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Michigan Homeowners Claim Representative II
The Auto Club Group 4.2
Claim specialist job in Apex, NC
Michigan Homeowners Claim Representative II - AAA The Auto Club Group Reports to: Claim Manager IWhat you will do:
Work under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units, resolve coverage questions, take statements, and establish clear evaluation and resolution plans for claims.
Review assigned claims, contact the insured and other affected parties, set expectations for the remainder of the claim, and initiate documentation in the claim handling system.
Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss.
Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler.
Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
Evaluate the financial value of the loss.
Approve payments for the appropriate parties accordingly.
Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
Utilize strong negotiating skills.
Employees assigned to the Homeowner/CAT claim unit will handle claims generally valued between $5,000 and $25,000 (for the inside desk role) and up to $100,000 (for field role). Investigate claims requiring coverage analysis. When handling claims in the field, prepare damage estimates using claims software. Review estimates for accuracy. May monitor contractor repair status and update.
Supervisory Responsibilities:
None
How you will benefit:
A competitive annual salary between $64,000 - $72,000
ACG offers excellent and comprehensive benefits packages, including:
Medical, dental and vision benefits
401k Match
Paid parental leave and adoption assistance
Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays
Paid volunteer day annually
Tuition assistance program, professional certification reimbursement program and other professional development opportunities
AAA Membership
Discounts, perks, and rewards and much more
We're looking for candidates who:Required Qualifications (these are the minimum requirements to qualify) Education:
Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience in property adjusting
In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states
A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members.
Experience:
One year of experience or equivalent training in the following:
Negotiating claim settlements
Securing and evaluating evidence
Preparing manual and electronic estimates
Subrogation claims
Resolving coverage questions
Taking statements
Establishing clear evaluation and resolution plans for claims
Knowledge and Skills:
Advance knowledge of:
Essential Insurance Act (Michigan)
Fair Trade Practices Act as it relates to claims
Subrogation procedures and processes
Intercompany arbitration
Knowledge of building construction and repair techniques
Ability to:
Handle claims to the line Claim Handling Standards
Follow and apply ACG Claim policies, procedures and guidelines
Work within assigned ACG Claim systems including basic PC software
Perform basic claim file review and investigations
Demonstrate effective communication skills (verbal and written)
Demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns
Analyze and solve problems while demonstrating sound decision making skills
Prioritize claim related functions
Process time sensitive data and information from multiple sources
Manage time, organize and plan workload and responsibilities
Research, analyze, and interpret subrogation laws in various states
Strong negotiating skills
Ability to work outside normal business hours as needed
Preferred Qualifications:
Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
Xactimate software experience/training or experience in an equivalent software
Claims adjuster experience specifically in home/property claims preferred
Experience working within a customer service setting
Call center experience or experience handling high volume calls preferred, but not required
Excellent communication skills both oral and written
Experience working within an insurance or claims-based role for one year or more
Full claims cycle experience preferred
Work Environment
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit ***********
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
$64k-72k yearly 1d ago
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Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claim specialist job in Charlotte, NC
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.
$28k-35k yearly est. 2d ago
Onboarding Specialist
Octapharma Plasma, Inc. 3.8
Claim specialist job in Charlotte, NC
Octapharma Plasma offers professional opportunities that make a meaningful difference. We enhance the lives of patients who need our life-saving medicines. We reward the donors who provide the plasma we collect to make them. And we inspire growth and development in the teams at our donation centers, offices, and labs. We invite you to do the same in this role:
Onboarding Specialist
This Is What You'll Do:
Plan and coordinate the logistics of new employee onboarding, including scheduling and preparing materials.
Conduct orientation sessions to introduce new hires to the company's culture, values, policies and procedures.
Schedule and coordinate onboarding activities, providing guidance and support to new hires throughout the process.
Ensuring completion of paperwork and following all legal and administrative compliance when onboarding candidates.
Assist new hires with completing the necessary paperwork, including employee forms, benefits enrolment, and IT setup.
Processes I-9 and E-Verify requests.
Processes background checks and drug screens.
This Is Who You Are:
Excellent interpersonal skills, strong written and verbal communication skills.
Highly ambitious and ability to think outside of the box.
Eager to share new ideas and contribute to a team.
Self-motivated and willing to assume the initiative.
Attentive to every detail.
Capable of thriving while working independently.
This Is What It Takes:
2+ years of experience in onboarding and recruitment with a proven track record of successful onboarding processes and employee retention.
Strong knowledge of onboarding best practices, HR policies and procedures, and employment laws and regulations to ensure compliance during the onboarding process.
Strong organizational skills to manage and streamline the onboarding process efficiently.
Excellent communication and interpersonal skills to build rapport with new employees and establish a positive onboarding experience.
Attention to detail and organizational skills to coordinate and manage multiple onboarding processes simultaneously.
Adaptability and flexibility to accommodate the diverse needs and backgrounds of new employees.
Ability to collaborate and work effectively with remote team members with prior experience in corporate onboarding.
Proficiency in Microsoft Office Suite.
Proficiency in using HRIS systems and experience with different applicant tracking systems.
May require travel to assist field locations with recruitment.
We're widely known and respected for our benefits and for leadership that is supportive and hands-on.
Formal training
Outstanding plans for medical, dental, and vision insurance
Health savings account (HSA)
Employee assistance program (EAP)
Wellness program
401 (k) retirement plan
Paid time off
Company-paid holidays
Personal time
More About Octapharma Plasma, Inc.
With donation centers and team members throughout the U.S., Octapharma Plasma, Inc. collects plasma to create life-saving medicines for patients worldwide. We are growing at an impressive pace, and so is the positive impact of our work. Our community relies on teamwork, compassion, and expertise to get things done the right way, while making a meaningful difference in the lives we touch.
INNER SATISFACTION.
OUTSTANDING IMPACT.
$33k-58k yearly est. 4d ago
Outpatient Specialist - Denver
Biomerieux Inc. 4.7
Claim specialist job in Durham, NC
The Outpatient Specialist's main mission is to maintain and grow the current customer base while creating new opportunities through selling the BIOFIRE product line. This includes the sales of instruments, reagents and other services to drive increased adoption and market share within a defined geographical region. The Outpatient Specialist is directly responsible for achieving the territory sales goal through outpatient clinics affiliated with IDNs and clinics not affiliated with IDNs within their assigned territory. Additionally, the Outpatient Specialist will manage both direct sales as well as sales through our distribution partners to achieve high performance in the areas of customer satisfaction, revenue, and profitability.
Primary Responsibilities
Deliver effective sales call management, opportunity management, pipeline management and forecast accuracy.
Identify and establish relationships with key customers and opinion leaders within defined territory.
Establish and maintain relationships with our distribution partners to support and advance opportunities and closes.
Assess, clarify, validate, and quantify the customer's existing and unmet needs on an ongoing basis.
As a part of the Regional Sales team, the Outpatient-Market specialist will identify high value targets within assigned territory and develop strategies to close new business those accounts.
Maintain existing customer business to minimize lost business.
Work cooperatively in a matrix team and other colleagues to advance and close opportunities.
Serve as a liaison between the Outpatient market and Marketing. Channel competitive intel from the field to Marketing and participate as needed in marketing projects and new product launch request.
Identify key opinion leaders (KOLs) within defined territory.
Manage opportunity pipeline to ensure the timing of closes matches the monthly forecast as it is represented in our CRM tool and related dashboards.
Ensure the compliance of business activities meet the most stringent requirements of legal and ethical standards and current company policies.
Education and Experience
Associates degree and a minimum of 4 years of professional sales experience ORBachelors degree and a minimum of 2 years of professional sales experience required
Bachelors degree with 4 years of customer facing experience within the IVD market in lieu of professional sales experience will receive consideration.
Strong Knowledge of molecular biology technologies, techniques, and disciplines preferred.
In vitro diagnostic (IVD) capital equipment preferred.
Point-of-care (POC) sales experience preferred.
Distribution-sales experience preferred.
Knowledge, Skills, and Abilities
Business Skills
Functional skills including critical thinking, adaptability, time management, communication, problem-solving and digital literacy.
Leading without authority through influence and guidance of others towards a common goal by using expertise, persuasion, and personal qualities to inspire action.
Business acumen to understand how a business operates and how to make it successful.
Intellectual Horsepower
Effective and efficient problem analysis that leads to high-quality decisions.
Understand complex information and interpret it accurately, often requiring critical thinking and analysis to grasp the full picture.
Manage and meet competing deadlines, requiring careful prioritization and time management to ensure all tasks are completed on time.
Creating the New and Different
Influence change using skills and relationships to persuade others to adopt new ideas, behaviors, or processes.
Perspective to see the world from another person's viewpoint thus gaining new insights and finding creative solutions to challenges.
Effectively deal with ambiguity requiring adaptability, critical thinking, and proactive communication to navigate situations with limited details
Maintaining Focus
Make timely decisions by quickly choosing effective solutions in high-pressure situations for optimal outcomes
Priority setting that align with business objectives
Thriving in a fast-paced environment by managing tasks, multitasking, and adapting quickly to maintain productivity.
Getting Organized
Organizing work and resources efficiently to ensure smooth operations
Planning objectives and strategies to achieve them within a set timeline
Practicing time management to allocate tasks, balance priorities, and meet deadlines efficiently
Getting Work Done Through Others
Informing others by sharing clear, timely information to ensure alignment.
Managing and measuring work by tracking progress, performance, and goal achievement using metrics and KPIs.
Managing Work Processes
Collect and analyze data to drive informed decision-making to improve performance and identify issues
Dealing with Complex Situations Communicates instructions clearly and effectively
Demonstrates assertiveness and confidence in the face of a challenge
Conflict Management
Solution oriented in the face of conflict
Comfortable giving clear, direct, and actionable feedback
Ability to deal with difficult situations in a timely and bold manner
Focusing on the Bottom Line
Drive for Results: Drive for Results while successfully removing barriers
Action Oriented: Takes action even when facing challenges
Being Organizationally Savvy
Ability to cooperate with others at all levels including leadership
Ability to work cross-functionally allowing for better collaboration and communication when working across teams to achieve shared objectives
Communicating Effectively
Effective verbal communication skills
Written Communications - including the ability to communicate technical data in written form
Effective Presentation Skills - including the ability to present technical data
Relating Skills
Build and maintain positive, productive interactions with colleagues
Easily accessible and open to communication
Effectively navigate social interactions in the workplace
Developing and Inspiring Others
Reach mutually beneficial agreements through effective communication and compromise
Managing Diverse Relationships
Participate in a way that enhances team performance and cohesion.
Fosters a culture of inclusiveness among all team members
Acting with Honor and Being Open
Consistently uphold and reflects the core ethical principles and values that bio Merieux promotes
Actively and attentively listen to others, ensuring a clear understanding of their messages, needs, and concerns.
Emotional intelligence by having the ability to recognize, understand, and manage one's own emotions, as well as the emotions of others.
Maintain composure by having the skill of staying calm, focused, and professional in high-pressure or stressful situations.
Working Conditions and Physical Requirements
Ability to remain in stationary position, often standing, for prolonged periods.
Ability to ascend/descend stairs, ladders, ramps, and the like.
Ability to adjust or move objects up to 50 pounds in all directions.
Domestic travel required 70% of time
Location dependent the selected incumbent will be required to be masked while working in client locations for extended periods when on site in hospitals.
Ability to conduct client visits which entails the safe operation of motor vehicles, physically accessing customer facilities and frequent air travel in performance of assigned duties.
The estimated salary range for this role is between $87,700 - $140,000. This role is eligible to receive a variable annual bonus based on company, team, and individual performance per bio Merieux's bonus program. This range may differ from ranges offered for similar positions elsewhere in the country given differences in cost of living. Actual compensation within this range is determined based on the successful candidate's experience and will be presented in writing at the time of the offer.In addition, bio Merieux offers a competitive Total Rewards package that may include:
A choice of medical (including prescription), dental, and vision plans providing nationwide coverage and telemedicine options
Company-Provided Life and Accidental Death Insurance
Short and Long-Term Disability Insurance
Retirement Plan including a generous non-discretionary employer contribution and employer match.
Adoption Assistance
Wellness Programs
Employee Assistance Program
Commuter Benefits
Various voluntary benefit offerings
Discount programs
Parental leaves
#LI-US#biojobs
Please be aware that recruitment related scams are on the rise. Fraudulent job postings are being placed on other websites, and individuals posing as bio Merieux Talent Acquisition team members are reaching out via email or text message in an attempt to collect your personal and confidential information. In some cases, these scammers are also conducting bogus interviews prior to extending fraudulent offers of employment. Beware of individuals reaching out using general phone numbers and non-bio Merieux email domains (i.e. Hotmail.com, Gmail.com, Yahoo.com, etc.). If you are concerned that an interview experience or offer of employment might be a scam, please make sure you are searching for the posting on our careers site or contact us at [emailprotected].
BioMerieux Inc. and its affiliates are Equal Opportunity/Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Please be advised that the receipt of satisfactory responses to reference requests and the provision of satisfactory proof of an applicant's identity and legal authorization to work in the United States are required of all new hires. Any misrepresentation, falsification, or material omission may result in the failure to receive an offer, the retraction of an offer, or if already hired, dismissal. If you are a qualified individual with a disability, you may request a reasonable accommodation in BioMerieux's or its affiliates' application process by contacting us via telephone at , by email at [emailprotected], or by dialing 711 for access to Telecommunications Relay Services (TRS).
$87.7k-140k yearly 3d ago
Claims Specialist
Libra Solutions 4.3
Claim specialist job in Huntersville, NC
Job Description
When life gets hard, we make it easier! Libra Solutions helps overcome the burdens created by slow-moving legal processes. Combining technical innovation and financial strength, we help speed cumbersome workflows and ease financial barriers for our customers. And our companies are leaders in their industries! Oasis Financial is the largest and most recognized national brand in consumer legal funding. Oasis helps consumers awaiting legal settlements to move forward with their lives. MoveDocs is a personal injury solutions platform that integrates and streamlines medical, financial, and professional services for personal injury cases. Our mission is to improve outcomes for plaintiffs, accelerate settlements for attorneys, and ensure timely payment for providers. We are proud of our mission and passionate about applying technology to the challenge of making healthcare more accessible. We also are the leading inheritance funding provider through Probate Advance, helping heirs access their inheritance immediately, without the lengthy process of probate.
Together, under the Libra Solutions banner, we have relationships with over 40,000 attorneys and over 7,000 healthcare providers nationwide, which gives us an amazing platform to service our customers.
MoveDocs is seeking a ClaimsSpecialist to join our growing Operations team. The successful candidate will be highly motivated to deliver exceptional customer service to various parties within the medical and legal community. This position will function as the primary point of communication with our clients to stay up to date on existing cases and answer client questions. MoveDocs takes pride in providing excellent and expedient service to our clients and the qualified candidate must be self-motivated, able to work autonomously and enjoy working in a fast-paced, high-volume environment.
This role is located in our Huntersville, NC office.
Answers high volume of inbound calls from insurance companies, attorneys, clients and/or medical providers daily
Statuses cases to get updates on pending and ongoing case litigation and/or medical treatment.
Drafts correspondence to defense insurance companies and/or attorneys including demand letters, emails, and faxes
Delivers customer satisfaction through timely, accurate communications
Develops rapport with the attorneys, firms, insurance companies and medical providers
Requirements
High School or GED required
Experience in a high-volume call environment preferred
Knowledge or experience with personal injury, medical billing, or claims a plus
Previous claims and/or personal injury case manager experience preferred
Self-motivated with desire to build great relationships, and to meet and exceed goals
Ability to multitask while on the phone and the computer is a must
Able to adapt to change and pivot easily between tasks
Ability to work quickly and accurately to meet tight deadlines
Possess excellent verbal and written communication skills for communicating with insurance companies, attorneys, and medical providers
Basic computer proficiency and Outlook experience
Benefits
MoveDocs offers competitive compensation, benefits that include medical, dental, vision and life insurance plans, plus 401(k) with company match and paid time off.
$38k-67k yearly est. 8d ago
Complex Liability Claims Specialist - Commercial General Liability
Utica National Insurance Group 4.8
Claim specialist job in North Carolina
The Company
At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an “A” rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
Manage all claims in accordance with Utica National's established claim procedures.
Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability ClaimsSpecialist's individual monetary authority level.
Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
Achieve the service standard of “excellent” during all phases of claims handling.
Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
Four year degree or equivalent experience preferred.
Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
Proven experience negotiating claims and active participation in alternative dispute resolution practices.
Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $140,000
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
Medical and Prescription Drug Benefit
Dental Benefit
Vision Benefit
Life Insurance and Disability Benefits
401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
Health Savings Account (HSA)
Flexible Spending Accounts
Tuition Assistance, Training, and Professional Designations
Company-Paid Family Leave
Adoption/Surrogacy Assistance Benefit
Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
Student Loan Refinancing Services
Care.com Membership with Back-up Care, Senior Solutions
Business Travel Accident Insurance
Matching Gifts program
Paid Volunteer Day
Employee Referral Award Program
Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
$42k-64k yearly est. 41d ago
Associate VB Claims Specialist
Unum Group 4.4
Claim specialist job in Columbia, SC
When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
+ Award-winning culture
+ Inclusion and diversity as a priority
+ Performance Based Incentive Plans
+ Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
+ Generous PTO (including paid time to volunteer!)
+ Up to 9.5% 401(k) employer contribution
+ Mental health support
+ Career advancement opportunities
+ Student loan repayment options
+ Tuition reimbursement
+ Flexible work environments
**_*All the benefits listed above are subject to the terms of their individual Plans_** **.**
And that's just the beginning...
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!
**General Summary:**
Minimum starting hourly rate is $22.60
This is an entry level position within the Voluntary Benefits Claims Organization. This position is responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims in conjunction with providing technical expertise regarding applicable regulations. This position is responsible for providing excellent customer service and interacts on a regular basis with employees, employers, health care providers and other specialized internal resources.
Incumbents in this role are considered trainees and are assigned a formal mentor for 6-12 months until they are assessed as capable of independent work. Incumbents are primarily responsible for learning and developing the skills, knowledge, and behaviors necessary to successfully adjudicate assigned claims, in accordance with our claims philosophy and policies and procedures.
Incumbent must demonstrate the ability to effectively manage an assigned caseload, exercise discretion and independent judgment, and appropriately render timely claim decisions while demonstrating strong customer service prior to movement to the exempt level claimsspecialist role.
**Principal Duties and Responsibilities:**
+ Maintain organizational service standards on all assigned claims demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity.
+ Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including products, policies, procedures, and contracts.
+ Develop an understanding of the applicable contract/policy definitions and relevant provisions, clauses, exclusions, riders, and waivers, as well as regulatory and statutory requirements for claim products administered.
+ Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions, and benefits payee.
+ Develop problem solving skills by demonstrating analytical and logical thinking resulting in the timely and accurate adjudication of a variety of simple to complex voluntary benefits claims.
+ Develop a working knowledge of systems needed for claims adjudication.
+ Provide excellent customer service and independently respond to all inquiries within service guidelines.
+ Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (i.e., medical assessments, billing, etc.) as appropriate.
+ Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively communicate determinations while ensuring compliance with Voluntary Benefits procedures and all legal requirements including state regulations.
+ Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation, when appropriate.
+ Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business, ensuring a coordinated and continuous claims experience for customers.
+ Be familiar with specialized workflow requirements and performance standards for any assigned customers.
+ May perform other duties as assigned.
**Job Specifications:**
+ 4-year degree preferred or equivalent work experience
+ Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience
+ Medical background, voluntary benefits claims and/or disability management experience preferred
+ Possess strong analytical, critical thinking, and problem-solving skills
+ Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decision and ongoing medical management.
+ Able to effectively utilize a broad spectrum of resources, materials, and tools needed to assist with the decision-making process
+ Strong service and quality orientation.
+ Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc.
+ Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness.
+ Excellent communication skills, written and verbal
+ Meets the standards for this position, as defined in the Talent Management framework
~IN3
\#LI-LM2022
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$40,000.00-$75,600.00
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.
Company:
Unum
$40k-75.6k yearly 6d ago
Claims Specialist
Primeritus Financial Services 4.4
Claim specialist job in Raleigh, NC
Primeritus Financial Services is a national leader in repossession management, remarketing, skip tracing, and title services for the automotive finance industry across the United States and Puerto Rico. We provide our clients with comprehensive, outsourced solutions that combine a nationwide network of certified recovery agents, advanced investigative techniques, and a commitment to compliance and customer service. Our approach ensures that collateral is located, recovered, and remarketed quickly, efficiently, and professionally.
As a ClaimsSpecialist, you will be responsible for gathering, investigating, and analyzing information related to automotive damage claims arising from the repossession, transportation, or storage process. You will work directly with clients, vendors, and consumers to facilitate timely resolutions, ensure compliance with applicable laws and company standards, and maintain the integrity of the claims process, the company and its clients. This position requires excellent communication and organizational skills, sound judgment, and the ability to work effectively in a fast-paced, detail-oriented environment. The ClaimsSpecialist will serve as a key point of contact throughout the life cycle of a claim and contribute to the overall quality and accountability of our service delivery. This is a full-time, in-office HYBRID position based in our Raleigh, NC office. Key Responsibilities
Collaborate with internal teams, clients, vendors (recovery agents), and consumers to collect necessary information for claim investigations.
Analyze documentation and supporting evidence to determine claim validity and assist in recommending resolution strategies.
Draft clear and professional communications, including denial letters and settlement agreements, for review by the Claims Manager.
Guide consumers through the formal claims process via inbound calls, providing excellent customer service and maintaining professionalism under pressure.
Maintain accurate records in claims tracking systems, ensuring up-to-date case statuses and documentation.
Support compliance efforts by coordinating with the Vendor Relations team on agent-related concerns.
Conduct audits to ensure vendor and internal adherence to claims policies, industry regulations, and company procedures.
Stay informed on business operations and privacy/security protocols to ensure accurate and compliant claims handling.
Perform other duties as assigned to support the Claims team and company objectives.
Required Qualifications
High School Diploma or equivalent required; Associate's or Bachelor's degree preferred.
3-5 years of administrative experience required; prior experience in claims handling, insurance, repossession, or related industries preferred.
Strong interpersonal and written communication skills with the ability to manage sensitive conversations professionally.
High level of confidentiality, discretion, and sound judgment.
Proficient in Microsoft Office Suite and general office software.
Ability to multitask, prioritize work, and manage time effectively in a deadline-driven environment.
Why Primeritus?
Join a collaborative and growing organization at the forefront of the automotive finance recovery industry. At Primeritus, you'll have the opportunity to make a meaningful impact while working with a team that values accountability, respect, and continuous improvement. Equal Opportunity Employer
Primeritus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, pregnancy, national origin, age, veteran status, or disability status.
$40k-70k yearly est. 1d ago
Inventory Claim Specialist
Kioti Tractor
Claim specialist job in Wendell, NC
Job Description
Inventory Claims Coordinator
Department:
Warehouse Operations - 171032
Reports to:
Inventory Supervisor
Full-time
Status:
Hourly, Non-Exempt
Management Level:
Non-Management
JOB SUMMARY
The Inventory Claims Coordinator serves as a support element and liaison for all distribution centers and the dealer network. This person will be cross trained and gain exposure to many functions including claims processing, inventory investigations, dealer network relationship building and recording claim data.
KEY RESPONSIBILITIES OF JOB
The Inventory Claims Coordinator key responsibilities are outlined below:
Claims:
Resolve and process claim disputes
Technical drawing look-up
Inventory background investigations
Credit and Debit process on claim investigations
Issuing and monitoring call tags
Resolve and process freight claim disputes and tracking reimbursement if applicable
Inventory Management
Provide inventory control reporting and vendor reports
Track claim data and communicate common themes for mitigation
Directly or indirectly locate misplaced parts to help satisfy sale to customer/dealer
Help maintain or relay proper product identification and location accuracy and ability to transfer product to correct location if needed
Other Responsibilities
Determine and record data for KPI's
Promote dealer satisfaction utilizing customer service skills
EDUCATIONAL AND PHYSICAL REQUIREMENTS
High school diploma or GED equivalent required with minimum of 3 years' related experience
Associate or Bachelor degree with a minimum of 1 year experience
1-5 Years of related customer service or inventory experience.
Must be a team player with strong interpersonal communication skills
Good time-management skills and attention to detail
Outstanding written and oral communication skills with the ability to effectively present information
Proficiency in Microsoft programs, including Excel, a plus
SAP experience preferred
SalesForce experience preferred
$31k-55k yearly est. 6d ago
Insurance Claims Specialist
National Ondemand
Claim specialist job in Burlington, NC
National OnDemand, Inc. is a communications and utilities infrastructure provider delivering service solutions to the Fiber, Wireless, Energy and Technology sectors in the United States. Headquartered in Burlington, North Carolina, the Company provides full turnkey infrastructure solutions - on demand, anywhere across its service footprint and has secured and sustained its current standing in the market through the successful completion of mergers and acquisitions, along with demonstrable, steady organic growth.
Under the supervision Insurance Claims Manager, coordinate and administer workers' compensation program, automotive, property and casualty claims.
Primary Position Duties:
* Process and document all worker's compensation claims and property & casualty claims, ensuring compliance with relevant policies, procedures, and legislation.
* Serve as liaison with external agencies and regulatory bodies in the claims administration and the care and disposition of claimants.
* In coordination with the Insurance Claims Manager, evaluate property and casualty claims to determine liability, damage and exposure.
* Elevate to the Insurance Claims Manager larger, more complex claims.
* Assist the Insurance Claims Manager, the Senior Director of EHS & Compliance, Human Resources, and Legal, in third-party claims, including negotiations and settlement when required.
* Reviews and evaluates all work-related accident reports for completeness and clarity of data; analyzes data, as needed, to ensure compliance with policy and regulatory requirements.
* Determines appropriateness and amount of worker's compensation claims; investigates individual claims for eligibility for workers' compensation benefits; ensures that all legal and procedural requirements are met for the processing of claims to ensure proper and timely payment to employees and medical facilities.
* Provide authoritative advice and counsel to organizational leadership on interpreting and applying for worker's compensation and property & casualty policies, legislation, regulations, and processes.
* Liaison with the organization's insurance broker and providers.
* Coordinates and participates in strategic planning aimed at reducing the incidence of worker's compensation-related injuries.
* Assembles appropriate medical information and facts regarding claims for cases pending litigation; participates in the Workers' Compensation Administration mediation and formal hearings.
* Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts and to facilitate either return to work, job restrictions or, depending upon the medical status of the claimant, placement into appropriate alternative positions, ensuring compliance with all appropriate regulations and guidelines.
* Updates organizational leadership on employees' return to full duty status.
* Prepares all necessary forms, records and documentation, including statistical analyses and reports, for all claims, as required by various regulatory agencies.
* Makes recommendations for reducing the frequency and severity of losses using a workers' compensation database and/or other claims data reports; designs and develops databases; performs integrated data analyses and prepares reports.
* Process assigned property and casualty claims and performed other job-related duties as assigned.
* Claims support during Emergency Events.
* Assist EHS & Compliance Administrator as needed.
* Assists the Director of EHS & Risk in developing policies and procedures to reduce risk.
* Performs miscellaneous job-related duties as assigned.
Position Requirements:
* Access-only office environment with reasonable heating and cooling.
* The position will be at a computer workstation much of the time.
* Ability to work extended or irregular hours/days (nights and weekends)
* Prolonged sitting at a computer workstation performing repetitive tasks.
* Ability to occasionally lift, push, or pull up to 25 lbs.
* Must have reliable transportation and a valid driver's license.
* Ability to travel 10% of the time.
Education or Skills:
* Bachelor's Degree in Business Administration; at least four years of directly related experience in claims adjusting, investigations, litigation and/or risk management.
* Completed degree(s) from an accredited institution.
* One or more certifications - Certified Medical Insurance Specialist (CMIS), Certified Risk Insurance Specialist (CRIS), Transportation Risk Insurance Professional (TRIP), Associate in Claims (AIC), or Associate in General Insurance (AINS).
* 4 years of experience in risk management handling various claims processes.
* Ability to liaison with insurance carriers professionally.
* Ability to work independently or with a team at all levels of the organization.
* Ability to maintain confidentiality.
* Ability to professionally represent the organization.
Benefits:
This is a full time position with access to our comprehensive benefits which include paid time off (PTO), medical, dental, vision, short- and long-term disability, and life insurance, an Employee Assistance Program (EAP), and 401(k).
EQUAL OPPORTUNITY EMPLOYER:
NATIONAL OnDemand, Inc. is an equal opportunity employer. The company's policy does not discriminate against any applicant or employee based on race, gender, sex, sexual orientation, gender identity, color, religion, national origin, disability, genetic information, age, veteran status or any other consideration made unlawful by applicable federal, state or local laws. NATIONAL OnDemand, Inc. prohibits harassment of applicants and employees based on any of these protected categories.
$31k-54k yearly est. 13d ago
Billing Procedure Claims Specialist
Summit Spine and Joint Centers
Claim specialist job in North Carolina
Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty-three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard-working Claims Processor who can join our growing team of professionals. Job Duties:
Audits and ensure claim information is complete and accurate.
claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
Ensures accurate and timely billing of HCFA 1500 claims.
Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.).
Creates logs for providers of pending medical encounters and or encounters with errors.
Work directly with other billing staff and management to meet end of month closing deadlines.
Able to work with clearinghouse rejections, print, and mail secondaries.
Address inquiries from insurance companies, patients, and providers.
Understands CPT, ICD10, HCPCS coding and modifiers.
Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc.
Knowledge of ERAs, EOBs
Knowledge of payer specific/LCD guidelines
Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification
Must be proficient with spreadsheets and word processing applications.
Qualifications:
Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting
Experience with Medicare, Medicaid, Commercial insurance plans, Workers' comp, and Personal Injury cases.
Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management
Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials.
Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required.
Excellent computer skills and familiarity with Microsoft Office
Comfortable working in a growing, dynamic organization and able to navigate change.
Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment.
Bachelor's degree preferred.
Experience using eClinicalWorks preferred.
Experience with high level procedure billing and coding for Pain Management preferred
The position is full time with competitive salary, PTO, health benefits and 401k match. The ideal candidate will be located in Georgia and able to be present at our administrative office, or near Austin, Texas where other members of the billing team are located.
$31k-54k yearly est. 31d ago
Claims Specialist
Capsigna
Claim specialist job in Charlotte, NC
Responsibilities: Processing fast paced inbound customer service calls. Taking inbound calls from clients Providers, Consumers and Insurance companies regarding medical billing. Resubmitting claims, and answering questions regarding benefits Demonstrates excellent customer service skills with the ability to take ownership in assisting, researching and resolving customer issues.
Performs other duties as assigned.
Requirements
Previous Call Center or Customer Service experience preferred.
Ability to develop rapport and demonstrate a caring attitude.
Clear, distinct oral and written communication skills.
Must be detail oriented.
$30k-54k yearly est. 60d+ ago
Ambulatory Claims Analyst Specialist (72255)
Onslow Memorial Hospital 4.0
Claim specialist job in Jacksonville, NC
Responsible for the billing, review and follow-up of all outstanding patient clinic accounts. This includes but is not limited to timely review of Patient Accounting Desktop, Clearinghouse billing list and Intermediary on line error list. Contact insurance companies and patients, filing primary, secondary and tertiary insurance, re-bills, and review payment remittance. Review line item denials and claim rejections for possible appeal and/or research for resubmission. Be proficient in the use of multiple payer software systems. The knowledge of billing codes including CPT, ICD9, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits and claim formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payers to ensure maximum cash flow. May be required to work overtime if needed.
Qualifications
Education:
High School graduate or recognized equivalent GED.
Experience:
Two years of specialized training in billing and follow up procedures.
At least one year relevant experience in a physician based business office setting preferred.
$32k-66k yearly est. 10d ago
Claims Specialist
PRG 4.4
Claim specialist job in Charlotte, NC
Project Resources Group (PRG) is seeking a Claims Recovery Specialist for our Charlotte, NC office. Be part of our expanding team focused on recovering third-party property and utility damage claims, primarily in a B2B setting. We're looking for motivated, detail-oriented professionals with strong negotiation skills. Experience in collections or insurance adjusting is highly relevant and transferable. We offer a competitive base salary plus commission. Key Responsibilities
Resolve and negotiate claims recovery of repair and replacement costs on third-party cable/fiber and utility damages across multiple state lines, via phone, email, and letters.
Work directly with liable parties' insurance providers to defend and negotiate claims settlements.
Collaborate with claims departments and management of liable parties, from small businesses to large corporations to municipalities.
Learn, understand, and be able to utilize state dig laws and statutes, 811 excavator requirements, NESC standards, CGA guidelines, etc.
Develop a professional working relationship with damaging parties, on-site field investigators, management, and other personnel.
Conduct 40-50 inbound/outbound calls daily, approximately 2-2.5 hours of total talk time throughout the day.
Enter notes and documentation throughout the recovery process into the company's proprietary Claims Database Tool.
Use a calendar and diary system to coordinate handling claims to be worked twice weekly.
Follow advanced claim handling procedures as detailed by the OPD Claims Manager.
Use photographs, narratives, job costs, site sketches, locate tickets, and other components on-site field investigators provide to visualize and understand the damage scene to defend liability accurately.
Participate in weekly department meetings to discuss individual and team recovery tactics, strategies, and goals.
Maintain a working knowledge of the entire PRG claims recovery process.
Preferred Qualifications
Strong proficiency in Microsoft Word, Outlook, and Excel.
Tech-savvy with the ability to quickly adapt to new software and systems.
Excellent written and verbal communication skills, with an emphasis on professional phone and email correspondence.
Familiarity with the construction, cable, or utility locate industries is advantageous.
Understanding of B2B construction, claims management, recovery, or insurance claim negotiation and settlement processes is preferred.
Ideally, 3-5 years of experience in claims, recovery, and/or the insurance industry.
College education is preferred.
Bilingual in Spanish is a plus.
Compensation and BenefitsWe offer a competitive hourly pay ($19-$23/hour based on experience), plus the potential to earn substantial commissions up to $4,000-$10,000 monthly based on performance. Along with a comprehensive benefits package, including:
Medical, dental, and vision coverage for employees and dependents
401(k) retirement plan, with company match after 1 year
Short-term disability coverage after 1 year
Paid time off and holidays
Additional perks such as company-paid life insurance, and other supplemental insurances available
About PRG
Since 2001, PRG has been a leader in construction management and outside plant damage recovery for the telecommunications and utility industries. With 20+ offices and 800+ employees nationwide, we deliver industry-leading solutions with speed, accuracy, and expertise.
Equal Opportunity EmployerPRG is proud to be an Equal Opportunity Employer. PRG does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state, or local law and ordinances.
$19-23 hourly Auto-Apply 13d ago
Public Adjuster
The Misch Group
Claim specialist job in Charlotte, NC
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
Claims Processor I - PGBA-27
Bluecross Blueshield of South Carolina 4.6
Claim specialist job in Florence, SC
Logistics: PGBA- one of BlueCross BlueShield's South Carolina subsidiary companies
Location: This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. It may be necessary, given the business need to work occasional overtime. The role is located on-site at 200 N Dozier Blvd., Florence, SC 29501.
Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act
(
SCA
).
To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.
What You'll Do:
Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.
To Qualify for This Position, You'll Need the Following:
Required Education: High School Diploma or equivalent
Required Skills and Abilities:
Strong analytical, organizational and customer service skills.
Strong oral and written communication skills.
Proficient spelling, punctuation and grammar skills.
Good judgment skills.
Basic business math skills.
Required Software and Tools: Basic office equipment.
We Prefer That You Have the Following:
Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment.
Preferred Skills and Abilities: Ability to use complex mathematical calculations.
Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software. Proficient in word processing and spreadsheet applications.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
$33k-52k yearly est. Auto-Apply 5d ago
Independent Insurance Claims Adjuster in Camp Lejeune, North Carolina
Milehigh Adjusters Houston
Claim specialist job in Jacksonville, NC
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement.
Why This Opportunity Matters:
With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand.
As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation.
Join Our Team:
Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt?
If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster.
You're welcome to sign up on our jobs roster if you meet our guidelines.
How We Can Help You Succeed:
At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting.
Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges.
Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals.
Seize the Opportunity Today!
Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews.
You can also find us on YouTube at: (*********************************************************
and Facebook at: (************************************************** for additional resources and updates.
APPLY HERE
#AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston
By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.
$42k-52k yearly est. Auto-Apply 60d+ ago
Claims Processing Expert
The Strickland Group 3.7
Claim specialist job in Raleigh, NC
Join Our Dynamic Insurance Team - Unlock Your Potential!
Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential.
NOW HIRING:
✅ Licensed Life & Health Agents
✅ Unlicensed Individuals (We'll guide you through the licensing process!)
We're looking for our next leaders-those who want to build a career or an impactful part-time income stream.
Is This You?
✔ Willing to work hard and commit for long-term success?
✔ Ready to invest in yourself and your business?
✔ Self-motivated and disciplined, even when no one is watching?
✔ Coachable and eager to learn?
✔ Interested in a business that is both recession- and pandemic-proof?
If you answered YES to any of these, keep reading!
Why Choose Us?
💼 Work from anywhere - full-time or part-time, set your own schedule.
💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month.
📈 No cold calling - You'll only assist individuals who have already requested help.
❌ No sales quotas, no pressure, no pushy tactics.
🧑 🏫 World-class training & mentorship - Learn directly from top agents.
🎯 Daily pay from the insurance carriers you work with.
🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary
🏆 Ownership opportunities - Build your own agency (if desired).
🏥 Health insurance available for qualified agents.
🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom.
👉 Apply today and start your journey in financial services!
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Results may vary. Your success depends on effort, skill, and commitment to training and sales systems.
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$27k-34k yearly est. Auto-Apply 60d+ ago
Liability Adjuster
HDVI
Claim specialist job in Anderson, SC
What we do High Definition Vehicle Insurance (HDVI): Technology meets Insurance. HDVI brings telematics, software and data together with commercial trucking insurance, taking transportation insurance and fleet risk management to the next level. Our platform arms fleets with an end-to-end solution that empowers them to save money, mitigate risk, and increase operational efficiencies. Our customers are small to midsize truck fleet operators who benefit from dynamic and transparent pricing - automatically reducing their premiums for safer driving. Leveraging a best-in-class partner ecosystem, HDVI combines magnitude and stability with innovation to revolutionize the commercial trucking insurance space. Why work here HDVI is building the industry defining commercial auto insurance company for the next 100 years. The $50 billion commercial auto industry hasn't seen real innovation for decades and is broken in a number of ways, creating a significant opportunity for HDVI. HDVI is co-founded by a former Esurance co-founder, and has a senior management team with experience building innovative insurance and logistics companies from zero to $1B+ enterprises, and deep expertise in trucking insurance. HDVI is well-funded by leading logistics and mobility-focused venture capital firms and strategic investors including Munich Re, Daimler Trucks and Qualcomm. The HDVI Team is values-driven, data-driven, ambitious, and collaboratively minded with a diverse background of experiences and skills in the insurance and logistics industries. We like challenges and building solutions that improve the quality of life for our customers. We offer generous benefits, including employee stock options, health, dental, vision, 401k, flexible work environment, and unlimited PTO.
About the RoleAs a Liability Adjuster, you will work closely with HDVI's Claims and Fleet Services Teams. The ideal candidate will have extensive knowledge of handling all aspects of Commercial Trucking claims inclusive of but not limited to Third Party Bodily Injury, Third Party Auto Property Damage, First Party Auto Property Damage, Cargo, Truckers General Liability and First Party Medical. You will be responsible for influencing and providing claim resolution and tactical guidance to both internal and external customers in order to achieve world class claims outcomes. The Liability Adjuster role is an associate level position with senior level growth potential as the company expands. What You'll Do
Responsible for the handling First and Third Party Property Damage, and Cargo and Third Party Bodily Injury claims stemming from accidents involving tractor-trailers
Engage with various internal and external partners to drive resolution on high-severity matters that are identified
Be adaptable to various business demands and willing to assist with special claims projects and other duties as assigned
Participate in regular claims reviews with both internal and external customers
Maintain current knowledge of insurance contracts and industry trends by proactively maintaining required adjuster license(s)
Provide technical expertise in response to inquiries from internal and external customers
3+ years experience with handling complex Commercial Trucking claims
Extensive experience across all technical areas of Commercial Auto inclusive of but not limited to Physical Damage, Auto Liability, First Party Medical / Personal Injury Protection and Motor Truck Cargo
Extensive experience with analyzing, determining and applying Coverage for Commercial Auto claims
Advanced experience and capabilities in litigation claims management, including ADR and mediation processes involving Commercial Auto exposures
Experience attending and controlling cases at mediations/settlement conferences, pre-suit, post suit, pretrial and post-trial
Ability to work in a rapidly evolving, high-growth environment with the ability to collaborate across and within different levels of the organization
Experience with large Fleets (250+) with self-insured retentions and/or large deductibles
Excellent communication skills (verbal/written) and strong negotiation skills
Strong time management, organizational and problem-solving skills
Ability to adapt, embrace the unknown and shift priorities
Willingness to look outside your day to day to ensure you keep learning and growing in a startup environment
Preferred Skills
College Education
Active Adjusters License - strongly preferred
Strong analytical, critical thinking, and problem-solving skills
Proficiency in Google Suite, Microsoft Office and Adobe Acrobat
Experience with self-insured retention (SIR), large deductibles and claims involving Independent Owner Operators (IOO)
Benefits
Competitive salary & stock options - we want our success to be yours too
Unlimited PTO with 11 paid holidays each year
Medical, Dental, Vision, Short/Long Term Disability, Basic Life, and AD&D to support you and your well-being
FSA / HSA programs
401(k) retirement plan with company match contribution
Inclusive Parental Leave policy that supports all parents
Wednesdays are standing meeting-free, allowing you to focus on deep work without distractions
Birthday meal reimbursement, because celebrating our employees is part of our company culture
A remote-friendly environment with the opportunity to participate in periodic in-person team offsites
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
$37k-50k yearly est. Auto-Apply 60d+ ago
Plant/Manufacturing - Adjuster
Schwarz Partners 3.9
Claim specialist job in Pineville, NC
STS Packaging, a Schwarz Partners, L.P. Joint Venture company, is currently seeking an Adjuster in Charlotte, NC. The primary responsibility of the Adjuster is to serve as the technical and operational leader for a designated group of bag machines. Duties focus on safety, operational efficiencies, machine uptime, instruction and guidance to the group operators, reporting and the overall performance of the machine group/shift. This position is located at 1201 Westinghouse Blvd in Charlotte, NC. 28273
ESSENTIAL JOB FUNCTIONS FOR THIS POSITION
Proven experience in operating a bag machine per production standards and output
Actively check bag quality (both for defects and predictive changes to bag attributes)
Maintain machine - Make comprehensive machine adjustments and lead major machine adjustments effort as needed to ensure quality and efficiency - See position tier levels for specific tasks
Keep machine running at optimal speeds
Interact, train and mentor all employees within the machine group
Maintain cleanliness of machine group and work area
Convey to the Production Superintendent any pending or current conditions that may impede the output of the machine group.
Oversee the accurate, complete documentation of daily shift paperwork
Perform any and all job assignments/functions as necessary to daily business demands as instructed by Management.
Lead PM activities (via dedicated or rotating schedule)
Maintain a positive, instructive attitude every day to foster employee job satisfaction
Technical Duties Include:
Effectively manage the machine group's performance (all operators)
Maximize uptime through optimal adjustments and time-efficient repair of machine during breakdowns
Mentor group Operators and Adjuster Trainees
Act as the area leader for meeting/exceeding production standards
OTHER SIGNIFICANTJOB FUNCTIONS INCLUDE
Maintains a clean and safe work area and reports unsafe conditions to management for resolution
Adheres to all safety policies, including always wearing required PPE, and sets an example to others for model safety behavior
Detailed understanding of quality defects, including how to detect as well as what to do if observed
Conform to Good Manufacturing Practices (GMP's), and Safe Quality Food (SQF) procedures and policies to assure products are suitable for food contact
Responsible for reporting any product quality or food safety issues to the Quality Manager (SQF Practitioner) or Management Team member
Additional duties as assigned by Production Superintendent
REQUIRED EDUCATION / EXPERIENCE
High School Diploma minimum required
Leadership skills and ability to work as an independent thinker
Proven team-oriented mindset
REQUIRED SKILLS (TECHNICAL, CLERICAL, LANGUAGE, ETC.)
Must follow Safety/GMP/PPE guidelines
Ability to work beyond 8-hour shifts as needed and participate in weekend PM and maintenance efforts as needed; Days of work may be shifted to accommodate a 5 day work week
Production-focused
Take direction from Production Superintendent/General Manager
High level of machine and mechanical knowledge
Read and understand instructions and job information
Excellent math and writing abilities
Desire to accept additional responsibility and learn new tasks
LANGUAGE SKILLS
Fluent in English required
Fluency in Spanish a plus
PHYSICAL DEMANDS
Continuous standing and walking with minimal sitting.
Able to bend, twist, kneel, crawl, and lay down on floor during cleanup/startup of machine - involves frequent, constant, continuous, and repetitious motions
Frequent lifting overhead & carrying of cases that can weigh in excess of 35-lbs
Frequent, regular pushing and pulling of paper rolls in excess of 1,500-lbs
Frequent ladder and stair climbing
WORK ENVIRONMENT
Standard production/manufacturing environment; Plants can be hot noisy, exhibit vibrations have, uneven surfaces mechanical hazards, dust/dirt, odor/fumes; work performed inside.
OTHER INFORMATION
Personal Protective Equipment required for the job: Steel toe shoes, hearing protection, safety glasses, hair nets
Steel toe shoes are provided by employee, all other tools provided by employer
If you would like to be part of a forward-thinking team with a family feel, culture of excellence, and customer-focused reliability, we want you to be a part of our team!
Our organization is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
How much does a claim specialist earn in Wilmington, NC?
The average claim specialist in Wilmington, NC earns between $24,000 and $71,000 annually. This compares to the national average claim specialist range of $27,000 to $67,000.