Responsibilities:
Conduct in-depth investigations into complex bodily injury claims, determining coverage, establishing liability, and evaluating damages by analyzing medical records, police reports, and witness statements.
Develop and execute effective negotiation strategies to achieve fair and timely settlements with claimants, attorneys, and other parties.
Manage litigated files, including developing defense strategies, communicating with legal counsel, and attending mediations, arbitrations, and trials as necessary.
Maintain meticulous and accurate claim file documentation in compliance with company standards and regulatory requirements.
Provide exceptional customer service, guiding insureds and claimants through complex claim processes with professionalism and empathy.
Candidate & SkillsTop 3-5 Skills:
5 + years of direct experience handling casualty claims, with a strong focus on bodily injury (BI) claims across various lines (Auto, Homeowners, Commercial).
Proven ability to investigate, analyze, and evaluate complex BI claims, including understanding medical terminology and injury causation.
Solid understanding of insurance policies, relevant state laws, and the litigation process.
Strong negotiation and conflict resolution skills, with a track record of successful settlements.
Takes ownership of files, even when litigation is involved.
Soft Skills:
Exceptional communication (verbal and written), interpersonal, and customer service skills.
Ability to work independently, manage a challenging caseload, and make sound judgments.
Strong analytical, problem-solving, and decision-making abilities.
Meticulous attention to detail and excellent organizational skills.
An eagerness to learn, adapt, and embrace new technologies
Ability to work effectively both independently and as part of a supportive team.
Certifications/Licenses/Education:
Active Adjuster License in CT, MA, RI - willing to get additional licenses as needed (company to assist)
A bachelor's degree is preferred, or equivalent work experience.
Pay Range:
$80,000-$100,000
We understand salary is an important factor in your job search and encourage you to apply even if your desired compensation falls outside this range. The final rate is determined based on several factors including relevant experience, education, certifications, and market conditions.
Benefits:
Our comprehensive benefits package includes:
o Medical insurance
o Dental insurance
o Vision insurance
o 401(k) retirement savings plan
Contact:
Justine Haley
************************
Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!
Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at ********************* or ***************** to make a request.
$80k-100k yearly 4d ago
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Auto Claims Representative
Beacon Hill 3.9
Claim specialist job in Boston, MA
Auto Claims Representative to $47K - Lauch Your Career!
Our client, a leading insurance organization, is seeking an Auto Claims Representative to manage automobile property damage claims while delivering exceptional customer service. As part of a growth-oriented training program, you'll investigate claims, assess liability, and ensure timely resolution.
Position Details:
Location: Boston, MA
Work Model: Hybrid
Degree: Preferred
Responsibilities include analyzing policy provisions to determine coverage; investigating auto accidents and gathering documentation; negotiating and settling claims within authority limits; maintaining accurate records and follow-up systems; coordinating with vendors and internal teams to resolve disputes; initiating subrogation processes when applicable; and managing phone and email communications to ensure timely updates.
The ideal candidate possesses strong organizational and multitasking skills; excellent verbal and written communication abilities; proficiency in Microsoft Office Suite; ability to handle sensitive situations with professionalism; and a customer-focused mindset with adaptability to manage multiple priorities.
Enjoy a role that offers comprehensive benefits, long-term career growth, and a supportive team environment committed to your success!
Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply.
California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
If you would like to complete our voluntary self-identification form, please click here or copy and paste the following link into an open window in your browser: *****************************************
Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for reporting purposes only and will be kept separate from all other records.
Company Profile:
Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement.
Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.
Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting *************
Benefits Information:
Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.
We look forward to working with you.
Beacon Hill. Employing the Future (TM)
$47k yearly 16h ago
Senior Complex Claims Specialist - General Liability
Hiscox
Claim specialist job in Boston, MA
Job Type: Permanent Build a brilliant future with Hiscox The Senior Complex ClaimsSpecialist is the most senior technical role in the organization. This person adjudicates assigned claims within given authority and provides operational support to the claims team.
This person will also:
* Strategize and maximize early settlement opportunities for Construction Defect and 3rd Party Property Damage Claim
* Demonstrates proficient knowledge regarding coverage triggers and time on risk allocation
* Draft and Review coverage analyses
* Manage/Partner with local defense counsel while monitoring litigation
* Drives litigation best practices to manage deployment and utilization of defense counsel
* Continually assess exposures and adequacy of claim reserves
* Demonstrates proficient knowledge regarding theories of liability and State specific negligence standards
* Accurately document claim files with all relevant correspondence, documentation, and file notes
* Demonstrates proficient knowledge of ACV vs RCV property damage assessments
* Attend mediations and/or settlement conferences where appropriate
* Identifies suspected fraudulent claims and tracks with special investigations unit
* Actively participate in the Claims/UW/Actuarial feedback loop
* Keep senior claims management adequately and appropriately informed of key issues
* Liaising directly on daily basis with insureds and brokers
The Team:
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling.
Requirements:
* 10+ years of claims handling experience with Commercial General Liability and Construction Defect
* A JD from an ABA accredited law school may be considered as a supplement to claims handling experience
* Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation
* Expert knowledge of coverage within the team's specialty or focus
* Expert knowledge of litigation process and negotiation skills
* Proven track record of mentoring others
* Excellent verbal and written communication skills
* Advanced analytical skills
* B.A./B.S degree from an accredited College or University preferred
What Hiscox USA Offers:
* Competitive salary and bonus (based on personal & company performance)
* 401(k) with competitive company matching
* Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
* Company paid group term life, short- term disability and long-term disability coverage
* 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
* Paid parental leave
* 4 week paid sabbatical after every 5 years of service
* Financial Adoption Assistance and Medical Travel Reimbursement Programs
* Annual reimbursement of 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 value-driven culture
* Modern and open office spaces, complimentary drinks
Please note that this position is hybrid and requires two (2) days in our office weekly
Salary range: $90-$130k
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.
About Hiscox:
As an international specialist insurer, we are far removed from the world of mass market insurance products. Instead, we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things.
We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions.
Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places.
Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch.
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 500 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and Scottsdale. 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, and terrorism.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
#LI-RM1
Work with amazing people and be part of a unique culture
$90k-130k yearly Auto-Apply 11d ago
Property Claims Examiner
Safety Insurance Company 4.6
Claim specialist job in Boston, MA
Safety Insurance is proud to be one of the leading property and casualty insurance providers in Massachusetts. We are committed to supporting independent agents and their customers through our unwavering dedication to excellence. Our success is built on a simple philosophy: deliver the highest quality insurance products at competitive rates while providing exceptional service at every step.
At Safety Insurance, we don't just offer jobs - we offer careers that are challenging, fulfilling, and designed to grow with you.
Our people are our greatest asset. A diverse workforce makes us stronger, more innovative, and better equipped to serve our customers. At Safety, we empower our employees to be their best by fostering an inclusive environment and offering resources that support their careers, education, and families. We also understand the importance of work-life balance. That's why we offer hybrid work options, flexible schedules, and a 37.5-hour workweek. Conveniently located in the heart of Boston's financial district, our downtown office is a positive space where employees can stay connected to both each other and the pulse of the city.
Safety's benefits go beyond the basics. In addition to competitive salaries, our comprehensive benefits package includes:
3 weeks accrued paid time off + 11 paid holidays per year
Health insurance (medical, dental, vision)
Annual 401(k) Employer Contribution (up to 8% of your base salary)
100% tuition reimbursement
Free on-site fitness center
Complimentary coffee and breakfast service
Hybrid work schedules
Working Advantage Discount Program
Employee Assistance Program
…and much more!
Join Safety Insurance and discover a career that's built to support your success - both personally and professionally.
Qualifications
Responsible for the fair and accurate disposition of property claims by determining coverage, applying policy terms and conditions, determining damages, and negotiating settlements
Duties
Coordinates the investigation and settlement of large and/or complex homeowners and commercial claims assigned to independent adjusters.
Determines the likely cause of loss and damages of large losses according to company guidelines
Monitors the submission of supporting claim information from the independent adjusters, vendors, experts, and attorneys
Reviews the policy to determine coverage and issues denials when appropriate
Reviews reports and estimates for accuracy and approves settlement requests from independent adjusters
Provides periodic reports and authority request to management
Issues claim settlement checks
Coordinates the investigation and disposal of salvage
Investigates and prepares claims for subrogation recovery
Maintains current diary on all claims
Reviews independent adjusters' reports and estimates for accuracy
Attends mediations, reference hearings and trials as company representative
Performs other activities as directed
Qualifications
College degree or commensurate insurance experience required
CPCU and/or AIC preferred
Ability to work independently to resolve large and/or complex property claims.
5+ years of experience settling first party homeowners' & commercial claims required
Experience using an automated claim system required
$54k-79k yearly est. 10d ago
Outside Property Claim Representative
Travelers Insurance Company 4.4
Claim specialist job in Foxborough, MA
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$52,600.00 - $86,800.00
**Target Openings**
1
**What Is the Opportunity?**
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. This position services a territory in South Eastern MA. The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory.
Experienced candidates will also be considered.
**What Will You Do?**
+ Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
+ The on the job training includes practice and execution of the following core assignments:
+ Handles 1st party property claims of moderate severity and complexity as assigned.
+ Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
+ Broad scale use of innovative technologies.
+ Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
+ Establishes timely and accurate claim and expense reserves.
+ Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
+ Negotiates and conveys claim settlements within authority limits.
+ Writes denial letters, Reservation of Rights and other complex correspondence.
+ Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
+ Meets all quality standards and expectations in accordance with the Knowledge Guides.
+ Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
+ Manages file inventory to ensure timely resolution of cases.
+ Handles files in compliance with state regulations, where applicable.
+ Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
+ Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
+ Identifies and refers claims with Major Case Unit exposure to the manager.
+ Performs administrative functions such as expense accounts, time off reporting, etc. as required.
+ Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
+ May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
+ Must secure and maintain company credit card required.
+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
+ In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
+ This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience.
+ Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic.
+ Verbal and written communication skills -Intermediate.
+ Attention to detail ensuring accuracy - Basic.
+ Ability to work in a high volume, fast paced environment managing multiple priorities - Basic.
+ Analytical Thinking - Basic.
+ Judgment/ Decision Making - Basic.
+ Valid passport.
**What is a Must Have?**
+ High School Diploma or GED and one year of customer service experience OR Bachelor's Degree.
+ Valid driver's license.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
$52.6k-86.8k yearly 60d+ ago
General Liability Claims Adjuster II
Delhaize America 4.6
Claim specialist job in Quincy, MA
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.
Position Summary
Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.
Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.
Applicants must be currently authorized to work in the United States on a full-time basis.
Principle Duties and Responsibilities:
Claims Management
* Manage caseload within established targets and appropriate level. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
* Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
* Analyze facts of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines.
* Identify fraud indicators and actively pursue subrogation opportunities.
* Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
* Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.
Financial Impact Administration
* Manage book of claims business (up to $ 2million) with authority to settle/negotiate a single claim within their authority of up to $25,000.
* Communicate ongoing causes of incidents to Safety and Brands.
* Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.
Basic Qualifications:
* Licensed adjuster (as appropriate by jurisdiction)
* Bachelor's degree or experience handling General Liability claims or equivalent expertise.
* Thorough knowledge of rules, regulations, statutes, and procedures pertaining to general liability claims.
* Knowledge of medical terminology involved in complex claims
* Negotiates resolution of claims of various exposure and complexity
Skills and Abilities:
* Demonstrates relationship building and communication skills, both written and verbal.
* Highly self-motivated, goal oriented, and works well under pressure.
* Customer focused solid understanding of legal procedures, processes, practices and standards in the handling of general liability claims
* Ability to identify problems and effectuate solutions
* Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail
* Able to apply critical thinking when solving problems and making decisions.
ME/NC/PA/SC Salary Range: $63,440-$95,160
IL/MA/MD/NY Salary Range: $72,880 - $109,320
Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.
#LI-SM1 #LI-Hybrid
At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent.
Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.
Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work.
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.
$72.9k-109.3k yearly 60d+ ago
Billing Claims Specialist
Reliable Respiratory 3.9
Claim specialist job in Merrimack, NH
Equal Opportunity Employer/Disability/Veterans
Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.
Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.
The Billing C laims Specialist focuses on claims and procurement of authorizations and medical documentation to ensure Reliable is reimbursed in accordance with the procedures provided. This position reports to the Billing Manager, but will perform duties that pertain to customer service, documentation retrieval, medical billing and coding, and reimbursement. The primary purpose of this position is to identify reasons for claim denials and take all corrective action to resubmit the claim and obtain full reimbursement for the services rendered. Additional duties include:
Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services.
Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures).
Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins)
Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice
Issue invoices and bills and send them to customers through various channels (mail, e-mail etc.)
Receive payments through various methods (cash, online payments etc.) and check for credibility.
Answer questions and handle complaints from customers and payors regarding claims
Reconcile deposits and invoices posted.
Basic Qualifications
18 years of age or older
Must be eligible to work in the United States and not require work authorization from us now or in the future
Bachelor's Degree required
At least 2 years of medical billing, coding, reimbursement or health insurance experience preferred
Required Skills
Strong health insurance knowledge of New England payers and Massachusetts ACO plans
Proficient in obtaining authorizations in the most efficient manner (portal, fax form, phone in submission)
Ability to learn Billing functions and be adaptable to the needs of the position.
Strong interdepartmental communication
Effective and professional verbal and written communication abilities
Professional computer experience (especially Microsoft Office Suite)
Ability to investigate problems and make decisions independently.
Strong analytical skills
Competencies
Computer skills
Interpersonal skills
Product expertise
Communication skills
Results driven
Conflict management
Customer service
Organizational skills
Work Environment & Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
This role routinely uses standard office equipment such as computers, phones, and printers/scanners
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
This job operates in a professional office environment
The noise level in the work environment is usually moderate to loud
Direct Reports - None
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.
$38k-67k yearly est. Auto-Apply 23d ago
Claim Representative
A.I.M. Mutual Insurance Companies 4.1
Claim specialist job in Burlington, MA
Ask Yourself This... Are you someone who thrives working in a fast-paced environment? Do you enjoy providing support to others?
Then join us as a Claim Representative
in Burlington, MA!
What You'll Do
This fast-paced, highly rewarding entry-level position is all about helping people with a focus on customer service, and is the first point of contact when a worker is injured at work. The Claim Representative handles the claim process from beginning to end; working closely with injured workers, employers, doctors, insurance companies, as well as co-workers in other departments within the company. The Claim Representative manages the claim process and treatment plans, with the goal of getting an injured worker back on the job as soon as possible.
This position offers a hybrid working schedule after an initial training period.
We're looking for someone that:
has a college degree,
has experience in a call center or customer service environment,
can organize and prioritize workflows and meet company/industry deadlines,
is self-motivated and once trained, able to work with little direction, and
has or is willing to pursue a professional insurance designation.
At A.I.M. Mutual Insurance Companies, we are committed to building a diverse and inclusive workplace, and we believe that all people are capable of great things. So, if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway!
Who We Are
At A.I.M. Mutual Insurance Companies, we are committed to setting the standard in service excellence. We are guided by our founding principles to help employers effectively manage their workers' compensation program, providing quality services to injured workers and creating safe workplaces. We are one of the largest regional workers' compensation specialists, and we credit our staff for putting their service-oriented work ethic and workers' compensation insurance knowledge into practice, every day, in all they do.
What we do
...
We provide a workers' compensation experience that ensures peace of mind for all.
Why we do it
...
To protect and support the well-being of all New England workers and their families.
How we do it
...
Listening with empathy
Acting with compassion
Doing the right thing
Succeeding through collaboration
We proudly offer robust compensation and benefits packages, including:
35-hour work week
Summer hours June through September
Competitive pay, with opportunities to advance
Medical, dental, vision plans and pet insurance
Employer-sponsored retirement plan with matching employer contribution
Tuition reimbursement
Company-paid life and disability insurance
Paid time off and generous holiday time
A.I.M. Mutual has also earned the 2024 Best Place for Working Parents business designation.
At. A.I.M. Mutual, we recognize the importance of having a highly experienced staff to meet day-to-day customer needs. Come be a part of a great team of people that strives to surpass customer expectations every day. Working for A.I.M. Mutual is not just a job, it's a career.
Thank you for your interest in joining the A.I.M. Mutual Insurance team!
$39k-52k yearly est. 4d ago
Branch Claims Representative 2
Concord General Mutual Insurance Company 4.5
Claim specialist job in Westborough, MA
Branch Claims Representative II handles first party personal property and commercial property claims through the life-cycle including but not limited to: investigation, evaluation and claim resolution. The purpose of this position is to provide service to agents, insureds and others to ensure claims resolve accurately.
Responsibilities
Investigate first party personal property and commercial property assigned claims, confirm coverage, verify damages, and determine liability where applicable
Take loss reports directly from insureds and/or claimants and/or their representatives
Assist with claims related phone calls and handle incoming correspondence
Evaluate and settle assigned claims based upon investigative results
Demonstrate ownership and accountability for the complete claims adjusting cycle in accordance with Business Unit and Company procedures for assigned claims including:
Loss Reporting
Initial Claim Handling
Investigation and Damage Verification
Estimate Preparation
Ability to Review, Understand and Negotiate from Independent Adjusters' Reports
Setting and Recommending Reserves
Negotiation and Settlement of Claims
File Administration
Requirements
Bachelor's Degree preferred but may be waived by Company appropriate experience.
Experience writing estimates with Xactimate and XactContents preferred
2-3+ years' experience investigating and resolving first party property claims
Excellent oral and written communication skills via in person, on the phone, and in electronic interactions
Excellent understanding and skill level of claim handling and customer service
Strong willingness and ability to learn
Possess or ability to timely secure and maintain multi-line adjuster's license(s) as required
Benefits
At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness.
Why Concord Group Insurance
Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont.
At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do.
Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve.
Compensation
We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities. For this position, the anticipated annualized starting base pay range is: $70,000 - $80,000.
Equal Employment Opportunity
The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on 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.
The Concord Group participates in E-Verify.
$70k-80k yearly Auto-Apply 14d ago
Claims Manager II, Hospital Professional Liability
Liberty Mutual 4.5
Claim specialist job in Boston, MA
Ready to lead and shape Hospital Professional Liability claims strategy? Apply to this senior-level claims leader position, Claims Manager II.
Join a high-performing team leading the Hospital Professional Liability claims unit for IronHealth/NAS Claims. We're looking for a seasoned Claims Manager with deep Hospital Professional Liability experience who wants to lead a technical team, shape claims strategy, and drive measurable improvements across a portfolio of complex and high-severity matters consistent with the standards of Liberty International Underwriters.
*This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. This policy is subject to change.
The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, and the overall cost of labor for that region, and based on you location you may not qualify for the top salary listed in the range.
Responsibilities
Responsible for performance, development and coaching of staff (including hiring, terminating, performance and salary management). Serve as technical resource not only for claims staff, but also cross-functional partners, including Underwriting (UW), Actuarial, Finance and Operations.
Work with claims team and external attorneys to review coverages, investigate claims, analyze liability and damages, establish adequate indemnity and expense reserves, develop strategies and resolve claims, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions.
Perform quality assurance reviews/observations and provide feedback to team as well as action plan for development of team, where necessary.
Actively pursue all avenues of recovery including, but not limited to timely recovery of deductibles from insureds and manage subrogation activities.
Provide regular reports to claims management regarding losses either exceeding or likely to exceed the authority level in accordance with best practices. Must be able to present effectively, produce appropriate reports and develop team and train team in these skills
Partner with underwriting managers/team to provide excellent customer service and to market and meet with brokers, risk managers and reinsurers. Serve as external face claims leader for product line and demonstrate ability to forge and maintain relationships with external customers, effectively resolving concerns where necessary. Ability to effectively articulate the claims value proposition in claims advocacy meetings, account renewals and new business prospecting. Present at industry conferences or publishes external industry content.
Lead short to medium-term strategic claims activities/priorities for the product line, with alignment with the strategic priorities of IronHealth and NAS Claims. Oversee projects assigned by the department head.
Direct and manage the Claims participation and content for multidisciplinary reviews, monthly UW connectivity meetings, and quarterly actuarial meetings. Ensure timely feedback to senior management, underwriting and actuaries regarding relevant losses, account issues, and trends.
Assist and coordinate with underwriting team regarding new policy forms, product development and/or product rollouts and provide timely feedback to senior management and underwriting regarding recommendations.
Ability to achieve fluency in Loss Triangle interpretation and Product Level Profitability Understanding/Awareness.
Other duties as assigned, including delivery on established operational goals and objectives.
Qualifications
Qualifications - what will make you successful!
Bachelors' degree or equivalent training; advanced degrees or certifications preferred.
A minimum of 8+ years of relevant and progressively more responsible work experience required, including at least 2 years of supervisory experience.
At least 5 years claims handling within a technical specialty. Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace.
Requires advanced knowledge of a technical specialty. Knowledge of law and insurance regulations in various jurisdictions.
The ability to effectively interact with brokers and internal departments is also required. Strong verbal and written communications and organizational skills.
Strong negotiation, analytical and decision-making skills also required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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$105k-172k yearly est. Auto-Apply 6d ago
Litigated Claims Specialist
DWP, IWP, and AWP Careers
Claim specialist job in Andover, MA
Working as part of the Claims Department, the Litigated ClaimsSpecialist lends expertise in the laws, regulations, and jurisdictional statutes to identify or resolve disputed claims, assuring effective reimbursement.
What You'll Do
Investigate/rectify partial payments from claims in litigation
Secure payment on outstanding invoices
Investigate claim that are in litigation
Assess current and ongoing risk of continued medications service in relation to ongoing litigation
Research and act upon information obtained
Interact and communicate daily with other departments
Communicate with external sources such as attorneys and adjusters
Obtain medical documentation to facilitate/warrant collections
Analyze information and data for resolution
Participate and develop special processes/procedures to better the Litigated Claims Team
Special projects as designated by manager
What You'll Need to Succeed
2+ years Workers Compensation knowledge
Bachelor's Degree or equivalent related experience
Familiar with medical terminology
Knowledge of databases and MS Office (Excel & Word)
Knowledge of IWP reimbursement process and procedures
Make A Difference With IWP
Injured Workers Pharmacy (IWP) is proud to be
THE
Patient Advocate Pharmacy, helping injured workers around the country access their prescription medications with ease. As a specialized workers' compensation home delivery pharmacy, we collaborate with the legal, medical, and insurance communities to help injured workers return to a productive life. At IWP we believe in our service, but it's the people who make it a great place to work. We value our employees and strive for a culture of teambuilding, open mindedness, and fun. If that sounds like something you'd like to be part of, we'd love to hear from you! Your compensation will include a competitive salary, generous benefits, and opportunities for growth and development.
IWP is an Equal Opportunity Employer. IWP does not discriminate on the basis of race, creed, color, religion, national origin, sex, sexual orientation, gender identity, age, physical or mental disability, or any other basis covered by appropriate law. All employment decisions are made on the basis of qualifications, merit, and business need. IWP is committed to providing reasonable accommodations for qualified individuals with physical and mental disabilities in our job application procedures. If you need assistance or an accommodation due to a disability, you may contact us at
humanresources@IWPharmacy.com
We will make a determination on your request for reasonable accommodation on a case-by-case basis.
We are dedicated to attracting and retaining top talent with competitive and fair compensation. The salary range for this role is $23/hr - $25/hr.
$23-25 hourly 3d ago
Associate PIP Claims Representative
Amica Mutual Insurance 4.5
Claim specialist job in Lincoln, RI
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.
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$40k-50k yearly est. 17d ago
Independent Insurance Claims Adjuster in Waltham, Massachusetts
Milehigh Adjusters Houston
Claim specialist job in Waltham, MA
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.
$50k-65k yearly est. Auto-Apply 60d+ ago
Outside Property Claim Representative - West Bridgewater, MA
Msccn
Claim specialist job in West Bridgewater, MA
ATTENTION MILITARY AFFILIATED JOB SEEKERS
- Our organization works with partner companies to source qualified talent for their open roles. The following position is available to
Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers
. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$52,600.00 - $86,800.00
What Is the Opportunity?
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
What Will You Do?
Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Handles 1st party property claims of moderate severity and complexity as assigned.
Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves.
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
Negotiates and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with the Knowledge Guides.
Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations, where applicable.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
Identifies and refers claims with Major Case Unit exposure to the manager.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Must secure and maintain company credit card required.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
Perform other duties as assigned.
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience.
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic.
Verbal and written communication skills -Intermediate.
Attention to detail ensuring accuracy - Basic.
Ability to work in a high volume, fast paced environment managing multiple priorities - Basic.
Analytical Thinking - Basic.
Judgment/ Decision Making - Basic.
Valid passport.
What is a Must Have?
High School Diploma or GED and one year of customer service experience OR Bachelor's Degree.
Valid driver's license.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
$52.6k-86.8k yearly 28d ago
Employment Practice Liability Claim Manager
Questor Consultants, Inc.
Claim specialist job in Boston, MA
Job Description- National Insurance Carrier is looking for an experienced EPL Claims Manager that is currently managing a team. Prior experience in EPLI & professional liability claims is preferred but not mandatory. Will need a minimum of 5 to 7 years experience in EPL and or professional liability claims.
JD preferred with good interpersonal skills.
Call for additional details.
$45k-119k yearly est. 24d ago
Associate, Claims Receipt Processor
Ametros Financial 4.0
Claim specialist job in Wilmington, MA
Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone.
A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements.
A Claims Receipt Processor is primarily responsible for ensuring timely and accurate reimbursements of receipts submitted by our members. The position requires excellent phone and email skills with the ability to explain coverage in a way that is understandable to our members. The role works closely with the claim administrators and member care team to keep our members happy and compliant with their settlements.
What you will do
Responsible for reviewing receipt submissions for required information.
Outreach to providers, pharmacies, and members to obtain additional information as needed.
Reviewing settlement documentation to determine whether a receipt is reimbursable.
Keying in the necessary information to create a claim.
Explaining coverage determinations to members while maintaining a pleasant and helpful demeanor.
Maintain the expected turnaround time for processing receipts.
Performing other clerical tasks, as required.
Demonstrates a commitment to service by consistent attendance and punctuality.
Skills and Abilities
Proficient in MS Office.
Excellent critical thinking and decision-making skills.
Good administrative and organizational skills.
Excellent written and verbal communication skills with ability to adapt communication style depending on audience.
Meticulous attention to detail.
Familiar with the language of medical billing, Medicare guidelines and/or workers' compensation.
Ability to work independently and as part of a team.
Education Qualifications
H.S. Diploma or General Education Degree (GED) required
Experience Qualifications
0-2 years experience as a Claims Processor or in a related role required
The estimated salary range for this position is $20.00-$23.00 per hour, 40 hours per week. Actual salary may vary up or down depending on job-related factors which may include knowledge, skills, experience, and location. In addition, this position is eligible for incentive compensation.
#LI-BB1
#LI-HYBRID
Webster Financial Corporation and its subsidiaries (“Webster”) are equal opportunity employers that are committed to sustaining an inclusive environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, national origin, ancestry, citizenship, sex, sexual orientation, gender identity and/or expression, physical or mental disability, protected veteran status, or any other characteristic protected by law.
$20-23 hourly Auto-Apply 9d ago
Public Adjuster
The Misch Group
Claim specialist job in Boston, MA
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
$75k-100k yearly 16d ago
Analyst (Graduate Hire 2026) - Medical (Boston)
Prescient Healthcare Group
Claim specialist job in Boston, MA
Analyst (Graduate Hire 2026) - Medical Important Dates: * Application Deadline: February 13, 2026 * Start Date Range: August - September 2026 Application & Recruitment Process As part of your application, please submit a cover letter addressing the questions below.
Candidates who do not submit a cover letter with responses to these questions will not be considered.
Cover Letter Questions:
* Why are you interested in Prescient Healthcare Group? What attracted you to this role?
* What are your top three attributes that will make you a successful consultant?
* How many times have you practiced a case with a peer?
* What interests you most about working in the life sciences and pharmaceutical industry, and how have your academic experiences, internships, or other relevant exposure prepared you for this role?
Recruitment Timeline:
* February 16- February 27: Selected candidates will complete an introductory interview with a member of our Talent Acquisition team
* February 27: All candidates will be notified of next steps.
* March 4th: Final in-person assessment day (behavioral + case interviews)
To ensure availability, candidates are encouraged to tentatively block March 4th for the in-person interview day.
About You
Do you have a passion for:
* Understanding tomorrows emerging therapeutic areas?
* Unlocking the full potential of new therapies and shaping successful future therapies?
* Understanding why healthcare professionals and patients behave the way they do, and applying this to medical, clinical, and commercial strategies?
* Are you a highly motivated professional interested in being part of a new and exciting team, working with global healthcare and pharmaceutical clients across the full product life cycle?
About Prescient Healthcare Group (PHG)
Our goal is a simple one: we solve exciting, real-world pharma challenges that ultimately make a meaningful difference in patients' lives.
PHG is a unique global biopharma, insight-led strategy consultancy. Our core focus is helping biopharmaceutical clients create clinical and commercial strategies that deliver groundbreaking new treatments for patients.
With offices in ten major cities across the world, we are a truly global enterprise and are still growing fast, offering our people endless opportunities, supporting rapid personal and professional development.
We work with industry leading companies across the full product life cycle, to help them unlock the full potential of their brands.
About the Opportunity
The role will be varied, giving you the opportunity to develop and hone new skills whilst improving your knowledge of the healthcare industry. You will receive exposure to a broad mix of projects - varied therapeutic areas, a range of client sizes, and domestic vs. global reach. This will enable you to get the experience to decide if you want to take a more specialized route as your career progresses. Our onboarding and training program will provide the support and development you need to hit the ground running; a mix of formal classroom training, shadowing colleagues on projects and 'on the job' coaching will equip you with the capabilities you need to succeed at Prescient.
Key Responsibilities:
* Exhibit high degrees of professionalism across each aspect of working life, demonstrating respect, integrity and support for colleagues and in our interactions with clients
* Take pride in and full responsibility for meeting high levels of performance in work process and output; take charge of own professional development and proactively seek opportunities for growth
* Demonstrate a strong willingness to learn and a 'can-do' attitude; showcase ability to gain expert status on a new topic and create an impact within the team and with clients
* Demonstrate an ability to thrive in an environment through efficient planning
* Demonstrate an ability and willingness to take risks, work in a non-hierarchical environment and take step-up/step-down roles to support strong outcomes
* Act as a role model in line with company and client codes of ethics and processes; represent the company and promote its reputation to a high standard
Desired Experience and Skills
* Bachelors in a relevant field (e.g., Life Sciences, Biotechnology, Neuroscience, Pharmacology, Business, Economics, Marketing, or Psychology).
* Demonstrated passion for the life sciences and pharmaceutical industry, supported by academic research, industry exposure, or relevant coursework.
* Ability to rapidly synthesize, analyse, and apply new information, demonstrating intellectual agility and a proactive approach to problem-solving.
* Exceptional verbal and written communication abilities, with a track record of delivering clear, concise, and impactful presentations and reports.
* A drive for self-improvement - the best consultants are those that seek out and action on feedback to improve themselves.
* Entrepreneurship - The ability to lead and drive outcomes, particularly in situations that have some ambiguity.
* Consulting is a team sport so a demonstrated willingness and enthusiasm to collaborate with others is required.
What We Offer
* Highly competitive base salary plus performance-related bonus, 401K matching and Health & Dental benefits.
* A strong values-based culture that promotes respect, inclusion and teamwork, encouragement to contribute and influence on the business - where everybody has a voice.
* Leaders who are accessible, truly listen, are ambitious for our teams, and committed to coaching & sharing their expertise.
* A high-growth, entrepreneurial environment where our thinking and our work are innovative, imaginative and bright.
* Endless and tailored career development that stretches you and is based on your ambition, abilities and interests - not just box-ticking.
* Flexible working, recognition for going the extra mile, and a flat hierarchy.
More about Prescient Healthcare Group
Prescient is a pharma services firm specializing in dynamic decision support and product and portfolio strategy. We partner with our clients to turn science into value by helping them understand the potential of their molecules, shaping their strategic plans and allowing their decision-making to be the biggest differentiating factor in the success of their products. When companies partner with Prescient, the molecules in their hands have a greater potential for success than the same science in the hands of their competitors.
Founded in 2007, Prescient is a global firm with a footprint in ten cities across three continents. Our team of nearly 475 experts partners with 27 of the top 30 biopharmaceutical companies, the fastest-growing mid-caps and cutting-edge emerging biotechs, including some of the biggest and most innovative brands. More than 70% of our employees hold advanced life sciences degrees, and our teams deliver an impressive depth of therapeutic, clinical and commercial expertise.
The annual full time base salary range for this role is ($75,000 - $85,000). Specific compensation is determined through interviews and a review of relevant education, experience, training, skills, geographic location and alignment with market data. Additionally, positions may be eligible to receive a discretionary bonus as determined by bonus program guidelines. Prescient offers PTO and paid holidays, the terms of which are set forth in the program policies. All full-time employees also are eligible to participate in various benefit plans, including medical, dental, vision, life, disability insurance and 401K; in each case in accordance with the terms of the applicable plans.
Prescient has been a portfolio company of Bridgepoint Development Capital since 2021 and Baird Capital since 2017. For more information, please visit: ********************
We are an equal opportunity employer and fully comply with applicable legislation in all the geographies in which we operate. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable national, federal, state or local laws.
$75k-85k yearly 5d ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claim specialist job in Boston, MA
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.
$51k-64k yearly est. Auto-Apply 41d ago
Pharmacy Benefits Verification Specialist
Onco360 3.9
Claim specialist job in Waltham, MA
Are you someone looking for professional career growth? Onco360 Pharmacy is looking for Pharmacy Benefit Verification Specialists for our Pharmacy located in Waltham, MA. Work Hours: Monday-Friday shifts available; some weekends as needed. **Starting salary at $25.00/hr and up** We also offer quarterly incentive bonuses. Sign-On Bonus: $5,000 for employees starting before March 1, 2026. We offer a variety of benefits including:
Medical, Dental & Vision insurance
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Paid Volunteer Day
Floating Holiday
Referral Incentive
Paid Life, and short & long-term disability insurance
Pharmacy Benefit Verification Specialist Summary: The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders. Pharmacy Benefit Verification Specialist Major Responsibilities:
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 benefit information.
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.
Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.
Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.
Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws
Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Benefit Verification Specialist Qualifications:
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
Work Experience
Required: 1+ years pharmacy or benefit verification experience
Desired: 3+ years pharmacy or benefit verification experience
Skills/Knowledge:
Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, 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.
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 skill
Onco360 is a Closed door specialty pharmacy that focuses on patients who are currently undergoing cancer treatment. Our patients are important to us, so we always strive to meet and exceed their needs. We are seeking Pharmacy Benefit Verification Specialists who go above and beyond for our patients, and also passionate about helping others.
How much does a claim specialist earn in Waltham, MA?
The average claim specialist in Waltham, MA earns between $32,000 and $88,000 annually. This compares to the national average claim specialist range of $27,000 to $67,000.
Average claim specialist salary in Waltham, MA
$53,000
What are the biggest employers of Claim Specialists in Waltham, MA?
The biggest employers of Claim Specialists in Waltham, MA are: