceeds authority reviews daily, weekly quality audits; resolves escalated phone calls. * Analyzes trending opportunities to provide ongoing trainings. * Provides real time coaching to Claims Specialists. * Provides feedback to Unit Leaders on individuals' and overall team performance. * Daily and weekly reporting to ensure compliance measures are met. * Performs other related duties as assigned or required. What You Need to Succeed (Required Qualifications) * Positive mindset and willingness to learn. * 1+ years of Disability Insurance experience. * Must be able to communicate clearly and effectively, both written and verbal. * Ability to work with autonomy, minimal direction. * Strong computer skills (word, excel, manipulating reports, spreadsheets, etc...). * High School Diploma. What Can Give You an Edge (Additional Skills) * 1+ years of Paid Family Leave experience. * 5+ years of Disability Insurance experience. * Excellent analytical, decision making and problem-solving skills. * Highly self-motivated. Equal Employment Opportunity/Disability/Veterans If you need an accommodation due to a disability, please email us at accommodations@metlife.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process. MetLife maintains a drug-free workplace.