Sr. Claims Specialist
Claims adjuster job in Orange, CA
CAP seeks a Senior Claims Specialist for its Orange County office. This role involves handling technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members.
Our dedicated employees are the essential element to CAP's success. CAP's team of well-trained professionals with a commitment to excellence has helped deliver to our member physicians an unparalleled quality of products and services. Our corporate culture and collegial collaboration of minds and efforts is unmatched.
Essential Duties and Responsibilities:
Manage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Manage increasingly complex cases with larger financial exposure.
Investigate and evaluate claim files including complying with the standards of performance, interviewing members, reviewing medical records, corresponding with plaintiff attorneys, obtaining preliminary expert evaluation/opinions, and preparing interview summaries.
Prepare case evaluation reports for publication and presentation to the CRC and CSC.
Prepare case evaluation reports for discretionary authority on selected cases.
Manage and participate in all litigation activity, including discovery plan, mediation, MSC, and negotiation under supervision, as necessary.
Monitor trials and arbitrations including daily progress reports, providing member and defense attorney with support.
Education and/or Experience:
Bachelor's degree from four-year college or university.
Relevant legal and/or medical education background or the equivalent.
Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.
Starting Salary: $110,000 - $130,000 annually (Depending on Experience)
Claims Adjuster
Claims adjuster job in Santa Clarita, CA
JOB TITLE:Claims Advocate FLSA CLASSIFICATION:Salaried - Exempt
The Claims Advocate plays an essential role in mitigating BBSI's risk related to workers' compensation claims. This role requires exceptional business and customer service acumen and significant experience in workers' compensation claims, including claims handling.
This role will coordinate the essential duties related to the claims advocacy program. Duties and related issues by assisting in the monitoring of new loss intake to confirm an appropriate beginning to each claim, assisting injured workers in navigating the claims process and communicating with external client customers and internal personnel.
REPORTING RELATIONSHIPS: This position reports to the Corporate Claims Manager and interacts with the Corporate Claims team and local branch personnel.
DUTIES AND RESPONSIBILITIES:
Maintain clear focus on mitigating BBSI's financial risk associated with workers' compensation claims.
Understand and articulate BBSI's business objectives internally and with key partners
Written communication with injured workers when new claims are received.
value workers compensation claims.
Serve as a resource responding to questions and concerns from internal and external customers, vendor partners, and injured workers.
Serve as back up to Claim Consultants
members.
activity. Approve reserve activity within authority.
workers compensation claims, including status of the claims. Provide claims
information for the coordination of human resource and safety efforts and
requirements.
relative to workers compensation.
by third parties administrators
CORE TRAITS/COMPETENCIES:
Exceptional business acumen
Customer service acumen
Flexibility and adaptability
Innately curious
Highly developed interpersonal and communication skills
QUALIFICATIONS:
Four-year college degree is preferred, as well as 2-5 years of directly relevant claims experience
Customer service acumen
Bi-lingual (Spanish) would be preferred or familiarity with translation vendors
Multi-Jurisdictional Workers' Compensation experience preferred
Salary and Other Compensation:
The starting hourly rate for this position is between 87,500-95,000. Factors which may affect starting pay within this range may include geography, skills, education, experience, certifications, and other qualifications of the candidate.
This position is also eligible for annual incentive pay equal to 8% of annual regular pay, prorated in the first year, in accordance with the terms of the Company's plan.
Benefits: The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, health savings account, flexible savings account, dental insurance, vision insurance, 401(k) retirement plan, accidental death and dismemberment, life insurance, voluntary life insurance, voluntary disability insurance, voluntary accident, voluntary critical care, voluntary hospital indemnity, legal, identity & fraud protection, commuter benefits, pet insurance, employee stock purchase program, and an employee assistance program.
Paid Time Off: Accrued sick leave of 1 hour for every 40 hours of work, with maximum based on state or regional requirements; vacation accrues up to 80 hours in the first year, up to 120 hours in years 2-4, and up to 160 hours in the fifth year; 6 paid holidays annually, 4 paid volunteer days annually.
Diversity and Inclusion are critical parts of our corporate culture. BBSI strives to create a workplace where everyone feels included and empowered to bring their full, authentic selves to work, and is treated fairly. BBSI is an equal opportunity employer and makes employment decisions on the basis of merit.
If you meet the above requirements, we welcome the opportunity to learn more about you. For more information, visit us at www. bbsi.com Please apply via this posting and not by contacting our local or corporate offices.
Click here to review the BBSI Privacy Policy: ***********************************
Claims Supervisor
Claims adjuster job in Ontario, CA
Work directly with regional Claims Managers to supervise employees in the assigned claims office. This includes assisting with recruiting, hiring and management of required staff. Supervise, evaluate, train, discipline and support staff. Ensure that supervised staff follows policies and procedures to ensure company compliance with regulatory standards, company policies and procedures, and best practices. Assist the manager in the day to day operations of the assigned office. Must be able to handle multiple jurisdictions with strong California experience or knowledge.
RESPONSIBILITIES:
Monitor the production and measure the performance of claims staff for full compliance with procedure manual and adopted best practices.
Assign new claims and when necessary transfer existing claims to appropriate adjusters based on expertise of adjuster.
Assist claims manager with training in claims related topics.
Address claims related concerns and issues directly with the claims manager.
Complete regular claim reviews for each assigned employee and address any concerns that may be identified, including but not limited to: timely determinations, accurate calculations of wages and benefits, statutory and regulatory compliance, reserve adequacy, subrogation, claim investigations, surveillance, litigation management, subsequent injury fund, reinsurance/excess insurance reporting and assist adjusters in addressing all topics.
Assist in the development and implementation of work performance standards for claims adjusters.
Ensure claims adjusters are responding to telephone calls, e-mails and correspondence timely and effectively.
Complete annual performance evaluations of each assigned adjuster in accord with adopted procedures and best practices.
Work directly with clients, brokers, agents, and employers in the explanation of claims related services for policy holders.
When required, work directly with state regulators to address claims questions, complaints, and audits to ensure full compliance with applicable laws, regulations and directives from the regulator(s).
Timely address concerns with injured workers, medical providers and employers.
Other related assignments as assigned.
Eligible for remote or hybrid work arrangement.
QUALIFICATIONS:
High school diploma or GED required
Bachelor's degree or equivalent experience preferred
Minimum of 5 years claims management experience.
Insurance industry knowledge required
Excellent technical skills associated with claims management
Strong organizational skills
Strong oral and written communication skills
Senior Claim Representative
Claims adjuster job in Los Angeles, CA
Job Title: Workers' Compensation Senior Claim Representative
Duration: 6 Months (Contract to Hire-CTH)
Job hours-8:00-4:30
Job schedule-40 hours on site
Interview process-WEBEX prescreen/Then in-person interview
Job Description: Client is currently seeking a Workers' Compensation Lost Time Senior Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA
Duties & Responsibilities:
• Handles all aspects of workers' compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• Reviews claim and policy information to provide background for investigation.
• Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
• Evaluates the facts gathered through the investigation to determine compensability of the claim.
• Informs insureds, claimants, and attorneys of claim denials when applicable.
• Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
• Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
• Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team Leader throughout the life of the claim.
• Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
• Works with attorneys to manage hearings and litigation
• Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
• Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
• Files workers' compensation forms and electronic data with states to ensure compliance with statutory regulations.
• Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
• Works with in-house Technical Assistants, Special Investigators, Nurse
• Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.
Technical Skills & Competencies:
• Lost Time Claim Examiner position with prior experience in workers' compensation as a lost time examiner, or similar examiner experience in short-term / long-term disability, auto personal injury protection / medical injury, or general liability claims.
• Requires basic knowledge of workers' compensation statutes, regulations, and compliance.
• Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
• Exceptional customer service and focus.
• Ability to openly collaborate with leadership and peers to accomplish goals.
• Demonstrates a commitment to a career in claims.
• Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
• Use analytical skills to find mutually beneficial solutions to claim and customer issues.
• Ability to prepare and make exceptional presentations to internal and external customers.
• Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
• Willing to take ownership and tackle obstacles to meet Client's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
• Superior verbal and written communication skills.
Experience, Education & Requirements:
• Experience working in a customer focused, fast-paced, fluid environment
• Experience utilizing strong communication and telephonic skills
• Prior experience requiring a high level of organization, follow-up, and accountability
• Prior workers' compensation claim handling experience or other similar type of claim handling experience is required (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
• Prior insurance, legal or corporate business experience is a plus but not required
• AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
• Proficiency with Microsoft Office Products
• Knowledge of medical terminology is required
• Knowledge of bill processing is required
• Certification to handle CA Workers Compensation claims is required
• Experience handling claims in the states of CO, UT, NV and AZ preferred
• If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
Claims Service Representative
Claims adjuster job in Chino, CA
Job Title: Claims Analyst
Duration: 12 + Months Contract Job Location:
Chino, CA, 91710 (Onsite)
Pay Rate: $23-25/hr on W2
Ensures that complaints are resolved effectively and without delay and that those not resolved at the entity organization level have been escalated and taken into account in the competent entities. Drive Customer Centricity - for the entity.
What do you get to do in this position?
- Ensure that complaints are resolved effectively and without delay and those not resolved have been escalated to the appropriate entity
- Collaborate with other organizations in order to contain, correct, and prevent problems affecting customers
- Utilize I2P tools to process claims on a timely basis
- Ensure that Complaint process is supported with warm loop
- Share critical customer feedback information with management and all employees at all levels of meetings and on information boards
- Work in collaboration with continuous improvement engineer
- Update Logistics dashboard
Key Responsibilities:
- Act as the Customer Experience advocate.
- Drive Customer Centricity in entities.
- Ensure the Customer Experience is measured according to the Business priorities.
- Define and follow-up the improvement action plan and priorities with the Business stakeholders.
- Ensure that Customer dissatisfactions are solved quickly and effectively through containment, correction and prevention steps.
Qualifications:
We know skills and competencies show up in many ways and can be based on your life experience. If you do not necessarily meet all the requirements that are listed, we still encourage you to apply for the position.
This job might be for you if:
- Excellent verbal and written communication skills, listen effectively and solicit input from others.
- Excellent organizational skills including the ability to handle multiple demands and assignments, the ability to prioritize tasks effectively and efficiently, and drive issues/ tasks to closure
- Candidate must be a self-starter, highly motivated, and results driven.
- Strong problem-solving skills and experience with root cause analysis and implementation of corrective action for process related concerns.
- Proficiency with MS Office suite of products, especially Power point and Excel.
- Ability to work effectively in a group setting as well as independently.
Claims Supervisor - Workers' Compensation
Claims adjuster job in Orange, CA
DETAILS
Claims Supervisor
Department:
Workers' Compensation
Reports To:
Division Claims Manager
FLSA Status:
Exempt
Job Grade:
14
Career Ladder:
Next step in progression could include Division Claims Manager
ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a Claims Supervisor to support our Southern California Workers Compensation department. Management that lives less than 36 miles from the Orange, CA office AND have a direct report in the office, are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Southern California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. Employee work a 37.5-hour work week with the ability to work a flex schedule with every third Monday or Friday off. As a Claims Supervisor, you'll play a pivotal role in leading and collaborating with Athens management to achieve exciting company goals, run insightful reports, and streamline processes. You'll make impactful daily claims decisions, review files for accuracy, and approve payments that exceed examiner authority. Additionally, you'll ensure top-notch file handling, accurate claims coding, and meet unit closing goals. You'll be the guiding force for your team, planning, organizing, delegating workloads, supervising daily activities, providing training, and offering valuable guidance. In client management, you'll address policy and claims issues, build and maintain strong relationships, attend key meetings, ensure compliance with client instructions, and document interactions, always acting in the client's best interest. Join us and make a difference every day! PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Claims Leadership
Work with Athens management to achieve company initiatives and performance goals
Consistently strive to improve and streamline current processes
Authorize release of payment and settlement
Make daily claims decisions regarding plan of action, handling of payment, etc.
Review claim files for accuracy
Run various reports with an eye for accuracy and confidentiality
Approve payments and reserve increases when they rise above Examiner's authority level
Work collaboratively with internal and clients' senior management as well as with attorneys to draft settlements and assist with litigation strategies
Provide timely information to clients, attorneys, doctors, investigators and injured workers with strong, professional communication
Discuss appropriateness of medical treatment with medical case manager
Assure consistent and accurate claims coding is occurring on the team
Ensure quality file handling and resolution. This includes meeting unit closing goals, verifying proper reserves, providing thorough claims analysis and guiding to correct resolution
Use flexibility when working in demanding and changing situations
Employee Management
Effectively plan, organize and delegate workload for optimal results and to ensure time commitments are met
Supervise daily activities of the team by monitoring progress, ensuring compliance with policies, and promptly addressing any issues or conflicts
Identify, coordinate, coach, and perform training with staff to improve performance and increase their growth and knowledge in claims
Participate in the interview process, onboarding and training of new hires
Provide general guidance to the team by offering support and advice on work-related issues, fostering a positive work environment, encouraging professional development, and reviewing performance through evaluations, feedback, goal setting, and identifying areas for improvement
Provide direct feedback and use sound coaching techniques to solve disciplinary or workflow problems. Manage and document employee relations issues at all levels. Work in conjunction with Human Resources to ensure performance issues are managed in a timely and consistent manner
Regularly lead organized and collaborative staff unit meetings, including both remote and on-site employees
Maintain an open-door policy and an approachable attitude, and foster open communication with staff
Client Management
Work with clients with issues regarding policies, programs and/or claims
Manage existing client relationships by being accessible, making regular service calls, and proactively identifying
and solving potential problems
Attend client meetings, internal meetings, and workers' compensation meetings both virtual and in-person
Ensure notepads and diaries are set and completed timely in accordance with client handling instructions and Athens Best Practices and have meaningful action plans and information and are concise and well-written
Obtain audit results meets or exceeds best practice standards of Athens and client
Display integrity and always acts in the best interest of the client
Document client meeting notes in appropriate shared location
Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions.
Provide direct supervision for 6-10 employees, typically consisting of Senior Claims Examiners, Future Medical Claims Examiners, Claims Examiners, Assistant Claims Examiners and Assistant Claims Examiner Trainees.
Attend on-site Leadership Summit at Athens Concord headquarters every 18 months (including overnight)
Fiscal Responsibilities
Review and approve direct report's monthly expense reports
Ensure that all expenditures are in the best interest of the Company
Use effective monitoring and reporting mechanisms to control expenses without lowering quality
Search for and implement hidden cost improvements
Obtain, maintain, and demonstrate an understanding of wage and hour laws as applicable for employees
Ensure timely, accurate review and approval of timecards for your staff on payroll processing days.
ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
High School Diploma or equivalent (GED) required for all positions
AA/AS or BA/BS preferred but not required
Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
Administrators Certificate from Self-Insurance Plans. If not already obtained, the Administrators Certificate from Self-Insurance Plans will be required within one year of employment
Completion of IEA or equivalent courses
Solid and in-depth knowledge of workers' compensation laws, policies, and procedures
3+ years' recent workers compensation claims handling experience at a high level
5+ years' experience in a Workers' Comp claims lead or supervisor position preferred
At least 2 years Claims Supervisory experience required
Proficiency in determining case value and negotiating settlements
Prior Third-Party Administrator (TPA) experience preferred
Understanding of medical and legal terminology
Strong attention to detail and organizational skills and the ability to research and resolve problems and meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives.
Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency.
Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing them to execute tasks
Handles stressful situations and deadline pressures well
Must demonstrate accuracy and thoroughness in work product
Effectively influences people to achieve unit and organizational objectives
Must be flexible, adaptable, and positive. Exhibit passion and energy to ensure that all employees are respected and treated in a manner consistent with Athens Values.
Able to plan, prioritize and organize claims workload for a unit
Skilled at presenting in small and large group settings
Ability to create reports as required, using the report writing tools available or creating custom documents.
Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals
Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully.
Able to interpret information from multiple sources and draw logical conclusions; consults others based on analysis of data; able to think strategically and use data findings to consult others for improved business results.
Negotiating skills
Mathematical calculating skills
Exercise independent judgment and analytic ability in solving complex and sensitive problems
Highly developed verbal and written communication skills with strong attention to detail
Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency
Proficient in Microsoft Office Suite
Ability to type quickly, accurately and for prolonged periods
Ability to learn additional computer programs
ClaimsXpress program experience preferred but not required
Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
Valid Driver's license and availability for travel including in office file reviews and meetings
APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here
Loan Adjuster II
Claims adjuster job in Tustin, 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.
Auto-ApplyAdjuster II - LA
Claims adjuster job in Los Angeles, CA
Marketing Statement:
TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
Process and adjust ocean and inland marine claims.
Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
Review survey reports or supporting documentation for determining loss.
Determine whether coverage exists for loss.
Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
Handle tasks that require a high level of organization and attention to detail.
Conclude all settlement agreements.
Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
Such responsibility may include direct recovery handling.
Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
Participate in training seminars and additional technical training courses.
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
College degree preferred
Strong PC skills, including Word and Excel
Strong written and oral communication skills
Auto industry experience preferred
Minimum 3 years claims handling experience.
Ability to work as part of a team
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Auto-ApplyBottler Claims Representative (Temp to Hire)
Claims adjuster job in Corona, CA
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.
Auto Bodily Injury Claim Representative
Claims adjuster job in Diamond Bar, CA
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.
Be the Hero in Someone's Story
When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most.
As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner.
In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process
What Will You Do?
* Provide quality claim handling of auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations.
* Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates.
* Determine claim eligibility, coverage, liability, and settlement amounts.
* Ensure accurate and complete documentation of claim files and transactions.
* Identify and escalate potential fraud or complex claims for further investigation.
* Coordinate with internal teams such as investigators, legal, and customer service, as needed
What Will Our Ideal Candidate Have?
* Bachelor's Degree.
* Three years of experience in insurance claims, preferably auto claims.
* Experience with claims management and software systems.
* Strong understanding of insurance principles, terminology with the ability to understand and articulate policies.
* Strong analytical and problem-solving skills.
* Proven ability to handle complex claims and negotiate settlements.
* Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants
What is a Must Have?
* High School Degree or GED with a minimum of one year bodily injury liability claim handling experience or successful completion of Travelers Claim Representative training program is 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 *********************************************************
Independent Insurance Claims Adjuster in Anaheim, California
Claims adjuster job in Anaheim, CA
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.
Auto-ApplyPublishing - Content Claiming Specialist
Claims adjuster job in Los Angeles, CA
Create Music Group is currently looking for a Youtube Publishing Administrator to join our Publishing Department. This role is responsible for ensuring complete delivery of our publishing content, as well as maintaining internal systems and metadata to company standards. This is a full-time position located in our Hollywood office.
YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for artists and labels.
REQUIREMENTS:
1-3 years work experience
Excellent communication skills, both written and verbal
Internet culture and social media platforms, especially YouTube
Conducting basic level research
Organizing large amounts of data efficiently
Proficiency with Mac OSX, Microsoft Office, and Google Apps
PLUSES:
Strong understanding of the online video market (YouTube, Instagram, TikTok)
Bilingual - any language, although Spanish, Mandarin, and Russian is preferred
RESPONSIBILITIES:
Watching YouTube videos for several hours daily
Content claiming
Uploading and defining intellectual assets
Administrative metadata tasks
Researching potential clients
Staying on top of accounts for current client roster
You are required to bring your own laptop for this position.
BENEFITS:
Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included.
TO APPLY:
Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste
Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.
Auto-ApplyField Claims Adjuster
Claims adjuster job in Anaheim, CA
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.
Work Comp Claims Adjuster Temporary Assignment
Claims adjuster job in Glendale, CA
Workers Compensation Claims Adjuster - Temporary Assignment MUST Reside in California & MUST have California Workers Compensation Claims Experience. Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Glendale We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations.
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
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 [email protected]
We look forward to hearing from you!
“Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.”
Auto-ApplyClaims Adjuster
Claims adjuster job in Rancho Cucamonga, CA
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.
Claims Adjuster
Claims adjuster job in Los Angeles, CA
Los Angeles | Onsite | Claims
Knight Insurance Group is a well-established insurance company dedicated to delivering outstanding service to its clients. As a part of Knight Insurance Group, Onward insurance is a growing and dynamic auto insurance provider focused on offering extensive coverage to its clientele.
At Onward Insurance, we're redefining what it means to deliver exceptional auto coverage. Our focus is simple: innovation, efficiency, and customer-first service. We specialize in private passenger auto insurance for both standard and non-standard drivers-and we're growing fast. We're building something special-and we're looking for motivated, curious, and customer-focused individuals to help us shape the future of auto insurance.
Pay Range: $55,000- $65,000 Per Year. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire and will be dependent on a wide range of factors, including but not limited to geographic location, skill set, experience, education, credentials, and licensure when applicable.
We're hiring a Claims Adjuster to manage auto liability claims and support the resolution of more complex cases. In this role, you'll investigate losses, determine coverage and liability, evaluate damages, and negotiate settlements. You'll also assist senior adjusters with subrogation, salvage, and complex matters.
This is a great opportunity for someone with early experience in claims adjusting who thrives in a collaborative, fast-paced environment and wants to grow.
What you'll do as a Claims Adjuster?
Manage an inventory of auto liability claims
Evaluate coverage, assess liability/compensability, and determine damages
Establish and adjust reserves; escalate claims to SIU or subrogation as needed
Negotiate settlements within your authority limits
Communicate with policyholders, claimants, attorneys, and third parties
Assist with subrogation and salvage on complex cases
Contribute to department improvement initiatives
Ensure regulatory compliance and perform other related duties as assigned
Experience and Qualifications
What we look for in our Claims Adjuster?
1-3 years of experience handling auto liability claims (private passenger)
Bodily injury claims experience (preferred)
Familiarity with California and Texas insurance regulations (preferred)
Excellent organization and attention to detail
Strong written and verbal communication skills
Comfort with claims management software + Microsoft Office
A growth mindset and collaborative spirit
Bilingual skills are a plus
Active adjuster licenses (or ability to obtain as required)
Benefits
What do we offer?
Medical, Dental, and Vision benefits
Supplemental life insurance policies for you and your dependents
Long term disability insurance
Flexible Spending Account (FSA)
Employer paid life insurance
Retirement plans: Employer match, 401(k) and Employee Stock Ownership Plan (ESOP)
Metro Tap Card and Metro-link Reimbursement
Professional Development Opportunities
Onsite Gym with group Yoga and Pilates classes (California)
UKG Wallet (access to your pay before payday)
Tickets at Work- Discounts on parks, museums, movie tickets and much more
AT&T Wireless Discounts
Midway Rent a Car- Rental car Discounts (California)
Dell Member Purchase Program
Supervisor, Claims (CQI) Needed!
Claims adjuster job in Irvine, CA
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!
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Public Adjuster
Claims adjuster job in Los Angeles, CA
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
Adjuster II - LA
Claims adjuster job in Los Angeles, CA
Marketing Statement: TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
* Process and adjust ocean and inland marine claims.
* Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
* Review survey reports or supporting documentation for determining loss.
* Determine whether coverage exists for loss.
* Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
* Handle tasks that require a high level of organization and attention to detail.
* Conclude all settlement agreements.
* Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
* Such responsibility may include direct recovery handling.
* Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
* Participate in training seminars and additional technical training courses.
* Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
* College degree preferred
* Strong PC skills, including Word and Excel
* Strong written and oral communication skills
* Auto industry experience preferred
* Minimum 3 years claims handling experience.
* Ability to work as part of a team
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Auto-ApplyProperty Claims Adjuster - Southern California
Claims adjuster job in Los Angeles, CA
Job Description
Applicants must reside in and be able to travel locally within the Los Angeles and Orange County areas.
We are seeking a skilled and motivated Property Claims Adjuster to join our Southern California team, servicing Los Angeles and Orange County. This remote, field-based role includes conducting on-site inspections and managing residential and commercial property claims from initial loss through final resolution.
Schifrin, Gagnon & Dickey, Inc. (SGD) is a trusted, family-owned claims investigation and adjustment firm, proudly serving the insurance industry for over 50 years. With a team of 80+ professionals, we specialize in delivering high-quality, timely, and ethical claims solutions across California and beyond.
Compensation:
$35 - $50 per hour DOE plus overtime eligibility
Responsibilities:
Conduct on-site inspections of residential and commercial property damage
Prepare detailed repair estimates in Xactimate
Compile and value inventories of damaged personal and business property
Perform investigations, including witness interviews and recorded statements
Assess policy coverage and provide well-supported adjustment recommendations
Prepare comprehensive written reports with supporting documentation
Manage and prioritize a full caseload independently and efficiently
Qualifications:
Minimum of 5 years' experience handling property claims
Strong proficiency in Xactimate estimating software
Excellent written and verbal communication skills
Strong analytical and organizational skills
Demonstrated interpersonal and customer service abilities
Valid California driver's license and reliable transportation for field work
Preferred:
Experience handling both residential and commercial losses
Bilingual skills (Spanish/English) preferred
About Company
Benefits:
401(k) with employer matching
Health, dental, and vision insurance
Flexible Spending Account (FSA)
Life insurance
Paid Time Off (PTO)
Compensation Package:
Employer-paid and continuing education courses and designations
Equipment and support provided
Remote/flexible work allowed
Apply Now
Join a company that values professionalism, integrity, and long-term relationships. Submit your resume today to be considered for this exciting opportunity.