Claims Specialist
Claims adjuster job in North Carolina
Annual Salary Range: $47,393 - $59,241 This is a non-exempt (hourly) position. Pay rates are based on education, skill, experience level and internal equity Performs thorough review, and transmission of healthcare claims, conducts financial analysis to ensure compliance with established local, state, and governmental billing and coding guidelines, thorough understanding of third-party financial reimbursement, payment posting, and reconciliation policies. This position, under general supervision, is to apply laws, rules, regulations, and policies to complex paraprofessional work.
ESSENTIAL FUNCTIONS
* Analyze claim data to ensure proper reimbursement
* Prepare, review, and submit claim payments to financial management system (live check within 24 hours, Online Credit Card payments by next business day, EFT (Electronic Funds Transfer) deposits within 72 hours
* Monitor and analyze all referred accounts to determine categorization, level of the appeal process, and personally handle complex appeal responses for private health care and government-specific denials
* Record financial and statistical data within payment receipt database and accurately balance financial transaction reports
* Performs accurate financial clearance review along with a comprehensive analysis of client/patient and payer specific benefit and liability
* Develop training materials and implement quality assurance processes to serve as a resource to and from internal departments, financial institutions, and external agencies
* Monitor and analyze collection of past due accounts, follow-up on payment arrangements, assign delinquent account as outlined in FIS-02_Uncollectible Account Policy
* Serve as a liaison to public health and clinical administration for financial and statistical claim data
* Participate in special projects related to financial activities
* May assist in monitoring of budgets for fiscal compliance
* Given the wide range of staff involved in the revenue cycle process, the incumbent must be able to work collegially and respond efficiently and effectively
MINIMUM QUALIFICATIONS
Experience: Minimum of three years of directly related experience.
Education: High School Diploma or equivalent and two years of basic accounting coursework.
Combination of relevant education and relevant experience accepted: Yes
Licenses and Certifications
May require a valid North Carolina or South Carolina Driver's License
PREFERRED QUALIFICATIONS
Associate degree in accounting or a related field
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of
* Revenue Cycle principles
* Federal, State, and local Healthcare Coding and Billing rules and regulations
* Accounting principles
* Medical terminology, ICD-10, CPT, and HCPCS codes
* Budgetary principles
* Arithmetic, algebra, geometry, calculus, statistics, and their applications
* The structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
* Principles and processes for providing customer service, including customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction
Skills
* Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times
* Understanding written sentences and paragraphs in work related documents
* Talking to others to convey information effectively
* Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
* Using mathematics to solve problems
Abilities
* Applied Learning - Assimilating and applying new job-related information in a timely manner.
* Communication - Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain information required
* Decision Making - Identifying and understanding issues, problems and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probably consequences
Computer Skills
Proficient in various computer applications including Microsoft Office Suite
REASONABLE ACCOMMODATIONS STATEMENT
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
DISCLAIMER STATEMENT
This is not intended to be an all-inclusive list of job-related responsibilities, duties, skills, requirements or working conditions. Other duties may be assigned based on business need and the supervisor's request. Mecklenburg County reserves the right to revise the job description at any time. Designated positions may be required to assist in emergency and/or disaster situations.
General Liability Claims Adjuster II
Claims adjuster job in Salisbury, NC
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.
Position Summary
Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.
Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.
Applicants must be currently authorized to work in the United States on a full-time basis.
Principle Duties and Responsibilities:
Claims Management
* Manage caseload within established targets and appropriate level. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
* Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
* Analyze facts of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines.
* Identify fraud indicators and actively pursue subrogation opportunities.
* Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
* Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.
Financial Impact Administration
* Manage book of claims business (up to $ 2million) with authority to settle/negotiate a single claim within their authority of up to $25,000.
* Communicate ongoing causes of incidents to Safety and Brands.
* Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.
Basic Qualifications:
* Licensed adjuster (as appropriate by jurisdiction)
* Bachelor's degree or experience handling General Liability claims or equivalent expertise.
* Thorough knowledge of rules, regulations, statutes, and procedures pertaining to general liability claims.
* Knowledge of medical terminology involved in complex claims
* Negotiates resolution of claims of various exposure and complexity
Skills and Abilities:
* Demonstrates relationship building and communication skills, both written and verbal.
* Highly self-motivated, goal oriented, and works well under pressure.
* Customer focused solid understanding of legal procedures, processes, practices and standards in the handling of general liability claims
* Ability to identify problems and effectuate solutions
* Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail
* Able to apply critical thinking when solving problems and making decisions.
ME/NC/PA/SC Salary Range: $63,440-$95,160
IL/MA/MD/NY Salary Range: $72,880 - $109,320
Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.
#LI-SM1 #LI-Hybrid
At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent.
Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.
Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work.
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.
Independent Insurance Claims Adjuster in Fayetteville, North Carolina
Claims adjuster job in Fayetteville, NC
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement.
Why This Opportunity Matters:
With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand.
As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation.
Join Our Team:
Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt?
If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster.
You're welcome to sign up on our jobs roster if you meet our guidelines.
How We Can Help You Succeed:
At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting.
Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges.
Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals.
Seize the Opportunity Today!
Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews.
You can also find us on YouTube at: (*********************************************************
and Facebook at: (************************************************** for additional resources and updates.
APPLY HERE
#AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston
By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.
Auto-ApplyClaims Adjuster -GL
Claims adjuster job in Charlotte, NC
Job Description
Manager's Note: Must have active NY license and BI litigation experience Auto casualty Experienced in complex liability and coverage. TPA experience a plus. Bodily injury/uninsured/underinsured motorist handling experience to include demonstrable (fatality, fractures, traumatic brain injury) injury handling.
$ threshold handling up to 1 million.
No fault (Personal Injury Protection) experience.
Licensed in the contiguous 48 states.
Litigation handling experience pertaining to BI/UM/UIM Not all candidates will need this but a minimum of 3 will need litigation handling experience.
Auto Physical Damage handling experience preferred.
Experience working in a fast-paced environment, participating in and presenting cases to both internal and external stakeholders.
Primary Purpose:
To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
Essential Functions and Responsibilities:
Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
Responsible for litigation process on litigated claims.
Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
Reports large claims to excess carrier(s).
Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
Communicates claim action/processing with insured, client, and agent or broker when appropriate.
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. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.
Experience Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws.
Skills & Knowledge:
In-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws
Knowledge of medical terminology for claim evaluation and Medicare compliance
Knowledge of appropriate application for deductibles, sub-limits, SIRs, carrier and large deductible programs.
Strong oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Strong organizational skills
Strong interpersonal skills
Good negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
Work Environment:
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
Note:
Credit security clearance, confirmed via a background credit check, is required for this position.
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.
at any time.
Public Adjuster
Claims adjuster job in Charlotte, NC
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
Senior Workers Compensation Claim Representative
Claims adjuster job in Charlotte, NC
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$67,000.00 - $110,600.00
**Target Openings**
2
**What Is the Opportunity?**
Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager.
Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery The injured worker is working modified duty and receiving ongoing medical treatment. The injured worker as returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out.
With close to moderate supervision, may handle claims of greater complexity where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and there has been a change in the current position. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.
**What Will You Do?**
+ Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability
+ Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions.
+ Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment.in collaboration with internal nurse resources where appropriate.
+ Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
+ Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Prepare necessary letters and state filings within statutory limits.
+ Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud.Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
+ Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.
+ Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction.
+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ 2 years Workers Compensation claim handling experience preferred.
+ Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
+ Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
+ Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
+ General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
+ Principles of Investigation: Intermediate investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
+ Value Determination: Intermediate ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
+ Settlement Techniques: Intermediate ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
+ Legal Knowledge: General knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
+ Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
+ WC Technical:
+ Intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
+ Intermediate knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
+ Customer Service:
+ Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes
+ Teamwork:
+ Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result
+ Planning & Organizing:
+ Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals
+ Maintain Continuing Education requirements as required or as mandated by state regulations
**What is a Must Have?**
+ High School Diploma or GED required.
+ Minimum of 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program required.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
Field Claims Adjuster
Claims adjuster job in Greensboro, NC
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.
Rec Marine Adjuster
Claims adjuster job in Fayetteville, NC
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Rec Marine Adjuster
**PRIMARY PURPOSE** **:** To investigate and process marine claims adjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement.
+ Receives and reviews new claims and maintains data integrity in the claims system.
+ Reviews survey reports and insurance policies to determine insurance coverage.
+ Prepares settlement documents and requests payment for the claim and expenses.
+ Assists in preparing loss experience report to help determine profitability and calculates adequate future rates.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required.
**Experience**
3 years or more of Marine Adjusting preferred.
**Skills & Knowledge**
+ Strong oral and written communication skills
+ PC literate, including Microsoft Office products
+ Good customer service skills
+ Good organizational skills
+ Demonstrated commitment to timely reporting
+ Ability to work independently and in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** **:**
+ Must be able to stand and/or walk for long periods of time.
+ Must be able to kneel, squat or bend.
+ Must be able to work outdoors in hot and/or cold weather conditions.
+ Have the ability to climb, crawl, stoop, kneel, reaching/working overhead
+ Be able to lift/carry up to 50 pounds
+ Be able to push/pull up to 100 pounds
+ Be able to drive up to 4 hours per day.
+ Must have continual use of manual dexterity
**Auditory/Visual** **:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
Claims Investigator - Full Time
Claims adjuster job in Fayetteville, NC
Claims Investigator
Fayetteville, NC area
Immediate need for a Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continues its expansion into all areas of investigations, allowing continual growth for its employees.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
Responsibilities/ Requirements
Responsibilities:
Duties and responsibilities include essential functions of positions assigned to this classification. Depending on assignment, the employee may perform a combination of some or all the following duties:
Ability to conduct multiple types of complex claims investigations
Daily submission of updates regarding work performed on each case
Ability to manage time
Maintain a sufficient level of client billable hours
Write and record detailed statements
Conduct scene investigations
Submit professional and client ready investigative reports
Conduct background/activity checks and courthouse research
Due to driving, constant state of alertness in a safe manner is an essential function of this position
Requirements:
Must be licensed as a Private Investigator in North Carolina and eligible to be licensed in surrounding states
1 year or more of full time report writing experience on field investigations cases
Field investigations experience - Face to face statements
Ability and willingness to travel within a multi-state coverage area (as necessary)
Experienced in investigation of product/auto/general liability claims, Workers Compensation, disability claims, life insurance and contestable death claims
Flexibility to work varied/irregular hours and days including nights, weekends
Reliable and fuel efficient vehicle with minimum of auto liability insurance
Possess or is willing to purchase: digital recording device and laptop computer with Windows Operating System with access to Microsoft Word and other necessary equipment for position
Educational/Experience Qualifications:
Associate or Bachelor's Degree in Criminal Justice or related field
Experience as a Private Investigator or detective
Military or Law Enforcement background
Comprehensive knowledge of insurance law and underwriting
Self-starter who holds themselves accountable for results and performance
Strong attention to detail with commitment to accuracy and quality
Ability to adapt and work under stressful and sensitive situations
Can type 50 words or more a minute
Benefits
CoventBridge Group offers the most premiere compensation and benefits package in the industry.
Flexibility to self-schedule
Ability to work from home-based office
Competitive pay
Paid time off
Monthly vehicle allowance
Company fuel card
Company cell phone
Medical, Dental, Vision plans
Employer paid Life, LTD, STD insurance
Company matching 401(k)
Travel and report writing compensation
Company paid investigator licensing fees
Paid ongoing career advancement training
Timely expense reimbursement with very minimal out-of-pocket expenses
The salary range for this role is $26 - $30 per hour. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
About Us:
CoventBridge Group is the global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************.
CoventBridge (USA) Inc. North Carolina License # BPN0072064PM
IND123
Auto-ApplyDaily Property Field Adjuster
Claims adjuster job in Fayetteville, NC
Alacrity Solutions
Independent Contractor
Daily Property Field Adjuster
Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy equipment, and casualty claims management services. Our staffing capabilities, temporary housing services, managed repair network, and subrogation services support a fully integrated solution for all your needs from first notice of loss through completion of repairs. By assembling the best service providers through strategic acquisitions and relying on the right talent, Alacrity Solutions provides consistent, professional, and scalable services throughout the entire claim handling and resolution process. To learn more, visit **************************
The objective of a Daily Property Field Adjuster is to provide excellent claim handling services for our clients regarding daily claim work within your area which can include multiple perils.
Contract Requirements Include:
A contract will be issued within 24 hours of accepting your first claim assignment with Alacrity. This IA contract will include pay details and other pertinent information regarding your work as an independent contract with Alacrity. A completed contract is required to issue pay.
Skills & Requirements/Licensure:
MUST live within 50-100 miles of posted location and willing to travel to location.
Minimum 2-3 years property field adjusting experience.
Independent adjusting license in your home state (area of work), or a designated home state license if residing in a non-licensing state.
Experienced in wind, hail, theft, fire, water losses and other perils preferred.
Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities.
Willing and able to climb roofs.
Computer and Phone System Requirements:
Smart Cell Phone able to access to internet.
Xactimate and/or Symbility proficient with current subscription
Working Laptop computer with reliable high-speed internet
Digital camera and other miscellaneous items necessary to perform adjuster responsibilities.
Working Conditions / Physical & Mental Demands:
The physical demands described here are representative and must be met by the independent contractor to successfully perform this job.
100% travel is required within designated working territory based on the location of assignments received.
Normal office or field claims environment. Ability to operate a motor vehicle for up to 8 hours daily, repeatedly entering and exiting the vehicle. Must be able to make physical inspections of auto loss sites. Must be able to work outdoors in all types of weather. Available to work catastrophic loss events. A willingness to work irregular hours and to travel with possible overnight requirements a plus.
Why Choose Alacrity?
Flexibility: Self-determined Scheduling
Diversity Statement
Alacrity is an equal opportunity employer and is committed to providing employees with a work environment free of discrimination and harassment. All decisions pertaining to an employee's employment are made without regard to race, color, religion, sex (including sexual orientation, pregnancy, childbirth), gender, gender identity or expression, age, national origin, ancestry, physical or mental disability, medical condition, reproductive health decisions, veteran's status, genetic information, creed, marital status, disability, citizenship status, or any other characteristic protected by applicable law.
How Long We Retain Personal Information:
We will keep your personal information for as long as necessary to fulfill legitimate business purposes and in accordance with applicable laws.
Auto-ApplyClaims Representative II
Claims adjuster job in North Carolina
Company Details
With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results.
All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P.
For further information about Key Risk please visit ***************
The company is an equal opportunity employer.
Responsibilities
Key Risk is looking for a Claims Representative who enjoys analysis and management of workers compensation claims.
Key functions include but are not limited to the following:
Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
Negotiate settlement of claims up to designated authority level and makes claims payments.
Calculates and assigns timely an appropriate reserve to claims and continues to manage reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
Prepares necessary state filings within statutory limits.
Actively manages the litigation process; ensures timely and cost-effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
Frequently communicates with all appropriate parties involved with the claim.
Maintains professional client relationships.
Actively executes appropriate claims activities to ensure consistent delivery of quality claims services.
Qualifications
BA/BS Degree
2-3 years of workers compensation claims experience
Adjuster license strongly desired or ability to obtain license within six months
Knowledge of appropriate insurance principles and laws of workers' compensation, preferably jurisdiction specific.
Strong verbal and written communication
Strong interpersonal, time management and organizational skills.
Strong negotiation skills.
Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail.
Ability to perform with a sense of urgency.
Ability to work both independently and within a team environment.
Ability to travel for business purposes, approximately less than 10%.
Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms.
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. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
Auto-ApplyCasualty Adjuster - Out-Of-State
Claims adjuster job in Raleigh, NC
About Us At North Carolina Farm Bureau Insurance, we take pride in our strong, community-oriented roots that began right here in North Carolina. In 1953, our company was born out of the need to provide insurance coverage to our farmers and rural communities. Now, with local offices in each of the 100 counties, we provide services to all North Carolinians across the state. Here at NCFB we are a familiar face in the community with a service oriented mindset that truly sets us apart. Guided by our mission, we are deeply committed to both our neighbors and employees. Helping you is what we do best! If you are passionate about making a meaningful impact and value a people-centered culture, we invite you to join us!
About the Role
Our Claims Department provides outstanding individuals with the opportunity for an exciting and rewarding career. Resolving claims combines the excitement of investigations with the reward of helping people through difficult times.
We are seeking motivated and proactive individuals to join our team. As a Casualty Adjuster, you will work directly with policyholders, claimants, and other involved parties to investigate, evaluate, and negotiate settlements of casualty insurance claims.
Education and Experience
Associate's degree or above preferred
Preference given to applicants with extended education and/or training
Mechanical aptitude or ability preferred
Required Skills and Abilities
Present a professional and personable attitude and communicate effectively in stressful situations
Demonstrate exceptional mental resilience and possess strong conflict management skills
Possess strong written, verbal, and interpersonal communication skills
Ability to organize and prioritize your workload to demonstrate effective time management towards meeting deadlines
Demonstrate the strong ability to make decisions and problem solve using logical and analytical skills
Must be reliable and capable of working independently as well with others
Location and Commitments
Full-time office role
Reports to: Out of State District Claims Manager at 5171 Glenwood Ave, Raleigh NC 27612
Must obtain and maintain licensing CE in compliance with N.C. Department of Insurance and N.C. Farm Bureau Mutual Insurance Company requirements
All offers are contingent on a Background Check
Responsibilities of the Role
Provide prompt, timely, and professional communication for insureds and claimants.
Appraise and determine covered damages using provided resources.
Investigate losses, verify coverage, and apply policy coverage.
Determine legal liability for losses and damages.
Authorize or deny claim payments based on policy guidelines.
Evaluate and establish reserves for the possible payout amounts.
Adhere to company policies, procedures, and regulatory guidelines.
Maintain current, accurate, and detailed documentation throughout the claims process.
Ensure the protection and proper maintenance of all company equipment assigned to you.
Participate in industry-related conferences and training programs. *Certain training programs are located at the Corporate Office in Raleigh, NC.
This document is intended to outline the essential responsibilities of the position, and does not limit the tasks that may be assigned or amended by the supervisor.
Claims Representative I
Claims adjuster job in Durham, NC
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
Hours: Monday - Friday, 8:30 am - 5:00 pm EST
The Claim Representative I is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
How you will make an impact:
* Learning the activities/tasks associated with his/her role.
* Works under direct supervision.
* Relies on others for instruction, guidance, and direction.
* Work is reviewed for technical accuracy and soundness.
* Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
* Researches and analyzes claims issues.
Minimum Requirements:
* Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
* Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.
* Previous experience working in health claims (CAS or ConnectsNX) is strongly preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $16.67 to $25.00
Locations: Massachusetts
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Non-Exempt
Workshift:
1st Shift (United States of America)
Job Family:
CLM > Claims Reps
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Claims Settlement Specialist
Claims adjuster job in Raleigh, NC
Now Hiring: Claims Settlement Specialist - Inspire, Lead, and Create Meaningful Impact!
Are you passionate about leading with purpose, empowering others, and making a lasting impact? We are looking for motivated individuals to join our team as Claims Settlement Specialist, where you'll mentor, inspire, and implement strategies that help individuals achieve financial and personal breakthroughs while building a career that aligns with your values.
Who We're Looking For:
✅ Visionary leaders who are passionate about servant leadership and impact
✅ Entrepreneurs and professionals eager to empower others while scaling success
✅ Licensed & aspiring Life & Health Insurance Agents (We'll guide you through licensing!)
✅ Individuals ready to lead with integrity, purpose, and a strong mission for success
As a Claims Settlement Specialist, you'll help individuals discover their potential, achieve financial independence, and create meaningful change in their lives and communities.
Is This You?
✔ Passionate about mentorship, leadership, and creating impact-driven success?
✔ A strong communicator who thrives on guiding and inspiring others?
✔ Self-driven, disciplined, and committed to personal and professional growth?
✔ Open to mentorship, leadership development, and continuous learning?
✔ Looking for a recession-proof career with unlimited earning potential?
If you answered YES, keep reading!
Why Become a Claims Settlement Specialist?
🚀 Work from anywhere - Build a career aligned with your values and goals.
💰 Uncapped earning potential - Part-time: $40,000-$60,000+/year | Full-time: $70,000-$150,000+++/year.
📈 No cold calling - Work with individuals who have already requested guidance.
❌ No sales quotas, no pressure, no pushy tactics.
🏆 Leadership & Ownership Opportunities - Develop and expand your own team.
🎯 Daily pay & performance-based bonuses - Direct commissions from top carriers.
🎁 Incentives & rewards - Earn commissions starting at 80% (most carriers) + salary.
🏥 Health benefits available for qualified participants.
This is more than just a career-it's an opportunity to lead with purpose, inspire positive change, and build a future that aligns with your mission and impact.
👉 Apply today and take your first step as a Claims Settlement Specialist!
(Results may vary. Your success depends on effort, skill, and commitment to learning and execution.)
Auto-ApplyComplex Liability Claims Specialist - Commercial General Liability
Claims adjuster job in North Carolina
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $136,400
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
General Medicine Claim Specialist
Claims adjuster job in Pinehurst, NC
General Medicine Claims Specialist
Join a mission-driven team that supports those who've served.
Veterans Guardian VA Claim Consulting is seeking a General Medicine Claims Specialist to help Veterans nationwide secure the VA disability benefits they have earned. This role is ideal for someone with a clinical or medical background who thrives in a fast-paced, high-volume environment and is passionate about making a difference.
You'll work directly with Veterans, reviewing medical records, gathering symptom information over the phone, and identifying the key medical evidence needed to support disability claims. Strong communication skills, attention to detail, and comfort with phone-based work are essential for success.
Key Responsibilities:
Review and analyze medical records to identify relevant information
Speak with Veterans daily about their medical history and symptoms
Process and document case details in internal systems
Manage a large caseload with a high call and client volume
Collaborate with internal teams to ensure timely and accurate case work
Qualifications:
1+ year experience in a clinical or medical support role
(e.g., LPN, LVN, EMT, Medical Assistant, Military Medic)
Familiarity with medical terminology and documentation
Strong verbal and written communication skills
High school diploma or GED required
Proficient with computers and comfortable using Google Workspace
Benefits
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Auto-ApplyClaims Specialist
Claims adjuster job in Charlotte, NC
Project Resources Group (PRG) is seeking a Claims Recovery Specialist for our Charlotte, NC office. Be part of our expanding team focused on recovering third-party property and utility damage claims, primarily in a B2B setting. We're looking for motivated, detail-oriented professionals with strong negotiation skills. Experience in collections or insurance adjusting is highly relevant and transferable. We offer a competitive base salary plus commission. Key Responsibilities
Resolve and negotiate claims recovery of repair and replacement costs on third-party cable/fiber and utility damages across multiple state lines, via phone, email, and letters.
Work directly with liable parties' insurance providers to defend and negotiate claims settlements.
Collaborate with claims departments and management of liable parties, from small businesses to large corporations to municipalities.
Learn, understand, and be able to utilize state dig laws and statutes, 811 excavator requirements, NESC standards, CGA guidelines, etc.
Develop a professional working relationship with damaging parties, on-site field investigators, management, and other personnel.
Conduct 40-50 inbound/outbound calls daily, approximately 2-2.5 hours of total talk time throughout the day.
Enter notes and documentation throughout the recovery process into the company's proprietary Claims Database Tool.
Use a calendar and diary system to coordinate handling claims to be worked twice weekly.
Follow advanced claim handling procedures as detailed by the OPD Claims Manager.
Use photographs, narratives, job costs, site sketches, locate tickets, and other components on-site field investigators provide to visualize and understand the damage scene to defend liability accurately.
Participate in weekly department meetings to discuss individual and team recovery tactics, strategies, and goals.
Maintain a working knowledge of the entire PRG claims recovery process.
Preferred Qualifications
Strong proficiency in Microsoft Word, Outlook, and Excel.
Tech-savvy with the ability to quickly adapt to new software and systems.
Excellent written and verbal communication skills, with an emphasis on professional phone and email correspondence.
Familiarity with the construction, cable, or utility locate industries is advantageous.
Understanding of B2B construction, claims management, recovery, or insurance claim negotiation and settlement processes is preferred.
Ideally, 3-5 years of experience in claims, recovery, and/or the insurance industry.
College education is preferred.
Bilingual in Spanish is a plus.
Compensation and BenefitsWe offer a competitive hourly pay ($19-$23/hour based on experience), plus the potential to earn substantial commissions up to $4,000-$10,000 monthly based on performance. Along with a comprehensive benefits package, including:
Medical, dental, and vision coverage for employees and dependents
401(k) retirement plan, with company match after 1 year
Short-term disability coverage after 1 year
Paid time off and holidays
Additional perks such as company-paid life insurance, and other supplemental insurances available
About PRG
Since 2001, PRG has been a leader in construction management and outside plant damage recovery for the telecommunications and utility industries. With 20+ offices and 800+ employees nationwide, we deliver industry-leading solutions with speed, accuracy, and expertise.
Equal Opportunity EmployerPRG is proud to be an Equal Opportunity Employer. PRG does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, pregnancy-related conditions, and lactation), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state, or local law and ordinances.#INDCS
Auto-ApplyClaims Adjuster -GL
Claims adjuster job in Charlotte, NC
Job Description
Manager\'s note: Auto casualty Experienced in complex liability and coverage. TPA experience a plus. Bodily injury/uninsured/underinsured motorist handling experience to include demonstrable(fatality, fractures, traumatic brain injury) injury handling.
$ threshold handling up to 1 million.
No fault(Personal Injury Protection) experience.
Licensed in the contiguous 48 states.
Litigation handling experience pertaining to BI/UM/UIM** Not all candidates will need this but a minimum of 3 will need litigation handling experience.
Auto Physical Damage handling experience preferred.
Experience working in a fast paced environment, participating in and presenting cases to both internal and external stakeholders.
Primary Purpose:
To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
Essential Functions and Responsibilities
Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
Responsible for litigation process on litigated claims.
Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
Reports large claims to excess carrier(s).
Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
Communicates claim action/processing with insured, client, and agent or broker when appropriate.
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. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.
ExperienceFive (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws.
Skills & Knowledge
In-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws
Knowledge of medical terminology for claim evaluation and Medicare compliance
Knowledge of appropriate application for deductibles, sub-limits, SIRs, carrier and large deductible programs.
Strong oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Strong organizational skills
Strong interpersonal skills
Good negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
Work Environment
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
Note:
Credit security clearance, confirmed via a background credit check, is required for this position.
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.
at any time.
Requirements:
Mananger\'s Note:
Must have P&C license for resident state. The client has business in all 50 states. The more licenses the better. Bodily injury experience/liability background in auto or GL
Claims Representative II
Claims adjuster job in High Point, NC
Company Details
With over 35 years of proven expertise in the workers' compensation industry, Key Risk delivers innovative and responsive solutions that provide our clients the freedom to do what they do best. Offering guaranteed cost options to employers nationwide, Key Risk focuses on delivering products and services within specialized verticals to reduce workers' compensation exposures and deliver industry-leading results.
All products and services are distributed through appointed insurance agents and brokers. Key Risk is a member company of W. R. Berkley Corporation, whose insurance company subsidiaries are rated A+ (Superior), Financial Size Category XV by A.M. Best Company and A+ (Strong), by S&P.
For further information about Key Risk please visit ***************
The company is an equal opportunity employer.
Responsibilities
Key Risk is looking for a Claims Representative who enjoys analysis and management of workers compensation claims.
Key functions include but are not limited to the following:
Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
Negotiate settlement of claims up to designated authority level and makes claims payments.
Calculates and assigns timely an appropriate reserve to claims and continues to manage reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
Develops and manages claims though well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
Prepares necessary state filings within statutory limits.
Actively manages the litigation process; ensures timely and cost-effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
Frequently communicates with all appropriate parties involved with the claim.
Maintains professional client relationships.
Actively executes appropriate claims activities to ensure consistent delivery of quality claims services.
Qualifications
BA/BS Degree
2-3 years of workers compensation claims experience
Adjuster license strongly desired or ability to obtain license within six months
Knowledge of appropriate insurance principles and laws of workers' compensation, preferably jurisdiction specific.
Strong verbal and written communication
Strong interpersonal, time management and organizational skills.
Strong negotiation skills.
Proven critical thinking skills that demonstrates analysis/judgment and sound decision making with focus on attention to detail.
Ability to perform with a sense of urgency.
Ability to work both independently and within a team environment.
Ability to travel for business purposes, approximately less than 10%.
Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms.
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. Sponsorship Details Sponsorship not Offered for this Role
Auto-ApplyClaims Representative I
Claims adjuster job in Winston-Salem, NC
Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual/ work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
Hours: Monday - Friday, 8:30 am - 5:00 pm EST
The Claim Representative I is responsible for successfully completing the required basic training. Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
How you will make an impact:
* Learning the activities/tasks associated with his/her role.
* Works under direct supervision.
* Relies on others for instruction, guidance, and direction.
* Work is reviewed for technical accuracy and soundness.
* Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
* Researches and analyzes claims issues.
Minimum Requirements:
* Requires HS diploma or equivalent and related experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
* Good oral and written communication skills, previous experience using PC, database system, and related software (word processing, spreadsheets, etc.) strongly preferred.
* Previous experience working in health claims (CAS or ConnectsNX) is strongly preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $16.67 to $25.00
Locations: Massachusetts
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Non-Exempt
Workshift:
1st Shift (United States of America)
Job Family:
CLM > Claims Reps
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.