Claim specialist jobs in Wisconsin

Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers exciting openings for Workers Compensation Claims Specialists within the Central Region! As a Workers Compensation Claims Specialist, the successful candidate will join a dedicated Claims Team, utilizing the latest technology to manage a caseload of routine to moderately complex claims. Responsibilities include investigating claims, assessing liability and compensability, evaluating losses, and negotiating settlements. The role involves interactions with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in February 2026. This position may be filled as a Workers Compensation Associate Claims Specialist, Workers Compensation Claims Specialist I, or a Workers Compensation Claims Specialist II. The salary range posted reflects the range for the varying pay scale across various locations. To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, and Virginia are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change. Responsibilities * Manages an inventory of claims to evaluate compensability/liability. * Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. * Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. * Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. * Evaluates actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. * Performs other duties as assigned. Qualifications * Effective interpersonal, analytical and negotiation abilities required * Ability to provide information in a clear, concise manner with an appropriate level of detail * Demonstrated ability to build and maintain effective relationships * Demonstrated success in a professional environment; success in a customer service/retail environment preferred * Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent * Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory * Licensing may be required in some states About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices * California * Los Angeles Incorporated * Los Angeles Unincorporated * Philadelphia * San Francisco

Please note, employment offered to residents in the following states only: Connecticut, Delaware, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont. At Preferred, we understand the importance of holistic health. To meet the diverse needs of our employees, we offer a comprehensive set of benefits: Financial * Short-term disability, long-term disability, and life insurance coverage are provided at no cost * Optional benefits include enhanced life insurance and critical illness plans * 401k plan with an employer contribution that you will receive regardless of your own contribution to the plan * A cash-balance pension plan * Student Loan Repayment Assistance * A short-term incentive plan for all employees Social * Generous paid time off, offering of 25 days at hire (prorated based on start date for the first year) * 7 days of paid sick leave * 10 paid company holidays * Personalized paid time off after 3 years! Emotional * Access to 26 sessions with a BetterHelp therapist each year for you and up to 5 dependents, as well as access to all of BetterHelps group and digital resources * Access to Family First, a team of care experts who can provide you and your loved ones 1:1 assistance with a variety of caregiving solutions, from elder care to legal and financial challenges, insurance and Medicare navigation, and more! Physical * Medical, dental, and vision coverage options begin on the first day of employment * Health Savings Accounts (with a generous employer contribution!) YOUR PURPOSE AND FUNCTION IN OUR COMPANY: Alleviate the impact of adversity during challenging life events by the prompt investigation and resolution of claims. Supports and contributes to the Claims Department and Companys missions, visions, values, and goals. KEY CAPABILITIES FOR SUCCESS: * Evaluate files for the accurate and timely reserving of claims in accordance with the Preferred Mutual reserving philosophy. * Appropriately manage indemnity and loss expenses. * Conduct thorough and timely investigation to determine liability and claim valuation. * Treat customers in a proactive and responsible manner * Adjust schedule as needed to accommodate customer needs and/or fluctuations in work volume. * Leverage technology as a critical component in achieving efficiencies and delivering superior customer service. * Handle claims of moderate severity and complexity, with authority up to $45,000 * Display an understanding of avenues of contribution and recovery by third parties and takes appropriate action when necessary. * Resolve claims promptly and fairly in a manner that is reflective of coverage, liability, and damages. * Demonstrate an understanding of claim procedures and file administration for proper file documentation and claim reporting. * Demonstrate an understanding of products and coverages offered by Preferred Mutual; * Meet file quality standards as determined by internal and external audits. * Maintain work load in accordance with Key Performance Driver standards. * Develop an understanding of fraud indicators. * Recognize Key data points within the claim management and other systems and utilizes the data to make informed decisions and reach better claim resolutions. FUNCTIONAL AREA RESPONSIBILITIES: * Handles low to moderately complex losses, including liability exposures, with a focus on soundness and promptness of coverage and liability investigation and verification * Demonstrates independent and effective analysis and decision making when a scenario is not new * Demonstrate a developed understanding of the policies with an ability to identify coverage concerns & red flags independently * Researches then seeks help when a situation is new or complex * Displays a high quality of damages verification and negotiation; subrogation investigation and preservation * Demonstrates soundness and timeliness of liability and coverage denials * Displays effective expense management and accurate file reserving * Able to draft appropriate coverage letters/communications to customers with some intervention * Demonstrates willingness to lead and direct their files with less oversight needed QUALIFICATIONS: * High School Diploma or Equivalent * Bachelor's degree preferred * 2 or more years of experience in claim processing * Progress toward attaining one professional designation preferred (i.e., AIC, CPCU, SCLA). * Exceptional active listening skills paired with effective oral and written communication skills. * Make timely, definitive, and fact driven decisions. * Strong time and project management skills that support continued process improvement. * Skilled at collaboration, group decision making, problem solving and negotiation. Pursues duties and interactions with integrity. * Proficient in technology platforms utilized by Preferred Mutual (including but not limited to Windows, Microsoft Office Suite, Outlook, and Internet-based applications). ABOUT US: As a mutual company, we are independent by nature, so we think about insurance solutions a little differently. Through listening, problem solving, examining your challenges and collaborating on the right solutions for you, Preferred Mutual independent agents provide flexible solutions and adapt to your evolving needs. We do the same for our employees. We are process and domain experts, focused on the solutions that deliver results for our clients and our company. We offer a great work environment, professional development, challenging careers, and competitive compensation. With Preferred, there are no surprises. You can count on us to deliver on our promises and be there when you need us, as your insurance provider and your employer. Preferred Mutual is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law. DISCLAIMER: This role (job) description indicates in general terms, the type and level of work performed as well as the typical responsibilities of employees in this classification. The duties described are not to be interpreted as being all-inclusive to any specific employee. Management reserves the rights to add, modify, change or rescind the work assignments of different positions and to make reasonable accommodations so that qualified employees can perform the essential functions of the job. Nothing in this position description changes the at-will employment relationship existing between Preferred Mutual Insurance Company and its employees. The salary range for the role is $60,500 - $78,000 per year paid on a salaried basis. The rate offered to any candidate will be reflective of the candidates experience and any relevant education, certification, or qualifications related to their ability to perform the responsibilities of this position as permitted by law.

Job Title:Billing and Claims Specialist Reports to:Director of Operations Description:The Billing and Claims Specialist will work with clinicians, administrative staff, patients, and insurance companies to submit and process insurance claims for mental health services at Behavioral Health Clinic (BHC). Duties and Responsibilities: Oversee coding of services using ICD-10 and DSM-5 Coding Submit claims using the Electronic Health Record and claims processing software Enter Payments (ERA, EFT, & Other Payments) Prepare Billing Statements Research and Resolve billing issues by working with insurance companies Run Billing Cycle Reports Research Coding Rules and Regulations with Contracted Payers to help guide best business practice Patient Collection Duties (collecting copays and patient allowed amounts, creating refunds, managing collections process etc.) Other duties as assigned Qualifications: Compassionate and Confidential Efficient with computer software systems (with training) Working knowledge of Microsoft Office and Google products (Documents, Sheets, etc.) Ability to work effectively both independently and as part of a team Willingness to learn and adapt Strong organization and time management skills Skilled in verbal and written communication including good phone skills Experience in medical coding and billing preferred but not required; 3-5 years of work experience (preferred) Willingness to work occasional overtime Benefits: Starting pay $22.00 - $26.00 per hour Healthcare Benefit Package - Including Dental, Vision, STD, LTD, and Retirement Plan Options Supportive and collaborate team environment & Opportunities for advancement and leadership Paid Time Off (PTO) and Holidays *In accordance with legal requirements and company policies, successful candidates for this position will be required to complete the form I-9, Employment Eligibility Verification and Background Check, as part of the onboarding process*

Resolution Recruiters has a new opening in Wisconsin. This position is remote; however, candidate must live in the State of Wisconsin. Salary for the role is $60K-80K dependent on experience and salary history. Role is for a Global Third Party Administrator whose clientele tend to be Municipalities (Should you have this experience plus over five years of claims handling, you will be at higher salary bracket). To Be Considered YOU MUST HAVE: Field Adjusting experience in Auto, General Liability, and Property Understanding of Coverage Ability to write Reservation of Rights and Declining Coverage letters Set Reserves Report Large Loss to Superior Investigation experience in-person (20% travel to insureds) Maintain a Diary plus Close Claims EDUCATION AND EXPERIENCE: High school Diploma (College Degree Preferred) 3 plus years of technical claims handling in Auto Property Damage, General Liability, and Property Claims Industry Designations preferred Experience working with a Municipality would be of great advantage Salary: $65,000.00 to $80,000.00 full menu of benefits.

At TruStage, we're on a mission to make a brighter financial future accessible to everyone. We put people first, and work hand in hand with employees and customers to create a diverse and inclusive environment. Passionate about building insurance and financial services solutions, we push the boundaries of what's possible. We need you to help us shape what's next. You'll be encouraged to share your experiences, ideas and skills to help others take control of their financial future. Join a team that has received numerous awards for being a top place to work: TruStage awards and recognition This position is responsible for oversight of assigned Program Third Party Administrators (TPA's) and handling new and existing litigation claims. Ensure timely and effective application of policies and processes. Accountable for team goals related to customer service and compliance with best practices. Provide claim file direction and assistance with complex claim issue resolution. Maintain effective communication with internal and external business partners. Participate in quality assurance reviews and work on special projects to best meet the needs of the department. Contribute to the development of functional/team strategy. The position will also oversee complex professional and general liability litigated claims. Job Responsibilities: Serve as the primary point of contact and relationship manager for program claims. Oversee proactive litigation management on assigned claims including investigating, evaluating, and negotiating to resolution. Coordinate operational and leadership responsibilities to ensure consistent claim results, quality, and customer service. Develop protocols to aid in the establishment and maintenance of claim strategies and appropriate claim handling authority providing education and training as required. Collaborate with business partners vetting and onboarding new Programs and TPA's. Develop/maintain tools to monitor and improve the communication of essential claim information to ensure that monthly data collection and information sharing practices support TruStage Corporate standards. Work in close collaboration with cross-functional teams including Underwriting, Actuarial, Product, Finance, and Treasury to analyze and structure existing and new Program Business. Conduct in-person or remote claim file reviews and audits on multiple TPA claim systems. Identifies emerging claim trends as warranted. Monitor and document claim processes/guidelines for effectiveness and efficiency, identifying and implementing process improvements. Participate in Claim organization strategy initiatives and projects in collaboration with the Claim Operations team. Collaborate with Claim Operations leaders regarding the selection and ongoing management of TPA's and other outside vendors. The above statement of duties is not intended to be all inclusive and other duties will be assigned from time to time. Job Requirements: Bachelor's Degree in Business Administration, Insurance, Finance, Economics, or related field of study is strongly preferred. 7+ years of P&C Insurance claims experience. CPCU, AIC, ASLI, or other industry designations or certifications are highly desirable. Adjuster license and continuing education as needed. Proven ability to clearly and effectively communicate information to internal/external clients remotely or in person. Strong critical thinking and analytical skills. Demonstrated experience in progressively senior claim roles with strong technical skills. Experience in a range of Property and Casualty lines of business and products including Property, General Liability, Automobile Liability and Physical Damage Liability, and Professional Liability. Strong interpersonal and consultative skills. Creativity, flexibility, emotional intelligence, adaptability, and problem-solving skills. Ability to manage and develop existing and new industry relationships with Program Managers, Brokers, and Reinsurance partners. Ability to travel ~10%. If you're ready to help make a difference, apply today. A resume is required to apply. TruStage may process applicant information using an Artificial Intelligence (AI) tool. This tool automatically generates a screening score based on how well applicant information matches the requirements and qualifications for the position. TruStage recruiters use the screening score as a guide to further evaluate candidates; the score is one component of an application review and does not automatically determine whether a candidate moves forward. Candidates may choose to opt out of this process. Compensation may vary based on the job level, your geographic work location, position incentive plan and exemption status. Base Salary Range: $91,300.00 - $136,900.00 At TruStage, we believe a sound, inclusive benefits program is of vital importance, along with a flexible workplace that allows for work-life balance, career growth and retirement assistance. In addition to your base pay, your position may be eligible for an annual incentive (bonus) plan. Additional benefits available to eligible employees include medical, dental, vision, employee assistance program, life insurance, disability plans, parental leave, paid time off, 401k, and tuition reimbursement, just to name a few. Beyond pay and benefits, we also recognize that flexibility, including working in a place you prefer, is essential to caring for our employees. We will continue to strive to offer flexibility and invest in technology and other tools that will make hybrid working normal rather than an exception, so that when “life happens,” you can focus on what's most important. Accommodation request TruStage is a place where everyone can bring their best self and thrive. If you need application or interview process accommodations, please contact the accessibility department.

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team. We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following: Adjudicate claims by following departmental policies, operating memos, and corporate guidelines. Resolve claims and related issues in compliance with policy provisions. Compare claims applications and provider statements with policy files and other records to ensure completeness and validity. Process payments for claims that are approved. This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday. Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. The target start date for this position is January 12, 2026. Job Responsibilities: Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality. Reviews claims to ensure compliance with proper billing standards and completeness of information. Obtains additional information from appropriate person and/or agency as needed. Maintains department quality standards. Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards. Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly. Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution. Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed. Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc. Reviews home office claims for payment up to $18,000.00. Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts. Appropriately documents attributes and memos for pertinent information related to claims payment. Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract. Performs other duties and responsibilities as assigned. Job Requirements: High school diploma or equivalent preferred. 2-4 years claims processing experience required Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. Past experience using QNXT™ Claims Workflow a plus Prior experience with ACA, Medicaid, or similar health plans preferred. Coding experience preferred. Network Health is an Equal Opportunity Employer.

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** As a Product Liability Litigation Adjuster, Risk Management, you will be responsible for managing lawsuits and overseeing outside counsel defending CVS in high exposure, product liability mass tort litigations and general liability cases filed throughout the United States. Responsibilities include: + Developing relationships with internal colleagues for fact-finding and key litigation activities. + Utilizing legal skills to oversee and manage claims against CVS from the initiation of suit through resolution. + Managing all aspects of product liability mass tort litigations and complex general liability cases. + Working with outside national counsel and sr. management to develop consistent litigation strategies applicable to mass tort cases filed across the country. + Providing reporting to key internal stake holders on case developments and litigation trends for product liability mass torts and other cases. + Managing large scale discovery investigations by working with internal custodians, outside counsel and vendors to develop comprehensive procedures for identifying, locating, preserving and producing corporate records. + Analyzing case and internal materials and utilizing resources across CVS to discern key issues and identify the litigation strategy in every case assigned. + Creating a plan for claim evaluation to most efficiently resolve or defend cases against CVS while working with and overseeing outside counsel. + Participating in meetings and attending mediation and trial as necessary to oversee and assist in the defense or resolution of cases. **Required Qualifications** + 2+ years of legal experience, ideally with a law firm or as a litigation adjuster with a large self-insured company or insurance carrier. + Juris Doctor degree from an ABA accredited university. + Ability to travel and participate in legal proceedings, arbitrations, depositions, etc. **Preferred Qualifications** + Experience overseeing or defending product liability claims and litigation. + Familiarity or experience with insurance and coverage issues related to litigated claims. + Strong attention to detail and project management skills. + Experience overseeing and answering written discovery. + Ability to work independently and in an environment requiring teamwork and collaboration. + Strong written and verbal communication skills. + Demonstrated negotiation skills and ability. + Ability to articulate and summarize cases with management in a concise, cogent manner. + Litigation experience at a law firm, and/or significant experience overseeing litigated claims for an insurance carrier or corporation, including mediation experience and trial exposure. + 3-5 years of legal or claims experience. + Familiarity with the rules and procedures applicable to mass tort litigations, class actions, and/or multidistrict litigations. + Knowledge and experience navigating attorney-client privilege issues, corporate litigation holds, corporate witness depositions, and e-discovery. + Ability to influence and work collaboratively with senior leaders, CVS' in-house legal counsel and outside counsel. + Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook) with a proven ability to learn new software programs and systems. + Ability to positively and aggressively represent the company at mediation, arbitration and trial. + Ability to navigate difficult situations and communicate effectively with both internal and external groups. + Excellent organizational and time management skills and ability to handle a high volume of litigated claims. + Experience with and understanding of legal documents (pleadings, discovery, motions and briefs). **Education** + Verifiable Juris Doctor degree **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims, coordinating, investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems. **Knowledge/Skills/Abilities** + Facilitates the resolution of claims issues, including incorrectly paid claims, by working with operational areas and provider billings and analyzing the systems. + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from providers regarding claims inquiries and provides excellent customer service; documents calls and interactions. + Assists in the reviews of state or federal complaints related to claims. + Supports the other team members with several internal departments to determine appropriate resolution of issues. + Researches tracers, adjustments, and re-submissions of claims. + Adjudicates or re-adjudicates high volume of claims in a timely manner to ensure compliance to departmental turn-around time and quality standards. + Manages defect reduction by supporting the identifying and communicating error issues and potential solutions to management. + Handles special projects as assigned. + Other duties as assigned. Knowledgeable in systems utilized: + QNXT + Pega + Verint + Kronos + Microsoft Teams + Video Conferencing + Others as required by line of business or state **Job Function** Provides customer support and stellar service to assist Molina providers with claims inquiries. Leads and resolves issues and addresses needs appropriately and effectively, while demonstrating Molina values in their actions. Responsible for effectively managing and documenting calls and responding to providers regarding issues with claims and inquiries. Handles escalated inquiries, complex provider claims payments, records, and provides counsel to providers. Helps to mentor and coach Provider Claims Adjudicators. **Job Qualifications** **REQUIRED EDUCATION:** Associate's Degree or equivalent combination of education and experience; **REQUIRED EXPERIENCE:** 2-3 years customer service, claims, provider and investigation/research experience. Outcome focused and knowledge of multiple systems. 1+ years of claims research and/or issue resolution or analysis of reimbursement methodologies within the managed care health care industry **PREFERRED EDUCATION:** Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE:** 4 years **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in a home or office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $67,000.00 - $110,600.00 **Target Openings** 3 **What Is the Opportunity?** Under general supervision, the position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims. Provide quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This job does not manage staff. **What Will You Do?** + Timely coverage analysis and communications with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel. + Investigates each claim through prompt contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Takes necessary statements. + Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings. + Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. + Keeps effective diary management system to ensure that all claims are handled timely. At required time intervals, evaluates liability and damages exposure, and establishes proper indemnity and expense reserves. + Utilizes evaluation documentation tools in accordance with department guidelines. + Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority. + Negotiates disposition of claims with insureds and claimants or their representatives. + Recognizes and implements alternate means of resolution. + May manage litigated claims. Develops litigation plan with staff or panel counsel, track and control legal expenses Assures appropriate resolution. + Maintains claim files, have an effective diary system, and document claim file activities in accordance with established procedures. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options. + Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit. + Appropriately deals with information that is considered personal and confidential. + Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions, and inquiries from agents and brokers. + Represents the company as a technical resource, attends legal proceedings as needed, act within established professional guidelines as well as applicable state laws. + Provides quality customer service and ensures file quality. + Shares accountability with business partners to achieve and sustain quality results. + Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. + Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. + Resolve complex, severe exposure claims, using high service oriented file handling. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred. + 2 years bodily injury liability claim handling experience preferred. + Commercial Claim handling experience preferred + General knowledge and skill in claims handling and litigation preferred. + Basic working level knowledge and skill in various business line products preferred. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Intermediate + Demonstrated good organizational skills with the ability to prioritize and work independently. - Intermediate + Demonstrated strong written, verbal and interpersonal communication skills including the ability to convey and receive information effectively. Intermediate + Attention to detail ensuring accuracy -Intermediate + Analytical Thinking- Intermediate + Judgment/Decision Making- Intermediate + Communication- Intermediate + Negotiation- Intermediate + Insurance Contract Knowledge- Intermediate + Principles of Investigation- Intermediate + Value Determination- Intermediate + Settlement Techniques- Intermediate + Medical Knowledge- Intermediate **What is a Must Have?** + High school diploma or GED required with a minimum of one year bodily injury liability claim handling experience or two years of general liability claim handling experience. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Contents Adjuster PRIMARY PURPOSE: To handle losses and claims for property and casualty insurers. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Examines insurance policies and other records to determine insurance coverage. Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance. Estimates cost of repair, replacement, or compensation. Prepares report of findings and negotiates settlement with claimant. Recommends litigation by legal department when settlement cannot be negotiated. Attends litigation hearings. Revises case reserves in assigned claims files to cover probable costs. Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Obtain IIA-AIC designation within 12 to 18 months. Appropriate state adjuster license is required. Experience None. Skills & Knowledge Strong oral and written communication, including presentation skills PC literate, including Microsoft Office products Demonstrated commitment to timely reporting Strong customer service skills Strong interpersonal skills Attention to detail and accuracy Good time management and organizational skills Ability to work independently or in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Must be able to stand and/or walk for long periods of time. Must be able to kneel, squat or bend. Must be able to work outdoors in hot and/or cold weather conditions. Have the ability to climb, crawl, stoop, kneel, reaching/working overhead Be able to lift/carry up to 50 pounds Be able to push/pull up to 100 pounds Be able to drive up to 4 hours per day. Must have continual use of manual dexterity. Auditory/Visual: Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($45,000 - $60,000 USD annually). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of low complexity and low exposure claims and provide support to other team members as directed. This position will work closely with their manager to train and develop fundamental claims handling skills. Job Responsibilities * Confirms coverage of claims by reviewing policies and documents submitted in support of claims. * Conducts, coordinates and directs investigation into loss facts and extent of damages. * Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure. * Strong emphasis on customer service to both internal and external customers is a major focus for the ACE as this role will handle small commercial claims that require excellent customer service to insureds and agents. * Set reserves within authority (up to $25,000) and resolve claims within a prompt timeframe avoiding expense relating to independent adjusting. Required Qualifications * This role will is responsible for Equine claims; equine knowledge or hands-on experience working with horses is strongly preferred. * Must have or be eligible to receive claims adjuster license. * Successful completion of basic insurance courses or achievement of industry designations. * Ability to be trained in insurance adjusting up to two years of claims experience. * 2-4 years of experience in general liability, construction defect, or related liability lines preferred. * Bachelor's degree preferred * Excellent written and oral communication skills. * Strong organizational and time management skills. #LI-Hybrid US Work Authorization US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future. Who we are: Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world. We're all about people | We win together | We strive for better We enjoy the everyday | We think further What's in it for you: In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work. * We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life. * All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. * We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave. Are you ready to play your part? Choose 'Apply Now' to fill out our short application, so that we can find out more about you. Caution: Employment scams Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that: * All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings. * All legitimate communications with Markel recruiters will come from Markel.com email addresses. We would also ask that you please report any job employment scams related to Markel to ***********************. Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law. Should you require any accommodation through the application process, please send an e-mail to the ***********************. No agencies please.

Let's grow together! About Zurich Cover-More Zurich Cover-More is one of the world's largest travel insurance and assistance providers and part of Zurich Insurance Group, a leading multi-line insurer. We stand for more care, more cover, for all, and we look after more than 20 million of the world's travelers every year, making sure we are there every step of their journey. Our family of customer-facing brands include Travel Guard, Cover-More Travel Insurance, Travelex Insurance, Universal Assistance, World Travel Protection, Freely and Blue Insurance. We are a connected and caring workforce of more than 2900 employees with teams in North America, Europe, Latin America and Asia Pacific. Our global delivery platform provides a consistent multi-lingual service experience and ability to write insurance policies in more than 50 countries. Zurich Cover-More has more 200 distribution partners around the world including airlines, global travel companies, major banks and credit card providers and leading retailers. Travel Guard is seeking a Claims Adjuster in Houston, TX. We're seeking empathetic, dependable, detailed, and service-minded individuals who are dedicated to delivering exceptional customer experiences and are excited to grow in the insurance industry. No claims or insurance experience? No problem - we'll provide all the training you need to succeed. What's the job? * You'll provide exceptional customer support to claimants throughout the claims process * You'll spend 50-75% of your time conversing with stakeholders to ensures claims are efficiently brought to a final resolution within 30-45 days * You'll assess new and existing claims for coverage, conduct claim investigations and establish clear claim action plan for timely claim resolutions * You'll communicate with claimants using empathy to gather necessary documentation * You'll apply policy guidelines to determine coverage and claim validity * You'll maintain detailed claim records within the internal claims systems * You'll comply with all statutory and regulatory requirements in all applicable jurisdictions What are we looking for? * You'll possess 1-2 years of customer service experience * You'll be eager to learn new skills within the claims and insurance industry * You'll have excellent written and verbal communication skills * You'll have an eye for details, supporting thorough investigations and precise documentation * You'll be willing to obtain your State Specific Adjuster Licensing within 6 months of employment Why choose us? We value optimism, caring, togetherness, reliability, results focus and forward-thinking. We have more than 2900 employees worldwide: we are a global group of digital specialists, actuaries, marketers, doctors, nurses, case managers, claims specialists, finance experts and customer service professionals. We share a global purpose to look after travelers, at every step of their journey. Career growth. This is an extremely exciting time for us at Zurich Cover-More, as we are rapidly growing our business around the world. We are dedicated to helping our employees reach their full potential through a comprehensive onboarding program, ongoing professional development opportunities and a supportive work environment that encourages growth. Take the time you need, for you and your community. We encourage you to take the time you need when you need it. We offer regular annual and personal leave benefits along with volunteer leave and a comprehensive paid parental leave scheme. Investing in your health and your future. We offer a competitive high deductible health plan, EAP programs and access to health and well-being activities along with 401(k) program with employer matching to help you plan for your future. Diversity and inclusion. We respect who you are and thoroughly embrace diversity. So whatever walk of life you wander, just be you and come as you are. Apply today and let's go great places together! Nearest Major Market: Wausau

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. This mission drives the decisions we make, including the people we choose to join our growing team. We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following: * Adjudicate claims by following departmental policies, operating memos, and corporate guidelines. * Resolve claims and related issues in compliance with policy provisions. * Compare claims applications and provider statements with policy files and other records to ensure completeness and validity. * Process payments for claims that are approved. This position plays a vital role in ensuring accurate and efficient claims processing, contributing to the overall success of Network Health. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model. Hours: 1.0 FTE, 40 hours per week between 8am-5pm Monday through Friday. Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team. The target start date for this position is January 12, 2026. Job Responsibilities: * Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality. * Reviews claims to ensure compliance with proper billing standards and completeness of information. * Obtains additional information from appropriate person and/or agency as needed. * Maintains department quality standards. * Maintains established department turn-around processing time. Maintain and/or improves individual production rate standards and department quality standards. * Identifies potential coordination of benefits (COB), Workers Compensation, and Subrogation issues and adjudicates claims accordingly. * Investigates and resolves pending claims in accordance with established time frames. Identifies claims needing to be pended or suspended. Reviews pending claims timely and denies claims after established time frame is reached without resolution. * Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed. * Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc. * Reviews home office claims for payment up to $18,000.00. * Reviews claims for re-pricing. Enters eligible claim data into appropriate WRAP network re-pricing website. Overrides claims allowed amounts to apply internal/external discounts. * Appropriately documents attributes and memos for pertinent information related to claims payment. * Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract. * Performs other duties and responsibilities as assigned. Job Requirements: * High school diploma or equivalent preferred. * 2-4 years claims processing experience required * Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. * Past experience using QNXT Claims Workflow a plus * Prior experience with ACA, Medicaid, or similar health plans preferred. * Coding experience preferred. Network Health is an Equal Opportunity Employer.

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to: Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims Become familiar with insurance coverage by studying insurance policies, endorsements and forms Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary Ensure that claims payments are issued in a timely and accurate manner Handle investigations by phone, mail and on-site investigations Desired Skills & Experience Bachelor's degree or direct equivalent experience handling property and casualty claims A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims Field claims handling experience is preferred but not required Knowledge of Xactimate software is preferred but not required Above average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Ability to effectively deal with a diverse group individuals Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents) Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage Benefits Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you! Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. *Please note that the ability to work in the U.S. without current or future sponsorship is a requirement. #LI-DNP #LI-Hybrid #IN-DNI

Job Details Butler Corporate HQ - Butler, WI Full Time Equivalent Work Experience $24.00 Hourly None Any ManufacturingDESCRIPTION SIGN-ON BONUS OF $5,000 Are you a hands-on problem solver? Do you have the mechanical ability but no chance for advancement, and no one will invest the time to train you? If you love tinkering with machinery and turning ideas into reality, this is your chance to shine in our climate-controlled facility. Are you looking for a Career and not just a job? APPLY with Western States, we will invest the time to train candidates for this role and start you off at $24.00/hr. with GUARANTEED RAISES at 30 days, then EVERY 90 DAYS after that, we are talking a $1.20 increase within your first 90 days. We seek a skilled and detail-oriented Order Setup Operator (Adjuster) to join our production team at our Butler, WI facility, minutes from Milwaukee! This role ensures efficient and smooth operations by setting up and configuring machinery for production runs. This role is to operate ALL machines in the department, set up work orders to specifications, troubleshoot, and perform daily maintenance and minor repairs on envelope folding machines. We are seeking candidates with hands-on mechanical skills who have experience setting up orders on machines in a production/manufacturing environment, or candidates with experience in an automotive or fleet mechanic setting. SHIFTS AVAILABLE: 2nd shift 2:30 pm - 10:30 pm Mon-Fri + $0.75/hr shift premium 3rd shift 10:30 pm - 6:30 am Sun-Thur.+ $1.00/hr shift premium TRAINING: ALL training is completed on the 1st shift. Training will take at least 6 months to learn our machines and our industry, but most often up to 1 year on FIRST SHIFT before transitioning to your home shift on 2nd or 3rd. HERE'S WHAT MAKES WESTERN STATES A GREAT PLACE TO WORK: Competitive compensation: Regular pay raises and a comprehensive benefits package including 401k with company match. Work-life balance: 9 paid holidays, 80 hours of PTO, Sick Days starting your first year to help you recharge and enjoy time with loved ones. Flexibility: We have multiple shifts available to meet your scheduling needs. Growth potential: Join a company with a long history and a commitment to employee development. Stability: Family-owned company with over 117 years in operation. WHAT DOES MY WORKDAY LOOK LIKE IN THIS ROLE? As a key member of our Folding Department, you'll ensure the smooth and efficient operation of our machinery. Your responsibilities will include: Performing daily machine maintenance, changeovers, and set-ups. Inspecting products and making necessary mechanical adjustments to eliminate quality variations and address mechanical malfunctions. Troubleshooting minor operating difficulties using hand tools. Executing minor machine repairs. Operating all machines within the Folding Department. Examining work orders to determine production specifications. Inspecting product quality following established guidelines. Verifying order accuracy throughout production, including labeling, printing, and packaging. Performing machine wash-up and other general cleaning duties to maintain a tidy workspace. Accurately completing paperwork for labor, time, and quality tracking. Maintaining precise counts of envelopes for boxing, cartonizing, and palletizing. Neatly and uniformly packing envelopes into containers, keeping pace with machine speeds. Placing die-cut paper stacks into machine feeds and splicing paper rolls into web machine feeds. mechanic, automotive, fleet mechanic, farm mechanic QUALIFICATIONS: Demonstrated expertise a Set-Up Operator, Envelope Adjuster or Auto Mechanic experience. Industry on an RA and/or WD machines in a position of similar skill set and level of responsibility within the Envelope Industry preferred but not required. 5 years machine set-up and/or repair experience preferred. Proven ability to set up orders on production manufacturing equipment Capacity to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Capable to speak effectively with employees of the organization. Aptitude to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Proficiency in reading and interpreting ruler measurements. Ability to walk and stand frequently during an eight-hour shift. Ability to move up to 50 lbs. Willing to train for an extended period of time on First Shift before moving to home shift of 2nd or 3rd shift. ESSENTIAL FUNCTIONS Ability to stand for approximate duration of scheduled shift (minus paid breaks), lift up to 20 lbs. frequently and up to 50 lbs. occasionally, repetitive grasping, frequent, twisting, lifting above shoulder height, occasional bend, reach, crouch, or stoop. Sensory requirements are tactile/touch with hands and digits, near and far visual acuity, color vision, peripheral vision, depth perception and ability to adjust focus. Reasoning, mechanical aptitude and mathematical skills for appropriate operations of the equipment.

Dohrn Transfer is a leading Midwest LTL Carrier providing less-than-truckload, truckload, and value-added services throughout our 10-state service area. Join our team and become a part of our new growth and bright future. We offer competitive salary and a great benefit package in an exciting, rewarding industry. Dohrn is currently seeking a Full Time Claims Prevention Coordinator at our Janesville, WI terminal. Hours: Monday - Friday, 8:00am - 4:30pm Pay: $19.00/Hour Benefits: Health / Vision / Dental insurance, 401k matching, life insurance, short/long term disability and more. POSITION SUMMARY: Locating and correctly placing over, short, damaged, and missing freight as well as preventing claims. Responsibilities ESSENTIAL DUTIES Daily telephone and written communication with internal and external customers Locate missing freight and overages, shortages, and damaged freight Monitor the OS&D webs 4.5 hours daily in addition to answering the OS&D and Driver lines Review manifests, bills of lading, delivery receipts, and drivers' green sheets Assist terminals in regards to all OS&D freight Research miss-delivered freight and ensure it gets delivered correctly Request dispositions, re-delivery charges, and re-consignment charges to ensure freight keeps moving to its destination May assist with customer service/pick up calls and set appointments as needed Other duties as needed Qualifications MINIMUM REQUIREMENTS High School completion or equivalent Computer skills including Microsoft Office Ability to multi-task in a fast paced environment Detail-oriented, problem-solver, self-motivated Excellent verbal and written communication skills Ability to establish and maintain great relationships with customers Ability to work in a team as well as individually Excellent attendance WORKING CONDITIONS/PHYSICAL DEMANDS Primarily sedentary work, which involves sitting most of the time May be occasionally required to exert up to 20 pounds of force and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects The general office environment is favorable; Lighting and temperature are adequate, and there are minimal hazardous or unpleasant conditions caused by noise, dust, etc; Visual Acuity including regular use of items including a computer screen or monitor Manual dexterity is regularly required including fingering, grasping, and typing; manual dexterity includes repetitive motion of the wrists, hands, and fingers Talking and hearing required to communicate with and listen to others to share or receive information; May be occasionally exposed to noise including telephone, office machinery, and conversations of others Dohrn Transfer Company, LLC is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, color, religion, age, sex, sexual orientation, gender, gender identity or expression, national origin, geographic background, physical and/or mental disability, protected veteran status, or any other classification protected by applicable law.

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a claims adjuster trainee, you'll learn how to help customers get back on the road after an accident. This is not a field position, which means you'll be building relationships with customers over the phone. In a fast-paced environment, you'll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and insurance contracts so you can confidently and independently adjust claims. This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like. Duties & responsibilities (upon completion of training) Determine coverage Determine liability (who's at fault for the damages) Interview customers, claimants, and witnesses Partner with appraisers/estimators to manage vehicle repairs Negotiate with customers and other insurance carriers and resolve claims Additional Qualifications/Responsibilities Must-have qualifications Three years of work experience OR Bachelor's degree OR Two years work experience and an associate degree Schedule: Monday - Friday, 8:30 am - 5:30 pm for the first four weeks during training, then 9:00 am - 6:00 pm. Location: 2505 E Evergreen Dr, Ste B, Appleton, WI or 8333 Greenway Blvd, Ste 200, Middleton, WI Compensation Once you complete training and pass any necessary testing requirements, your salary will be $54,000-$57,500/year, however, during training, you'll be paid hourly based on your annual salary. Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Benefits 401(k) with dollar-for-dollar company match up to 6% Medical, dental & vision, including free preventative care Wellness & mental health programs Health care flexible spending accounts, health savings accounts, & life insurance Paid time off, including volunteer time off Paid & unpaid sick leave where applicable, as well as short & long-term disability Parental & family leave; military leave & pay Diverse, inclusive & welcoming culture with Employee Resource Groups Career development & tuition assistance

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.