130521 We are excited to share that Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and Liability experience preferred) to join our team! We are open to remote work for the right candidate located within the U.S..
In this role you will be responsible for:
+ Ability to handle dedicated accounts.
+ Frequent interaction with Assureds, Brokers and Underwriters.
+ Some travel may be required but this is not very frequent.
Basic Qualifications:
+ Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.AND
+ Must obtain and maintain required adjuster license(s)
+ Microsoft Office experience
+ Knowledge of insurance regulations, markets, and products as well as maritime and admiralty practices.
Preferred Qualifications:
+ Extensive Marine Hull claims experience preferred.
+ Emphasis on Marine Liability, Hull, Blue water and brown water claims, Jones Act, General Average and Ocean Cargo Claims experience preferred.
+ Licensed in all states as needed required.
+ Effective verbal and written communication skills
+ Strong analytical, critical thinking and problem-solving skills
+ Strong multi-tasking and prioritization skills
+ Experience collaborating in a team environment and building cross functional working relationships
+ Proactively shares and promotes sharing of insights
+ Ability to gather unique perspectives from other teams/functions to optimize outcomes.
+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims
+ Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
+ Ability to determine the scope and exposure for complex claims
+ Ability to leverage trend and relationships to provide high-quality customer service
+ Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
+ Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
+ Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply-your unique background matters to us.The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $75,800.00 - $124,100.00, with short-term incentive bonus eligibility set at 15%.
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here .]
**Why Zurich?**
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment-so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500 .
Join us for a brighter future-for yourself and our customers.
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.
Zurich complies with 18 U.S. Code § 1033.
**Please note:** Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.
Location(s): AM - Texas Virtual Office, AM - Remote Work (US)
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-JJ1 #LI-ASSOCIATE #LI-REMOTE
EOE Disability / Veterans
$75.8k-124.1k yearly 4d ago
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Field Claims Adjuster
EAC Claims Solutions 4.6
Claims adjuster job in Boise, ID
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.
$47k-57k yearly est. Auto-Apply 7d ago
Independent Insurance Claims Adjuster in Boise, Idaho
Milehigh Adjusters Houston
Claims adjuster job in Boise, ID
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMSADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance ClaimsAdjuster? 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 ClaimsAdjuster, 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 ClaimsAdjuster 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 ClaimsAdjuster.
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 claimsadjusting.
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 claimsadjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claimsadjusting 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 ClaimsAdjuster. 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.
$45k-55k yearly est. Auto-Apply 60d+ ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Claims adjuster job in Boise, ID
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss Claims Analyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$22.71
**Pay Range Maximum:**
$35.18
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273755
$22.7-35.2 hourly 36d ago
Sr. Claims Specialist, Professional Liability | Medical Malpractice
Sedgwick 4.4
Claims adjuster job in Boise, ID
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Sr. Claims Specialist, Professional Liability | Medical Malpractice
**PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
+ Negotiates claim settlement up to designated authority level.
+ Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
+ Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
+ Represents Company in depositions, mediations, and trial monitoring as needed.
+ Communicates claim activity and processing with the client; maintains professional client relationships.
+ Ensures claim files are properly documented and claims coding is correct.
+ Refers cases as appropriate to supervisor and management.
+ Delegates work and mentors assigned staff.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
**Experience**
Six (6) years of claims management experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent negotiation skills
+ Good interpersonal skills
+ Ability to work in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000 - $110,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$100k-110k yearly 13d ago
Field Claims Representative
Auto-Owners Insurance 4.3
Claims adjuster job in Boise, ID
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to:
Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
Become familiar with insurance coverage by studying insurance policies, endorsements and forms
Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
Ensure that claims payments are issued in a timely and accurate manner
Handle investigations by phone, mail and on-site investigations
Desired Skills & Experience
Bachelor's degree or direct equivalent experience handling property and casualty claims
A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field claims handling experience is preferred but not required
Knowledge of Xactimate software is preferred but not required
Above average communication skills (written and verbal)
Ability to resolve complex issues
Organize and interpret data
Ability to handle multiple assignments
Ability to effectively deal with a diverse group individuals
Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-DNI #IN-DNI
$42k-52k yearly est. Auto-Apply 52d ago
Senior Litigation Adjuster
CVS Health 4.6
Claims adjuster job in Homedale, ID
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
**Position Summary**
As a Senior Litigation Adjuster in Risk Management, you will be responsible for managing litigation against CVS and overseeing outside counsel defending CVS in premises lawsuits filed throughout the United States.
Responsibilities Include:
- Utilizing legal skills and knowledge to oversee and manage complex premises lawsuits against CVS from the initiation of suit through resolution.
- Analyzing case files and internal materials and utilizing resources across CVS to investigate and discern key issues in each case.
- Developing and implementing a litigation strategy in each case to most efficiently resolve or defend that case.
- Assessing the value of all cases through investigation of the pertinent allegations, evaluating the defenses and issues present in each case, and setting appropriate financial reserves.
- Reviewing discovery responses, pleadings, motions, etc. drafted by defense counsel.
- Providing reporting to key internal stake holders and leadership on case developments.
- Developing relationships with internal colleagues for fact-finding and key litigation activities.
- Participating in internal meetings and attending mediation and trial as necessary to oversee and assist in the defense or resolution of cases.
**Required Qualifications**
- 2+ years of litigation experience, ideally with a law firm or as a litigation adjuster with a large self-insured company or insurance carrier.
- Ability to travel and participate in legal proceedings, arbitrations, trials, etc.
**Preferred Qualifications**
- Experience overseeing or defending premises litigation.
- Litigation experience at a law firm, and/or significant experience overseeing litigated claims for an insurance carrier or corporation, including mediation experience and trial exposure.
- Experience overseeing and answering written discovery, reviewing pleadings and case filings.
- Ability to influence and work collaboratively with senior leaders, CVS's in-house legal counsel and outside defense counsel.
- Ability to positively and aggressively represent the company at mediation, arbitration and trial.
- Ability to work independently and in an environment requiring teamwork and collaboration.
- Ability to navigate difficult situations and communicate effectively with both internal and external groups.
- Excellent organizational and time management skills and ability to handle a full docket of litigated claims.
- Strong written and verbal communication skills, ability to summarize complex issues in a concise, cogent manner.
- Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook) with a proven ability to learn new claims software programs and systems.
**Education**
- Verifiable Bachelor's degree or equivalent work experience required.
- JD degree highly desired.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$46,988.00 - $122,400.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit *****************************************
We anticipate the application window for this opening will close on: 02/28/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
$47k-122.4k yearly 6d ago
Senior Analyst, Claims Research
Molina Healthcare 4.4
Claims adjuster job in Boise, ID
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively.
**Job Duties**
+ Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects
+ Assists with reducing re-work by identifying and remediating claims processing issues
+ Locate and interpret regulatory and contractual requirements
+ Expertly tailors existing reports or available data to meet the needs of the claims project
+ Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error
+ Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements.
+ Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits.
+ Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions.
+ Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes.
+ Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time.
+ Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format.
+ Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach.
+ Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency.
+ Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ 5+ years of experience in medical claims processing, research, or a related field.
+ Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management.
+ Advanced knowledge of medical billing codes and claims adjudication processes.
+ Strong analytical, organizational, and problem-solving skills.
+ Proficiency in claims management systems and data analysis tools
+ Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers.
+ Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment.
+ Microsoft office suite/applicable software program(s) proficiency
**PREFERRED QUALIFICATIONS:**
+ Bachelor's Degree or equivalent combination of education and experience
+ Project management
+ Expert in Excel and PowerPoint
+ Familiarity with systems used to manage claims inquiries and adjustment requests
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $80,168 - $106,214 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-106.2k yearly 13d ago
Technical Claims Specialist, Workers Compensation - West Region
Liberty Mutual 4.5
Claims adjuster job in Meridian, ID
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics.
Candidates should be based in California with California Self-Insured Certification or based in West Region with experience in handling Alaska Workers Compensation claims.
The salary range posted reflects the range for the varying pay scale that encompasses each of the Liberty Mutual regions and the overall cost of living for that region.
Responsibilities
Investigates claims to determine whether coverage is provided, establish compensability and verify exposure.
Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority.
Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management.
Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols.
Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely.
Identifies and appropriately handles claims with third party subrogation potential, SIF (Self-Insured Fund) and MSA (Medicare Set Aside) exposure.
Establishes and maintains accurate reserves on all assigned files.
Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority.
Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds.
Demonstrates the ability to understand new and unique exposures and coverages.
Demonstrates the ability to understand key data elements and claims related data analysis.
Confers directly with policyholders on coverage and resolution strategy issues.
Coordinates and participates in training sessions for less experienced staff, including both Complex Non-Complex staff.
Qualifications
A bachelor's degree or equivalent business experience is required
In addition, the candidate will generally possess 5-7 years of related claims experience with 1-2 years of experience in complex claims
Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skills required
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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$56k-84k yearly est. Auto-Apply 19d ago
Sr Claim Examiner- WC
Crawford & Company 4.7
Claims adjuster job in Boise, ID
Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices.
Evaluates and sets reserves using independent judgment.
Assists supervisor and company attorneys in preparing cases for litigations.
Conducts training and mentors new hires.
$54k-72k yearly est. Auto-Apply 6d ago
Daily Property Field Adjuster
Alacrity Solutions
Claims adjuster job in Boise, ID
Job Description
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.
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$48k-63k yearly est. 17d ago
Independent Insurance Claims Adjuster in Meridian, Idaho
Milehigh Adjusters Houston
Claims adjuster job in Meridian, ID
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMSADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance ClaimsAdjuster? 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 ClaimsAdjuster, 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 ClaimsAdjuster 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 ClaimsAdjuster.
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 claimsadjusting.
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 claimsadjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claimsadjusting 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 ClaimsAdjuster. 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.
$45k-56k yearly est. Auto-Apply 60d+ ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims adjuster job in Caldwell, ID
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.
$47k-57k yearly est. Auto-Apply 6d ago
Specialty Loss Adjuster
Sedgwick 4.4
Claims adjuster job in Boise, ID
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Specialty Loss Adjuster
**Embark on an Exciting Career Journey with Sedgwick Specialty**
**Job Location** **: USA, Mexico, Brazil and strategic locations globally**
**Job Type** **: Permanent**
**Remuneration** **: Salaries can range from** **_$40,000.00USD to $250,000.00USD_** **taking into account skills, experience and qualifications.**
**We have a number of fantastic opportunities for Specialty Loss Adjusters across the US, Mexico and Brazil and a number of key locations**
We are looking for a variety of skill sets at all levels. Whether you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your skills and grow with a company that values innovation, excellence, and employee satisfaction.
Are you ready to be a part of providing a differentiated and best of class proposition to clients whilst working with like-minded colleagues? Sedgwick Specialty is thrilled to announce that we are investing in growth across Natural Resources, Property, Casualty, Technical and Special Risks and Marine. As we expand our operations, we are seeking individuals who are passionate about making a difference to the Adjusting industry.
**As a member of the Specialty platform, you will have the opportunity to:**
+ Work with a wide range of clients across the globe, handling complex cases and claims
+ Collaborate with a talented and supportive team of professionals who are dedicated to delivering exceptional results
+ Utilise state-of-the-art technology and resources to streamline processes and enhance efficiency
+ Receive ongoing training and development opportunities to further enhance your skills and knowledge in the marine industry
+ Enjoy a flexible work arrangement that allows you to maintain a healthy work-life balance while contributing to our global success
**The skills you will have when you apply:**
+ **Qualified** : it is important to us that you are either accredited, on your way to be accredited or qualified by experience
+ **Insurance claims experience:** it is imperative that you have experience working on insurance claims within you respective field. Full claims life cycle experience is a must
+ **Great communicator:** you will be constantly working with policy holders, brokers, carriers and various third parties, so being able to communicate accurately important. Providing an excellent customer service with our clients in mind. Able to approach issues empathetically
+ **Commercially minded:** An understanding of how the industry operates and where the role of a Loss Adjuster fits in. Being able to negotiate. Understanding how to market your services is a big advantage
**What we'll give you for this role:**
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the annual salaries can range from _$40,000.00 to $250,000.00USD._ Bonus eligible role. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always Accepting Applications.
**This isn't just a position, it's a pivotal role in shaping our industry**
At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education.
Together, we're not only reshaping the insurance landscape, we're building a legacy of talent. Come and be a catalyst for change within our industry.
**Next steps for you:**
**Think we'd be a great match? Apply now -** ** we want to hear from you.**
As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation.
After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person).
\#LI-HYBRID
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
$49k-65k yearly est. 60d+ ago
Technical Claims Specialist, Workers Compensation - West Region
Liberty Mutual 4.5
Claims adjuster job in Meridian, ID
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level of knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics.
Candidates should be based in California with California Self-Insured Certification or based in West Region with experience in handling Alaska Workers Compensation claims.
The salary range posted reflects the range for the varying pay scale that encompasses each of the Liberty Mutual regions and the overall cost of living for that region.
Responsibilities
* Investigates claims to determine whether coverage is provided, establish compensability and verify exposure.
* Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority.
* Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management.
* Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols.
* Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely.
* Identifies and appropriately handles claims with third party subrogation potential, SIF (Self-Insured Fund) and MSA (Medicare Set Aside) exposure.
* Establishes and maintains accurate reserves on all assigned files.
* Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority.
* Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds.
* Demonstrates the ability to understand new and unique exposures and coverages.
* Demonstrates the ability to understand key data elements and claims related data analysis.
* Confers directly with policyholders on coverage and resolution strategy issues.
* Coordinates and participates in training sessions for less experienced staff, including both Complex Non-Complex staff.
Qualifications
* A bachelor's degree or equivalent business experience is required
* In addition, the candidate will generally possess 5-7 years of related claims experience with 1-2 years of experience in complex claims
* Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal communication skills required
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco
$56k-84k yearly est. Auto-Apply 19d ago
Sr Claim Examiner- WC
Crawford 4.7
Claims adjuster job in Boise, ID
Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices. Evaluates and sets reserves using independent judgment. Assists supervisor and company attorneys in preparing cases for litigations. Conducts training and mentors new hires.
Bachelor's degree or equivalent experience required. Industry designations preferred but not required (IIA, AIC, AEI and/or CPCU)..
Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
Ability to work independently while assimilating various technical subjects..
Strong written and oral communication, negotiation and presentation skills.
Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements
#LI-ET1
Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.
Analyzes claims activity and prepares reports for clients/carriers and management.
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
Develops subrogation and third party recovery potential and follows reclaim procedures.
Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
$54k-72k yearly est. Auto-Apply 6d ago
Bodily Injury Claims Specialist
Auto-Owners Insurance 4.3
Claims adjuster job in Boise, ID
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated individual to join our Claims department as a Bodily Injury Claims Representative. The position requires the person to:
Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments in accordance with coverage, damage and liability determination, and perform other functions or duties to properly adjust the loss.
Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage.
Follow claims handling procedures and participate in claim negotiations and settlements.
Deliver a high level of customer service to our agents, insureds, and others.
Devise alternative approaches to provide appropriate service, dependent upon the circumstances.
Meet with people involved with claims, sometimes outside of our office environment.
Handle investigations by telephone, email, mail, and on-site investigations.
Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute.
Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials.
Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule.
Assist in the evaluation and selection of outside counsel.
Maintain punctual attendance according to an assigned work schedule at a Company approved work location.
Desired Skills & Experience
A minimum of three years of insurance claims related experience.
The ability to organize and conduct an investigation involving complex issues and assimilate the information to reach a logical and timely decision.
The ability to effectively understand, interpret and communicate policy language.
The dissemination of appropriate claim handling techniques so that others involved in the claim process are understanding of issues.
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-DNP #LI-CH1 #LI-Hybrid
$50k-67k yearly est. Auto-Apply 44d ago
Senior Analyst, Claims Research
Molina Healthcare 4.4
Claims adjuster job in Meridian, ID
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively.
**Job Duties**
+ Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects
+ Assists with reducing re-work by identifying and remediating claims processing issues
+ Locate and interpret regulatory and contractual requirements
+ Expertly tailors existing reports or available data to meet the needs of the claims project
+ Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error
+ Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements.
+ Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits.
+ Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions.
+ Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes.
+ Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time.
+ Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format.
+ Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach.
+ Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency.
+ Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals.
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ 5+ years of experience in medical claims processing, research, or a related field.
+ Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management.
+ Advanced knowledge of medical billing codes and claims adjudication processes.
+ Strong analytical, organizational, and problem-solving skills.
+ Proficiency in claims management systems and data analysis tools
+ Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers.
+ Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment.
+ Microsoft office suite/applicable software program(s) proficiency
**PREFERRED QUALIFICATIONS:**
+ Bachelor's Degree or equivalent combination of education and experience
+ Project management
+ Expert in Excel and PowerPoint
+ Familiarity with systems used to manage claims inquiries and adjustment requests
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $80,168 - $106,214 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-106.2k yearly 13d ago
Daily Scope Only Property Field Adjuster
Alacrity Solutions
Claims adjuster job in Boise, ID
Job Description
Alacrity Solutions
Independent Contractor
Daily Scope Only 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 Scope Only Field Adjuster is to provide excellent scope-only 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.
Experience as a roofing contractor, installer OR background in construction or building inspections is highly recommended.
Well-versed in roofing material options, construction standards, and recurring structural issues.
Knowledge of common signs of wear, damage, and potential issues regarding home inspections.
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.
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.
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$48k-63k yearly est. 6d ago
Rec Marine Adjuster
Sedgwick 4.4
Claims adjuster job in Boise, ID
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Rec Marine Adjuster
**PRIMARY PURPOSE** **:** To investigate and process marine claimsadjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement.
+ Receives and reviews new claims and maintains data integrity in the claims system.
+ Reviews survey reports and insurance policies to determine insurance coverage.
+ Prepares settlement documents and requests payment for the claim and expenses.
+ Assists in preparing loss experience report to help determine profitability and calculates adequate future rates.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required.
**Experience**
3 years or more of Marine Adjusting preferred.
**Skills & Knowledge**
+ Strong oral and written communication skills
+ PC literate, including Microsoft Office products
+ Good customer service skills
+ Good organizational skills
+ Demonstrated commitment to timely reporting
+ Ability to work independently and in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** **:**
+ Must be able to stand and/or walk for long periods of time.
+ Must be able to kneel, squat or bend.
+ Must be able to work outdoors in hot and/or cold weather conditions.
+ Have the ability to climb, crawl, stoop, kneel, reaching/working overhead
+ Be able to lift/carry up to 50 pounds
+ Be able to push/pull up to 100 pounds
+ Be able to drive up to 4 hours per day.
+ Must have continual use of manual dexterity
**Auditory/Visual** **:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
How much does a claims adjuster earn in Boise, ID?
The average claims adjuster in Boise, ID earns between $41,000 and $61,000 annually. This compares to the national average claims adjuster range of $40,000 to $64,000.
Average claims adjuster salary in Boise, ID
$50,000
What are the biggest employers of Claims Adjusters in Boise, ID?
The biggest employers of Claims Adjusters in Boise, ID are: