Claim specialist jobs in West New York, NJ - 207 jobs

The Auto Property Damage Claims Representative is responsible for managing Auto Property Damage claims within our “Auto PD Claim Unit.” This role demands a high level of customer service, patience, and professionalism while working in a fast-paced environment with significant phone interaction. Strong customer service, organizational, verbal, and written communication skills are essential. The ability to navigate adversarial situations with professionalism is critical. Comparative negligence claim handling experience is a plus but not required. RESPONSIBILITIES Policy Analysis: Investigate and interpret policy provisions, endorsements, and conditions to determine coverage for automobile property claims. Identify and investigate contested coverage claims that may require a roundtable discussion. Claim Investigation: Investigate auto accidents to assess liability by interviewing first- and third-party claimants, witnesses, investigating officers, and other relevant parties. Secure and analyze pertinent records, documentation, and loss scene information to determine proximate cause, negligence, and damages. Claims Management: Evaluate and adjust reserves as necessary. Prepare dispatch instructions for field personnel to inspect vehicles. Negotiate and settle claims within individual authority limits and seek supervisor approval for claims exceeding authority or requiring additional guidance. Maintain effective follow-up systems on pending files, advising insureds, claimants, and brokers on claim status. Act as an intermediary between the company, preferred vendors, and customers to resolve disputes. Ensure adherence to privacy guidelines, laws, and regulations in claims handling. Subrogation and Legal Handling: Investigate and initiate subrogation processes when applicable. Handle and respond to special civil part lawsuits or intercompany arbitrations related to auto property damage claims. Administrative Duties: Manage a customer-focused phone environment by answering calls, returning voicemails, and responding to emails and text correspondence promptly. Process incoming and outgoing mail timely and in accordance with state guidelines. Complete other duties as assigned. QUALIFICATIONS Bachelor's degree required. A minimum of 1 year of related PD claim experience is welcomed but not required. Proficiency in personal computer skills, including Microsoft Office Suite. Ability to prioritize and manage multiple tasks effectively. Excellent communication, organizational, and customer service skills. SALARY RANGE The pay range for this position is $47,000 to $55,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS 4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) Annual 401(k) Employer Contribution Resources to promote Professional Development (LinkedIn Learning and licensure assistance) Robust health and wellness program and fitness reimbursements Various Paid Family leave options including Paid Parental Leave Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

Senior General Liability Claim Representative - Property & Casualty Insurance Industry Union County NJ The management of accounts and the processing of claims related to litigated matters in hotels, real estate, hospitality, liquor liability, general liability, and bodily injury cases is a specialized function. This role necessitates an individual with a personality geared toward customer satisfaction. Responsibilities also include the negotiation of claims that are under litigation. Candidates should have at least 3 to 5 years of experience in handling middle market claims and possess a college degree. A valid New York adjuster's license is essential, while licenses from other states are considered a plus.

Requisition ID JR1005191 Category Claims - General Liability Type Regular Full-Time Amtrust Financial Services, a fast growing commercial insurance company, is seeking an Excess and Surplus Complex Commercial Claims Adjuster. This position can be located in one of our claims offices, with the possibility of working remotely. The successful candidate will directly handle both litigated and non-litigated commercial general liability claims. The successful candidate will also exhibit a strong proficiency in insurance coverage analysis and risk transfer. This position will report to an AVP of Claims. Responsibilities Recognizing exposures and ensuring reserving is appropriate and timely Evaluating coverage issues and risk transfer opportunities Ensuring appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary, selection and utilization of counsel is appropriate, proper negotiation strategy is employed. Effectively communicate exposures both internally and externally Overall responsibility for formulating proper resolution strategy to ensure best total outcome. Position may require periodic travel to attend meditations, trials and / or other related meetings Perform other duties as assigned Qualifications Minimum of 5+ years' experience in the handling or litigating of commercial general liability claims. Strong contractual analysis skills to include the analysis of insurance contracts for coverage analysis and other contracts for risk transfer obligations/opportunities Proficient computer skills required to navigate our paperless claim file system. Possesses a high level of technical claim and legal knowledge and skills. Excellent communication skills both written and oral. Ability to professionally interact at a high level with parties both internal and external to AmTrust. Ability to effectively influence others without damaging relationships. Skillful negotiator. Adjuster licensing as required CPCU designation/AIC certification preferred. The expected salary range for this role is $126K-$155K/year. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. #LI-BL1 #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

About Us Dealer Owned Warranty Company LLC is a leading provider of F&I (Finance and Insurance) partnership services in the automotive industry, offering a full suite of obligor and administrator services, top-of-the-line products, technology, and training. We understand the importance of leveraging process and technology in the F&I industry to drive revenue and ensure success. Our goal is to provide visibility, transparency, and the tools needed for our partners to build their wealth and achieve their goals. DOWC prides itself on taking care of its employees (We were voted one of the “Best Places to Work” three years in a row!), and we also offer award-winning products. All of our positions are fully on-site in Parsippany, NJ. Overview We are seeking a dedicated and motivated Claims Representative to join our dynamic team. This role is essential in providing exceptional customer support to our contract holders related to warranty claims. The ideal candidate will possess strong communication skills, professional phone etiquette, a keen attention to detail, a love for customer service, excellent problem resolution, and the ability to work effectively in a fast-paced and high-volume environment. This person will be solution-oriented and eager to learn a complex business. Opportunities for advancement within the department with training provided. Job Duties: Provide outstanding customer support via phone, email, and chat related to claims inquiries. Handle a high volume of inbound calls with a minimum of 40 calls answered per day. Assist contract holders with inquiries regarding products and services, ensuring a high level of satisfaction pertaining to our contract guidelines. Accurately log and track customer issues, inquiries, and requests in the incident management system from identification through resolution. Deliver timely and reliable roadside assistance to customers in need. Process payments accurately and efficiently to ensure a smooth customer experience. Communicate effectively with team members and customers to resolve issues promptly. Adjudicate simple claims and troubleshoot basic to intermediate product or service issues. Connect and triage customers calling in for a claim with the appropriate mechanical claims analysts. Demonstrate excellent phone etiquette while handling client interactions. Collaborate internal departments to streamline customer services with adherence to SLAs. Maintain a queue of ongoing support tasks and resolve all customer issues in a high-priority manner. Proactively communicate with leadership to escalate any issues for immediate resolution. Create a positive support experience through active listening, problem-solving, and professional communication. Analyze information and process documents to resolve issues prior to escalation. Develop product knowledge to become a subject matter expert and confidently address customer concerns. Participate in further training sessions to enhance product knowledge and service skills. Qualifications Minimum of 2+ years as a claims adjuster or role in a customer service/call center environment. Proven experience handling a high volume of inbound customer calls. Insurance claims or automotive industry highly preferred. Ability to resolve escalated issues with a sense of urgency. Strong business acumen with the ability to identify customer needs and recommend appropriate solutions. Excellent communication skills, both verbal and written. Proficiency in data entry and familiarity with MS office software applications. Ability to work independently as well as part of a team in a collaborative environment. Strong organizational skills with an emphasis on attention to detail. Superior sense of urgency and ability to complete tasks in a timely manner. Strong customer-first attitude and relationship building skills. Come join our growing team here in Parsippany! As NJ's Best Places to Work Honoree for three years in a row, we offer: Competitive compensation Medical, Dental, Vision, 401k matching, Life Insurance, medical expense card PTO and Sick Time Corporate events, team and culture building activities, employee awards and recognition, company trips and more! DOWC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran status, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact us for assistance.

An Insurance Claims Court Representative role involves overseeing litigated claims, analyzing legal/medical data, collaborating with claims and trial lawyers, requiring strong analytical, negotiation, and communication skills to resolve high-stakes cases efficiently for optimal outcomes and cost control, often involving court appearances including conferences, mediations, and trials. Position requires the candidate to be the face of GNY in the NYC, Long Island and Westchester courts, working closely with defense counsel. Essential Duties and Responsibilities: Monitoring the legal defense of claims and coordinating with claims examiners and claims management. Reviewing claims files, reviewing medical records/police reports, evaluating policy coverage, and assessing damages. Working with defense attorneys. Analyzing claim data for trends, providing status reports to management, and ensuring accurate record-keeping. Negotiating settlements and presenting cases at claim committee meetings or mediations. Occasionally making settlement calls. Document file notes in ImageRight. Participates in special projects and performs additional duties as required. QualificationsEducation and Experience: Bachelors degree required; J.D. would be a plus. Minimum of 5 years' related experience. Strong analytical, negotiation, and communication (written/verbal) skills. Highly skilled in trial preparation. Proficiency with claims management software, databases, and MS Office. Understanding of relevant insurance laws and regulations. Experience in claims adjusting. Good knowledge of the law, settlement values, judges, adversaries, defense firms, venues. Knowledge of New York State Insurance Department regulations including fair claim standards. Other Requirements: Ability to travel back and forth between office and court. The salary range for this role is $74,600 - $136,100. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.

We are seeking a motivated and knowledgeable Commercial Insurance Specialist to join our business insurance team. This role is responsible for advising commercial clients on insurance products, quoting and binding policies, servicing accounts, and ensuring customer satisfaction. The ideal candidate has a strong understanding of P&C insurance products and thrives in a fast-paced, client-focused environment. Key Responsibilities: Develop and maintain relationships with commercial clients, ensuring their property and casualty insurance questions are answered. Provide quotes, online policy insurance policies, and process endorsements, renewals, and cancellations. Respond to client inquiries and follow up to ensure excellent customer service and retention. Stay current on products, underwriting guidelines, and regulatory requirements. Maintain accurate records in the CRM and agency management systems. Requirements: 2+ years of experience in commercial property and casualty insurance preferred. Active P&C insurance license is a bonus Strong phone skills Familiarity with small and mid-size business insurance products and rating tools. Strong communication and customer service skills. Ability to multitask, manage priorities, and meet deadlines. Ability to commute daily to our Woodcliff Lake, NJ office is required. This is an in-office position, Monday through Friday, from 8:30 AM to 5:30 PM. Business attire and a clean-shaven appearance are required each day. Preferred Qualifications: Experience working in an independent agency or with a direct writer. Bilingual abilities are a plus. Bachelor's degree or equivalent professional experience.

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include: Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations. Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies. Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic. Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning. Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives. Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support. Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations. Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery. Continue developing technical, analytical, and consulting skills while building credibility with clients. Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement. Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team. What You Bring Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred. Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles. Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance. Epic Resolute or other hospital billing system experience preferred; Epic certification a plus. Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required. Additional certifications such as CHC, CFE, or AHFI preferred. Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization. Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred. Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act. Willingness to travel up to 25%, based on client and project needs. How You'll Thrive Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions. Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships. Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time. Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment. Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility. Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.

Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! * Competitive compensation * Healthcare benefits package that begins on first day of employment * 401K retirement plan with company match * Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays * Up to 6 weeks of parental and bonding leave * Hybrid work schedule (3 days in the office, 2 days from home) * Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) * Tuition reimbursement after 6 months of employment * Numerous opportunities for continued training and career advancement * And much more! Responsibilities Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service. Key Responsibilities * Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures. * Review and interpret policy language to determine coverage and consult with coverage counsel when needed. * Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies. * Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information. * Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts. * Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards. * Participate in file reviews, team meetings, and ongoing training to support continuous learning. Salary Range $95,000.00-$145,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Qualifications * Minimum of 3 years of trucking industry experience. * Experience with bodily injury and/or cargo exposures. * Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices. * Strong analytical and negotiation skills, with the ability to manage multiple priorities. * Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism. * Possession of applicable state adjuster licenses. * Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.

Company Details Berkley Luxury Group is an operating unit of W.R. Berkley Corporation, one of America's largest commercial lines writers in the United states. At Berkley Luxury Group we offer tailored, all-inclusive insurance solutions for luxury condo, co-op, rental properties and fine dining restaurants. Berkley Luxury Group has been a mainstay in the commercial real estate and hospitality business since 1986. We specialize in luxury condominiums, cooperatives, and apartments in the habitational space, Class A Office buildings and fine dining restaurants in the hospitality space. BLG maintains a standard of prompt and fair settlement of claims, and endeavors to treat insureds and brokers in a partnership-like manner. BLG has developed a strategic plan to grow their success by expanding their footprint geographically and adding complementary products. At BLG there is a shared vision to be the best option for its customers. We aim to provide comprehensive insurance solutions, use enhanced data and technology to make more informed decisions and rely on a field-based underwriting, claims and loss control model to be closer to our customers and brokers. Our goal is to provide superior services and products to these unique businesses. At Berkley Luxury Group, our employees are our most important asset. We recognize that if we properly support and develop our employees, they will become our primary sustainable competitive advantage and the key to achieving success. As such, we have created a high performing culture incorporating our values into work practices, policies, and processes to foster, reinforce and sustain an environment where employees share a strong sense of purpose, commitment, and motivation to meet and exceed their goals. As a Berkley company, we enjoy operational flexibility that allows us to deliver quality coverage solutions. W. R. Berkley Corporation, and all member insurance companies, are rated A+ (Superior) by A.M. Best Company and carry Standard & Poor's Financial Rating of A+ (Strong). The company is an equal opportunity employer. Responsibilities Berkley Luxury is seeking a Senior Claims Specialist to join our team! This role is located is our new Parsippany NJ office. As a Claim Specialist, you will manage a wide range of commercial lines casualty claims, focusing on developing and implementing effective resolution strategies while delivering exceptional customer service. In this role, you will ensure high-quality claims handling through investigation, accurate analysis of coverage and liability, precise damage assessment, and resolution of claims, including those in litigation. As a key member of the casualty team, you will also help foster a culture of accountability, collaboration, continuous learning, and proactive performance improvement-contributing to both departmental excellence and the overall success of the company. Conduct thorough investigation and expert analysis of claims facts to determine coverage, liability, and applies appropriate legal concepts to evaluate damages and recommend appropriate course of action. Analyze and interpret policy language and case law in conjunction with specific loss facts to reach appropriate coverage decisions and write appropriate coverage correspondence in compliance with state statutes and regulations. Demonstrate a strong sense of urgency in promptly conducting comprehensive claims investigations to assess damages and liability, establish accurate reserves, and actively pursue timely and appropriate resolutions. Prepare and present reports for management that accurately reflect loss development, potential/actual financial exposures, risk transfer, reserve adjustments, coverage issues, and claim resolution strategies. Resolve claims through negotiation, mediation, and arbitration with minimal assistance. Address inquiries from brokers and policyholders and provide superior customer service. Attend and participate in industry related conferences, seminars, and webinars and demonstrating a personal commitment to professional development. Ensure claims handling compliance and alignment with insurance regulations and Company policies. May participate in projects and other corporate initiatives such as audits, task forces, focus groups, etc. Other duties as required. Qualifications Education Bachelor's degree or equivalent experience JD degree a plus Experience 5-7 years of experience handling commercial general liability claims. Experience managing litigated claims and working with defense counsel. Proven track record of effective claims resolution and negotiation. Technical Skills Strong knowledge of claims investigation techniques, liability assessment, and damage evaluation. Demonstrated expertise in legal processes and litigation management. Ability to interpret and apply policy language accurately. Analytical & Decision-Making Demonstrated critical thinking and sound judgment in analyzing claims. Advanced analytical abilities to evaluate liability, quantify damages, and determine exposure. Proven capacity to make prompt, well-reasoned, and evidence-based decisions. Communication & Interpersonal Excellent written, verbal, and presentation communication skills. Effective communicator with diverse stakeholders, including policyholders, claimants, attorneys, and internal teams. Strong negotiation skills Organizational & Time Management Strong organizational skills with attention to detail. Effectively manages priorities and meets deadlines in a fast- paced environment. Team & Culture Fit Takes ownership, shows initiative, and approaches problem-solving with a proactive mindset. Collaborative team player dedicated to achieving shared goals. Committed to continuous improvement and ongoing professional development. Supports and upholds the company's commitment to equal employment opportunity. Additional Company Details The company is an equal opportunity employer. We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role includes: Base Salary Range: $83,000 - $156,000 The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Eligible to participate in the annual discretionary bonus program. Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. Sponsorship Details Sponsorship not Offered for this Role

Location: Brooklyn, NY Salary: $52K-$80K The Billing and Claims Specialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials. Key Responsibilities for Billing/Claims Specialist: Billing & Claims Processing Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance Review authorizations, service hours, and eligibility prior to billing Ensure accurate coding and claim data in accordance with payer guidelines Process electronic and paper claims as required by payers Claims Follow-Up & Reconciliation Monitor claim status and follow up on unpaid, denied, or underpaid claims Investigate and resolve billing discrepancies and denials Submit corrected or resubmitted claims as needed Post payments, adjustments, and denials accurately into billing systems Reconcile remittance advice (EOBs/ERAs) with billed claims Authorization & Compliance Track MLTC authorizations, service limits, and expiration dates Ensure billing aligns with approved care plans and service authorizations Maintain compliance with Medicaid, MLTC, and insurance regulations Stay current on payer rule changes and billing requirements Qualifications for Billing/Claims Specialist: Required Minimum 2-3 years of billing and claims experience in home care, healthcare, or related setting Hands-on experience with MLTC billing and insurance claims Strong knowledge of Medicaid and managed care billing processes Proficiency with home care billing software and clearinghouses Excellent attention to detail and organizational skills

Who are we? Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries. People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden. * Classification: Exempt/Full-time * Reports to: Head of Claims for Transactional Risk * Travel: 0-15% * Salary: $150,000.00-$215,000.00 Role overview DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team. The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice. This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time. Role responsibilities * Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion. * Assist with entering claim data into operational systems. * Assist with quality control and performance management, to ensure high-quality claim handling. * Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers. * Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices. * Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners. * Perform other duties as assigned. Key requirements * Bachelor's degree required and law degree preferred. * Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable. * Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions. * Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives. * Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint). * Ability to manage multiple competing priorities. * Ability to adapt to evolving regulatory and legal environments. * Complete assigned tasks correctly, on time and able to learn quickly. * Self-motivated and demonstrating attention to detail. * Be able to work independently for extended periods. * Excellent written and verbal communication skills as well as general business understanding. * Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment. * If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team. What do we offer in return? A career that you define. Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more. What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community. Our culture: people first Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world. The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key. Diversity and inclusion At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances. What do we offer in return? A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us: * Our successes have all come from someone brave enough to try something new * We support each other in the small everyday moments and the bigger challenges * We are determined to make a positive difference at work and beyond Reasonable adjustments We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*. If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require. * Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more. Permanent

Who are we? Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries. People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden. Classification: Exempt/Full-time Reports to: Head of Claims for Transactional Risk Travel: 0-15% Salary: $150,000.00-$215,000.00 Role overview DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team. The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice. This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time. Role responsibilities Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion. Assist with entering claim data into operational systems. Assist with quality control and performance management, to ensure high-quality claim handling. Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers. Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices. Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners. Perform other duties as assigned. Key requirements Bachelor's degree required and law degree preferred. Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable. Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions. Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives. Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint). Ability to manage multiple competing priorities. Ability to adapt to evolving regulatory and legal environments. Complete assigned tasks correctly, on time and able to learn quickly. Self-motivated and demonstrating attention to detail. Be able to work independently for extended periods. Excellent written and verbal communication skills as well as general business understanding. Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment. If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team. What do we offer in return? A career that you define. Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more. What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community. Our culture: people first Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world. The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key. Diversity and inclusion At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances. What do we offer in return? A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us: Our successes have all come from someone brave enough to try something new We support each other in the small everyday moments and the bigger challenges We are determined to make a positive difference at work and beyond Reasonable adjustments We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*. If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require. *Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more. Permanent

Job Description Circet USA is the leading provider of Network Services in North America, and we're looking for talented professionals to join our team. We specialize in engineering and construction services delivering comprehensive solutions across Inside Plant, Outside Plant, and Wireless networks to meet the evolving infrastructure needs of our customers. With nearly 50 years of industry experience, we work with major telecom service providers, MSOs, cloud service providers, and utilities. At Circet USA, you'll have the opportunity to make an impact by helping to create customized solutions that address our clients' unique challenges. If you're passionate about innovation and thrive in a dynamic environment, we'd love to hear from you. Circet USA's benefits package includes the following: Medical, Dental, and Vision insurance Digital Health & Wellness Support Critical Illness, Accident, & Hospital Insurance Short-term & Long-term disability Group term & Voluntary life insurance Flexible Spending and Health Savings Accounts Paid Time Off & 401K Company Discount Website Responsibilities We are seeking a highly skilled and experienced Claims Specialist 3 to fulfill a staff augmentation role with Circet USA's customer. The primary objective of the Claims Specialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the Claims Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable. ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties may be assigned: Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators. Generate daily/weekly/monthly reports, with analysis and recommendations Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics Ensure that all projects have required documentation as they move through the project tollgates Communicate to Product Liability leadership on project status and escalation/decision points Works cross functionally with HQ teams in Korea (occasional evening conference call) and SEA operations to manage all possible risks. Pending Claim Management, KPI & TAT Management - Claim registration to closure Product Verification Liability Assessment by reviewing diagnosis results Reporting on high-profile claims to the leadership Qualifications Bachelor's Degree (or equivalent experience) 3-5 years of hands-on claims management & customer care experience Expertise in MS, Excel, and PPT Proven capability to analyze data and develop a course of action Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution Process, procedure, strategic planning and project development experience Experience working with and influencing cross-functional teams. Experience working within the insurance and/or home appliance industry a plus Experience with product development or testing a plus Experience working in a complex and wide organization and department Claims Adjuster License a plus Takes project ownership and possess leadership qualities with an entrepreneurial approach Circet USA is an Equal Opportunity Employer - Veteran/Disabled. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by law.

Job Title: Remote Claims Specialist Hourly Pay: $22 -$27/hour We are looking for a skilled Claims Specialist to join our work-from-home team. In this role, you will assist in processing and reviewing insurance claims, ensuring all necessary information is gathered, and helping resolve claims efficiently. If you have strong attention to detail and enjoy supporting customers through the claims process, this is a great opportunity for you. Key Responsibilities: Assist in processing insurance claims, ensuring accuracy and timely resolution Review claims documentation, including reports, medical records, and other evidence Communicate with claimants, insurance adjusters, and third parties to gather information Help resolve disputes or issues with claims and escalate when necessary Maintain detailed records of claims progress and updates Ensure compliance with industry regulations and internal policies Provide excellent customer service and answer inquiries related to claims Qualifications: Experience in insurance, claims handling, or a related field Strong attention to detail and organizational skills Excellent communication and customer service abilities Ability to handle multiple claims and prioritize effectively in a remote environment Familiarity with insurance policies and claims procedures is a plus Must have reliable internet and a quiet, dedicated workspace Perks & Benefits: 100% remote work flexibility Competitive hourly pay: $22 - $27 Paid training and professional development opportunities Flexible work hours, including evening and weekend options Opportunities for career growth in the insurance industry A supportive and team-oriented work environment

Requisition ID 2026-19752 Category Claims - Specialty Lines Type Regular Full-Time Amtrust Financial Services, a fast-growing commercial insurance company, is seeking a Complex Claim Specialist to support our Financial Institutions claim team. The successful candidate will evaluate coverage, assess risk transfer opportunities, analyze liability and damages, manage litigation, negotiate and ensure all files are appropriately reserved. This position reports to a line of business executive. Responsibilities Recognize exposures and ensure reserving is appropriate and timely Evaluate coverage issues and risk transfer opportunities Complete a thorough, independent investigation with an understanding and utilization of available resources to fill in any gaps in understanding, i.e. internet, PACER, experts, etc. Manage litigation by proper selection, planning, budgeting and partnership with counsel Exhibit strong negotiation skills Effectively communicate exposures both internally and externally Responsible for formulating proper resolution strategy to ensure best claim outcome The position will require periodic travel to attend meditations, trials and / or other related meetings Perform other duties as assigned Qualifications Minimum of 7+ years of experience in the handling of professional liability claims Proficient computer skills required to navigate our paperless claim file system Possesses a high level of technical claim skills and legal knowledge Excellent communication skills, both written and oral Easily adapts to changing situations, requirements and priorities Ability to effectively influence others without damaging relationships Skillful negotiator Ability to work in a fast paced environment Good time management skills JD / CPCU / RPLU designation preferred #LI-BL1 #AmTrust What We Offer AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off. AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities. AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future. Connect With Us! Not ready to apply? Connect with us for general consideration.

To examine, adjust, defend, claims and lawsuits against our insureds. Entails reviewing policies to determine coverage, resolving questions of coverage, investigating and making liability determinations, and evaluating damages such as property damage or medical records. Essential Duties and Responsibilities: Review and verify coverage for each claim, includes policy review and comparing to allegations made by the claimant. Issue timely coverage position letters. Conduct factual investigation directly or with the assistance of investigators. Review and analyze various documents such as contracts, leases, condo/co-op governing documents, the insured's business records, public records, medical records, property damage scopes, etc. Setting proper reserves timely; making a fair and prompt settlement determination Negotiate settlements. Follow all company and departmental protocols Direct defense counsel, monitor/review discovery. Make certain that all discovery, expert/IME, and motions are made timely and in accordance with the established defense strategy. Coordinate and assist defense counsel as requested. Maintain accurate and complete file notes. Maintain current and meaningful diary system. Participates in special projects and performs additional duties as required. QualificationsEducation and Experience: A bachelors degree required. CPCU, AIC, SCLA and other insurance professional designations preferred. 5+ years of experience handing premises liability claims required. 4+ years handling litigated files required. 4+ plus years experience and an understanding of NY Labor Law (if handling NY claims) required. Minimum 2 years experience in handling other complex claims such as wrongful death, mold, drownings, negligent security, etc. required. Must be well versed in handling litigated file in the state(s) they will be assigned to handle and must be able to direct defense counsel and think independently. Must be able to develop defense tactics and strategies. Familiarity with ImageRight and Guidewire a plus. Skills: Strong written and verbal communication skills required as well as good interpersonal, analytical and negotiation skills. Intellectual curiosity. A strong sense of urgency. Ability to establish relationships and rapport with insured's brokers, attorneys, etc. To be able to empathize with unrepresented claimants Other Requirements: Ability to travel occasionally, generally locally. Attain/maintain any licenses in states that require them if assigned to those states. The salary range for this role is $77,400-$141,400. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team. Associate - DCI (Disputes, Claims & Investigations), Wage & Hour Stout is seeking an Associate with 2-5 years of experience to join our Disputes, Claims & Investigations (DCI) Wage and Hour practice. This is a full-time role offering comprehensive benefits, a 401(k), and eligibility for annual bonuses. Stout brings deep expertise supporting clients in high-stakes business litigation and economic consulting matters. Associates work closely with experienced professionals and subject-matter experts to analyze complex data and deliver independent, thoughtful analyses. Impact You'll Make This role plays a critical part in delivering high-quality analytical support on complex wage and hour matters. Your work will directly contribute to successful client outcomes and the effectiveness of project teams. Execute and support complex data analyses related to wage and hour disputes and investigations. Contribute to the development of sound methodologies and analytical approaches that support defensible conclusions. Help ensure projects are completed on time, within scope, and with a high standard of quality. Build strong working relationships across project teams to drive collaboration and efficiency. Support client-facing deliverables that clearly communicate findings and insights. What You'll Do These responsibilities reflect the day-to-day work required to support engagements and achieve project objectives. Review, organize, and analyze large and complex datasets to support litigation and consulting engagements. Support multiple concurrent projects, anticipating scope, timing, and budget considerations. Assist in developing work plans, methodologies, and resource needs to optimize project outcomes. Collaborate closely with team members to meet deadlines and manage competing client expectations. Support written analyses, reports, and presentations prepared for clients and other stakeholders. Apply creative problem-solving techniques to manage risks and address analytical challenges. What You Bring This section outlines the qualifications and technical skills needed to succeed in the role. Bachelor's degree from an accredited college or university, preferably in Economics, Mathematics, or a related field. 2-5 years of experience in wage and hour consulting or a closely related field. Working knowledge of advanced data management and analytical tools such as SAS, SQL, STATA, R, or similar platforms. Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Access. Strong written and verbal communication skills with the ability to present complex information clearly. Demonstrated ability to manage multiple projects simultaneously and work effectively with cross-functional teams. How You'll Thrive These competencies and behaviors will help you excel and grow within Stout's collaborative culture. Maintain flexibility and adaptability in response to changing project requirements and timelines. Demonstrate strong organizational skills and rigorous attention to detail. Exhibit intellectual curiosity, self-motivation, and a commitment to quality control. Collaborate effectively with colleagues while managing competing priorities. Uphold Stout's core values and deliver Relentless Excellence in both client service and internal teamwork. Why Stout? At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life. We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve. We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals. Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives. Learn more about our benefits and commitment to your success. en/careers/benefits The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job. Stout is an Equal Employment Opportunity. All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law. Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $74,000.00 - $135,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.

Job DescriptionLocation: Brooklyn, NY Salary: $52K-$80KThe Billing and Claims Specialist is responsible for managing all aspects of billing, claims submission, and reimbursement for a home care agency serving patients under MLTC (Managed Long Term Care) plans and other insurance providers. This role ensures accurate and timely billing, compliance with payer requirements, and effective follow-up on claims to maximize reimbursement and minimize denials.Key Responsibilities for Billing/Claims Specialist: Billing & Claims Processing Prepare, submit, and track claims for MLTC plans, Medicaid, Medicare (if applicable), and commercial insurance Review authorizations, service hours, and eligibility prior to billing Ensure accurate coding and claim data in accordance with payer guidelines Process electronic and paper claims as required by payers Claims Follow-Up & Reconciliation Monitor claim status and follow up on unpaid, denied, or underpaid claims Investigate and resolve billing discrepancies and denials Submit corrected or resubmitted claims as needed Post payments, adjustments, and denials accurately into billing systems Reconcile remittance advice (EOBs/ERAs) with billed claims Authorization & Compliance Track MLTC authorizations, service limits, and expiration dates Ensure billing aligns with approved care plans and service authorizations Maintain compliance with Medicaid, MLTC, and insurance regulations Stay current on payer rule changes and billing requirements Qualifications for Billing/Claims Specialist: Required Minimum 2-3 years of billing and claims experience in home care, healthcare, or related setting Hands-on experience with MLTC billing and insurance claims Strong knowledge of Medicaid and managed care billing processes Proficiency with home care billing software and clearinghouses Excellent attention to detail and organizational skills

To handle claims associated with GNY Custom book and other select accounts from inception to closure. To assure that there are accurate reserve and expense controls are implemented. To focus on the early and fair disposition of cases. To coordinate with defense counsel to make sure that all cases are properly prepared for a potential trial. To assist underwriting and loss control in account reviews. Interact with insured and broker as often as may be required. Essential Duties and Responsibilities: Inception to closure claim handling of claims on assigned special accounts, including multi-state claim handling. Review and verify coverage for each claim, includes policy review and comparing to allegations made by the claimant. Issue timely coverage position letters. Conduct factual investigation directly or with the assistance of investigators. Review and analyze various documents such as contracts, leases, condo/co-op governing documents, the insured's business records, public records, medical records, property damage scopes, etc. Setting proper reserves timely; making a fair and prompt settlement determination. Negotiate settlements. Follow all company and departmental protocols. Direct defense counsel, monitor/review discovery. Maintain accurate and complete file notes. Maintain current and meaningful diary system. Participates in special projects and performs additional duties as required. QualificationsEducation and Experience: Bachelor's degree required. CPCU, AIC, SCLA and other insurance professional designations preferred. 4+ years of experience handing premises liability claims required. Advanced knowledge and understanding of NY Labor Law required. 2 years experience handling labor law claims preferred. Must have experience in handling other complex claims such as wrongful death, mold, drownings, negligent security, etc. Must be able to direct defense counsel and think independently. Must be able to develop defense tactics and strategies. Familiarity with ImageRight and Guidewire a plus. Skills: Strong written and verbal communication skills required as well as good interpersonal, analytical and negotiation skills. Strong customer focus skills with the ability to handle complex accounts. Intellectual curiosity. Strong sense of urgency Ability to establish relationships and rapport with insured's brokers, attorneys, etc. Ability to empathize with unrepresented claimants. Other Requirements: Ability to travel occasionally, generally locally Attain/maintain any licenses in states that require them if assigned to those states. The salary range for this role is $77,500-$141,400. The listed annual salary range posted for this position is subject to change and may vary depending on performance, education, experience, skills, geographic location, travel requirements, demonstrated proficiency in the competencies required for the role and business needs. Base pay is just one component of GNY's total compensation package for employees. Other rewards include eligibility for an annual discretionary bonus based on performance.