Claims adjuster jobs in Aliso Viejo, CA

We're always looking for diverse, talented, service-oriented people to join our exceptional team. Loan Adjuster II The pay range for this position is listed below. Our pay ranges are built to allow for candidates with various levels of skill and experience to be considered, as well as for room for growth and tenure achieved in a role over time. Typical new hire salary offers fall within the minimum to midpoint of a pay range for many candidates. Any offer extended to a candidate will be based upon their unique set of knowledge, skills, education, and experience as well as internal equity. Pay Range: $22.00 - $31.90 Scheduled Weekly Hours: 40 What You'll Be Doing Collects on loans of all stages of delinquency made by the Credit Union where timely payments are not being received. Communicates with Members using advanced skills to identify the true cause of non-payment and provides a personalized options to each Member. * Works on all delinquency stages through inbound/out-bound calling, letters, and other approved methods, collects past due payments and/or negotiates payment arrangements or repayment plans to resolve delinquent loans or negative shares by identifying reason for delinquency and offering appropriate options to Members. * Documents all conversations and collections activity in collection systems. May be responsible for funding of workout loans or working collections reports, such as the available money letter report. * Maintains adherence to all federal and state regulations and credit union policies. * Performs file maintenance of delinquent accounts to reflect agreed upon collection activities. Processes adjustments to Member loans as needed, including but not limited to, due date changes, opening/closing lines of credit, closing negative accounts, and payment plan maintenance. * Recommends Members with delinquent accounts for work out loans, deferments, reages, reduced payments, repossession and charge-off. Refers complex situations to the appropriate resources to ensure timely resolution. * May provide suggestions for streamlining departmental and credit union operations. When assigned helps to complete projects and reports related to the department. * May perform more advanced research and analysis on accounts, may skip trace and perform asset searches. Additional Job Functions * Performs other duties as assigned * Complies with regulatory compliance and assigned training requirements including but not limited to BSA regulations corresponding to their specific job duties. Failure to do so may result in disciplinary and other employment related actions Qualifications * High School Diploma or GED required * 3-5 years of previous related experience required * Previous financial institution or credit union experience preferred Knowledge, Skills, and Abilities * Knowledge of bankruptcy laws, FDCPA, TCPA and SCRA * Excellent verbal and written skills. * Uses active listening skills to determine the Member's hardship and provides appropriate solution. * Ability to multi-task * Intermediate computer and typing skills * Experience with inbound/outbound phone system preferred * Conflict resolution and negotiation skills SchoolsFirst FCU is committed to Diverse, Equitable, and Inclusive Hiring At SchoolsFirst FCU we are dedicated to building and growing a diverse, inclusive, and authentic Dream Team, so if you're excited about a position or wanting to make a career change but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. Many skills are transferrable and you may be just the right candidate for the position, or for other roles we are working on. SchoolsFirst Federal Credit Union is committed to fostering, cultivating, and preserving a culture of diversity and inclusion. SchoolsFirst FCU is an equal opportunity employer and prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibits discrimination against all individuals based on their race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, political affiliation, or genetic information. This organization participates in E-Verify.

Workers' Compensation Claim Representative II Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $70,000-$80,000 annually (dependent on experience) Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a Workers' Compensation Claim Representative II to manage California workers' compensation claims from intake through resolution for a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch. This position is designed for an experienced adjuster who can independently manage claims, apply sound judgment, and deliver consistent results within California's complex regulatory environment. You'll handle more complex claim scenarios, contribute to claim strategy, and partner closely with supervisors, clients, and vendors to drive quality outcomes. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care. Independently investigate, evaluate, and resolve California workers' compensation claims in compliance with CCMSI standards and client handling instructions Manage claims cradle-to-grave, including compensability, medical management, litigation coordination, and resolution strategy Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim-relatedness; negotiate disputed bills Establish, monitor, and adjust reserves in accordance with authority levels and best practices Authorize and issue claim payments within assigned settlement authority Negotiate settlements with injured workers and attorneys in accordance with client authorization Coordinate with and assist in the selection and oversight of defense counsel Identify and pursue subrogation opportunities Prepare and maintain accurate claim documentation, reports, payments, and reserve summaries Ensure compliance with service commitments, jurisdictional requirements, and excess reporting obligations Deliver consistent, high-quality claim service aligned with CCMSI's corporate standards Qualifications What You'll Bring Required 5-10 years of workers' compensation claims experience, with demonstrated success handling California claims Proven ability to manage claims independently from intake through resolution Strong working knowledge of the California workers' compensation claims process Excellent communication, organization, and time-management skills Ability to prioritize work, meet deadlines, and manage a full caseload with minimal supervision Reliable, predictable attendance within established client service hours Preferred SIP designation or ability to obtain within a defined timeframe Associate degree or higher Experience supporting PEO and/or staffing accounts Proficiency with Microsoft Word, Excel, Outlook, and claims systems Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #WorkersCompensation #WCClaims #WCClaimRepII #ClaimsAdjuster #CaliforniaWorkersComp #CAClaims #CAAdjusters #InsuranceCareers #ClaimsCareers #TPACareers #PEOClaims #StaffingClaims #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWorkCertified #CareerWithPurpose #CCMSICareers #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

Energy: Forget about blending in. That's not our style. We're the risk-takers, the trailblazers, the game-changers. We're not perfect, and we don't pretend to be. We're raw, unfiltered, and a bit unconventional. But our drive is unrivaled, just like our athletes. The power is in your hands to define what success looks like and where you want to take your career. It's not just about what we do, but about who we become along the way. We are much more than a brand here. We are a way of life, a mindset. Join us. A day in the life: Rev up the excitement as you take charge of the Bottler Claims department! Your mission? Ensure the turbocharged processing and payment of promotional claims is as smooth and precise as our energy drinks. You're the policy guru, making sure all procedures are followed to a tee while also shaking things up by improving existing policies and creating new ones when needed. Build electrifying relationships with our sales force and bottlers, all centered around those thrilling promotional claims. Get ready to unleash your energy and make an impact! The impact you'll make: Ensure claims are processed timely and accurately Review and maintain aging Understand the promotional claims procedures and policies for processing invoices for payment Manage workload of claim reps Develops, implements, and maintains controls, procedures, and policies to ensure adherence to company guidelines met Addresses performance issues and makes recommendations for personnel actions Prepares annual performance evaluations Addresses day to day needs and issues as they arise Maintain open communicate with bottlers and sales personnel Approve timesheets Interview future candidates, when needed Train Bottlers on bill back submission, when needed for both Domestic and International roles Execute, Lead, Design, and/or Collaborate on Special projects as assigned (ad-hoc) Who you are: College degree a must - Preferably BA Accounting / Business Accounting Experience: 5- 7 years Management Experience: 2 years minimum Advanced/Power-User in Microsoft Excel and Outlook (please provide scores) SAP experience a plus Strong leadership skills Strong ability to problem solve Ability to prioritize work for themselves and others. Ability to adapt to frequent or ongoing changes. Flexibility and capacity to shift priorities based on the organizations' needs. Excellent interpersonal, written and verbal communication skills. Strong attention to detail, high level of accuracy, ability to prioritize/multi-task and meet deadlines in a fast-paced environment. Integrity, professionalism, discretion and ability to maintain confidentiality essential. Role requires the employee to have a sense of urgency, solid work ethics, strong organization skills, possess drive, attention to detail, ability to interact with key players, in addition to the ability to lead a team, provide guidance and support to subordinates and upper management. Eager to learn and open to suggestions Self-motivated Takes the initiative Strong Time Management Skills Bi-lingual capability a plus Monster Energy provides a competitive total compensation. This position has an estimated annual salary of $82,500 - $110,000. The actual pay may vary depending on your skills, qualifications, experience, and work location.

**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** 1 **What Is the Opportunity?** This role is eligible for a sign-on bonus! LOCATION REQUIREMENT: This position services Insureds/Agents in Riverside County. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Ideal locations include Riverside, Redlands, Jurupa Valley, Moreno Valley, Beaumont, Grand Terrace, Colton, Bloomington, Rialto, and surrounding areas. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelors Degree preferred. + General knowledge of estimating system Xactimate preferred. + Customer Service experience - preferred + Interpersonal and customer service skills - Advanced + Organizational and time management skills- Advanced + Ability to work independently - Intermediate + Judgment, analytical and decision making skills - Intermediate + Negotiation skills - Intermediate + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate + Investigative skills - Intermediate + Ability to analyze and determine coverage - Intermediate + Analyze, and evaluate damages -Intermediate + Resolve claims within settlement authority - Intermediate + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED required. + A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. + Valid driver's license required. **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 ******************************************************** .

Healthcare Talent is assisting our client in hiring a Supervisor, Claims (CQI) for their Claims Department. The Claims Supervisor oversees the day-to-day operations of the Quality Analyst (QA) staff in the Continuous Quality Improvement (CQI) Unit of the Claims Department. This position is responsible for ensuring adherence to regulatory and internal guidelines in conjunction with company policies and procedures as they apply to claims processing and adjudication. Our client has a unique business philosophy; their goal is to provide employees with a place to excel - while really creating something meaningful in their work. This philosophy has helped them grow into an award-winning company. Employees are provided with room for advancement, competitive compensation, and an excellent benefit package. Job Description Position Responsibilities • Train, audit and supervise all QA staff to ensure adherence to the Medi-Cal and Medicare processing guidelines. Identify any new learning opportunities for staff (i.e. new desktops). • Monitor staff to ensure department turn-around times for claims auditing are met. Ninety five percent (95% of all claims must be paid or denied within 30 calendar days and 100% within 60 days from date of receipt to date of financial run. • Must serve as a back up to claims processing when needed to ensure the department turn-around times are met and maintain inventory within 21 days on hand. • Responsible for prompt communication with staff. Must schedule monthly unit meetings to go over any changes to programs or training issues; schedule monthly one-on-one meetings with staff to go over their monthly progress regarding their success factors (production, quality, etc). • Plan work for staff, assign daily claims and determine priorities of work done by staff. • Set or recommend work performance standards. • Review work procedures and recommend or change procedures to be more time/cost efficient. • Assist with interviewing job applicants and make recommendations for hire as needed. • Train, evaluate, and provide performance feedback to staff. • Conduct employee counseling/corrective interviews with the assistance of Human Resources. • Conduct claims presentations as assigned. • Other projects and duties as assigned. Qualifications Required Skills • Diffuse emotional situations with employees and/or provider representatives. • Interact with peers face-to-face, over the phone and in writing in a manner that is professional and productive. • Influence others using a positive approach. • Provide clear, concise instruction to individuals of varying skill levels. • Troubleshoot problem areas. • Encourage and utilize suggestions and new ideas. • Manage and keep track of multiple tasks. • Remain objective when dealing with emotional topics or when having to give feedback to staff. • Establish and maintain effective working relationships with all levels of staff, other programs, agencies, and the general public. • Effectively utilize computer and appropriate software and interact as needed with company claims processing systems. • Speak and write clearly and concisely. • Encourage the professional performance and development of subordinate staff. • Plan, organize and prioritize work. Required Experience Experience & Education • High school diploma or equivalent is required; some college preferred. • 3+ years of experience in a managed care environment that would have developed the knowledge and abilities listed. • Substantial practical knowledge and understanding of relevant business practices and applicable regulations/policies. • Previous experience in directing the work of others (i.e. training, responding to questions, etc.) and supervisory experience are preferred. • Demonstrated ability to work closely and often with others. Knowledge of: • Principles and techniques of effective supervision. • Technical area(s) of medical claims administration, including medical terminology, CPT, ICD-9 codes and HCPCS codes. • Medi-Cal and Medicare program guidelines. • Benefit interpretation and administration. • Department reports, their purpose and how to interpret them. • Department procedures, policies and expectations. • Fundamental principles of writing and grammar, including proper report and correspondence format, correct spelling and proper word usage, grammar, punctuation, and sentence structure. • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Additional Information If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document. We look forward to hearing from you today! ************************ *********************************

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.

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

Job DescriptionDescription: Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service. Our company values can best be described with ABLE: to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success. What You'll Do Under the close supervision of the Training Supervisor, the Claims Adjuster Trainee performs essential functions to develop the skills and knowledge required to investigate, evaluate, and resolve automobile claims. This entry-level position involves comprehensive training in a classroom setting and practical, on-the-job experience to ensure proficiency in all aspects of claims adjudication. Responsibilities Successfully complete all assigned claims training programs in a classroom setting Engage actively in learning sessions, demonstrating a clear understanding of the material covered. Investigate automobile claims thoroughly to gather relevant information; Evaluate claims to determine their validity and potential payout based on policy terms and conditions. Resolve automobile claims efficiently and in a timely manner, ensuring customer satisfaction Ensure ongoing adjudication of claims within company standards, industry best practices and all state and federal regulations; Stay updated on changes in regulations and company policies Document all investigations, evaluations, recommendations, and action plans accurately Maintain detailed and organized records in the claims management system Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation; Communicate effectively with claimants, policyholders, and other stakeholders through written and verbal means Regular and predictable punctuality and attendance; Perform other duties as necessary to support the claims department and organizational goals Requirements: A 4 year college degree or at least 1 year industry experience; Must have strong communication skills; Must have strong written communication skills; Must be able to multi-task; Must be able to pass a background check; Must have a disciplined approach to all job-related activities; Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills; Ability to work in a fast paced environment while managing multiple priorities simultaneously; Ability to achieve targeted performance goals. Ability to develop excellent working relationships with staff, clients, Partners and outside agencies; Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of good will, indicative of a professional environment and atmosphere; Ability to be a team player and work cohesively with other Company Partners and Companies staff to achieve company goals; Able to represent the company in a professional manner and contribute to the corporate image; Able to consistently provide excellent client service. Working Conditions This is a non-exempt position which complies with alternative work schedule when applicable; This position may require mandatory overtime as deemed appropriate by management; The office is that of a highly technical company supporting a paperless environment; Travel may be required; This work environment is fast-paced and accuracy is essential to successful task completion; Travel may be required; Requires extended periods of computer use and sitting Benefits: Medical, Dental, Vision, HSA*, PTO, 401k, Company observed Holidays Individuals seeking employment at Aspire General Insurance Services LLC are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation in accordance with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements. *dependent on plan(s) selected Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, location, etc.

The Department of Risk Management is recruiting for a Medical Only Claims Adjuster who examines and adjusts "medical only" workers' compensation claims. Duties include, but are not limited to, the following: perform initial review of claim to determine the complexity of the claim and identify issues; determine the employee's status and if the illness or injury is compensable; advise employee of entitlement to workers' compensation benefits under State law and County policy; calculate and track salary continuation benefits; arrange and coordinate medical treatments; monitor and coordinate temporary modified duties with departments, etc. For more detailed information, please refer to the Medical Only Claims Adjuster job description. This excellent opportunity for career growth also offers a lucrative compensation and benefits package! To review job-specific benefits, refer to: * Benefits by Occupational Unit (BbOU) Summary * Employee Benefits * County Memoranda of Understanding (MOU) A hybrid telework schedule may be offered upon satisfactory work performance. The department may also offer a 9/80 schedule, where incumbents enjoy a nine-day biweekly schedule. CONDITIONS OF EMPLOYMENT Pre-Employment Process: Prior to appointment, applicants must successfully pass a background check, including fingerprinting, verification of employment history, and physical exam/drug test. Travel: Travel throughout the county may be required. Employees will be required to make provision for transportation. Mileage reimbursement may be available. Sponsorship: San Bernardino County is not able to consider candidates who will require visa sponsorship at the time of application or in the future. Certification: A valid California Self Insurance Administrator Certificate is required and must be obtained within twelve (12) months of hire or be terminated.Experience: Eighteen (18) months of full-time equivalent experience working as a workers' compensation claims assistant or medical only claims adjuster, calculating worker's compensation benefits, scheduling medical appointments, preparing benefit notices, authorizing payment for medical treatment, processing claims, and other related duties. Note: Workers' compensation claims experience must be clearly demonstrated in the work experience section of the application. Substitution: Six (6) months of the required experience may be substituted with one (1) of the following options: * Successful completion of one (1) course taken toward the Insurance Education Association (WCCA) certificate (or comparable coursework involving State of California workers' compensation laws) * Twelve (12) semester units or eighteen (18) quarter units of completed college coursework from an accredited institution in finance, accounting, biology, paralegal studies, or closely related If substituting coursework for experience, transcripts must be attached to the application. The ideal candidate will have extensive experience working in a public sector worker's compensation claims management environment. Examination Procedure: There will be a competitive evaluation of qualifications based on the information provided in the Application and Supplemental Questionnaire. You are encouraged to include detailed descriptions of your qualifying experience and skills, as only the most highly qualified applicants will be referred to the department. Do not refer to a resume; it will not be reviewed. Application Procedure: To be considered for this excellent opportunity, please complete and submit the online employment application and supplemental questionnaire by 5:00pm, Friday, December 26, 2025. To ensure timely and successful submission of your online application, please allow ample time to complete and submit your application before the posted filing deadline. Applicants will be automatically logged out if they have not submitted the application and all required materials prior to the posted deadline. Once your application has been successfully submitted, you will receive an onscreen confirmation and an email. We recommend that you save and/or print these for your records. Please note, if you do not receive an onscreen confirmation and an email acknowledging our receipt of your application, we have not received your application. All communications regarding the selection process will be via e-mail. Applicants are encouraged to check their e-mail frequently to learn additional information regarding this recruitment. Check your Government Jobs account for notifications. Update your firewalls to allow e-mails from San Bernardino County through governmentjobs.com. Update your Spam, Junk, and Bulk settings to ensure it will not spam/block/filter communications from e-mail addresses with the following domain "@hr.sbcounty.gov". Finally, be sure to keep your personal information updated. Taking these steps now will help ensure you receive all communications regarding this recruitment. If you require technical assistance, please follow the link to review the Government Jobs online application guide or contact their Toll-Free Applicant Support line at **************. Please note that Human Resources is not responsible for any issues or delays caused by the internet connection, computer or browser used to submit the application. EEO/ADA: San Bernardino County is an Equal Employment Opportunity (EEO) and Americans with Disabilities Act (ADA) compliant employer, committed to providing equal employment opportunity to all employees and applicants. ADA Accommodation: If you have a disability and require accommodations in the testing process, submit the Special Testing Accommodations Request Form within one week of a recruitment filing deadline. Veterans' Preference: Eligible veterans and their spouses or widows/widowers who are not current County employees may receive additional Veterans' Preference points. For details and instructions on how to request these points, please refer to the Veterans' Preference Policy. Review important Applicant Information and the County Employment Process for more information

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjusts and manages claims within the limit of assigned authority. Experience with California Workers Compensation jurisdiction is required for this role. High preference for candidates in the West Coast. What you will do for C&F: Must be well versed in California Compensation statute claims. Receives lost time and complex medical only assignments. Verifies and determines applicability of coverage. Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician. Handles catastrophic claims with supervisory oversight. Conducts telephone investigations as required by company claims handling manual and procedures. Evaluates and adjusts claims within the limits of authority. Consults with Claim Manager on those claims where assistance and consultation is needed. Makes assignments to nurse case management when indicated, monitoring their billing and performance. Sets reserves for anticipated exposure up to authority limits. Completes mandatory Reserve Worksheets. Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation. Coordinates return to work (RTW) and sets target dates. Maintain diaries on maximum three (3) month intervals. Documents files in the claims system. Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments. Adheres to special account handling (SHI) instructions. Attends account meetings by telephone and in-person. Manages litigation on the files. What you will bring to C&F: College degree, B.A. or equivalent experience. 3+ years of experience handling workers compensation claims required, 5+ years preferred. Strong organizational skills. Good time management skills. Foreign language communications a plus. Excellent verbal and written communication skills are essential. Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs. Will abide by departmental policies and procedures, including authority levels, to comply with C&F's risk management controls. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $55,800.00 to a maximum of $104,900.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-AV1 #LI-Remote

JOB TITLE: Senior Claims Examiner DEPARTMENT: Claims Services Carl Warren & Company is a leading nationwide Third-Party Administrator (TPA) founded in 1944. Carl Warren has been a trusted partner specializing in property and casualty claims management, subrogation recovery, and litigation management for private and public sectors, insurance companies, and captives. Our clients count on us to care for their needs when the unexpected happens. Our culture is derived from the people that create it. We are not different in what we do. We are different in how we do it. Our culture helps us collaborate, unite, and create a diverse workforce. Our people are at the core of our purpose, vision, mission, and values. We offer competitive compensation and a comprehensive benefits package: • 401k + employee match • Medical, dental, vision, life, and disability insurance • Paid Time Off (PTO) • Paid Holidays • Paid Sick leave • Professional development programs • Work-life quality and flexibility Visit us online at ****************** RESPONSIBILITIES • Executes client/Carl Warren strategies to achieve claims quality, customer service, and operational objectives. • Proactively work claims to ensure file quality meets Carl Warren & Company Claim Handling Guidelines and client requirements. • A high level of productivity measured according to the age and complexity of the assigned caseload. • Maintains a timely diary of claims. • Consistently achieves audit scores of 90% and above. • Focuses on providing the client with an outstanding work product. • Provides excellent customer service to internal and external customers. • Develops strategies for claims resolution with file notes reflecting clarity, focus, control/management, and momentum. • Identifies/utilizes vendors and effectively manages the vendors to achieve satisfactory results on both the expense and indemnity costs. • Up to 25% travel for field work and court appearances. QUALIFICATIONS • Four or more years handling auto and/or general liability claims for a standard auto and/or general liability insurance carrier • Two or more years' experience handling litigated claims with a well-developed understanding of the litigation process • College degree preferred • Strong claim evaluation skills with the ability to identify the issues involved, formulate an action plan, assess liability, evaluate the damages involved, and put a settlement number on the claim and explain why • Strong negotiation skills • Must be able to function and support others in a team environment • High level of personal responsibility and pride in work product Salary up to $105,000

Job Description Workers' Compensation Claims Supervisor - Lead a Dynamic Team in Orange, CA We're seeking an experienced and motivated Workers' Compensation Claims Supervisor to join our team in Orange, CA. As a Supervisor, you'll lead a team of 8, including 6 Claims Adjusters and 2 Claims Assistants, providing guidance, mentorship, and performance feedback to ensure exceptional claim handling and adherence to company standards and regulations. Our Mission: To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives. Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes. Our Goal: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients. Your Impact: Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance Ensure all claims are handled in accordance with relevant statutes and company guidelines Address personnel issues promptly and decisively, keeping management informed of corrective action Foster a collaborative and productive team environment focused on excellence in claim resolution Our Offer: Competitive salary and benefits package, including medical, dental, vision, and 401(k) Opportunity for professional growth and advancement in a dynamic organization Collaborative work environment with a team dedicated to workers' compensation excellence Interested? Get in Touch: To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following: Apply to this posting Call me directly at ************ Email ************************ We look forward to hearing from you! Powered by JazzHR pTIQWPhGiE

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $53,700.00 - $88,600.00 Target Openings 4 What Is the Opportunity? This position is responsible for handling low to moderate Personal and Business Insurance Auto Damage claims from the first notice of loss through resolution/settlement and payment process. This may include applying laws and statutes for multiple state jurisdictions. Claim types include multi-vehicle (2 or more cars) auto damage with unclear liability and no injuries. Will also handle more complex Auto Damage claims such as non-owned vehicles, fire/theft, and potential fraud as well as non-auto, property related damage. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. What Will You Do? Customer Contacts/Experience: Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follows-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC). Coverage Analysis: Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for Auto Damage only claims in assigned jurisdictions. Addresses proper application of any deductibles and verifies benefits available and coverage limits that will apply. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration other issues relevant to the jurisdiction. Investigation/Evaluation: Investigates each claim to obtain relevant facts necessary to determine coverage, causation, extent of liability/establishment of negligence, damages, contribution potential and exposure with respect to the various coverages provided through prompt contact with appropriate parties (e.g.. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, etc.) Takes recorded statements as necessary. Recognizes and requests appropriate inspection type based on the details of the loss and coordinates the appraisal process. Maintains oversight of the repair process and ensures appropriate expense handling. Refers claims beyond authority as appropriate based on exposure and established guidelines. Recognizes and forwards appropriate files to subject matter experts (i.e., Subrogation, SIU, Property, Adverse Subrogation, etc.). Reserving: Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities to resolve claim in a timely manner. Negotiation/Resolution: Determines settlement amounts based upon appraisal estimate, negotiates and conveys claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to insureds and claimants. May provide support to other parts of Auto Line of Business (e.g. Total Loss, Salvage, etc.) when needed. Insurance License: 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. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's degree preferred. Demonstrated ownership attitude and customer centric response to all assigned tasks Ability to work in a high volume, fast paced environment managing multiple priorities Attention to detail ensuring accuracy Keyboard skills and Windows proficiency, including Excel and Word - Intermediate Verbal and written communication skills - Intermediate Analytical Thinking- Intermediate Judgment/Decision Making- Intermediate Negotiation- Intermediate Insurance Contract Knowledge- Basic Principles of Investigation- Intermediate Value Determination- Basic Settlement Techniques- Basic What is a Must Have? High School Diploma or GED required. A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is required.

About Monster Energy: Forget about blending in. That's not our style. We're the risk-takers, the trailblazers, the game-changers. We're not perfect, and we don't pretend to be. We're raw, unfiltered, and a bit unconventional. But our drive is unrivaled, just like our athletes. The power is in your hands to define what success looks like and where you want to take your career. It's not just about what we do, but about who we become along the way. We are much more than a brand here. We are a way of life, a mindset. Join us. A day in the life: As a Bottler Claims Representative at Monster Energy, you'll be at the heart of the action, processing, validating, and coding promotional invoices with the precision of a high-speed racer! Get ready to rev up your data-entry skills and keep the promotions engine running smoothly. Your role is all about ensuring everything flows seamlessly, just like the thrilling rush of a Monster Energy drink! The impact you'll make: * Review, validate, and process distributor invoices in accordance with company policies and procedures. Requires frequent communication with distributors and the Sales Team to obtain necessary supporting documentation and approvals. * Verify invoice program details, ensure accuracy, compliance, and adherence to promotional execution or contractual agreements. -->> Collect, organize, and maintain supporting documents required for invoice validation and/or support in SAP, Vistex, Sales Force and or other source locations. * Accurately code and enter invoice details into SAP, Vistex, Sales Force, and or other source locations, to ensure proper GL coding and reporting. * Identify discrepancies or errors in claims and work with relevant teams to resolve issues efficiently. * Ensure all claims adhere to company policies, industry regulations, and audit requirements. * Maintain accurate and up-to-date records of processed claims for tracking and audit purposes. * Identify opportunities to enhance efficiency and accuracy in claims processing workflows. * Work closely with internal teams, including Finance and Sales and Chain Claims, to support business objectives and streamline operations alongside any additional ad hoc duties. Who you are: * Prefer a Bachelor's Degree in the field of --Accounting, Math, Business Administration, or other related field of study * Additional Experience Desired: Minimum 1 year of experience in Accounts Payable position * Additional Experience Desired: Minimum 1 year of experience in processing vendor invoices, data entry, account reconciliation * Computer Skills Desired: Proficiency with Microsoft's office desktop solutions (Intermediate Excel a must - Test Scores required), Teams, Outlook, SharePoint, SAP or other accounting technology a plus. * Preferred Certifications: N/A * Additional Knowledge or Skills to be Successful in this role: Typing, 10 Key desired Monster Energy provides a competitive total compensation. This position has an estimated hourly rate of $17.00 - $23.00 per hour. The actual pay may vary depending on your skills, qualifications, experience, and work location.

Alacrity Solutions Independent Contractor Daily Property Field Adjuster Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy equipment, and casualty claims management services. Our staffing capabilities, temporary housing services, managed repair network, and subrogation services support a fully integrated solution for all your needs from first notice of loss through completion of repairs. By assembling the best service providers through strategic acquisitions and relying on the right talent, Alacrity Solutions provides consistent, professional, and scalable services throughout the entire claim handling and resolution process. To learn more, visit ************************** The objective of a Daily Property Field Adjuster is to provide excellent claim handling services for our clients regarding daily claim work within your area which can include multiple perils. Contract Requirements Include: A contract will be issued within 24 hours of accepting your first claim assignment with Alacrity. This IA contract will include pay details and other pertinent information regarding your work as an independent contract with Alacrity. A completed contract is required to issue pay. Skills & Requirements/Licensure: MUST live within 50-100 miles of posted location and willing to travel to location. Minimum 2-3 years property field adjusting experience. Independent adjusting license in your home state (area of work), or a designated home state license if residing in a non-licensing state. Experienced in wind, hail, theft, fire, water losses and other perils preferred. Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities. Willing and able to climb roofs. Computer and Phone System Requirements: Smart Cell Phone able to access to internet. Xactimate and/or Symbility proficient with current subscription Working Laptop computer with reliable high-speed internet Digital camera and other miscellaneous items necessary to perform adjuster responsibilities. Working Conditions / Physical & Mental Demands: The physical demands described here are representative and must be met by the independent contractor to successfully perform this job. 100% travel is required within designated working territory based on the location of assignments received. Normal office or field claims environment. Ability to operate a motor vehicle for up to 8 hours daily, repeatedly entering and exiting the vehicle. Must be able to make physical inspections of auto loss sites. Must be able to work outdoors in all types of weather. Available to work catastrophic loss events. A willingness to work irregular hours and to travel with possible overnight requirements a plus. Why Choose Alacrity? Flexibility: Self-determined Scheduling Diversity Statement Alacrity is an equal opportunity employer and is committed to providing employees with a work environment free of discrimination and harassment. All decisions pertaining to an employee's employment are made without regard to race, color, religion, sex (including sexual orientation, pregnancy, childbirth), gender, gender identity or expression, age, national origin, ancestry, physical or mental disability, medical condition, reproductive health decisions, veteran's status, genetic information, creed, marital status, disability, citizenship status, or any other characteristic protected by applicable law. How Long We Retain Personal Information: We will keep your personal information for as long as necessary to fulfill legitimate business purposes and in accordance with applicable laws.

Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR 14hNFhVCCV

The Claims Analyst is responsible for analyzing and adjudicating medical claims. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or CSIM (Customer Service Inquiry Module). Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and CSIMs. Collaborates with other departments and/or providers in successful resolution of claims related issues. QUALIFICATIONS: •Minimum 1-2 years financial analyses/accounting experience and 2-5 years medical claims examining experience, or a combination/equivalent of the two •2 or more years experience in managed care organization a plus •Minimum typing speed of 45 WPM and use of Ten-Key by touch •Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus •Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements a plus •Ability to write analytical reports and comprehensive summaries •Advanced proficiency in Microsoft Word and Excel; Access knowledge a plus •Must be detail oriented •Ability to effectively communicate with internal and external associates •Ability to deal with complex claim issues •Knowledge of DMHC, DHS, CMS, Title XX II CRC, Title 42, and Medi-Cal and Medicare processing guidelines a plus •Ability to work in a fast pace environment with minimal supervision •Ability to handle multiple projects and is able to prioritize workflow ESSENTIAL DUTIES AND RESPONSIBILITIES TO INCLUDE BUT NOT LIMITED TO: •Conducts claims payment analyses to identify root cause of claims issues/deficiencies. •Adjudicates medical claims according to regulatory and Care1st Health Plan processing guidelines and contractual agreements: ◦Verifies patient account, eligibility, benefits and authorizations. ◦Prioritizes assigned claims according to regulatory timelines. ◦Requests additional information for incomplete or unclean claims; follows up with provider as necessary. ◦Contacts providers on claims related issues as necessary. •Notifies Claims Management immediately when claims or other projects cannot be completed within the processing timelines. •Performs payment reviews and adjustments due to retroactive effective date of contracts and/or fee schedule changes: ◦Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes. •Responds to provider inquiries/calls related to claims payments. •Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process, CSIM (Customer Service Inquiry Module) and/or provider calls. •Generates and develop reports which include but not limited to root causes of PDRs and CSIMs •Maintains productivity and quality standards as defined by Management. •Communicates with other departments (such as Provider Data Maintenance, Provider Network Operations, and Utilization Management) to resolve provider claims related issues. •Contacts providers either telephonically or in writing for additional information to resolve or clarify submitted claims issues. •Handles misdirected claims inquiries: ◦Corresponds with IPAs/Medical Groups regarding misdirected claims. ◦Reviews Division of Financial Responsibility (DOFR) to ensure proper routing of claims. ◦Notifies Management and/or Provider Network Operations (PNO) Department of any issues related to misdirected claims routing. •Complies with company's attendance and punctuality standards. •Promotes teamwork and cooperation with other staff members and management. •Performs additional related duties as assigned by Additional Information All your information will be kept confidential according to EEO guidelines.

The Senior Claims Specialist will report directly to the Director of Risk Management. Duties include overseeing and monitoring the timely response and proper handling of General Liability, Auto and Property claims on behalf of Superior Grocers. Moreover, attendance of Small Claims court matters will be ensured as required. Position will have the autonomy and authority to make settlement decisions within a pre-determined range. Responsible for timely feedback/response and providing necessary documentation to insurance company/TPA, defense counsel and corporate office staff as instructed. Display and communicate an understanding of insurance concepts, internal practices and procedures. DAILY JOB DUTIES: 1. Claim documentation * Respond timely to incoming claims and monitor ongoing open claim inventory 2. Claim investigation as needed * Telephone and on-site investigation * Employee and customer interviews * Referrals to outside vendors 3. Review and oversee new and existing customer related claims * Accident Reports and related support documentation must be completed timely, thoroughly and objectively, thereafter provided to TPA/defense counsel/necessary parties. * Assist with determination of liability and corresponding/appropriate defense tactics * Ensure the timely logging of all new claims (delegate to Claims Assistant if necessary) and timely reporting to our Insurance Carrier, with guidance by the Dir of Risk Management 4. Review, oversee and manage legacy customer claims continuously and ongoing * Utilize TPA website/database (if appl.) or internal tracking system to review the status and monitor claims being handled by outside adjusters. * Review and approve the status of any claim, any reserve changes, and maintain communication with the adjuster handling the claim. * Vice-Versa the adjuster can communicate with Senior Claims Specialist for added information a. Authority requests are presented to the Director of Risk Management b. Other Samples of requests from adjusters * Coordinate employee recorded statements * Coordinate internal/external investigations of incidents * Copy and analyze video tapes * Provide information on employees; current and terminated a. When a claim is sent to our Attorney, same duties as above apply b. Follow instructions communicated to pass on to defense attorney c. Defense attorney is assigned in coordination with the Director of Risk Management * Be prepared with monthly status report (when requested) concerning any significant changes on our position of liability or damages * Calendar deposition appearances as necessary * Calendar hearings as necessary * Calendar Mediation or settlement conferences WEEKLY JOB DUTIES: 1. Maintain customer claim files in order * Systematically inspect and maintain the claims database to ensure all reported claims are accurately logged, properly classified according to protocols, and fully accounted for * Ensure all supporting evidence, including video footage and investigation reports, is collected on new claims, promptly updated as information becomes available, and efficiently forwarded to the assigned insurance adjuster * Manage the open claims inventory through disciplined diary maintenance, conducting a weekly review of all active files and utilizing a 45- to 60-day diary system to monitor case progression and address pending issues 2. Store Inspections * Store visits will be done as instructed by the Director of Risk Management Inspect for adverse liability conditions and/or store operations a. Report to manager my findings and discuss a solution b. Report to manager if a sweep compliance is unacceptable 3. Porter Inspections * Meet with a Store and Safety personnel as instructed * Review porter inspections * Review porter schedules for each store * Provide porter training on using scanners, the purpose for a sweep, and the need to be diligent in doing their job and in using the scanner 4. Insurance Certificate Program * Assist to Maintain up to date our Insurance Certificate Program a. Insurance certificates from vendors and contractors as needed. b. Requests are made as needed c. New Vendor Application process 5. Insurance Needs * Handle any General Liability Auto, and Property insurance needs a. Add new vehicles as instructed b. Add new stores as instructed MONTHLY JOB DUTIES: 1. Claims * Generate monthly reports, regarding frequency and location of customer claims a. Analyze report; recommend preventative measures share with store management * Review monthly billing and present to Director of Risk Management timely a. Check figures, claims, etc. ensuring reimbursement is appropriate b. Perform monthly store inspections as needed QUARTERLY JOB DUTIES: 1. Claims * Quarter end reports (same as monthly) * Participate in quarterly claim reviews with TPA YEARLY JOB DUTIES: 1. Assist where necessary regarding General Liability, Auto, and Property Insurance renewal * Administrative duties only Job Requirements: Education: * Bachelor's degree in business is preferred * In addition, attend insurance seminars and insurance classes with emphasis in insurance concepts, including, premises liability and related tort applicable to the position. Experience: * At least 5 years work experience in the field if no bachelor's degree Knowledge: * Working knowledge of Excel and Word. Skills and Ability: * Excellent verbal and written communication skills * Ability to multi-task * Bilingual (Spanish and English) helpful, but not mandatory Wage: $90,000 - $100,000 annually [1] Cal. Civ. Code § 1798.100 et seq . [2] Código Cal. Civ. § 1798.100 et seq.

Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead - our policyholders count on us to be there when it matters most. It's a big ask, but it's one that we have the power to deliver when we work together. We collaborate and innovate - pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it's the right thing to do. Pacific Life is more than a job, it's a career with purpose. It's a career where you have the support, balance, and resources to make a positive impact on the future - including your own. We're actively seeking a talented Operations Claims Associate to join our CMD Claims team in Newport Beach, CA or Omaha, NE. This role is hybrid. We believe in empowering our employees to get work done both in and out of the office. As an Operations Claims Associate you'll move Pacific Life, and your career, forward by reviewing, processing and paying of contestable and non-contestable death and living claims on both annuity contracts and life insurance policies. You will fill an existing role that sits on a team of 15 people in the Consumer Markets Division. Your colleagues will include Operations Claims Specialists, Senior Operations Claims Specialists and Senior Operations Claims Analysts. How you'll help move us forward: Completes training and masters Foundational Life and Annuity death and living claims functions (as defined per department learning progression). Once cross-trained on functions, can demonstrate a strong technical understanding of process, purpose of steps, and impact to client. In-queue and out-of-queue client requests are reviewed against contract/policy information and department procedures to determine good order and necessary steps for resolution; Transaction details are accurately input into administration systems; Final review is completed prior to initiating pay; Takes all appropriate action to ensure a superior service experience. Outstanding requirements are accurately and clearly noted, including action to be taken and relevant details of any interaction with client; Notes ensure any future action can be conducted smoothly for the client. Prepares before making contact with customers; Follows guidelines for clear and professional verbal and written communication and demonstrates right level of effort to successfully resolve client requests. Handles client interactions efficiently while communicating with empathy around sensitive topics. Demonstrates ability to navigate to and use appropriate procedural resources; Advises Supervisor of scenarios where documentation may need updating to best support team and/or customer. Consistently meets established benchmarks for processing handling times, utilization, accuracy, and service quality; “Escapes” are minimized and within acceptable thresholds, oldest items in queue are worked first, and non-queue processing time is accurately recorded and maps to assignments. All discovered errors are reported to minimize impact to client and help leaders identify uptraining opportunities. Follows guidelines to appropriately hand off complex or escalated cases to senior team members, ensuring a smooth transition for the customer. Adheres to regulatory requirements as defined in current processes. Calls and emails are monitored and answered as assigned; Inquiries for advanced topics are forwarded to appropriate senior team members immediately for escalated handling within expected timeframes. Follows Operations Call Guidelines during each call, creating a positive service experience for both internal and external callers; Issues are appropriately researched, status on inquiries are provided before department service level expectations, and escalated calls are minimal. Effectively drafts emails for outstanding requirements and query responses. Emails follow protocols, are clear, and accurate. Documents, notes, job-aids and other appropriate resources are reviewed to ensure accuracy of communication with client; Contract/policy notes accurately reflect contacts, and correctly document status to ensure customer needs are addressed. Maintains positive and professional interactions with peers, trainers, internal customers, and leaders across all activities (training, day to day, meetings, etc.). Effectively collaborates to overcome challenges. Rotates assignments as requested in support of workflow needs; Accepts temporary assignments within Operations in support of other departments or contingency planning, as directed by Supervisor. Demonstrates awareness of the Workday Performance Mgmt. and goal writing process, partners with Supervisor to identify areas of skill building opportunities and develop SMART goal(s) and meets target check-in and self-evaluation dates; Comes prepared for coaching sessions with status of progress; Follows through on action plans. The experience you bring: 2 years Operations experience, demonstrating broad knowledge of Annuities and/or Life Insurance business, workflow, procedural and system knowledge from an Operations perspective; Experience with review and administration of insurance-related death and living benefit claims not required by highly beneficial. A strong desire to deliver a superior customer service experience. Requires strong research and analysis, critical thinking skills, attention to detail, and the ability to work independently and meet deadlines in a fast-paced environment. Ability to balance accuracy, speed, and work quality. Effective verbal and written communication skills; Ability to comfortably communicate sensitive, death benefit related information with empathy. 4-year degree or equivalent combination of work and experience. What makes you stand out: Knowledge of both Life and Annuity claims and administrative systems. You can be who you are. People come first here. We're committed to an inclusive workforce. Learn more about how we create a welcoming work environment through Diversity, Equity, and Inclusion at ******************** What's life like at Pacific Life? Visit Instagram.com/lifeatpacificlife. Benefits start Day 1. Your wellbeing is important. We're committed to providing flexible benefits that you can tailor to meet your needs. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we've got you covered. Prioritization of your health and well-being including Medical, Dental, Vision, and a Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents Generous paid time off options including Paid Time Off, Holiday Schedules, and Financial Planning Time Off Paid Parental Leave as well as an Adoption Assistance Program Competitive 401k savings plan with company match and an additional contribution regardless of participation. #LI-RB1 Base Pay Range: The base pay range noted represents the company's good faith minimum and maximum range for this role at the time of posting. The actual compensation offered to a candidate will be dependent upon several factors, including but not limited to experience, qualifications and geographic location. Also, most employees are eligible for additional incentive pay. $24.44 - $29.88 Your Benefits Start Day 1 Your wellbeing is important to Pacific Life, and we're committed to providing you with flexible benefits that you can tailor to meet your needs. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we've got you covered. Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off Paid Parental Leave as well as an Adoption Assistance Program Competitive 401k savings plan with company match and an additional contribution regardless of participation EEO Statement: Pacific Life Insurance Company is an Equal Opportunity /Affirmative Action Employer, M/F/D/V. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Pacific Life Insurance Company.