Associate Property Claims Representative
Claims adjuster job in Lansing, MI
OBJECTIVE
Associate Property Claims Representative Objective
To assure the consistent application of company procedures and practices in commercial, residential, farm property and property damage liability claim handling, so as to have a significant and positive overall effect on the company. To provide quality service to insureds and aid in the retention of business. To ensure that claims are properly investigated, evaluated and resolved within the company's contractual and legal obligations. To ensure timely service, while providing appropriate and equitable resolution to insureds, claimants and the company.
RESPONSIBILITIES
Associate Property Claims Representative Responsibilities
Investigate, evaluate and control property and casualty claims under close supervision.
Acquire working knowledge of general procedures and good claim practices.
Acquire basic working knowledge of various types of buildings, construction, and repair costs
and methods, repair estimating system and scoping damages.
QUALIFICATIONS
Associate Property Claims Representative Qualifications
Required: High school diploma or equivalent required.
Minimum one year experience with direct public contact, such as sales or service representatives required.
Must possess outstanding listening and superior customer service skills.
Must have access to high speed Internet at home if position is field-based.
Must be able to live within a defined territory.
Must possess a valid driver license with an acceptable driving record.
Preferred: Bachelor's degree with focus on construction trades, agriculture-related studies, business administration or insurance-related field preferred.
Knowledge of company and divisional policies and procedures preferred.
Designations in INS, AIC, CPCU and/or similar professional insurance designation preferred.
Note: If a candidate is not identified, a Property Claims Representative may be considered based on level of experience.
Farm Bureau offers a full benefit package including medical, dental, vision, and 401K.
PM19
Auto-ApplyAuto Claims Representative
Claims adjuster job in Lansing, MI
Who are we? Michigan Millers Mutual Insurance Company, an affiliate of Western National Mutual Insurance, is a mutual insurance company, rated A (Excellent) by A.M. Best, with over 140 years of experience serving policyholders' property-and-casualty insurance needs across multiple regions in the United States. We believe in striving for growth without sacrifice and know that our culture creates and cultivates happy and dedicated employees, which we believe gives us the ability to deliver the highest level of customer service.
The core values for Michigan Millers and Western National Insurance, Connectiveness - Accountability - Empowerment are incorporated into all that we do. Our workplace culture encourages employees to seek out learning opportunities and to strive for growth and development in the insurance industry.
We understand the importance of a positive work community and a healthy workplace environment when striving for organizational success. Our emphasis on internal growth and maintaining healthy team relationships translates into external growth and building sustainable customer relationships.
Does this opportunity interest you?
Michigan Millers Mutual Insurance Company is seeking an Auto Claims Representative to join our team!
The individual in this role will have the opportunity to investigate, evaluate, negotiate, and resolve auto insurance claims.
What are the responsibilities and opportunities of this role?
* Handles high volume, low-to-moderate complexity claims within settlement authority.
* Ensures customer service excellence.
* Investigates and reviews policy forms, facts, and documents that are related to claims to make appropriate decisions on claims resolutions.
* Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience while maintaining appropriate reports to ensure the current statuses of claims is clearly documented at all times.
* Provides direction to outside resources.
* Performs duties and activities covered by specific instructions, standard practices, and established procedures that generally require some interpretation.
* Gathers input and makes recommendations to solve problems of moderate complexity.
* Deals with moderately complex problems that must be broken down into manageable pieces.
* Sees relationships between problem components and prioritizes them.
* Utilizes knowledge, experience, and available resources to find solutions.
* Participates in development of improvements and helps implement changes.
* Maintains regular contact with customers (e.g., policyholders, claimants, agents) as well as regular contact with employees across the organization and outside vendors.
* Travels for field work as required.
* Performs special projects and other duties as assigned.
Requirements
What are the must-have qualifications for a candidate?
* Understanding of industry practices, standards, and claims concepts.
* Prior claims experience.
* Ability to multitask and solve problems.
* Proficient oral and written communication skills.
* Bachelor's degree or equivalent related experience.
What will our ideal candidate have?
* Negotiation and relationship-building skills.
* Analytical with ability to exercise sound business judgment.
* Strong time management skills.
* Proficient use of various core systems, office and computer equipment, and software packages.
* Bachelor's degree or equivalent related experience.
* Working toward AIC or AINS certification is preferred.
Compensation overview
The targeted hiring range for this role is $56,240 - $77,330, annually. However, the base pay offered may vary depending on the job-related knowledge, skills, credentials, and experience of each candidate, as well as other factors such as the scope and location of the role. Candidates looking for compensation outside of the posted range are encouraged to apply and will be considered based on their individual qualifications and / or may be considered for other positions.
Culture and Total Rewards
We offer full-time employees a significant Total Rewards Package, including:
* Medical insurance options and other standard employee benefits, including dental insurance, vision benefits, life insurance, and more!
* Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)
* 401(k) Plan (plus company match)
* Time Off - including vacation, volunteer, and holiday pay
* Paid Parental Leave
* Bonus opportunities
* Tuition assistance
* Wellness Program - including an onsite fitness studio
Michigan Millers and Western National Insurance believe in supporting the balance between work and life by providing a flexible work environment, which includes a variety of hybrid work arrangements designed to balance individual, job, department, and company needs.
Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
Michigan Millers provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
WC Sr. Claims Examiner
Claims adjuster job in Appleton, WI
Company Details We're a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.
Responsibilities
Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.
* Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
* Document claim handling activities; create and document action plans.
* Establish appropriate case reserves.
* Actively manage medical treatment and disability while assisting the injured worker to return to work.
* Comply with all performance guidelines.
* Identify loss trends and communicate to supervisor and/or clients.
* Use automated diary system to issue indemnity payments and for claims management
* Investigate and manage claim subrogation and negotiate settlements.
* Manage coverage B or conflict of interest cases as assigned.
* Address customer complaints and inquiries in an exemplary and professional manner.
* Participate in client claim reviews when scheduled or requested
May perform other functions as assigned
Qualifications
* Demonstrated working knowledge of workers' compensation administration rules/laws in at least one of the following states: MN, IL or WI.
* Excellent communication and presentation skills.
* Must be able to interface with clients, legal counsel, health care professionals, etc.
* Good math and analytical ability.
* Excellent customer service skills.
* Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.
Education
* BA/BS degree with three years' experience. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years' experience in workers compensation claims management.
Additional Company Details
**************************** The Company is an equal employment opportunity employer. We do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: • Base Salary Range: $75k - $88k • Benefits include Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans 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 Responsibilities Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines. - Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files. - Document claim handling activities; create and document action plans. - Establish appropriate case reserves. - Actively manage medical treatment and disability while assisting the injured worker to return to work. - Comply with all performance guidelines. - Identify loss trends and communicate to supervisor and/or clients. - Use automated diary system to issue indemnity payments and for claims management - Investigate and manage claim subrogation and negotiate settlements. - Manage coverage B or conflict of interest cases as assigned. - Address customer complaints and inquiries in an exemplary and professional manner. - Participate in client claim reviews when scheduled or requested May perform other functions as assigned
Auto-ApplyClaims Adjuster Trainee
Claims adjuster job in Appleton, WI
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 claims adjuster trainee, you'll learn how to help customers get back on the road after an accident. This is not a field position, which means you'll be building relationships with customers over the phone. In a fast-paced environment, you'll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and insurance contracts so you can confidently and independently adjust claims.
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 (upon completion of training)
* Determine coverage
* Determine liability (who's at fault for the damages)
* Interview customers, claimants, and witnesses
* Partner with appraisers/estimators to manage vehicle repairs
* Negotiate with customers and other insurance carriers and resolve claims
Must-have qualifications
* Three years of work experience OR
* Bachelor's degree OR
* Two years work experience and an associate degree
Schedule: Monday - Friday, 8:30 am - 5:30 pm for the first four weeks during training, then 9:00 am - 6:00 pm.
Location: 2505 E Evergreen Dr, Ste B, Appleton, WI or 8333 Greenway Blvd, Ste 200, Middleton, WI
Compensation
* Once you complete training and pass any necessary testing requirements, your salary will be $54,000-$57,500/year, however, during training, you'll be paid hourly based on your annual 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
For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************
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Field Claims Adjuster
Claims adjuster job in Green Bay, WI
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.
Independent Insurance Claims Adjuster in Appleton, Wisconsin
Claims adjuster job in Appleton, WI
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-ApplyAdjuster, Property Insurance Claims
Claims adjuster job in Grand Rapids, MI
Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate?
Elevate Claims Solutions is seeking an Independent Adjuster in Western Michigan.
How will we Elevate you?
We want to know and understand your unique skillset and goals. We are committed to receiving your feedback on how we can best support your progression and advancement towards those goals.
Expand your career opportunities in a role where you can see that you are making a difference in people's lives.
Meaningful work in a culture of continuous improvement.
A diverse market of carriers
Clear communication of service and quality expectations; internal and external.
Guidelines that provide upfront understanding of each carrier's requirements.
Continuous feedback, including real -time Quality Assurance and formalized quarterly coaching sessions to identify areas of strength and opportunity. Training and development opportunities tailored to individual growth objectives.
A tenured foundation of industry experts with a wide knowledge base for you to consult.
How will you Elevate?
Prioritize policyholders during their time loss through demonstrated empathy and understanding.
Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders.
Outstanding work ethic. This is not a 9 -5 position and you will be called upon to maintain a flexible schedule to help meet the needs of insureds and carriers.
Clear, consistent, and timely communication. We, and our carriers, want and need strong lines of communication.
You must be open to receiving and providing feedback.
The ability to effectively and independently manage workload while exercising good judgement.
Strong written and verbal communication skills.
Strong technological skills with the ability to work within various claims management systems.
Minimum of three years of residential and commercial property adjusting experience.
Carrier experience is desired.
Liability experience is a plus.
Current, active Xactimate license and experience writing both residential and commercial damage estimates in Xactimate.
Ability to pass a background screen.
Current, active license where required.
Equipment and ability to access roofs.
If you are ready to Elevate claims with a firm that truly values and supports you, let us know - we may be a fit.
WC Sr. Claims Examiner
Claims adjuster job in Appleton, WI
Company Details
We're a member company of W. R. Berkley Corporation, an A. M. Best A+ rated Fortune 500 holding company. Berkley is comprised of individual operating units that serve a defined insurance market segment. Berkley Risk is focused on providing self-insured entities program administration services and insurance operations which can include taking or sharing risk using Berkley paper. This capability allows us to customize both an insurance company option and a purely administrative option for our customers.
Responsibilities
Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.
Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
Document claim handling activities; create and document action plans.
Establish appropriate case reserves.
Actively manage medical treatment and disability while assisting the injured worker to return to work.
Comply with all performance guidelines.
Identify loss trends and communicate to supervisor and/or clients.
Use automated diary system to issue indemnity payments and for claims management
Investigate and manage claim subrogation and negotiate settlements.
Manage coverage B or conflict of interest cases as assigned.
Address customer complaints and inquiries in an exemplary and professional manner.
Participate in client claim reviews when scheduled or requested
May perform other functions as assigned
Qualifications
Demonstrated working knowledge of workers' compensation administration rules/laws in at least one of the following states: MN, IL or WI.
Excellent communication and presentation skills.
Must be able to interface with clients, legal counsel, health care professionals, etc.
Good math and analytical ability.
Excellent customer service skills.
Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.
Education
BA/BS degree with three years' experience. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years' experience in workers compensation claims management.
Additional Company Details ****************************
The Company is an equal employment opportunity employer.
We do not accept unsolicited resumes from third party recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary Range: $75k - $88k
• Benefits include Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans
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-ApplyBU Adjuster in Training 2nd or 3rd
Claims adjuster job in Butler, WI
Job Details Butler Corporate HQ - Butler, WI Full Time Equivalent Work Experience $24.00 Hourly None Any ManufacturingDESCRIPTION
SIGN-ON BONUS OF $5,000
Are you a hands-on problem solver? Do you have the mechanical ability but no chance for advancement, and no one will invest the time to train you?
If you love tinkering with machinery and turning ideas into reality, this is your chance to shine in our climate-controlled facility. Are you looking for a Career and not just a job? APPLY with Western States, we will invest the time to train candidates for this role and start you off at $24.00/hr. with GUARANTEED RAISES at 30 days, then EVERY 90 DAYS after that, we are talking a $1.20 increase within your first 90 days.
We seek a skilled and detail-oriented Order Setup Operator (Adjuster) to join our production team at our Butler, WI facility, minutes from Milwaukee! This role ensures efficient and smooth operations by setting up and configuring machinery for production runs. This role is to operate ALL machines in the department, set up work orders to specifications, troubleshoot, and perform daily maintenance and minor repairs on envelope folding machines. We are seeking candidates with hands-on mechanical skills who have experience setting up orders on machines in a production/manufacturing environment, or candidates with experience in an automotive or fleet mechanic setting.
SHIFTS AVAILABLE:
2nd shift 2:30 pm - 10:30 pm Mon-Fri + $0.75/hr shift premium
3rd shift 10:30 pm - 6:30 am Sun-Thur.+ $1.00/hr shift premium
TRAINING:
ALL training is completed on the 1st shift. Training will take at least 6 months to learn our machines and our industry, but most often up to 1 year on FIRST SHIFT before transitioning to your home shift on 2nd or 3rd.
HERE'S WHAT MAKES WESTERN STATES A GREAT PLACE TO WORK:
Competitive compensation: Regular pay raises and a comprehensive benefits package including 401k with company match.
Work-life balance: 9 paid holidays, 80 hours of PTO, Sick Days starting your first year to help you recharge and enjoy time with loved ones.
Flexibility: We have multiple shifts available to meet your scheduling needs.
Growth potential: Join a company with a long history and a commitment to employee development.
Stability: Family-owned company with over 117 years in operation.
WHAT DOES MY WORKDAY LOOK LIKE IN THIS ROLE?
As a key member of our Folding Department, you'll ensure the smooth and efficient operation of our machinery. Your responsibilities will include:
Performing daily machine maintenance, changeovers, and set-ups.
Inspecting products and making necessary mechanical adjustments to eliminate quality variations and address mechanical malfunctions.
Troubleshooting minor operating difficulties using hand tools.
Executing minor machine repairs.
Operating all machines within the Folding Department.
Examining work orders to determine production specifications.
Inspecting product quality following established guidelines.
Verifying order accuracy throughout production, including labeling, printing, and packaging.
Performing machine wash-up and other general cleaning duties to maintain a tidy workspace.
Accurately completing paperwork for labor, time, and quality tracking.
Maintaining precise counts of envelopes for boxing, cartonizing, and palletizing.
Neatly and uniformly packing envelopes into containers, keeping pace with machine speeds.
Placing die-cut paper stacks into machine feeds and splicing paper rolls into web machine feeds.
mechanic, automotive, fleet mechanic, farm mechanic
QUALIFICATIONS:
Demonstrated expertise a Set-Up Operator, Envelope Adjuster or Auto Mechanic experience. Industry on an RA and/or WD machines in a position of similar skill set and level of responsibility within the Envelope Industry preferred but not required. 5 years machine set-up and/or repair experience preferred.
Proven ability to set up orders on production manufacturing equipment
Capacity to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Capable to speak effectively with employees of the organization.
Aptitude to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Proficiency in reading and interpreting ruler measurements.
Ability to walk and stand frequently during an eight-hour shift.
Ability to move up to 50 lbs.
Willing to train for an extended period of time on First Shift before moving to home shift of 2nd or 3rd shift.
ESSENTIAL FUNCTIONS
Ability to stand for approximate duration of scheduled shift (minus paid breaks), lift up to 20 lbs. frequently and up to 50 lbs. occasionally, repetitive grasping, frequent, twisting, lifting above shoulder height, occasional bend, reach, crouch, or stoop. Sensory requirements are tactile/touch with hands and digits, near and far visual acuity, color vision, peripheral vision, depth perception and ability to adjust focus. Reasoning, mechanical aptitude and mathematical skills for appropriate operations of the equipment.
Field Adjuster (Residential or Commercial) - Green Bay, WI
Claims adjuster job in Green Bay, WI
CCMS & Associates is looking for a 1099 Field Adjuster in Wisconsin, specifically the Green Bay area. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team! We are seeking a residential or commercial field adjuster with at least 1 year of field experience.
Requirements:
Minimum 1 year first-party commercial and/or residential property adjusting experience
Maintain own current estimating software - Xactimate preferred (Symbility experience a plus)
Working computer - internet access and Microsoft Word required
Must demonstrate strong time management and customer service skills
Experience in preparing Statement of Loss, Proof of Loss, and denial letters
Must have a valid drivers license
Responsibilities:
Complete residential and commercial field property inspections utilizing Xactimate software
Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses and by interviewing fire, police, or other governmental officials as well as inspecting claimed damages
Recommend claim reserves based on investigation, through well-supported reserve report
Obtain and interpret official reports
Review applicable coverage forms and endorsements, provide a thorough analysis of coverage and any coverage issues in a well-documented initial captioned report to the client
Maintain acceptable product quality through compliance with established best practices
Knowledge and Skills:
In-depth knowledge of property and liability insurance coverage and industry standards
Ability to prepare full-captioned reports by collecting and summarizing required information
Strong verbal and written communications skills
Prompt, reliable, and friendly
Preferred but Not Required:
College degree
AIC, IICRC, HAAG or other professional designations
All candidates must pass a full background check (void in states where prohibited)
CCMS & Associates offers multi-line claim adjusting and third-party administration services dedicated to solving the challenges of the complex claim in the property and casualty insurance industry. We create programs that drive a successful claim life cycle while strategically managing all aspects of the complicated issues carriers and policyholders are facing. Servicing excess and surplus/domestic carriers in the United States.
Auto-ApplyClaims Representative
Claims adjuster job in Detroit, MI
Join Our Dynamic Insurance Team - Unlock Your Potential!
Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential.
NOW HIRING:
✅ Licensed Life & Health Agents
✅ Unlicensed Individuals (We'll guide you through the licensing process!)
We're looking for our next leaders-those who want to build a career or an impactful part-time income stream.
Is This You?
✔ Willing to work hard and commit for long-term success?
✔ Ready to invest in yourself and your business?
✔ Self-motivated and disciplined, even when no one is watching?
✔ Coachable and eager to learn?
✔ Interested in a business that is both recession- and pandemic-proof?
If you answered YES to any of these, keep reading!
Why Choose Us?
💼 Work from anywhere - full-time or part-time, set your own schedule.
💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month.
📈 No cold calling - You'll only assist individuals who have already requested help.
❌ No sales quotas, no pressure, no pushy tactics.
🧑 🏫 World-class training & mentorship - Learn directly from top agents.
🎯 Daily pay from the insurance carriers you work with.
🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary
🏆 Ownership opportunities - Build your own agency (if desired).
🏥 Health insurance available for qualified agents.
🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom.
👉 Apply today and start your journey in financial services!
(
Results may vary. Your success depends on effort, skill, and commitment to training and sales systems.
)
Auto-ApplyWorkers Compensation Claim Representative
Claims adjuster job in Brookfield, WI
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$67,000.00 - $110,600.00
**Target Openings**
1
**What Is the Opportunity?**
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.
+ 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.
+ 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program.
**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 ******************************************************** .
Pharmacy 340B Claims Specialist
Claims adjuster job in White Cloud, MI
Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist!
General Function: This position functions at the highest level (III) in the series of Pharmacy Technician roles within Family Health Care. The individual in this role is a “work-leader” serving as the expert on prescription claims reimbursement and performing self-auditing for the pharmacy department. This individual will ensure prescription claim integrity by having advanced knowledge of claim requirements for the various pharmacy benefit managers (PBM) and shall use that information to identify areas of improvement by performing targeted claim audits and will provide education to the pharmacy staff on billing requirements, when needed.
Responsibilities:
Acts as pharmacy claims auditor and will audit claims daily into order to track claims accuracy, trends, anomalies and other critical information to help BFHC ensuring appropriate reimbursement while mitigating organizational risk for claims remediations resulting from claim processing errors.
Acts as pharmacy 340B claims auditor and audits claims on a scheduled basis into order to track 340B claims accuracy, trends, anomalies, and other critical information to help BFHC maintain 340B claim integrity while ensuring adherence to 340B policies, procedures, rules and regulations.
Ensures timely and accurate billing/collections of all pharmacy charges and reimbursement activities through the use of reporting and reconciliation.
Ensures integrity if financial reports and provides necessary reports to the finance department upon request.
Assists the Chief Pharmacist and pharmacy staff in the research, development and implementation of new and existing pharmacy services.
Location(s): White Cloud, MI
Employment Type: Full Time
Exempt/Non-Exempt: Non-Exempt
Benefits: Competitive wage and excellent benefits package. FHC is an eligible organization for State and Federal Loan Repayment Programs.
Family Health Care is an Equal Opportunity Employer.
Claims Representative - Appraisal Service Team
Claims adjuster job in Neenah, WI
This position supports the Auto Physical Damage Claims department by reviewing a variety of vehicle damage estimates. The representative is responsible for investigating, evaluating, and resolving vehicle damage efficiently and accurately. This role requires strong attention to detail, effective communication skills, and a commitment to delivering excellent customer service.
Reviews, writes and approves auto physical damage estimates. Determines whether a vehicle is repairable.
Negotiates price and repair methods with vehicle repair shops.
Corresponds with independent adjusters, repair shops, insureds, claimants, and agents.
Provides superior customer service for all internal and external customers.
Assists in reviewing photos and estimates from subrogation demands.
QUALIFICATIONS:
ESSENTIAL:
1-3 Years of Auto Physical Damage estimating experience
Experience with Audatex software
Good keyboard/PC Skills
Ability to work in a fast-paced environment
Excellent verbal and written communication skills
Top notch organization and prioritization skills
Excellent problem-solving and negotiation skills
Superior customer service and team skills
PREFERRED:
Heavy Equipment, Semi-Tractor and Trailer knowledge
I-Car certifications
AIC, CPCU, CIC, or ARM designations (or actively pursuing)
Certificate in General Insurance (or actively pursuing)
College degree
At SECURA, we are transforming the insurance experience by putting authenticity at the forefront of everything we do. Our mission is clear: we're making insurance genuine. We recognize that our associates are our greatest assets, and we invest in their well-being and professional growth. We offer opportunities for continuous learning and career advancement, competitive benefits, and a culture that champions work-life balance. Joining SECURA means becoming part of a dynamic team that values each individual's contribution and fosters a collaborative atmosphere. Here, you'll not only find a fulfilling career but also a place where you can make a positive impact every day.
SECURA Insurance strives to provide equal opportunity for all employees and is committed to fostering an inclusive work environment. We welcome applicants from all backgrounds and walks of life.
AMD Claims Representative
Claims adjuster job in Lansing, MI
OBJECTIVE
AMD Claims Representative Objective
To provide an efficient settlement of automobile physical damage losses while providing a
WOW!
customer experience.
RESPONSIBILITIES
AMD Claims Representative Responsibilities
Complete appraisals and evaluate damage on vehicles.
Relate appraisals to appropriate repair costs so as to have a significant positive effect on the overall profit picture of the company and provide quality service to the customer and aid in the retention of business.
Maintain general knowledge of automobile repairs, procedures and accepted repair practices.
Stay informed of the latest changes and updates in automobile repairs and technology.
Focus on customer service by maintaining timely contacts with customers to inform them of their claim status and their role in the settlement process.
Work with customers to agree upon a fair and equitable settlement on total loss claims using market information, condition of the vehicle, mileage and equipment to determine the value.
Obtain titles, discharge of liens and letters of guaranty to assist salvage technicians in the sale of salvage vehicles.
Ensure timely disposal of salvage vehicles in order to control excess storage and auction fees.
Review auto claims for accuracy, and authorize and issue payments accordingly.
Coordinate car rental coverage and billing for Farm Bureau customers and claimants according to policy coverage.
Review police reports to determine fault in auto accidents. Assess liability, subrogation potential and underwriting concerns in first and third party exposures.
Negotiate liability on out-of-state automobile claims. Assign out-of-state claims to independent appraisal companies while giving direction on coverage, liability and subrogation.
Resolve complaints/concerns regarding claim issues from insureds, claimants, agents, and attorneys via the phone and customer walk-ins.
Assist AMD Team Leader with coordinating workflows, new procedures and training assistance.
Maintain general knowledge of all physical damage contracts written by the companies, their various endorsements, exclusions, company procedures and accepted claim practices.
Maintain general knowledge of insurance law as it relates to the physical damage contracts written by the companies. Remain up-to-date with trends and developments in the insurance industry.
QUALIFICATIONS
AMD Claims Representative Qualifications
: High school diploma or equivalent required.
One to three years' experience required.
Must possess basic knowledge of computer word processing. Possess the capability to converse with customers regarding the settlement of automobile claims required.
Preferred: Bachelor's degree preferred.
Note: If a candidate is not identified, a Senior Claims Representative may be considered based on level of experience.
Farm Bureau offers a full benefit package including medical, dental, vision, and 401K.
PM19
Auto-ApplyIndependent Insurance Claims Adjuster in Grand Rapids, Michigan
Claims adjuster job in Grand Rapids, MI
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-ApplyField Claims Adjuster
Claims adjuster job in Grand Rapids, MI
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.
Property Adjuster Insurance Claims
Claims adjuster job in Green Bay, WI
Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate?
Elevate Claims Solutions is seeking an Independent Adjuster adjusters with commercial and residential property claims in Wisconsin: Greenbay Appleton and Fox Cities area.
How will we Elevate you?
We want to know and understand your unique skillset and goals. We are committed to receiving your feedback on how we can best support your progression and advancement towards those goals.
Expand your career opportunities in a role where you can see that you are making a difference in people's lives.
Meaningful work in a culture of continuous improvement.
A diverse market of carriers
Clear communication of service and quality expectations; internal and external.
Guidelines that provide upfront understanding of each carrier's requirements.
Continuous feedback, including real -time Quality Assurance and formalized quarterly coaching sessions to identify areas of strength and opportunity. Training and development opportunities tailored to individual growth objectives.
A tenured foundation of industry experts with a wide knowledge base for you to consult.
How will you Elevate?
Prioritize policyholders during their time loss through demonstrated empathy and understanding.
Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders.
Outstanding work ethic. This is not a 9 -5 position, and you will be called upon to maintain a flexible schedule to help meet the needs of insureds and carriers.
Clear, consistent, and timely communication. We, and our carriers, want and need strong lines of communication.
You must be open to receiving and providing feedback.
The ability to manage workload while exercising good judgment effectively and independently.
Strong written and verbal communication skills.
Strong technological skills with the ability to work within various claims management systems.
Minimum of three years of residential and commercial property adjusting experience.
Carrier experience is desired.
Liability experience is a plus.
Current, active Xactimate license and experience writing both residential and commercial damage estimates in Xactimate.
Ability to pass a background screen.
Current, active license where required.
Equipment and ability to access roofs.
If you are ready to Elevate claims with a firm that truly values and supports you, let us know - we may be a fit.
Workers Compensation Claim Representative
Claims adjuster job in Brookfield, WI
Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$67,000.00 - $110,600.00
Target Openings
1
What Is the Opportunity?
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.
* 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.
* 1 year Workers Compensation claim handling experience or successful completion of the WC trainee program.
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 *********************************************************
Pharmacy 340B Claims Specialist
Claims adjuster job in White Cloud, MI
Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist! General Function: This position functions at the highest level (III) in the series of Pharmacy Technician roles within Family Health Care. The individual in this role is a "work-leader" serving as the expert on prescription claims reimbursement and performing self-auditing for the pharmacy department. This individual will ensure prescription claim integrity by having advanced knowledge of claim requirements for the various pharmacy benefit managers (PBM) and shall use that information to identify areas of improvement by performing targeted claim audits and will provide education to the pharmacy staff on billing requirements, when needed.
Responsibilities:
* Acts as pharmacy claims auditor and will audit claims daily into order to track claims accuracy, trends, anomalies and other critical information to help BFHC ensuring appropriate reimbursement while mitigating organizational risk for claims remediations resulting from claim processing errors.
* Acts as pharmacy 340B claims auditor and audits claims on a scheduled basis into order to track 340B claims accuracy, trends, anomalies, and other critical information to help BFHC maintain 340B claim integrity while ensuring adherence to 340B policies, procedures, rules and regulations.
* Ensures timely and accurate billing/collections of all pharmacy charges and reimbursement activities through the use of reporting and reconciliation.
* Ensures integrity if financial reports and provides necessary reports to the finance department upon request.
* Assists the Chief Pharmacist and pharmacy staff in the research, development and implementation of new and existing pharmacy services.
Location(s): White Cloud, MI
Employment Type: Full Time
Exempt/Non-Exempt: Non-Exempt
Benefits: Competitive wage and excellent benefits package. FHC is an eligible organization for State and Federal Loan Repayment Programs.
Family Health Care is an Equal Opportunity Employer.