Claim taker jobs near me - 41 jobs

Job Title:Medical Claims Examiner-Work From Home Job Type:Full Time FLSA Status:Non-Exempt/Hourly Grade:H Function/Department:Health Plan and Healthcare Services Reporting to:Team Lead/Supervisor - Operations Role Description:The Claims Examiner evaluates insurance claims to determine whether their validity and how much compensation should be paid to the policyholder. The Claims Examiner is responsible for reviewing all aspects of the claim, including reviewing policy coverage, damages, and supporting documentation provided by the policyholder. Roles & Responsibilities * Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions. * Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information. * Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements. * Conduct investigations, when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts. * Analyze policy coverage to determine the extent of liability and benefits payable to claimants. * Evaluate the extent of loss or damage and determine the appropriate settlement amount. * Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates. * Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing. * Maintain accurate and organized claim files and records. * Stay updated on industry regulations and maintain compliance with legal requirements. * Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders. * Strive for high efficiency and accuracy in claims processing, minimizing errors and delays. * Stay informed about industry trends, insurance products, and evolving claims management best practices. * Generate and submit regular reports on claims processing status and trends. * Perform other duties as assigned. Top of Form Qualifications The qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. Top of Form Top of FormEducation * High School diploma or equivalent required Work Experience * Medical claims processing experience required, including use of claims processing software and related tools Competencies & Skills * Highly-motivated and success-driven * Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills * Exceptional analytical and problem-solving skills * Strong attention to detail with a commitment to accuracy * Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads * Basic mathematical skills * Intermediate typing skills * Basic computer skills * Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred * Knowledge of insurance policies, regulations, and best practices preferred Additional Qualifications * Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements * Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test Work Environment The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position may work onsite or remotely from home. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device. Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds. Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. Firstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities. About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies. Job Type: Full-time Benefits: 401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Referral program Vision insurance Work Location: Remote

Detail-oriented and highly organized claims specialist with expertise in D-SNP (Dual Eligible Special Needs Plan) claims processing. Skilled in researching, correcting, and resolving pended claims, ensuring compliance with regulatory guidelines, and maintaining accurate documentation. Adept at working in high-volume environments with strong attention to detail and excellent communication skills. Core Responsibilities + Research, correct, and respond to all D-SNP pended claims in a timely manner. + Review audit reports and determine claim payment eligibility in accordance with policies and procedures. + Maintain accurate correspondence and documentation for medical procedures, CPT, and HCFA codes. + Review, price, and release claims for assigned claim types (paper and electronic). + Analyze Manual Review reports for suspended D-SNP claims. + Stay current on all D-SNP policies and contribute to departmental improvement projects. + Ensure compliance with all regulatory guidelines and monitor adherence. + Maintain daily activity logs and assist with claims processing. + Perform additional duties and special projects as assigned. Skills + Claims Processing + Project Management + Healthcare Operations + Workflow Optimization + Medical Terminology & Coding Technical Skills + QNXT platform proficiency + Strong knowledge of D-SNP program + Expertise in dual eligible claims processing (Medi-Cal and Medicare D-SNP) Qualifications + Prior experience in high-volume production environments + Excellent oral and written communication skills + Strong attention to detail + Medical terminology and/or coding experience highly desirable Experience Level Entry Level Job Type & Location This is a Contract position based out of Santa Barbara, CA. Pay and Benefits The pay range for this position is $24.00 - $27.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 21, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Claims Examiner is considered an expert in managing insurance claims for our policyholders. The Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. PRIMARY RESPONSIBILITIES: • Maintains compliance with all state-specific timelines and MSI best practices, including timely initial contact, acknowledgments, diary management, and thorough claim documentation. • Provides professional, proactive communication to insureds, agents, vendors, public adjusters, and attorneys. • Applies policy language accurately to make fair, well-supported coverage decisions. • Participates in team trainings, process improvement initiatives, and ongoing development. • Meets performance expectations related to responsiveness, claim cycle times, reserve accuracy, and timely claim closure. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company's reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster's license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 2-3 years' experience in claims Must have Property & Casualty Insurance License #LI-JW2 #LI-REMOTE Click here for some insight into our culture!

5 Years Facets Claims Adjudication Experience The Claims Examiner must maintain production and inventory standards compliant with Claims Administration requirements High school diploma or equivalent required Must have 5+ years of relevant claim processing experience in healthcare industry (managed care or TPA Company) to support our clients Possess high productivity and quality standards within a claims processing automation environment Knowledge of CPT, HCPC, ICD-10 codes Knowledge of HMO, PPO, Medicare and Medicaid plans Knowledge of Medical terminology Computer with 2 Monitors High Speed Internet Connection Ability to work remote 8 hour day, Mon-Fri. Responsibilities: The claims examiner is responsible for accurate and timely adjudication of claims for the Health Plans lines of business Primary duties include analysis and resolution of claims, including reviewing pended claims and manually resolving based on client specified direction and criteria, including third-party liability claims The claims examiner must be able to work independently, effectively prioritizing work in a production environment that frequently changes to meet production standards and contractual requirements Success in this position will be based on the individual's ability to effectively prioritize work, identify, and resolve complex concerns in a professional manner, and work in a team environment to achieve and maintain production and audit standards Timely and accurate processing and adjudication of all types of claims from assigned workflow queues Compliance with state, federal and contractual requirements to Claims Administration Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications Demonstrates the ability to think analytically to resolve complicated claim issues and identify appropriately when to escalate issues for review Ability to review and apply Plan directives and desktop procedures to claims, following step by step guidelines Claim analysis of coding and billing compliance, potential third-party liability, accurate coordination of benefits (COB), benefit application including limitations and restrictions, pre-existing conditions, subrogation, medical necessity and other claim investigation as appropriate Complete all mandatory claims training/refresher courses Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives Complete all mandatory compliance and corporate training Must be able to adapt to a changing work priorities and requirements and perform other duties as directed to support the overall functions of Claims Administration and support of staff without boundaries within the Plan

Claims Processor needs office support, administrative assisting experience Claims Processor requires: Hybrid 2x in office a week. Hours: M-F/Full-Time; 8-4:30 (30-Minute lunch) Data Entry Test Scores required Ability to learn and adopt new processes quickly and with ease Ability to work remotely and autonomously Accustomed to working in a high-paced, high-volume environment Strong attention to detail Medium-Advance level of expertise with Microsoft Excel Proficient with Outlook Familiar with Cloud-based applications (i.e. OneDrive) Ability to multi-task and perform duties using multiple sources or systems; Data Entry experience preferred Ability to clearly articulate findings, issues or concerns requiring resolution Claims Processor duties: Ø Monitor team shared Outlook mailbox for incoming membership documents sent from clients, brokers or Third Party Administrators Review incoming membership documents (Microsoft Excel and Word) to confirm accuracy in formatting and validity of data; includes communicating when updates are needed for successful membership enrollment and/or submission for processing.

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job Purpose The Claims Clerk plays a vital role in supporting the claims team by handling daily administrative tasks, including reviewing and responding to claims portal messages, processing incoming faxes, and organizing documentation. This position ensures efficient communication and smooth workflow within the department, helping to maintain timely and accurate claims processing. Duties and responsibilities Monitor and respond to claims portal messages daily. Assist Customer Service department with portal registrations. Process and categorize incoming claims-related faxes. Assist with Claims related inquiries from other departments. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Serve as a primary point of contact for providers, members, and internal staff regarding claims status, documentation requirements, and resolution steps. Respond to inbound claims phone calls, emails, and portal inquiries in a professional and timely manner. Provide clear explanations of claim outcomes, payment decisions, and next steps while maintaining a high level of customer service. Research and resolve claim-related issues by gathering information, reviewing documentation, and escalating as needed. Document all interactions in the system to ensure accurate records of customer communications and resolutions. Must maintain an error accuracy of under 5%. Support claims examiners and workflow projects. Attend weekly or monthly departmental meetings and provide feedback when requested. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit activities. Support other departments as needed. All other duties as assigned. Qualifications Experience in administrative support, claims processing, or a related field preferred. Excellent communication skills including reports, correspondence, and verbal communications. Experience with EZ-Cap and Encoder preferred. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving. Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Must work well under pressure and deadlines.

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. The Claims Examiner is considered an expert in managing insurance claims for our policyholders. The Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. PRIMARY RESPONSIBILITIES: • Maintains compliance with all state-specific timelines and MSI best practices, including timely initial contact, acknowledgments, diary management, and thorough claim documentation. • Provides professional, proactive communication to insureds, agents, vendors, public adjusters, and attorneys. • Applies policy language accurately to make fair, well-supported coverage decisions. • Participates in team trainings, process improvement initiatives, and ongoing development. • Meets performance expectations related to responsiveness, claim cycle times, reserve accuracy, and timely claim closure. • Investigates and analyzes claim information to determine extent of liability. • Handles claims 1st Party Property Claims. • Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation. • Sets timely, adequate reserves in compliance with the company's reserving philosophy. • Engages experts to assist in the evaluation of the claim. • Monitors vendor performance and controls expense costs. • Evaluates, negotiates and determines settlement values. • Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties. • Handles all claims in accordance with Best Practices. • Responsible for monitoring and completing assigned claims inventory. • Acquire and maintain a state adjuster's license and meet state continuing education requirements. • Provides Best-In-Class customer service for insureds and agents. • Updates and maintains the claim file. • Identifies opportunities for subrogation and ensures recovery interests are protected. • Identifies fraud indicators and refers files to SIU for further investigation. • Participates in claims audits, internal and external. • Provides oversight of TPAs KNOWLEDGE, SKILLS & ABILITIES: EDUCATION & EXPERIENCE: High School/GED 2-3 years' experience in claims Must have Property & Casualty Insurance License #LI-JW2 #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

--------------------------------------------------------------- The Claims Examiner II is an intermediate level position responsible for the timely review, investigation and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims. Estimated Hiring Range: $22.82 - $27.89 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed. Consistently meet or exceed the quality and production standards established by the department and CareOregon. Provide excellent customer service to internal and external customers. Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals. Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed. Investigate third party issues as directed. May review, process and post refunds and claim adjustments or re-adjudications as needed. Report any overpayments, underpayments or other possible irregularities to the Lead or Supervisor as appropriate. Generate letters and other documents as needed. Proactively identify ways to improve quality and productivity. Continuously learn and stay up to date with changing processes, procedures and policies. Experience and/or Education Required Minimum 2 years' experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.) Preferred Experience using QNXT, Facets, Epic systems Knowledge, Skills and Abilities Required Knowledge Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding Knowledge of medical, dental, mental health and health insurance terminology Skills and Abilities Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and Medicaid/Medicare industry Ability to perform fast and accurate data entry Strong spoken and written communication skills Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed Good customer service skills Ability to participate fully and constructively in meetings Strong analytical and sound problem-solving skills Detail orientation Strong organizational skills and time management skills Ability to work in a fast-paced environment with multiple priorities Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to lift, carry, reach, and/or pinch small objects for at least 1-3 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home Schedule: Monday - Friday, 8:00 AM to 5:00 PM We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Responsibilities & Duties:Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity. Conduct thorough investigations, including reviewing medical records and other relevant documentation. Analyze policy provisions and contractual agreements to assess claim validity. Utilize claims management systems to document findings and process claims efficiently. Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements. Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process. Address customer concerns and escalate complex issues to senior claims personnel or management as needed. Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements. Maintain accurate records and documentation related to claims activities. Follow established guidelines for claims adjudication and payment authorization. Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department. Participate in quality assurance initiatives to uphold service standards and improve claim handling practices. Collaborate with team members and management to implement best practices and enhance overall departmental performance. Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes. Contribute to the development of management reports and presentations regarding claims operations.

This position is responsible for the oversight of complex and large exposure losses and will report to the National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management, providing direction and oversight ensuring that compliance with best practices and state/local guidelines is achieved. In addition, this position will report findings and make recommendations on current practices including the claim department's performance on meeting regulatory standards. Job Responsibilities · Review home office casualty files, provide direction as required to ensure that handling is within best practice guidelines and local jurisdiction regulations. · Responsible for providing guidance and direction to claims staff in order to ensure proper handling and risk mitigation. · Provide authority and guidance on all bodily injury claims regarding coverage, liability and damages, as required. · Provide feedback to leadership and adjusting staff as required for continually improved file handling. · Responsible for collaboration with claims staff, front line claims management, senior claims management and legal counsel. · Available to answer questions and participate in roundtable discussions with claims staff and management to provide feedback and guidance on claim handling procedures. · Complete research pertaining to complex coverage issues, industry trends, and related topics. · May assist with targeted audits of a particular process or function (e.g. total loss handling, BI evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management re-audits to verify calibration and accuracy of the first level reviews completed. · Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling Job Qualifications Formal Education & Certification Bachelor's degree or equivalent work experience Knowledge & Experience · A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty claims with high complexity. · Prior claims management experience and/or auditing preferred. Skills & Competencies · Communication and analytical ability at a level to interact with associates, managers, agents and vendors. · Demonstrated team building and coordination skills. · Must possess strong interpersonal skills and the ability to present critical information to Senior Management. · Ability to manage multiple priorities and work independently. · Leadership abilities are necessary, with the ability to make autonomous decisions based on multiple facts. · Must be able to work in a fast-paced automated production environment and possess solid planning and organizational skills including time management, prioritization, and attention to detail. · Must meet company guidelines for attendance and punctuality and professional appearance/decorum. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without reason or notice by either the employer or the associate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role We are seeking a skilled BI-LIT Claims Examiner to manage litigated files and attend trials, conferences, mediations, and arbitrations. The successful candidate will: Investigate and gather all necessary information and documentation related to claims Evaluate liability and damages Negotiate and settle claims Manage litigation cases related to auto claims disputes The BI-LIT Claims Examiner will also be responsible for maintaining electronic files, analyzing defense counsel's performance, and regularly reporting to the Claims Manager. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Managing legal aspects of litigated cases, including evaluation of legal process and expenses Analyzing and reviewing auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers Managing litigation cases related to auto claims disputes, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders Collaborating with defense counsel, claims counsel, and litigation claims management for strategic planning, including developing and maintaining positive working relationships with approved defense firms and other vendors in the industry Reviewing legal documents and ensuring compliance with initial suit-handling plan of action Serving as corporate representative for discovery review and depositions, and appearing as Corporate Representative at depositions and trials when needed Analyzing policy language and reaching appropriate coverage decisions, drafting frequent and complex coverage correspondence, and proactively managing primarily litigated claim files from inception to closure Directing and controlling the activities and costs of numerous outside vendors including defense counsel and coverage counsel, experts and independent adjusters Maintaining adjuster licenses and continuing education requirements Requirements Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications) 10+ years of claim handling experience, with 5+ of those years handling a pending of >60% in litigation Transportation litigation (rideshare, auto, trucking, etc) is preferred but those with personal lines experience should still apply if they meet all other requirements. You are not intimidated by an attorney, even if you are not one! You are the driver of the litigation strategy for any particular claim. You manage the discovery in the order and timing of events and hold attorney accountable Understand transportation coverages. Understand contractual risk transfer and additional insured forms You have strong medical knowledge You have a sense of urgency and understanding of how to manage time-sensitive demands Ability and willingness to communicate both on the phone and in written form in a prompt, courteous, and professional manner Strong analytical and negotiation skills. You will conduct your own negotiations directly with opposing counsel Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines Ability to professionally collaborate with all stakeholders in a claim Have active adjuster license(s) and be willing to obtain all licenses within 45 days, including completing state required testing Attention to detail, time management, and the ability to work independently in a fast-paced, remote environment Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Provide a manageable pending for you to deliver the service in a way you've always wanted and a dedicated account Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Pets Best, a subsidiary of IPH, is building a digital first pet e-commerce platform with the aim of connecting key market services such as adoption, lost pet and insurance to make pet care easy. Job Summary: Pets Best is seeking a Claims Processing Specialist who will report to the Supervisor, Claims. Claims Processing Specialists are responsible for reviewing invoices and pet medical documents and determining coverage in compliance with the current Underwriter's policy. Job Location: Remote - USA Main Responsibilities: Review individual policies to make an eligibility determination with high degree of accuracy Contact with internal departments as well as veterinarians and clinic staff Ensure compliance guidelines are met with both internal policies and procedures and contractual commitments Work independently and with others on a virtual team Drive a “Great Place to Work” culture, attend and participate in team meetings as well as engagement events Use PC based programs to enter data into claims system, communicate with leaders and teammates, and organize information Create and issue claim decisions to pet parents using proper spelling, grammar, and punctuation in line with the policy terms Calculate invoice totals, discounts, and tax rates Perform other duties and/or special projects as assigned Qualifications: High school diploma or equivalent 3+ years recent clinical veterinary experience (dog and cat) as a veterinary assistant, veterinary technician or veterinarian Knowledge of veterinary terms, abbreviations and conditions. Knowledge of medical conditions and associated symptoms, procedures, treatments, secondary conditions and pharmaceuticals used in veterinary medicine Knowledge of canine and feline breeds, anatomy and associated predispositions to illness. Ability to read and interpret medical diagnoses via medical records review both written and digital. Ability to work cross functionally with our internal and external resources Ability to handle multiple projects concurrently Ability to navigate Windows OS, Google Chrome, and corresponding applications Demonstrable Microsoft Office proficiency: Word, PowerPoint, Excel, Outlook, Teams Strong writing skills: organization, spelling, grammar and punctuation Strong mathematical and problem-solving skills #LI-Remote #petsbest All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)

SUMMARY DESCRIPTION: The Residential Claims Examiner is responsible for approving and settling residential property claims from the field where an estimate of damage has been prepared, or for preparing and settling estimates, or documenting claims decisions and settling those claims with the policyholder and claimants. The role's primary duties include phone scoping, reviewing coverage, determining settlement amounts, communicating with the policyholder or their representative, and documenting the claim file as outlined by the client or RENFROE. They are also responsible for documenting all activity, submitting required claims documentation, issuing settlement payments, settling and closing the claim using fair claims settlement practices, and ensuring compliance with legal and contractual obligations. REPORTS TO: Assigned RENFROE Manager ESSENTIAL JOB FUNCTIONS: · Follows RENFROE and clients' policies and procedures to handle all assigned property claims · Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills · Assigns task work for property inspections and interacts with field adjusters and estimators to determine the scope of loss · Oversees claims files for assigned claims and updates claims as new information becomes available using the client's proprietary software · Manages the progression of claims/tasks and claim inventories assigned to them · Contacts and interacts with the policyholder or their representative to obtain documents such as purchase receipts, bills, photographs, or other documents to establish the existence, ownership, and value of the items claimed damaged · Determines coverage and amounts for additional living expenses such as rental housing, travel, meals, etc. · Sets claim reserves following the client's guidelines · Calculates settlement amounts and, within their settlement authority or after receiving requested authority from the client's designee, issues settlement checks with supporting claim documentation · Writes closing reports, including recommendations for the pursuit of subrogation or the disposal of salvage · Reviews the claim file to support and draft coverage decision letters · Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE · Does not handle claims for which they do not have client authorization or for which they are not licensed · Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes · Makes suggestions on ways to improve process efficiency · Participates in special projects and completes other duties as assigned Non-Authorized Activities: Claims Examiners should not: · Communicate training requirements to client staff adjusters and non-affiliated firms · Communicate training requirements to any claim handler who is not deployed with RENFROE · Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE · Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind EXPERIENCE/QUALIFICATIONS: · Minimum of 1 year of property claims experience is preferred · Participation in technical insurance coursework is preferred, such as CPCU · Experience using various claims processing systems is preferred · Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes · Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others · Strong analytical skills and consistent attention to detail · Knowledge of ISO forms, and client policy coverage, procedures, and systems · Communicates clearly and effectively, both verbally and in writing · Strong customer service orientation and good rapport with the insured · Well-organized and hard-working, with the ability to thrive in a fast-paced work environment · Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact · Computer skills, including but not limited to practical knowledge of Word and Excel PHYSICAL DEMANDS: · Sitting in a chair for extended periods of time · Ability to operate a telephone, computer, mouse, keyboard, and other similar equipment for extended periods of time · Extended and varying work schedules, which may include work from home or work from a centralized office · Regular attendance required, working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays · Ability to work in a fast-paced, changing, and multi-tasking environment

Our client is seeking to add a Commercial Auto Claims Examiner to their team. This individual will be responsible for handling commercial auto liability and physical damage claims from initial intake through resolution. The position involves evaluating coverage, investigating losses, and negotiating settlements across various jurisdictions. This person will have the ability to work fully remote. Key Responsibilities: Investigate, evaluate, and resolve Commercial Auto and Trucking claims from first notice of loss through closure. Review liability, assess damages, and determine appropriate claim strategies. Establish timely and accurate reserves based on claim investigation and exposure. Collaborate with insureds, claimants, attorneys, and vendors to move claims toward resolution. Handle coverage analysis and issue coverage position letters as required. Maintain consistent communication with policyholders and stakeholders throughout the claim lifecycle. Ensure proper file documentation and compliance with company and regulatory standards. Negotiate settlements within authority and in accordance with company/client expectations. Stay current on state-specific laws and regulations related to commercial auto claims. Requirements: 3 - 5+ years of Commercial Auto/Trucking claims handling experience. Active Adjuster's License required. Strong analytical, negotiation, and communication skills. Ability to draft detailed claim reports and correspond professionally with stakeholders. Highly organized, proactive, and able to manage workload independently. Proficient in Microsoft Office and relevant claims management systems. Salary & Benefits: $65,000 - $75,000 annually (depending on experience) Comprehensive Medical, Dental, and Vision coverage 401(k) with company match Paid Time Off and holiday benefits Professional development and career growth opportunities

Title: Claims Examiner Team Leader Job Type: Full-time Work Set-up: Remote Pay: up to $22.00 per hour DOE Work Schedule: Monday-Friday 5:00am to 2:00pm PST | 8:00am-5:00pm EST Position Summary The Claims Examiner Team Leader is responsible for leading and managing a team of claims examiners to ensure accurate, compliant, and timely processing of medical claims. This role serves as a critical bridge between frontline operations and leadership, driving performance against SLAs, quality standards, and productivity targets. The Team Lead is accountable for team performance, coaching and development, and continuous process improvement while ensuring adherence to Medicare regulations and CMS guidelines. Key Responsibilities Team Leadership & Performance Management Personal Production 50% of the time, Lead, supervise, and support a team of 15-20+ claims examiners. Provide ongoing coaching, mentoring, and real-time feedback to improve quality, accuracy, and productivity. Conduct regular performance evaluations and goal setting. Foster a culture of accountability, engagement, integrity, and continuous improvement. Claims Operations Oversight Oversee day-to-day medical claims processing for professional, facility, adjustments, corrected and adjustment claims. Ensure compliance with Medicare requirements, CMS guidelines, client policies, and Imagenet standards. Monitor and manage service level agreements (SLAs), turnaround times, and production. Quality Assurance & Compliance Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines. Review claims and audit results to identify trends, root causes, and training opportunities. Ensure consistent application of quality standards by partnering with other team leads to reduce error rates across the team. Reporting, Metrics & Business Reviews Analyze and manage key performance indicators including quality scores, error rates, productivity, attendance, and rework. Prepare and present operational and business reviews using accurate data and client feedback. Identify operational risks, performance gaps, and improvement opportunities and escalate as appropriate. Process Improvement & Cross-Functional Collaboration Identify process inefficiencies and implement improvement strategies to increase accuracy, efficiency, and cost effectiveness. Assist with QA, Training, IT, and Operations leadership to resolve technical or workflow issues. Support implementation of new policies, tools, workflows, and client requirements. Communication & Client Support Maintain clear, timely communication with leadership regarding team performance and operational risks. Address employee concerns and team conflicts professionally and promptly. Escalate client issues or compliance concerns to management immediately when identified. Engagement & Recognition Recognize and reward strong performance and team achievements. Promote teamwork, professionalism, and a positive attitude within the team. Measures of Success / Key Performance Indicators Claims quality and audit results both for personal performance and team performance Error rates and rework reduction both for personal performance and team performance Productivity (claims per day/hour) both for personal performance and team performance Turnaround time / time to completion both for personal performance and team performance Compliance with CMS, Medicare, Medi-Cal, and client guidelines Attendance and reliability both for yourself and your team Client satisfaction and assessment outcomes Team engagement, coachability, and retention Cost efficiency and margin impact Required Qualifications Min. 5 years of experience processing easy, moderate, and complex medical claims. 2+ years in a leadership role within claims or healthcare operations. Strong experience with Medicare and Medi-Cal claims, including a working knowledge of CMS guidelines and regulatory requirements. Prior quality assurance and training experience with demonstrated ability to identify trends Previous experience leading, coaching, or mentoring teams in a claims or healthcare operations environment. Strong analytical skills with the ability to interpret performance data and KPIs. Excellent communication, organizational, and decision-making skills. High attention to detail and commitment to accuracy, compliance, and operational excellence. What We Offer Remote work offered Equipment provided Paid training to set you up for success Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k) Paid Time Off (PTO) 7 paid holidays A supportive team and a company that values internal growth Ready to Grow Your Career? We'd love to meet you! Click “Apply Now” and tell us why you'd be a great addition to the Imagenet team. About Imagenet, LLC Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers. The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients. Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.

About the Role: A Buca Takeout/Order Taker Host plays a crucial role in ensuring a seamless dining experience for our customers who prefer takeout services. This position involves accurately taking customer orders, providing menu recommendations, and ensuring that all orders are processed efficiently and correctly. The ideal candidate will be responsible for managing the order-taking process, from greeting customers to finalizing their orders and handling payments. Additionally, this role requires effective communication with kitchen staff to ensure timely preparation and delivery of orders. Ultimately, the success of this position contributes to customer satisfaction and the overall reputation of Buca Claremont. Minimum Qualifications: High school diploma or equivalent. Previous experience in a customer service or food service role. Basic math skills for handling transactions. Preferred Qualifications: Experience with point-of-sale systems. Knowledge of food safety regulations. Ability to work in a fast-paced environment. Responsibilities: Greet customers warmly and assist them in placing their takeout orders. Provide detailed information about menu items, including ingredients and preparation methods. Process customer payments accurately and efficiently using the point-of-sale system. Coordinate with kitchen staff to ensure timely preparation and accuracy of orders. Handle customer inquiries and resolve any issues related to orders or service. Skills: Strong communication skills are essential for effectively interacting with customers and ensuring their needs are met. Attention to detail is crucial when taking orders to avoid mistakes and ensure customer satisfaction. The ability to multitask will be utilized daily as the order taker manages multiple customer interactions and coordinates with kitchen staff simultaneously. Customer service skills will enhance the overall dining experience, fostering a welcoming atmosphere. Familiarity with technology, such as point-of-sale systems, will streamline the order-taking process and improve efficiency.

About Us We're not like other insurance companies. From our specialty products to our business model, our culture to our results - we're different. Different is who we are, and how we work, interact, deliver and succeed together. Creating a different and better insurance experience doesn't just happen. It takes focus and a shared passion for going beyond the expected to forge relationships and deliver care that makes a difference. This approach rises from and is supported by our talented, ethical and smart team of employee owners united around a single purpose: to work alongside our customers and partners when they need us, in unexpected ways, with exceptional results. Apply today to make a difference with us. RLI is a Glassdoor Best Places to Work company with a strong, successful background. For decades, our financial track record has been stellar - a testament to our culture and validation of our reputation as an excellent underwriting company. Position Purpose Under occasional supervision, responsible for maintaining, processing, and resolving claims within defined authority. Assists in verifying policy limits, deductibles, locations, exclusions, and endorsements. Obtains information regarding each claim through various means and evaluates liability. Monitors claim status for potential exposure opportunities. Reviews coverage matters, analysis, and determinations. Principal Duties & Responsibilities Responsible for managing RLI Transportation claims. * Investigate, analyze, and handle new and reassigned Bodily Injury claims for coverage, liability, damages, and reserves. * Handles subrogation and arbitration. * Manage appraisers, investigators, adjusters and experts as needed. * Maintain claim files and ensure claims have full coverage, are properly documented, adjusted, and resolved. * May work on special project * Occasionally Handles cargo claims for consumer products Education & Experience * Bachelor's degree in business administration, insurance, or a related field. * 5+ years of auto claim handling experience * 5+ years of litigation handling to include mediation and trial observation experience. * Experience in handling trucking, bus and/or commercial auto claims is required for this position. * AIC or CPCU designation preferred. Knowledge, Skills, & Competencies * Proactive in initial investigation, claim handling and resolution. * Superior communication skills to work effectively with insureds, underwriters and claimants. * Excellent negotiation skills * Detail-oriented with good organizational skills. * Self-motivated and task-oriented. Compensation Overview The base salary range for the position is listed below. Please note that the base salary is only one component of our robust total rewards package at RLI. The salary offered will take into account a number of factors including, but not limited to, geographic location, experience, scope & responsibilities of the role, qualifications/credentials, talent availability & specialization, as well as business needs. The below range may be modified in the future. Base Pay Range $79,310.00 - $113,414.00 Total Rewards At RLI, we're all owners. We hire the best and the brightest employees and allow them to share in the company's success through our Total Rewards. With the Employee Stock Ownership plan at its core, the Total Rewards program includes all compensation, benefits and perks that come with being an RLI employee. Financial Incentives * Annual bonus plans * Employee stock ownership plan (ESOP) * 401(k) - automatic 3% company contribution * Annual 401k and ESOP profit-sharing contributions (Up to 15% of eligible earnings) Work & Life * Paid time off (PTO) and holidays * Paid volunteer time off (VTO) to support our communities * Parental and family care leave * Flexible & hybrid work arrangements * Fitness center discounts and free virtual fitness platform * Employee assistance program Health & Wellness * Comprehensive medical, dental and vision benefits * Flexible spending and health savings accounts * 2x base salary for group life and AD&D insurance * Voluntary life, critical illness, & accident insurance for purchase * Short-term and long-term disability benefits Personal & Professional Growth RLI encourages its employees to pursue professional development work in insurance and job-related areas. We make a commitment to employees to provide educational opportunities that help them enhance their skills and further their career advancement. RLI fosters a true learning culture and encourages professional growth through insurance courses, in-house training and other educational programs. RLI covers the cost for most programs and employees typically earn a bonus upon successful completion of approved courses and certifications. Our personal and professional growth benefits include: * Training & certification opportunities * Tuition reimbursement * Education bonuses Diversity & Inclusion Our goal is to attract, develop and retain the best employee talent from diverse backgrounds while promoting an environment where all viewpoints are valued and individuals feel respected, are treated fairly, and have an opportunity to excel in their chosen careers. We actively support, and participate in, initiatives led by the American Property Casualty Insurance Association that aim to increase diversity in the insurance industry. Cultivating an exceptional and diverse workforce to deliver excellent customer service reinforces our culture and is a key to achieving superior business results. RLI is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.

Through our dedicated associates, Arsenault delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day. Remote Data Entry Associate Equipment Provided Temp with chance to convert to full time Salary: $15-$20 HR. Hours: 8:00 am to 4:30 pm EST, M-F Would you enjoy being part of a team that makes a difference in people's lives Do you love helping people solve complex problems and delivering solutions? About The Role As a member of the team, you will be processing FSA and HSA claims. You will review and research the claim and process them on a web-based application. It is essential to have a good understanding of EOBs, FSAs, how to read receipts, doctor bills, and basic medical paperwork.We have 3 different classes with the 1st one starting in early October. A successful candidate will be computer literate, maintain good attendance, and have the right attitude and discipline to work from home. You will take pride in being a contributing member of a busy team. Meet your quality and volume requirements consistently. This starts as temporary position. You will receive fully paid training of 4-6 weeks. Based on performance and attendance you may be converted to a permanent employee with benefits. What You Will Be Doing Review and research claims Determine if the claim is valid to approve Process claims on a web-based application Completes assignments using multiple source documents to verify data or use additional information to do the work. Follows up on pending documents involving analysis. Requirements Be computer literate able to set up equipment and operate with ease Have own highspeed internet connection: 25 download and 5 upload Must be at least 18 years of age or older. Must have a high school diploma or general education degree (GED). Must be eligible to work in the Los Angeles, CA. Must be able to clear a criminal background check and drug test. Arsenault is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market - to do more for clients - and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company. Point C is looking for a detail-oriented and motivated Claims Examiner to join our team. In this role, you'll be responsible for accurately processing medical claims while ensuring compliance with plan documents, policies, and industry regulations. The ideal candidate is analytical, organized, and experienced in self-funded or third-party administration environments. Primary Responsibilities Adjudicate new claims and process adjustments, including denials upon receipt of additional information Review and resolve appeals and subrogation/third-party liability cases Manage individual inventory to ensure timely turnaround and production goals are met Ensure claims are processed in accordance with stop loss contract terms Respond to internal and external inquiries via email and other channels within established timeframes Follow up on missing or incomplete information to ensure claims can be accurately processed Maintain minimum production, financial, and procedural accuracy standards on a monthly basis Minimum Qualifications Associate's degree preferred Experience with Third Party Administrator (TPA) or self-funded claims administration preferred At least 1+ year of experience in insurance claims processing Working knowledge of CPT and ICD-10 coding Basic understanding of medical terminology Strong communication and customer service skills Proficiency in Microsoft Office and general computer applications Ability to maintain confidentiality and comply with all company policies and procedures Able to work independently with minimal supervision Ability to prioritize, multitask, and work overtime as needed Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency$38,000-$41,000 USDBenefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business-and our society-stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.