SUMMARY DESCRIPTION: The Residential Field Adjuster is responsible for investigating, inspecting, negotiating, and bringing to final resolution property claims of all named-peril losses. For claims where the damage is less severe, the Property Field Adjuster may be assigned tasks, such as verification of damage. The role's primary duties include reviewing coverage, inspecting damaged property, and estimating repair/replacement costs in accordance with the client's and RENFROE's guidelines. The Property Field Adjuster is also responsible for documenting all activity, submitting proper claims paperwork, handling renters and personal property policies, meeting with contractors, effectively communicating with the client and all stakeholders, and ensuring compliance with legal and contractual obligations.
REPORTS TO: Assigned RENFROE Manager
ESSENTIAL JOB FUNCTIONS:
Follows RENFROE and clients' policies and procedures to handle all assigned property claims
Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills
Completes assigned property adjustments, such as property or contents inspections, verification of loss, and updates claims as new information becomes available using XactAnalysis, Xactimate, or other estimating platforms
Manages the progression of claims/tasks and claim inventories assigned to the them
Travels to the loss location to inspect the property, which could include climbing the roof, inspecting the attic, or other inspection points, to establish the cause and scope of the loss
Works with contractors or another representative to reach an agreement on the scope of loss
Reviews the insurance policy and endorsement details to confirm coverage
Contacts and interacts with the insured to obtain documents such as property deeds, purchase receipts, warranties, photographs, or other documents to establish the existence, ownership, and value of the items claimed lost
Assists the client and claims examiner in determining coverage and amounts for additional living expenses such as rental housing, travel, meals, etc.
Writes closing reports, including recommendations for repair and/or replacement, the pursuit of subrogation, and salvage potential
Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE
Does not handle claims for which they do not have client authorization or for which they are not licensed
Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes
Makes suggestions on ways to improve process efficiency
Participates in special projects and completes other duties as assigned
Non-Authorized Activities:
Field adjusters should not:
Communicate training requirements to client staff adjusters and non-affiliated firms
Communicate training requirements to any claim handler who is not deployed with RENFROE
Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE
Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind
EXPERIENCE/QUALIFICATIONS:
Minimum of 1 year of property claims experience is preferred
Participation in technical insurance coursework is preferred, such as CPCU
Experience using various claims processing systems is preferred
Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes
Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others
Strong analytical skills and consistent attention to detail
Knowledge of ISO forms, and client policy coverage, procedures, and systems
Communicates clearly and effectively, both verbally and in writing
Strong customer service orientation and good rapport with the insured
Well-organized and hard-working, with the ability to thrive in a fast-paced work environment
Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact
Computer skills, including but not limited to practical knowledge of Word and Excel
PHYSICAL DEMANDS:
Ability to operate an automobile and have a valid driver's license with a safe driving record
Ability to travel by automobile or airplane
Must be able to lift, carry, unfold/extend, and climb a ladder (which may exceed 50 lbs. in weight) that is approved by the appropriate regulatory agency or complies with legislative or regulatory occupational health and safety requirements
Must be able to complete measurements of roofs and inspect interior as necessary, including attics, basements, and crawl spaces for residential and commercial structures
Must be able to do the following while conducting an inspection: climb, bend, crawl, stoop, walk, reach, kneel, squat, and carry/lift objects (typically weighing less than 50 lbs.)
Must be able to work outdoors in all types of weather
Ability to operate a telephone and a computer for extended periods of time
Must be able to work extended and varying work schedules, including working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays
Ability to work in a fast-paced, changing, and multi-tasking environment
$51k-64k yearly est. 8d ago
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Field Claims Adjuster
EAC Claims Solutions 4.6
Claims adjuster job in Buffalo, NY
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.
$51k-64k yearly est. Auto-Apply 3d ago
Independent Insurance Claims Adjuster in Buffalo, New York
Milehigh Adjusters Houston
Claims adjuster job in Buffalo, NY
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.
$51k-64k yearly est. Auto-Apply 60d+ ago
Multi-Line Adjuster Trainee
Geico Insurance 4.1
Claims adjuster job in Buffalo, NY
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities. Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Multi-line Adjuster Trainee -New York City, NY, Buffalo, NY, Syracuse, NY Rochester, NY, Albany, NY
Salary: "*Starting pay rate varies based upon position and location. Ask your Recruiter for details!"
We are looking for a highly motivated and service-oriented individual to join our Multi-line Damage team as a Multi-line Property Damage Trainee! As an ambassador for GEICO's renowned customer service, you will work in a dynamic environment that may include repair shops, salvage yards, a customer's home or in a virtual estimating environment. You will be responsible for inspecting damage, estimating cost of repairs, negotiating settlements, issuing payments, and providing excellent customer service. This position primarily will include servicing boat, motorcycle, RV and other specialty claims.
Our industry-leading, paid training, which includes 3-weeks of required hands-on experience at our Ashburn, VA training facility will teach you the ins and outs of physical damage adjusting. We will provide the resources and training so you can directly assist our customers after accidents or major disasters. We're looking for those who are equally as motivated as they are compassionate. Your unique skillset, along with the latest adjusting tools and tech, will help you.
Qualifications & Skills:
Valid driver's license (must meet company underwriting guidelines for at least the past 3 consecutive years) and the ability to maintain applicable state and federal certifications and permits
Willingness to be flexible with primary work location - position may require either remote or field work
Solid computer, mechanical aptitude, and multi-tasking skills
Effective attention to detail and decision-making skills
Ability to effectively communicate, verbally and in writing, and willingness to expand on these abilities
Minimum of high school diploma or equivalent, college degree or currently pursuing preferred
Annual Salary
$25.44 - $45.28
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
* Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
* Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
* Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
* Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$25.4-45.3 hourly Auto-Apply 10d ago
Claims Supervisor
Centivo 4.0
Claims adjuster job in Buffalo, NY
We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.
The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.
Responsibilities Include:
* Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
* Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations.
* Manages the inventory of claims against standard service level agreements (SLA's)
* Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement.
* Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
* Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
* Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
* Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
* Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
* Performs other duties as deemed essential and necessary
Qualifications:
Required Skills and Abilities:
* Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
* Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
* Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.
* Experience: Previous experience in claims processing or a related field, including supervisory experience.
* Understands health insurance benefit administration in a Self-Funded environment
* Ability to read and understand various forms, documentation, files, and information with the department.
Education and Experience:
* Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment
* Candidate must have at least 3 years of experience supervising a claims team
* Candidates must have prior experience with a highly automated and integrated claim adjudication system
* Experience working with HealthRules Payer
* Understanding of health insurance benefits administration in a self-funded environment
Preferred Qualifications:
* Past Training Experience
* Experience working at TPA
* Experience with self-funded plans
Work Location:
* An ideal candidate would be assigned to the Buffalo Office with ability to work from home.
* If not in the Buffalo area, the opportunity can be remote.
Leadership Skills & Behaviors:
● Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward.
● Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function.
● Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically.
● Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps.
● Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know.
● Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding.
● Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development.
● Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network.
● Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
$63k-100k yearly est. Auto-Apply 60d+ ago
Claims - Field Claims Representative
Cincinnati Financial Corporation 4.4
Claims adjuster job in Buffalo, NY
Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person.
If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow.
Build your future with us
Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Buffalo, New York. The candidate is required to reside within the territory.
This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements.
Be ready to:
* complete thorough claim investigations
* interview insureds, claimants, and witnesses
* consult police and hospital records
* evaluate claim facts and policy coverage
* inspect property and auto damages and write repair estimates
* prepare reports of findings and secure settlements with insureds and claimants
* use claims-handling software, company car and mobile applications to adjust loss in a paperless environment
* provide superior and professional customer service
* once eligible, become a certified and active Arbitration Panelist
To be an Entry Level Claims Representative:
The pay range for this position is $55,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance.
Be equipped with:
* be available and communicative during your regular business hours
* a desire to learn about the insurance industry and provide a great customer experience
* the ability to work unsupervised
* excellent verbal and written communication skills
* strong interpersonal skills
* excellent problem-solving, negotiation, organizational and prioritization skills
* preparedness to follow-up with others in a timely manner
* a valid driver's license
Bring education or experience from:
* a bachelor's degree
* AINS, AIC, or CPCU designations preferred
Benefits in addition to compensation include:
* company car
* company stock options, including Restricted Share Units and Incentive based stock options
* paid time off (PTO)
* 401K with 6% company match
To be an Experienced Claims Representative:
The pay range for this position is $62,000 - $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance.
Be equipped with:
* be available and communicative during your regular business hours
* multi-line claims experience preferred
* ability to completely assess auto, property, and bodily injury type damages
* capacity to work unsupervised
* excellent verbal and written communication skills
* strong interpersonal skills
* excellent problem-solving, negotiation, organizational, and prioritization skills
* preparedness to follow-up with others in a timely manner
* a valid driver's license
Bring education or experience from:
* one or more years of claims handling experience
* AINS, AIC, or CPCU designations preferred
* bachelor's degree or equivalent experience required
Benefits in addition to compensation include:
* company car
* company stock options, including Restricted Share Units and Incentive based stock options
* paid time off (PTO)
* 401K with 6% company match
Enhance your talents
Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career.
Enjoy benefits and amenities
Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities.
Embrace a diverse team
As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.
$62k-90k yearly 16d ago
Senior Complex Claims Specialist - Professional Liability
Hiscox
Claims adjuster job in Boston, NY
Job Type:
Permanent
Build a brilliant future with Hiscox
Join our dynamic and forward-thinking Claims team! Here, you'll be part of an energetic and innovative group, with the chance to help shape insurance products and collaborate with business leaders throughout the organization.
Please note that this position is hybrid and requires working in office a minimum of two (2) days per week. Position can be based in the following locations:
Atlanta, GA
Boston, MA
Chicago, IL
Manhattan, NY
West Hartford, CT
Our Senior Complex Claims Specialist-Professional Liability role is an individual contributor responsible for the handling of high-severity primary Professional Lines including Miscellaneous Professional Liability, A&E, Allied Health, and Media claims for the organization from inception to resolution. This role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required. In addition to handling assigned claims, this role also provides technical support to the overall claims team. This role also:
With minimal supervision, adjusts to resolution the highest severity claims and drafts the most complex technical coverage analysis and letters required in the given claim department
Acts as subject matter expert within the team
Models gold standard for litigation best practices and file integrity
Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions, including identifying appropriate matters for trial
Identifies and provides potential solutions for emerging exposures and claims trends
Identifies suspected fraudulent claims and tracks with special investigations unit
Accurately documents claim files with all relevant correspondence and notes in compliance with company policies and applicable regulatory authorities
Mentors other team members, including providing formalized training, as needed.
Develops content and conducts training for claims team and underwriters as requested
The Team:
The US Claims team at Hiscox is a growing group of professionals working collaboratively to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority in order to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling.
Requirements:
10+ years of Professional Liability and/or Specialty claims handling experience.
A JD from an ABA accredited law school may be considered as a supplement to claims handling experience
Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation
Ability to work in a fast-paced and changing environment
Expert knowledge of coverage within the team's specialty or focus
Expert knowledge of litigation process and negotiation skills
Proven track record of mentoring others
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S Degree required, JD optimal
Adjuster licensing required or ability to obtain within 90 days of employment
Additional Factors Considered:
Subject matter expertise or technical leadership in other lines of business and/or claim types
Demonstrates ability to work with minimal oversight
Demonstrates ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects across teams of lines of business
Demonstrates courage and confidence in addressing and solving difficult or severity matters with insureds, attorneys, and brokers
What Hiscox USA offers
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short- term disability and long-term disability coverage
24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
Paid parental leave
4-week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
2024 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox US
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range $140,000-$170,000
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.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-RM1
Work with amazing people and be part of a unique culture
$48k-90k yearly est. Auto-Apply 10d ago
Contents Adjuster
Sedgwick 4.4
Claims adjuster job in Buffalo, NY
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Contents Adjuster
**PRIMARY PURPOSE** : To handle losses and claims for property and casualty insurers.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Examines insurance policies and other records to determine insurance coverage.
+ Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim.
+ Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according to type of insurance.
+ Estimates cost of repair, replacement, or compensation.
+ Prepares report of findings and negotiates settlement with claimant.
+ Recommends litigation by legal department when settlement cannot be negotiated.
+ Attends litigation hearings.
+ Revises case reserves in assigned claims files to cover probable costs.
+ Assists in preparing loss experience report to help determine profitability and calculates adequate future rates.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Obtain IIA-AIC designation within 12 to 18 months. Appropriate state adjuster license is required.
**Experience**
None.
**Skills & Knowledge**
+ Strong oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Demonstrated commitment to timely reporting
+ Strong customer service skills
+ Strong interpersonal skills
+ Attention to detail and accuracy
+ Good time management and organizational skills
+ Ability to work independently or in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** : Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** :
+ Must be able to stand and/or walk for long periods of time.
+ Must be able to kneel, squat or bend.
+ Must be able to work outdoors in hot and/or cold weather conditions.
+ Have the ability to climb, crawl, stoop, kneel, reaching/working overhead
+ Be able to lift/carry up to 50 pounds
+ Be able to push/pull up to 100 pounds
+ Be able to drive up to 4 hours per day.
+ Must have continual use of manual dexterity.
**Auditory/Visual** : Hearing, vision and talking
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.
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 ($50,000 - $70,000). 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.
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**
$50k-70k yearly 60d+ ago
Crop Claims Seasonal Adjuster
Great American Insurance Group (DBA 4.7
Claims adjuster job in Alabama, NY
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.
The Crop Division of Great American has been helping generations of farmers take control of their risks since 1915. The Division is also one of a select few private companies authorized by the United States Department of Agriculture Risk Management Agency (USDA RMA) to write MPCI policies. With six regional offices throughout the U.S., the teams provide tremendous expertise in the specific needs of farmers and crops.
**********************************
Great American is currently seeking Seasonal Crop Adjusters. These positions are seasonal and may not be eligible for full-time or part-time benefits. Qualified candidates will cover territory in one of the following states:
* Alabama
* Arkansas
* California
* Colorado
* Florida
* Georgia
* Idaho
* Illinois
* Indiana
* Iowa
* Kansas
* Kentucky
* Louisiana
* Michigan
* Minnesota
* Mississippi
* Missouri
* Montana
* Nebraska
* New York
* North Carolina
* North Dakota
* Ohio
* Oklahoma
* Oregon
* Pennsylvania
* South Carolina
* South Dakota
* Tennessee
* Texas
* Washington
* Wisconsin
* Wyoming
Schedule: Seasonal part-time. Hours fluctuate based on seasonal needs.
As a Crop Adjuster, you will:
* Understand and can work claims for all major crops, policy/plan types, in all stages of growth.
* Complete field inspections, reviews, and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company Crop insurance policies.
* Review and evaluates coverage and/or liability.
* Secure and analyze necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims.
* Ensure compliant and cost effective application of Crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements.
* Accurately document, process and transmit loss information to determine potential.
* Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions, or trials as necessary.
* May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
* Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
* Ensures that claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed.
* Follow regulatory and company rules, policies, and procedures.
* Performs other duties as assigned.
Physical Requirements for employees in the Crop Business Unit/Crop Claims General Adjuster
* Requires continuous and prolonged walking and standing.
* Requires frequent lifting, carrying, pushing and pulling of objects up to 50 lbs.
* Requires frequent climbing grain bins, bending, twisting, stooping, kneeling and crawling.
* Requires overhead reaching and grabbing.
* Requires regular and predictable attendance.
* Requires ability to conduct visual inspections.
* Requires work outdoors, in inclement weather conditions.
* Requires frequent travel.
* May require ability to operate a motor vehicle.
Business Unit:
Crop
Salary Range:
$0.00 -$0.00
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
$53k-65k yearly est. Auto-Apply 60d+ ago
Claims Investigator - Experienced
Command Investigations
Claims adjuster job in Buffalo, NY
Job Description
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.
Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
AOE/COE, Auto, or Homeowners Investigations.
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
Full-Time benefits Include:
Medical, dental and vision insurance
401K
Extensive performance bonus program
Dynamic and fast paced work environment
We are an equal opportunity employer.
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$45k-58k yearly est. 21d ago
ESIS Senior Claims Representative, WC
Chubb 4.3
Claims adjuster job in Cheektowaga, NY
Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!
As an ESIS Claims Specialist, your primary responsibility will be to investigate and resolve claims efficiently and fairly under the guidance of the Claims Team Leader. Your goal is to ensure that all claims are processed in accordance with established best practices, while delivering exceptional service to our clients.
Major Duties & Responsibilities:
As a Claims Specialist, your duties will encompass the following responsibilities (but are not limited to):
Claim Assignment and Review: Promptly receive and review new assignments, analyzing claim and policy information to set the foundation for thorough investigations, while assessing the policy's obligations based on the specific line of business.
Information Gathering: Conduct in-depth interviews and secure statements (both recorded and in-person) from insured parties, claimants, witnesses, healthcare providers, legal representatives, and law enforcement to collect essential claim information.
Expert Coordination: Collaborate with experts and arrange for surveys when necessary to support claims investigations.
Liability Evaluation: Assess the facts obtained during investigations to determine the insured's liability, if applicable, and the extent of the company's obligations under the policy contract.
Reporting and Documentation: Prepare comprehensive reports that encompass investigation findings, claim settlements, denials, and evaluations of involved parties to maintain accurate and current records.
Reserve Management: Set reserves within your authority limits and recommend changes to reserves to the Claims Team Leader as appropriate.
Claims Progress Review: Regularly discuss the status and progress of claims with the Claims Team Leader, addressing any challenges and proposing solutions.
Litigation Management: Oversee litigation files proactively to ensure timely and appropriate management, while striving to settle claims before progressing to trial.
Assist with Legal Preparations: Support the Team Leader and company attorneys in trial preparations by organizing witness attendance and collecting statements, while actively seeking opportunities to settle claims prior to litigation.
Subrogation Referrals: Identify and refer claims for subrogation as relevant to recover costs.
File Audits and Reviews: Participate in claim file reviews and audits alongside customers, insured parties, and brokers to ensure compliance and accuracy.
Timely Benefits Administration: Administer benefits promptly and fairly, while maintaining control of the claims resolution process to mitigate risk and exposure.
Customer Relationship Management: Establish and uphold strong relationships with all stakeholders, including agents, underwriters, insured parties, and industry experts, to enhance customer satisfaction.
Additional Responsibilities (Depending on Line of Business):
Maintain accurate system logs.
Investigate compensability and benefits entitlement.
Review and authorize medical bill payments or coordinate external assessments as necessary.
Manage vocational rehabilitation processes as needed.
Scope of Position: This position reports directly to a Claims Team Leader or another member of the claims management team, offering opportunities for collaboration and professional growth within our dynamic environment.
Educational Background: A bachelor's degree in a relevant field or comparable work experience, with additional qualifications (e.g., MBA) being a valuable asset.
Extensive Claims Expertise: A minimum of 5 years of proven experience in claims handling, preferably within ESIS or a similar organization. Expertise in Workers' Compensation claims is essential, demonstrating thorough technical knowledge and competence.
Comprehensive Understanding of Products: In-depth knowledge of Workers' Compensation products, services, coverages, and relevant legal principles that govern them.
Cost Containment Proficiency: Familiarity with Workers' Compensation cost containment strategies and a track record of effective account management are crucial for this role.
Professional Designations: Relevant insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), or AICPCU are highly desirable and reflect commitment to professional development.
Strong Business and People Management Skills: Possess the ability to plan, organize, and implement effective business and personnel management practices. This should be evidenced through successful completion of management or technical programs or equivalent practical work experience.
Exceptional Communication Skills: Proven ability to communicate effectively and build relationships with diverse stakeholders, including subordinates, ESIS personnel, attorneys, producers, and clients.
Team Building Experience: Demonstrated understanding of team dynamics and the application of team-building principles in both ongoing and planned activities.
Analytical Evaluation Skills: Ability to assess the effectiveness of various programs and procedures, identifying opportunities for improvement while facilitating and leading group initiatives.
Evaluative and Critical Thinking: Strong evaluative thinking abilities, adept at sourcing and analyzing multiple data points to make informed conclusions and determine actionable strategies.
Personal Effectiveness: Evidence of cultivating personal effectiveness through confidence, credibility, and a commitment to the organization's established strategies and values.
Creativity and Initiative: A proactive approach to work, showcasing creativity and self-motivation in claims handling and related functions, driving engagement and improvement.
Resource Management Acumen: Demonstrated capability to manage activities and resource allocation effectively, prioritizing timely, high-quality service alongside long-term benefits related to claims processing.
An applicable resident or designated home state adjuster's license is required for ESIS Field ClaimsAdjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
The pay range for the role is $79,000 to $134,300. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.
ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry's broadest selections of risk management solutions covering both pre- and post-loss services.
$79k-134.3k yearly Auto-Apply 60d+ ago
Medical Claims Representative Trainee
Progressive 4.4
Claims adjuster job in Williamsville, NY
Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a medical claims representative trainee, you'll be instrumental in keeping the medical claims process efficient and supportive for our customers. Focusing on personal injury protection (PIP) medical coverage, you'll analyze accident details, medical records and terminology. You'll also adjustclaims while maintaining solid relationships with customers. Bring your passion for helping others and we'll teach you the insurance stuff - allowing you to be confident when speaking with customers.
This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like.
Duties & responsibilities after training
* Research policy contract, regulation and cause of injury to make coverage decisions
* Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions
* Identify and research wage loss expenses and documentation for payment consideration
* Review and interpret policy language when subrogation demands are received
Must-have qualifications
* Three years of work experience OR
* Bachelor's degree OR
* Two years work experience and an associate degree
Schedule
* Monday - Friday 8:00 AM - 4:30 PM during Onboarding
Compensation
* Once you complete training (which means passing any necessary training requirements) your salary will be $60,500 - $63,000. However, during training, you will be paid an hourly rate based on your salary.
* Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance
Benefits
* 401(k) with dollar-for-dollar company match up to 6%
* Medical, dental & vision, including free preventative care
* Wellness & mental health programs
* Health care flexible spending accounts, health savings accounts, & life insurance
* Paid time off, including volunteer time off
* Paid & unpaid sick leave where applicable, as well as short & long-term disability
* Parental & family leave; military leave & pay
* Diverse, inclusive & welcoming culture with Employee Resource Groups
* Career development & tuition assistance
Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership.
Equal Opportunity Employer
Applicants must be authorized to work for any employer in the U.S. without the need or potential need, of current or future sponsorship for employment. Progressive does not hire candidates with (e.g., F-1 CPT, OPT, or STEM OPT, H-1B, O-1, E-3, TN) statuses for this role.
For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at ****************************************************************
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$60.5k-63k yearly 10d ago
Pharmacy Claims Adjudication Specialist
Onco360 3.9
Claims adjuster job in Buffalo, NY
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $23.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 28, 2026. We offer a variety of benefits including:
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Document and submit requests for Patient Refunds when appropriate.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law
Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
$23 hourly 10d ago
Claims Specialist
P & A Administrative Services
Claims adjuster job in Williamsville, NY
Full-time Description
We're looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you'll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise.
Key Responsibilities
Accurately process claims within established timelines
Review and complete claimadjustment requests
Research claim reversal requests to determine approval or denial
Manage debit card dispute workflows, including fraudulent or disputed transactions
Provide clear and professional responses to routine phone and written inquiries related to claim processing
Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules
Adjudicate transactions that fail auto-review and determine whether additional documentation is needed
Requirements
High School Diploma or equivalent
Knowledge of ERISA guidelines preferred
Strong written and verbal communication skills with excellent attention to detail
Ability to manage multiple priorities using strong organizational and time-management skills
Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally
Self-starter who can work independently in a fast-paced environment with critical deadlines
An Equal Opportunity Employer.
Salary Description 16.00 - 18.00
$40k-69k yearly est. 51d ago
Claims Supervisor
Centivo 4.0
Claims adjuster job in Buffalo, NY
We exist for workers and their employers -- who are the backbone of our economy. That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.
Centivo is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.
The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.
Responsibilities Include:
· Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans
· Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations.
· Manages the inventory of claims against standard service level agreements (SLA's)
· Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement.
· Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics
· Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance
· Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems
· Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance
· Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades
· Performs other duties as deemed essential and necessary
Qualifications:
Required Skills and Abilities:
Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.
Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.
Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.
Experience: Previous experience in claims processing or a related field, including supervisory experience.
Understands health insurance benefit administration in a Self-Funded environment
Ability to read and understand various forms, documentation, files, and information with the department.
Education and Experience:
· Candidate must have at least 3 years of experience with self-funded health care plans, and processing in a TPA environment
· Candidate must have at least 3 years of experience supervising a claims team
· Candidates must have prior experience with a highly automated and integrated claim adjudication system
· Experience working with HealthRules Payer
· Understanding of health insurance benefits administration in a self-funded environment
Preferred Qualifications:
· Past Training Experience
· Experience working at TPA
· Experience with self-funded plans
Work Location:
An ideal candidate would be assigned to the Buffalo Office with ability to work from home.
If not in the Buffalo area, the opportunity can be remote.
Leadership Skills & Behaviors:
● Strategic Thinking - Knack for sorting through clutter to find the best route, often by pulling up from the current complexity to identify patterns that guide future direction and allow one to narrow the options and articulate the options from which others can work backward.
● Business Acumen - A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome. Critical to this is an ability to think beyond their own function.
● Systems/Analytical Thinking - Demonstrates the ability to think fluidly and integrate information. Able to anticipate non-linear and non-obvious relationships. Often includes an ability to think holistically/conceptually - very powerful when accompanied by ability to communicate & clarify tactically.
● Flexibility/Working through Ambiguity - Tendency to be energized by new experiences/perspectives that test assumptions and thinking. Considers different points of view, sometimes with fragmented information, to arrive at practical, effective, actionable next steps.
● Communicate - Managers discuss the company's vision and strategies, the department's direction and goals, and in times of crisis, what we know and don't know to make sure team members know what they need to know.
● Clarify - As managers, it's up to us to clarify what good looks like. What do we expect? What do our clients, customers or colleagues need? If our teams are not performing as expected, managers must clarify expectations and ensure understanding.
● Coach - Managers provide recognition and feedback; help team members find solutions to challenges; amplify good and filter weaker aspects of organizational culture and the work as they coach employees in their day-to-day performance and their growth and career development.
● Connect - Managers help our teams see their collective purpose and how their work connects to the greater whole. We connect people within our company and network.
● Customize - As managers, we need to understand what makes each team member unique, and then customize, tailor and adapt how we support them.
Who we are:
Centivo is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, Centivo saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. Centivo works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit centivo.com.
Headquartered in Buffalo, NY with offices in New York City and Buffalo, Centivo is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.
$63k-100k yearly est. Auto-Apply 60d+ ago
Independent Insurance Claims Adjuster in East Amherst, New York
Milehigh Adjusters Houston
Claims adjuster job in Amherst, NY
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.
$51k-65k yearly est. Auto-Apply 60d+ ago
Claims Investigator - Experienced
Command Investigations
Claims adjuster job in Buffalo, NY
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must.
Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments.
If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ******************
The Claims Investigator should demonstrate proficiency in the following areas:
AOE/COE, Auto, or Homeowners Investigations.
Writing accurate, detailed reports
Strong initiative, integrity, and work ethic
Securing written/recorded statements
Accident scene investigations
Possession of a valid driver's license
Ability to prioritize and organize multiple tasks
Computer literacy to include Microsoft Word and Microsoft Outlook (email)
Full-Time benefits Include:
Medical, dental and vision insurance
401K
Extensive performance bonus program
Dynamic and fast paced work environment
We are an equal opportunity employer.
$45k-58k yearly est. Auto-Apply 60d+ ago
ESIS Senior Claims Representative, WC
Chubb 4.3
Claims adjuster job in Cheektowaga, NY
Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!
The ESIS Senior Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.
Duties may include but are not limited to:
Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies. As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.
Communication: Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.
Investigation: Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.
Experience: Minimum of 3-5 years of experience handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is a plus.
Knowledge & Licensing: Knowledge of Pennsylvania Workers Compensation and active adjuster license or ability to obtain licensure within a specified timeframe.
Skills:
Strong analytical and problem-solving abilities.
Excellent verbal and written communication skills.
Proficiency in claims management systems and Microsoft Office Suite.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Knowledge: Familiarity with workers' compensation laws, medical terminology, and claim handling best practices. As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.
An applicable resident or designated home state adjuster's license is required for ESIS Field ClaimsAdjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.
The pay range for the role is $72,400 to $123,100. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.
ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry's broadest selections of risk management solutions covering both pre- and post-loss services.
$72.4k-123.1k yearly Auto-Apply 31d ago
Auto Damage Claims Adjuster
Progressive 4.4
Claims adjuster job in Williamsville, NY
Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As an auto damage claimsadjuster, you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end. Managing your own inventory while working independently, you'll work closely with body shops and others to negotiate repair pricing and assess liability. Ideal candidates will possess leadership and conflict management skills, along with strong attention to detail and a passion for providing excellent customer service.
This is a field position with access to a company car and frequent driving within your assigned geographical area. We assess our workload collectively, which means you may cover assignments outside your geographical area. You may also be required to report into an office occasionally.
Duties and responsibilities
* Complete vehicle inspections, write estimates, determine total loss evaluations, and set clear expectations and timelines
* Negotiate repair process with body shops
* Document information related to the claim and make decisions consistent with claims standards and local laws
* Evaluate and handle claim payments and resolution of claims without payments
* Review and determine validity of any supplement requests
Must-have qualifications
* A minimum of four years of relevant work experience with one year appraisal/estimatics or insurance experience
* {OR} Associate's degree and a minimum of three years relevant work experience with one year appraisal/estimatics or insurance experience
* {OR} Bachelor's degree and a minimum of one year appraisal/estimatics or insurance experience
* Valid driver's license, auto insurance, and compliance with Progressive's driving standards and/or policies
Compensation
* $67,000 - $81,200/year depending on experience
* Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance
Location
* Williamsville, NY
* We assess our workload collectively, which means you may cover assignments outside your geographical area as well.
Benefits
* 401(k) with dollar-for-dollar company match up to 6%
* Medical, dental & vision, including free preventative care
* Wellness & mental health programs
* Health care flexible spending accounts, health savings accounts, & life insurance
* Paid time off, including volunteer time off
* Paid & unpaid sick leave where applicable, as well as short & long-term disability
* Parental & family leave; military leave & pay
* Diverse, inclusive & welcoming culture with Employee Resource Groups
* Career development & tuition assistance
Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership.
Equal Opportunity Employer
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$67k-81.2k yearly 15d ago
Complex Claims Specialist-MPL
Hiscox
Claims adjuster job in Boston, NY
Job Type:
Permanent
Build a brilliant future with Hiscox
Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required.
Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization.
Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations:
Manhattan, NY
West Hartford, CT
Atlanta, GA
Chicago, IL
Boston, MA
The Role:
The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also:
Adjusts and resolves complex to severe claims that includes all phases of litigation
With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
Reviews and analyses claim documentation and legal filings
Drives litigation best practices to lead defense strategy on litigated files
Mentors Claim Examiners
Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
Identifies emerging exposures and claims trends
Identifies suspected fraudulent claims and tracks with special investigations unit
Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
Develops content and conducts training for claims team and underwriters as requested
The Team:
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling.
Requirements:
8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.)
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Advanced knowledge of coverage within the team's specialty or focus
Advanced knowledge of litigation process and negotiation skills
Experience in mentoring and training other claims examiners
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University preferred
Additional Factors Considered:
Ability to act a subject matter expert within team
Demonstrated ability to work with minimal oversight
Experience attending and leading mediations, arbitrations and trials
Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects
Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers
Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation
Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars.
What Hiscox USA offers:
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short- term disability and long-term disability coverage
24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
Paid parental leave
4-week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox USA:
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
Diversity and flexible working at Hiscox:
At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range: $125,000-$155,000
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.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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Work with amazing people and be part of a unique culture
How much does a claims adjuster earn in Buffalo, NY?
The average claims adjuster in Buffalo, NY earns between $46,000 and $72,000 annually. This compares to the national average claims adjuster range of $40,000 to $64,000.
Average claims adjuster salary in Buffalo, NY
$57,000
What are the biggest employers of Claims Adjusters in Buffalo, NY?
The biggest employers of Claims Adjusters in Buffalo, NY are: