Claims adjuster jobs in Hawaii - 15 jobs

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.

Manage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely claims processing. Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements. Contribute to the development and implementation of new policies, procedures, and systems to improve claims operations. #LI-Hybrid

**NOW HIRING: Temp-to-Hire Claims Specialist - Dental Agency (Honolulu, HI)** **Now Hiring: Claims Specialist** **Pay Rate:** $19/hr **Schedule:** Monday - Friday, 8 AM - 5 PM **Type:** Temp to Hire Opportunity Join a reputable dental agency in Honolulu as a Claims Specialist! Under the supervision of the Claims Supervisor, you'll perform essential functions related to dental claims processing. This role requires adherence to claims processing rules, guidelines, and policies, while consistently meeting departmental standards for productivity and quality. **Essential Duties and Responsibilities** + Complete all aspects of claims data entry, including documentation verification + Digitally image hardcopy claims, x-rays, and related attachments + Adjudicate dental claims in accordance with HDS rules and guidelines + Process coordination of benefit claims **Other Duties and Responsibilities** + Assist the Claims department with adherence to established document policies and procedures + Provide back-up support for Customer Service and other departments as needed **Minimum Qualifications and Experience** + **Education:** High School Diploma required; post-high school training in data processing, office management, business, or a related field preferred + **Experience:** 1-2 years of related clerical, data entry, accounting, or claims processing experience, or an equivalent combination of education, experience, and training; dental office or dental claims processing experience preferred **Skills and Knowledge** + Working knowledge of PC applications (word processing and spreadsheets highly desirable) + Demonstrated customer service skills and sales ability + Strong attention to detail and ability to maintain focus + Ability to multitask despite distractions + Effective oral and written communication skills for all levels of staff, customers, and vendors + Ability to maintain confidentiality and comply with laws and regulations (e.g., HIPAA, PHI) **How to Apply** Once you apply, you'll proceed to the next steps if your skills and experience match the role. Even if this position isn't a fit, you remain in our network-giving other recruiters access to your profile and expanding your opportunities. We are committed to helping you discover what's next in your career. **Apply today!** We look forward to meeting you and helping you take the next step in your career journey! As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here (********************************************************************* for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community. Trust the office staffing pioneer. Finding the right job isn't always easy. Kelly Professional & Industrial takes the guesswork out of your job search by connecting you with great opportunities that work for you. That means your schedule, your interests, and your career plan. In fact, our company created the staffing industry with the goal of connecting people with great office jobs-so you could say we're pretty good at it! About Kelly Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year. Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.

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 Workers Compensation Claims Adjuster | OH Jurisdictional Knowledge Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. **ARE YOU AN IDEAL CANDIDATE?** To analyze **Workers Compensation Lost-Time Claims** claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **OFFICE LOCATION** **Open to remote** **In-Office Schedule if within commutable distance to a Sedgwick office** **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **ESSENTIAL RESPONSIBILITIES MAY INCLUDE** + Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. + Negotiating settlement of claims within designated authority. + Communicating claim activity and processing with the claimant and the client. + Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. **QUALIFICATIONS** Education & Licensing: 5 years of claims management experience or equivalent combination of education and experience required. High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Jurisdiction Knowledge: OH** **Licensing: not required** **TAKING CARE OF YOU** Flexible work schedule. Referral incentive program. Opportunity to work in an agile or remote environment. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (50,000 - 65,000). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. \#remote \#LI-remote \#hybrid \#LI-hybrid \#Workerscompensation 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**

Manage and lead a claims team by providing training, mentorship, and best practice solutions. Manage daily operations of the claims team, including inventory analysis, tracking and resolution of claims Serve as the escalation point for complex or disputed claims and drive resolution within defined SLA. Monitor and analyze key performance indicators (KPIs) and take corrective actions to improve efficiency, accuracy, and customer satisfaction Collaborate with key stakeholders to include underwriting, LOB, legal, servicing teams to ensure a consistent and integrated approach to accurate and timely claims processing. Maintain documentation, audit trails, and reporting in line with internal controls and external compliance requirements. Contribute to the development and implementation of new policies, procedures, and systems to improve claims operations. #LI-Hybrid

Under minimal to no supervision, reviews, investigates, evaluates, negotiates and resolves a variety of multi-line casualty claims including but not limited to disputed liability, personal injury, coverage disputes, and contract based losses, and specialty claims of a complex nature. Independently handles all aspects of assigned claim inventory in line with department standards, procedures, and appropriate claims practices. Duties: * Claim Intake and Initial Processing * Receives claim loss information from agencies, insured, and claimants or other involved parties via telephone, facsimile, mail, or computer; and establish a claim on the appropriate computer claim handling system. * Reviews limited assignments, as well as assigned claims for applicable coverage, liability, and exposures. * Posesses working knowledge of all lines of business written by the company, including, but not limited to auto, homeowners, dwelling fire, commercial general liability, and umbrella. * Makes initial contact with insured and any other involved parties within the specified time frame, as outlined within department procedure. * Determines/confirms facts of loss, cause of loss, the identification of parties involved, and the existence of/extent of injuries and/or damages involved. * Reviews applicable policy forms/coverage documents, determine and explain available coverage and benefits, and address/resolve conflicts. * Establishes appropriate initial reserves on the computer claims-handling system within the specified time frame outlined within department procedures. * Investigates and handles losses in an appropriate, adequate, and thorough manner. * Obtains written or recorded statements as needed. * Investigation and Documentation * Ensures that damages, scenes, etc. are inspected, photographed, diagramed, and properly documented. Secures and protects evidence, as required. * Obtains other documents and records, such as police and fire reports, contracts and legal agreements, medical bills and reports, etc. * Prepares and submits any required data and reports (such as injury index, Medicare), per department procedure * Determines liability based upon the facts and a working knowledge of the applicable Hawaii Revised Statutes and any other applicable laws. * Stays abreast of statute changes, case law decisions, as well as policy and coverage changes. * Evaluates damages and/or injuries considering applicable coverage, liability determination, and any other pertinent information developed within the investigation. * Negotiates settlements within the authority granted. * Recognizes subrogation opportunity and complete the appropriate investigation in support of the pursuit of financial recovery on the claim. Assist the Subrogation unit, or complete arbitration filings as required. * Recognizes third party liability and contribution, and the handling and resolve of loss accordingly. * Initiates deductible recoveries with an insured per policy/coverage. * Communication and Reporting * Reviews questionable claims and all coverage issues with department management. * Communicates loss status to insured, claimant, or an attorney, as required by law or by department procedure. * Accurately processes financial transactions upon the applicable computer claims handling system, to include establishing or adjusting reserves and making payments within granted authority. * Prepares and submits requests and required reports, for increased financial authority, as required by department procedure. * Maintains a diary on all active claims with diary date established and addressed in line with department procedure. * Enters timely, clear, concise notes within the applicable computer claims handling system(s) related to investigation, handling, assessments, evaluations, and negotiations and settlements on all assigned claims. * Manages and directs any/all outside vendors (such as independent adjusters, contractors, repair shops, experts, or attorneys). * Litigation and Legal Compliance * Handles claims and/or litigation cases, as assigned. * Follows prescribed litigation guidelines and procedures, including reporting requirements and legal fee review program. * Attends and participates in mediations, arbitrations, settlement conferences as directed. * Travels to the neighbor islands as required for inspections and client visits. * Informs Claim Supervisor of any/all oral or written complaints, and any coverage dispute. * Prepares and timely submits required reports as may be required by procedure, department management, the company, or a vendor of the company. Education/Experience: * High school diploma or general education degree (GED); and 3 to 5 years multi-line claims and litigation management experience as a Claim Service Representative required. * College degree with credits in insurance related subjects preferred. * Equivalent combination of education and job-related experience will be considered. * Continuing education in insurance and job-related issues and subjects required Certificates, Licenses, Registrations: * Valid Hawaii Driver license and use of own vehicle required. * State of Hawaii general adjusting license preferred. An Equal Opportunity Employer Committed to an Inclusive Workplace.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Specialty Loss Adjuster **Embark on an Exciting Career Journey with Sedgwick Specialty** **Job Location** **: USA, Mexico, Brazil and strategic locations globally** **Job Type** **: Permanent** **Remuneration** **: Salaries can range from** **_$40,000.00USD to $250,000.00USD_** **taking into account skills, experience and qualifications.** **We have a number of fantastic opportunities for Specialty Loss Adjusters across the US, Mexico and Brazil and a number of key locations** We are looking for a variety of skill sets at all levels. Whether you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your skills and grow with a company that values innovation, excellence, and employee satisfaction. Are you ready to be a part of providing a differentiated and best of class proposition to clients whilst working with like-minded colleagues? Sedgwick Specialty is thrilled to announce that we are investing in growth across Natural Resources, Property, Casualty, Technical and Special Risks and Marine. As we expand our operations, we are seeking individuals who are passionate about making a difference to the Adjusting industry. **As a member of the Specialty platform, you will have the opportunity to:** + Work with a wide range of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team of professionals who are dedicated to delivering exceptional results + Utilise state-of-the-art technology and resources to streamline processes and enhance efficiency + Receive ongoing training and development opportunities to further enhance your skills and knowledge in the marine industry + Enjoy a flexible work arrangement that allows you to maintain a healthy work-life balance while contributing to our global success **The skills you will have when you apply:** + **Qualified** : it is important to us that you are either accredited, on your way to be accredited or qualified by experience + **Insurance claims experience:** it is imperative that you have experience working on insurance claims within you respective field. Full claims life cycle experience is a must + **Great communicator:** you will be constantly working with policy holders, brokers, carriers and various third parties, so being able to communicate accurately important. Providing an excellent customer service with our clients in mind. Able to approach issues empathetically + **Commercially minded:** An understanding of how the industry operates and where the role of a Loss Adjuster fits in. Being able to negotiate. Understanding how to market your services is a big advantage **What we'll give you for this role:** As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the annual salaries can range from _$40,000.00 to $250,000.00USD._ Bonus eligible role. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always Accepting Applications. **This isn't just a position, it's a pivotal role in shaping our industry** At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education. Together, we're not only reshaping the insurance landscape, we're building a legacy of talent. Come and be a catalyst for change within our industry. **Next steps for you:** **Think we'd be a great match? Apply now -** ** we want to hear from you.** As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation. After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person). \#LI-HYBRID Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements. **ESSENTIAL RESPONSIBILITIES** + Coordinate, analyze, and interpret the benefits and claims processes for the department. + Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties. + Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations. + Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes. + Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines. + Monitor and identify claim processing inaccuracies. Bring trends to the attention of management. + Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication. + Work independently of support, frequently utilizing resources to resolve customer inquiries. + Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop presentation/training materials for support and education. + Other duties as assigned or requested. **EDUCATION** **Required** + High School or GED **Substitutions** + None **Preferred** + Associate's degree in or equivalent training in Business or a related field **EXPERIENCE** **Required** + 3 years of customer service, health insurance benefits and claims experience. + Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies + PC Proficiency including Microsoft Office Products + Ability to communicate effectively in both verbal and written form with all levels of employees **Preferred** + Working knowledge of medical procedures and terminology. + Complex claim workflow analysis and adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures + The ability to take direction, to navigate through multiple systems simultaneously + The ability to interact well with peers, supervisors and customers + Understanding the implications of new information for both current and future problem-solving and decision-making + 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 + Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems + Ability to solve complex issues on multiple levels. + Ability to solve problems independently and creatively. + Ability to handle many tasks simultaneously and respond to customers and their issues promptly. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $21.53 **Pay Range Maximum:** $32.30 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273827

Investigates, adjusts, and negotiates for settlement of claims of real and personal property damage for and against the County of Hawai'i; conducts investigative work in contemplation of litigation and anticipated cases; handles personal injury cases not covered by insurance carried by the County of Hawai'i; and performs other related duties as required. There is one (1) immediate temporary full-time not-to-exceed 11/30/2028 vacancy with the Office of the Corporation Counsel - Litigation Division in Hilo. The eligible list may be used for other permanent and temporary vacancies as they arise during the life of the list. Temporary appointment may lead to conversion to permanent appointment. Examples of Duties * Determines, evaluates, and verifies the facts set forth in any claim or lawsuit filed against and by the County. * Locates, interviews, and interrogates the principals involved and/or the witnesses. * Inspects the physical evidence of damages; gathers and verifies the value of damages by asking for expert opinions when necessary; arrives at judgments of the worth of statements given by individuals. * Obtains additional, clarifying, or substantiating information, evidence, and facts. * Prepares reports on findings with recommendations. * Negotiates for the settlement of claims to the satisfaction of the principals involved. * Recommends to the Corporation Counsel the acceptance or rejection of liability by the County or action to be taken against individuals who owe the County. * Checks with the appropriate agencies to determine the assets of individuals against whom the County has claim. * Follows up on delinquent accounts by personal interview and recommends new terms or enforcement of terms based on findings. * Assists the County attorneys in the presentation of cases. * Testifies and presents supporting information in court, arbitrations, mediations, hearings, administrative hearings or any other quasi-judicial proceedings. * Assists the County attorneys in presenting evidence and producing witnesses. * As directed, works with County commissions, boards, administrators, and others in judicial or quasi-judicial hearings. * Monitors and evaluates all requests for No-Fault benefits, including medical treatment plans for compliance with appropriate laws and guidelines; recommends the approval or disapproval of payments, treatment plans, or modifications to plans. * Notifies claimant or authorized representative when No-Fault benefits are about to be or have been exhausted. * Locates missing persons. * Investigates complaints against County of Hawai'i employees. * Prepares detailed reports of investigations, analyses, findings, and recommendations; prepares other administrative reports as required. * Serves complaints, counter and/or cross claims, warrants, subpoenas, summonses, or other documents for the Office of the Corporation Counsel. * Investigates hardship cases in condemnation proceedings and workers' compensation cases. * Performs other related duties as assigned. Minimum Qualification Requirements Training and Experience: A combination of education and experience substantially equivalent to: * graduation from an accredited college or university with a baccalaureate degree (scan and attach a copy of your official transcript to your application), and * three (3) years of investigational or law enforcement work, of which * one (1) year shall have involved the investigation or the adjustment of claims relating to personal, medical, and property damages, and * possession of a valid State of Hawai`i driver's license (Class 3) or any other valid comparable driver's license at time of filing. (You will be required to submit your valid driver's license at time of hire.) Note: Foreign transcripts must be accompanied by an official credential evaluation report to determine U.S. equivalency. (Scan and attach a copy of your official credential evaluation report to your application.) Examination: All applicants who meet the minimum qualification requirements will be assigned a score of 70 points. An education and experience evaluation will be conducted based on the applicant's training, education and experience as presented in the application. Please read the minimum qualification requirements carefully. Be certain to list all pertinent training and experience, as this may be important in determining your examination score. It is essential that the applicant describe fully the duties and responsibilities of each position held, specify the date of each position held (from and to, month and year), and indicate the number of hours worked per week. Attach all required documentation (e.g. official transcript, professional license(s)/certification(s), DD-214, etc.) at the time of submitting your application. Note: In-person interviews and/or further testing in Hawai'i County may be required at the discretion of the hiring department/agency. If in-person interviews and/or further testing are required, applicants who are referred to the hiring department/agency must be available to participate in person and at their own expense at that phase of the selection process. Knowledge of: principles and practices of investigation; interviewing and interrogating methods and techniques; rules of evidence; elementary law of real property, insurance, and torts; court procedures; human relations and behavior. Ability to: interpret and apply laws and regulations; gather, analyze, and evaluate facts and settle liabilities; make sound observations and mature judgments; deal tactfully and effectively with the public and representatives of other government agencies; write accurate, clear, and concise reports. Physical Requirements: Persons seeking appointment to positions in this class must meet the health and physical condition standards deemed necessary and proper to perform the essential functions of the position with or without reasonable accommodations. Physical Effort Grouping: Light Benefits of County employment: The County of Hawai'i offers a competitive compensation package. Your total compensation is comprised of your salary and a generous range of valuable benefits, subject to eligibility requirements. * Flexible Working Arrangements: Options may include alternate work schedules (4-10) and flexible working hours. (Not all Departments/Agencies participate and not all positions are eligible.) * Vacation: Start accruing paid vacation time immediately upon hire - up to 21 days per year. * Sick Leave: Start accruing paid sick leave time immediately upon hire - up to 21 days per year. * Holidays: The County provides 13 paid holidays per year (plus General Election Day when applicable). * Training and Development: The County has a variety of training and development opportunities for employees. * County Tuition Reimbursement Program: This scholarship program rewards employees who take the initiative to advance their education and learning. * Public Service Loan Forgiveness (PSLF) Program: You may be eligible for this federal program which forgives portions of federal student loans for individuals working in public service. * Retirement Plan: The Employees' Retirement System is a qualified defined benefit public pension plan that provides retirement, disability, survivor and other benefits to all eligible full-time and part-time county employees in the State of Hawaii as well as their beneficiaries. * Deferred Compensation: Save additional money for retirement - this voluntary supplemental retirement savings plan allows for the investment of tax-deferred contributions. * Flexible Spending Plan: Use pre-tax dollars to pay for qualified dependent care and/or medical expenses, as well as insurance premiums. * Health Benefit Plans: The County of Hawai'i offers a variety of health benefit plans for eligible employees. * Employee Assistance Program (EAP): This voluntary assistance program provides employees and their family members with free professional and confidential assistance in overcoming personal and work-related problems. * Group Life Insurance: Free life insurance policy for active employees. * Credit Union Membership * Other Leaves: You may be eligible for other leaves, including Family Leave, Funeral Leave, Leave Sharing, Military Leave, Donor Leave, Victims Protection Leave, as well as leave for Parent-Teacher Conferences, Disaster Relief, Blood Bank Donations, and Jury Duty. All benefits are subject to eligibility requirements and change due to legislative actions and/or changes negotiated through collective bargaining. Please check out the benefits tab for additional information. Supplemental Information Please scan and attach these supporting documents to your on-line application, if required: * an official college transcript, * a valid driver's license, * a temporary assignment verification, * professional licenses, and/or * certificates. Veterans applying for veteran's preference points shall also scan and attach their DD-214 form and as needed, their VA claim letter to the on-line application. PLEASE APPLY IMMEDIATELY AS THIS RECRUITMENT MAY CLOSE AT ANY TIME. ELECTRONIC NOTIFICATION TO APPLICANTS: Please ensure that the email address and mobile phone number you provide is current, secure, and readily accessible to you. We will not be responsible in any way if you do not receive our emails and text messages or fail to check your email box or NEOGOV account INBOX in a timely manner. Checking your NEOGOV account INBOX daily is recommended and is the most secure method to check on notices sent to you. This is a new feature created by our vendor, NEOGOV. Please add *********************** to your contact list. Open your NEOGOV account using your user name and password. In the upper right hand corner of the account is your name, and under your name, click on INBOX to view all notices sent you. The notices will appear here in the INBOX even in the event you don't receive it on your cell phone, computer, or other electronic device. This is the best way to check and view all notices sent to you. You will receive a confirmation email upon successfully submitting your application. Failure to receive this confirmation email, indicates that your application was not submitted. APPLICATIONS MUST BE FILED ONLINE AT: *************************************************** E-mail: *********************

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

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 Claims Representative (IAP) - Workers Compensation Training Program Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? + A stable and consistent work environment in an office setting. + A training program to learn how to help employees and customers from some of the world's most reputable brands. + An assigned mentor and manager who will guide you on your career journey. + Career development and promotional growth opportunities through increasing responsibilities. + A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. **ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Attendance and completion of designated classroom claims professional training program. + Performs on-the-job training activities including: + Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. + Adjusting low and mid-level liability and/or physical damage claims under close supervision. + Processing disability claims of minimal disability duration under close supervision. + Documenting claims files and properly coding claim activity. + Communicating claim action/processing with claimant and client. + Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. + Participates in rotational assignments to provide temporary support for office needs. **QUALIFICATIONS** Bachelor's or Associate's degree from an accredited college or university preferred. **EXPERIENCE** Prior education, experience, or knowledge of: - Customer Service - Data Entry - Medical Terminology (preferred) - Computer Recordkeeping programs (preferred) - Prior claims experience (preferred) Additional helpful experience: - State license if required (SIP, Property and Liability, Disability, etc.) - WCCA/WCCP or similar designations - For internal colleagues, completion of the Sedgwick Claims Progression Program **TAKING CARE OF YOU** + Entry-level colleagues are offered a world class training program with a comprehensive curriculum + An assigned mentor and manager that will support and guide you on your career journey + Career development and promotional growth opportunities + A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_ 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**

Our client is seeking to add an experienced Senior Workers' Compensation Claims Specialist to enhance their team. This role is vital for managing a range of Workers' Compensation claims from inception through resolution. The position involves detailed claim investigation, assessment, and settlement of complex cases. The ideal candidate will possess an active Hawaii adjuster's license and have at least 3 years of focused experience in Workers' Compensation claims. Responsibilities: Thoroughly investigate Workers' Compensation claims to determine coverage, assess liability, and estimate damages. Manage a caseload of claims efficiently, ensuring thorough documentation and adherence to company policies and regulatory requirements. Engage in the settlement negotiation process, effectively resolving claims in a timely and fair manner. Develop and implement strategies to facilitate claim resolution and meet all necessary deadlines. Collaborate with medical providers, employers, and legal counsel to coordinate and manage the claims process. Identify and pursue opportunities for subrogation and cost recovery. Requirements: 3 - 7+ years' experience in handling Workers' Compensation claims. Must possess an active adjuster's license in Hawaii. Proven ability to manage and resolve complex Workers' Compensation claims. Strong analytical skills and attention to detail. Excellent communication and interpersonal skills, with an ability to negotiate settlements effectively. Capable of working both independently and as part of a team. Familiarity with Workers' Compensation laws and regulations in Hawaii. Salary/Benefits: $80,000 to $105,000 annual based salary Competitive Medical, Dental, and Vision plans Employer matching 401k Lucrative PTO

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.

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.