Claims assistant jobs near me

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates residential and commercial contents inventories obtained by or submitted to VeriClaim on both a Replacement Cost and Actual Cash Value (ACV) basis. Applies limitations and/or exclusions on claims based on coverage afforded by the policy. Tracks time and log file notes for daily field activity. Assists with answering telephones. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS: Education & Licensing High school diploma or GED required. Resident Insurance Adjuster License (Fire and Other Hazards) preferred. Experience One (1) year customer service experience or equivalent combination of education and experience preferred. Accounting and insurance background preferred. Skills & Knowledge Oral and written communication skills PC literate, including Microsoft Office products Good comprehensive decision making skills Ability to read and comprehend policy language Ability to work in a team environment Ability to meet or exceed Performance Competencies

Workers' Compensation Claims Assistant - 20068665 (250009KD) Organization: Workers' CompensationAgency Contact Name and Information: a85603@bwc. state. oh. us Unposting Date: Dec 31, 2025, 4:59:00 AMWork Location: William Green Building 30 West Spring Street Columbus 43215-2256Primary Location: United States of America-OHIO-Franklin County-Columbus Compensation: $22. 96/hr. Schedule: Full-time Work Hours: 8:00 am-5:00 pm Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Claims ExaminationTechnical Skills: Claims Examination, InsuranceProfessional Skills: Attention to Detail, Customer Focus, Listening, Teamwork Agency OverviewA Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries. Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills. Our Vision:To transform BWC into an agile organization driven by customer success. Our Mission:To deliver consistently excellent experiences for each BWC customer every day. Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence. What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work. I have worked at several state agencies and BWC is the best place to work. Best place to work in the state and with a sense of family and support. I love the work culture, helpfulness, and acceptance I've been embraced with at BWC. I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC. If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!Job DescriptionBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flextime work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. What You'll Be Doing:Provides assistance to the Workers' Compensation Medical Claims Specialists and supervisors in the Medical Billing and Adjustments unit;Reviews and cross-references data on bills, adjustments, Medicare correspondence, and other documents with data in BWC's claims management system and other ancillary systems;Scans, indexes and track bills, adjustments, Medicare documents, and correspondences into claim file; other tracking databases Reviews incoming claims and billing documents to obtain missing information and determine required action;Performs specialized clerical tasks and handling of all departmental incoming, outgoing, and misdirected mail, and other documents. QualificationsTo Qualify, You Must Clearly Demonstrate:Required Experience and/or Education:2 courses or 6 mos. exp. in English composition or grammar AND 2 courses or 6 mos. exp. in accounting, bookkeeping or general math AND 2 courses or 6 mos. exp. in communication or public speaking or 6 mos. exp. in a position involving receiving & responding to public inquiries or complaints or involving contact with injured workers, employers, legislators, providers or their representatives & public AND successful completion of one typing course or demonstrate ability to type 35 words per minute. Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination, InsuranceMAJOR WORKER CHARACTERISTICS: Knowledge of addition, subtraction, multiplication, division, fractions, decimals & percentages; ICD/CPT codes, BWC/IC policies & procedures & ORC rules & regulations*; applicable state &/or federal regulations governing documents processed, reviewed &/or prepared*; public relations. Skill in operation of pc to efficiently log & enter data. Ability to solve practical, everyday problems; gather, collate & classify information about data, people or things; handle routine inquiries from & contacts with injured workers, employers, legislators, providers or their representatives & public; complete routine forms & prepare standard reports. (*) Developed after employment. Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order. The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox bwcada@bwc. ohio. gov. BWC OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position. Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service. Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed. All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted. Background Check:Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws. Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

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 Assistant | Chicago, IL or Naperville, IL 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? 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? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. PRIMARY PURPOSE OF THE ROLE: To provide support to the claims staff and to perform other office tasks depending on the client program. ESSENTIAL RESPONSIBILITIES MAY INCLUDE: Sets up and enters new claims into claims management system. Inputs and reviews notes/diaries in claims management system as instructed. Processes payments. Processes mail; handles filing, faxing and photocopying. Reviews, prepares, creates, and/or sends letters, reports, and forms. Answers and initiates telephone calls, sets up medical appointments, and may provide customer service as required. Other activities/projects as assigned including the preparation and distribution of computer reports. Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS & LICENSING Education & Experience High school diploma or GED required. Experience Six (6) months of clerical or customer service experience or equivalent combination of education and experience required. TAKING CARE OF YOU Flexible Work Schedule Referral Incentive Program Opportunity to work from home Career development and promotional growth opportunities A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1 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 ($15.00 - $20.00 per hour). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Experienced WC Claim Adjuster - California ADR Program (CA | Remote | SIP Required) Schedule: Monday-Friday, 8:00 AM-4:30 PM PT Salary Range: $80,000-$85,000 annually Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary The Workers' Compensation Claim Consultant is responsible for handling California workers' compensation claims for a single dedicated Alternate Dispute Resolution (ADR) client account. This role requires California jurisdiction experience and an active CA Adjuster's License, along with the Self-Insurance Administrator Certificate (SIP). You'll join a team of 10 adjusters and play a key role in ensuring quality claim handling through compliance with client guidelines, state laws, and CCMSI claim standards. Important - Please Read Before Applying This is a true insurance claims adjusting role, not an HR, benefits, safety, consulting, or administrative position. Candidates must have direct experience investigating, evaluating, reserving, negotiating, and resolving claims as an adjuster or adjuster supervisor within a carrier, TPA, or similar claims environment. Applicants without hands-on adjusting experience will not be considered. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems. Investigate, evaluate, and adjust assigned California workers' compensation claims in compliance with jurisdictional requirements and ADR processes. Establish and monitor reserves, authorize claim payments, and negotiate settlements within authority and client guidelines. Review medical, legal, and vendor invoices to confirm accuracy and appropriateness. Maintain thorough documentation and diary updates in the claim system. Communicate effectively with clients, claimants, and involved parties throughout the claim process. Participate in claim reviews, hearings, and mediations as needed. Ensure compliance with state laws, CCMSI claim handling standards, and client-specific requirements. Qualifications Three or more years of experience adjusting California workers' compensation claims California Adjuster's License Self-Insurance Administrator Certificate (SIP) Strong written and verbal communication skills Proficiency with Microsoft Office Suite (Word, Excel, Outlook) Nice to Have Experience with Alternate Dispute Resolution (ADR) claims Strong organization, multitasking, and customer service skills Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us. Compensation & Compliance The posted hourly rate reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. Visa Sponsorship CCMSI does not provide visa sponsorship for this position. ADA Accommodations CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team. Equal Opportunity Employer CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #CaliforniaAdjuster #WorkersCompensation #ADRClaims #InsuranceCareers #ClaimsConsultant #CaliforniaJobs #RemoteAdjuster #SIPCertified #InsuranceProfessionals #ClaimsManagement #CareerGrowth #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Remote

BWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flextime work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. What You'll Be Doing: * Provides assistance to the Workers' Compensation Medical Claims Specialists and supervisors in the Medical Billing and Adjustments unit; * Reviews and cross-references data on bills, adjustments, Medicare correspondence, and other documents with data in BWC's claims management system and other ancillary systems; * Scans, indexes and track bills, adjustments, Medicare documents, and correspondences into claim file; other tracking databases * Reviews incoming claims and billing documents to obtain missing information and determine required action; * Performs specialized clerical tasks and handling of all departmental incoming, outgoing, and misdirected mail, and other documents. To Qualify, You Must Clearly Demonstrate: Required Experience and/or Education: * 2 courses or 6 mos. exp. in English composition or grammar AND 2 courses or 6 mos. exp. in accounting, bookkeeping or general math AND 2 courses or 6 mos. exp. in communication or public speaking or 6 mos. exp. in a position involving receiving & responding to public inquiries or complaints or involving contact with injured workers, employers, legislators, providers or their representatives & public AND successful completion of one typing course or demonstrate ability to type 35 words per minute. * Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination, Insurance MAJOR WORKER CHARACTERISTICS: Knowledge of addition, subtraction, multiplication, division, fractions, decimals & percentages; ICD/CPT codes, BWC/IC policies & procedures & ORC rules & regulations*; applicable state &/or federal regulations governing documents processed, reviewed &/or prepared*; public relations. Skill in operation of pc to efficiently log & enter data. Ability to solve practical, everyday problems; gather, collate & classify information about data, people or things; handle routine inquiries from & contacts with injured workers, employers, legislators, providers or their representatives & public; complete routine forms & prepare standard reports. (*) Developed after employment.

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we've built deep relationships with approximately 30 thousand companies that are key to the home-buying transaction, such as home inspectors, mortgage companies, and title companies. In 2020, Porch Group rang the Nasdaq bell and began trading under the ticker symbol PRCH. We are looking to build a truly great company and are JUST GETTING STARTED. Job Title: Liability Claims Examiner Location: United States Workplace Type: Remote Homeowners of America is a provider of Personal Lines Insurance products. We're always looking to add talented and passionate people to our team. We value the knowledge that comes from experienced individuals with diverse backgrounds and strengths that can contribute to the various departments within our company. Our shared values are no jerks, no egos, be ambitious, solve each problem, care deeply and together we win. Summary The Liability Claims Examiner is responsible for managing complex and litigated 3rd party claims arising under homeowners' insurance policies. This role involves investigating losses, evaluating coverage, assessing liability exposures, and directing litigation strategies to achieve fair and timely resolution of claims. The examiner will work closely with insureds, claimants, field adjusters, defense counsel, experts, and internal stakeholders ensuring compliance with company guidelines and regulatory requirements while mitigating risk and controlling costs. Liability Claims Examiners are responsible for requesting payments, documenting files, and preparing and issuing claim payment letters or denial letters when appropriate. What you Will Do As A Liability Claims Examiner Responsibilities: May include any or all the following. Other duties may be assigned. Investigate and Evaluate Claims: Review policy language, coverage issues, and liability exposures. Analyze incident reports, statements, expert opinions, and other evidence to determine liability and damages. Handles claims from all types of policies, including homeowners, dwelling fire, tenant, condo, and renters. Confers with legal counsel on claims involving coverage, legal, or complex matters Effectively manage difficult or emotional customer situations Litigation Management: Direct and oversee defense counsel in litigated matters, including strategy development, budgeting, and case progression. Attend mediations, settlement conferences, and trials as needed. Evaluate litigation reports and provide recommendations for resolution. Negotiation and Settlement: Negotiate settlements within authority limits to achieve equitable outcomes. Collaborate with legal counsel to resolve complex coverage and liability disputes. Financial Oversight: Establish and adjust reserves based on claim developments and litigation exposure. Monitor litigation costs and ensure adherence to budget guidelines. Seeking out and utilizing top vendors that build quality, increase efficiency, and reduce cost Communication and Documentation: Maintain accurate and detailed claim files, including litigation plans and correspondence. Communicate effectively with insureds, claimants, attorneys, and internal teams. Enters claims payments when applicable and maintains clean, concise, and accurate file documentation Manages correspondence and communication with various parties involved in the claim Draft and prepare letters and other correspondence related to the claim Compliance and Best Practices: Ensure adherence to claims handling guidelines, regulatory requirements, and ethical standards. Identify opportunities for process improvement and cost containment. Take on assignments and duties as requested by the management team What you Will Bring As A Liability Claims Examiner Bachelor's degree or equivalent experience Minimum 5+ years of liability claims experience, with a strong focus on litigated 3rd party claims Appropriate state adjuster license and continuing education credits In-depth knowledge of homeowners liability and med pay coverage, policy language, and litigation processes Strong negotiation, analytical, and decision-making skills Excellent written and verbal communication skills Ability to manage multiple complex cases and meet deadlines in a fast-paced environment Proficiency in claims management systems and Microsoft Office suite (Outlook, Word, Excel, PowerPoint) Works with integrity and ethics Exceptional customer service skills Effectively manages difficult or emotional customer situations Ability to read, write, and interpret routine correspondence, policies, and reports Makes decisions and completes activities in a confident and timely manner Follows Claims Handling Guidelines, policies and procedures Maintains confidentiality Works independently, with the ability to assess workload and plan accordingly to meet competing deadlines Cultivates environment of teamwork and collaboration Comprehensive and up-to-date knowledge of General Liability and P&C insurance, contractual policy language requirements and the implications of that language as it pertains to denial of claims Demonstrated commitment to continuing education in the industry through licensing or designations applicable to property and liability insurance field is preferred. Certificates, Licenses, Registrations Appropriate state adjuster license and continuing education credits. The application window for this position is anticipated to close in 2 weeks (10 business days) from December 17th, 2025. Please know this may change based on business and interviewing needs. At this time, Porch Group does not consider applicants from the following states for remote positions: Alaska, Arkansas, Delaware, Hawaii, Iowa, Maine, Mississippi, Montana, New Hampshire, and West Virginia. What You Will Get As A Porch Group Team Member Pay Range*: Annually$67,500.00 - $94,500.00 *Please know your actual pay at Porch will reflect a number of factors among which are your work experience and skillsets, job-related knowledge, alignment with market and our Porch employees, as well as your geographic location. Our benefits package will provide you with comprehensive coverage for your health, life, and financial wellbeing. Our traditional healthcare benefits include three (3) Medical plan options, two (2) Dental plan options, and a Vision plan from which to choose. Critical Illness, Hospital Indemnity and Accident plans are offered on a voluntary basis. We offer pre-tax savings options including a partially employer funded Health Savings Account and employee Flexible Savings Accounts including healthcare, dependent care, and transportation savings options. We provide company paid Basic Life and AD&D, Short and Long-Term Disability benefits. We also offer Voluntary Life and AD&D plans. Both traditional and Roth 401(k) plans are available with a discretionary employer match. Headspace is part of our employer paid wellbeing program and provides employees and their families access to on demand guided meditation and mindfulness exercises, mental health coaching, clinical care and online access to confidential resources including will preparation. Brio Health is another employer paid wellbeing tool that offers quarterly wellness challenges and prizes. LifeBalance is a free resource to employees and their families for year-round discounts on things like gym memberships, travel, appliances, movies, pet insurance and more. Our wellness programs include flexible paid vacation, company-paid holidays of typically nine per year, paid sick time, paid parental leave, identity theft program, travel assistance, and fitness and other discounts programs. #LI-JS1 #LI-Remote What's next? Submit your application and our Porch Group Talent Acquisition team will be reviewing your application shortly! If your resume gets us intrigued, we will look to connect with you for a chat to learn more about your background, and then possibly invite you to have virtual interviews. What's important to call out is that we want to make sure not only that you're the right person for us, but also that we're the right next step for you, so come prepared with all the questions you have! Porch is committed to building an inclusive culture of belonging that not only embraces the diversity of our people but also reflects the diversity of the communities in which we work and the customers we serve. We know that the happiest and highest performing teams include people with diverse perspectives that encourage new ways of solving problems, so we strive to attract and develop talent from all backgrounds and create workplaces where everyone feels seen, heard and empowered to bring their full, authentic selves to work. Porch is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable laws, regulations, and ordinances. Porch Group is an E-Verify employer. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.

Job Description As a Commercial Casualty Claims Adjuster, you will serve as a real partner to our members by processing claims accurately and efficiently so they can resume their life's work without unnecessary delay. If you are optimistic, enjoy helping others in times of need, and are compassionate about making positive change in the world, this may be the role for you. Accountabilities: This position handles Commercial General Liability, Commercial Trucking, Director's & Officer Liability, Employment Practices Liability, Commercial Auto injuries, Contractor's Pollution Liability, Professional Liability and other Casualty exposures. Investigates coverage and cause of loss on routine to more complicated claims, which includes but is not limited to policy review, interviewing all parties associated with the loss and gathering and analyzing all necessary investigative documentation. Handles non-represented, represented and litigated injury and property damage claims including investigating and evaluating those exposures. Identifies exposures with significate severity to triage to the large loss team. Provides accurate assessments and negotiates fair and efficient claims resolutions while managing costs. Settles losses according to the documented damage, the language of the policy of insurance, pertinent regulatory and statutory considerations and within granted authority. Prepares written communication, including but not limited to settlement letters, disclaimers of coverage and reservation of rights letters. Maintains effective claim file documentation and diary system. Monitor diary to achieve timely development of file and timely disposition of the claim. Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated. Assigns and supervises field examiners and vendor resources, including but not limited to independent adjusters, engineers and other experts as needed. Assumes additional duties as defined. Required Qualifications: 5 or more years in the handling of Commercial Liability Claims. Understands concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims towards resolution using best practices. Ability to take responsibility and work independently in a home-based environment. Ability to negotiate skillfully in difficult situations. Willingness to travel periodically. Recommended Qualifications: Environmental claim experience is preferred. Propane Gas Distributors claim experience is preferred Bachelor's degree preferred New York, Florida or Texas claims handling license preferred Willingness to obtain state licensing or certification where required Ability to formulate sound expense, indemnity, and business judgment while supporting loss evaluations and presenting them effectively. Basic computer skills including Microsoft applications Perform work related simple and advanced mathematical problems and calculations Compose written correspondence and factual reports which are well organized and concise, utilizing proper English, grammar, punctuation, and spelling Strong oral and written communication skills. Compensation: $59,400 - $99,000 commensurate with experience, plus bonus eligibility $65,400 - $109,000 commensurate with experience in CA, CT, MA, NJ, NY, and PA, plus bonus eligibility Benefits: We are proud to offer a robust benefits suite that includes: Competitive base salary plus incentive plans for eligible team members 401(K) retirement plan that includes a company match of up to 6% of your eligible salary Free basic life and AD&D, long-term disability and short-term disability insurance Medical, dental and vision plans to meet your unique healthcare needs Wellness incentives Generous time off program that includes personal, holiday and volunteer paid time off Flexible work schedules and hybrid/remote options for eligible positions Educational assistance #TMG

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job Purpose The Claims Clerk plays a vital role in supporting the claims team by handling daily administrative tasks, including reviewing and responding to claims portal messages, processing incoming faxes, and organizing documentation. This position ensures efficient communication and smooth workflow within the department, helping to maintain timely and accurate claims processing. Duties and responsibilities Monitor and respond to claims portal messages daily. Assist Customer Service department with portal registrations. Process and categorize incoming claims-related faxes. Assist with Claims related inquiries from other departments. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Serve as a primary point of contact for providers, members, and internal staff regarding claims status, documentation requirements, and resolution steps. Respond to inbound claims phone calls, emails, and portal inquiries in a professional and timely manner. Provide clear explanations of claim outcomes, payment decisions, and next steps while maintaining a high level of customer service. Research and resolve claim-related issues by gathering information, reviewing documentation, and escalating as needed. Document all interactions in the system to ensure accurate records of customer communications and resolutions. Must maintain an error accuracy of under 5%. Support claims examiners and workflow projects. Attend weekly or monthly departmental meetings and provide feedback when requested. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit activities. Support other departments as needed. All other duties as assigned. Qualifications Experience in administrative support, claims processing, or a related field preferred. Excellent communication skills including reports, correspondence, and verbal communications. Experience with EZ-Cap and Encoder preferred. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving. Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Must work well under pressure and deadlines.

As a third-party administrator, Grand River Services specializes in first party property and third-party casualty claims. We work directly with insureds and agencies to provide a level of high touch service rarely found in today's marketplace. We are looking for a Commercial Claims Adjuster who is focused on accountability, exceptionally accurate case reserves, and outstanding agent satisfaction. What You'll Do Supports and demonstrates IMA's core values Values and understands the importance of diversity, equity, and inclusion among all IMA associates Manages multiple jurisdictions and multiple lines of business Works directly with insureds and agencies to provide excellent, high touch service Thinks critically to evaluate coverage, investigate claims, and negotiate settlements Maintains highly organized and detailed claims files Communicates a clear, concise action plan for moving cases to conclusion You Should Have 5-7+ years of claims handling experience Need to be located in either the Eastern or Central Time Zone Commercial General Liability experience required Multi-state experience a plus Multiple lines a plus Must be a licensed adjuster with the ability to obtain licenses in other states Ability to be cross trained to handle other lines of business Experience in handling bodily injury, med pay, and property damage claims Ability to handle and negotiate settlements on both non-litigated and litigated claims Must be comfortable and self-directed to work independently in a remote, virtual office environment Light to moderate travel to attend training, mediations, trials, and company functions Bachelor's degree preferred Valid driver's license required Strong proficiency with Microsoft products and agency systems #LI-JS1 If this role is hired in Los Angeles County, CA the following applies: Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prior Criminal history will only be considered after a conditional job offer is made and accepted. Applicants will have the opportunity to explain the circumstances surrounding any convictions, provide mitigating evidence, or challenge the accuracy of the background report. Salary Range$70,000-$90,000 USD Compensation & Benefits Being a part of IMA has its benefits. When you become part of the IMA family, you become eligible to take part in our valuable benefits and rewards package designed to benefit you, your family, and your life. Our plans are cost-effective, convenient and provide progressive ways for staying healthy, protecting loved ones, pursuing financial security and living a full and balanced life. This role is eligible for the following: Annual Performance Bonus, Stock Purchase, Medical Plans, Prescription Drugs, Dental, Vision, Family Assistance Program, FSA, HSA, Pre-Tax Parking Plan, 401(k), Life/AD&D, Accident, Critical Illness, Hospital Indemnity, Long Term Care, Short-term Disability, Long-term Disability, Business Travel Accident, Identity Theft, Paid Time Off, Flexible Work Options, Paid Holidays, Sabbatical, Gift Matching, Health Club Reimbursement, Personal and Professional Development. In addition to our robust benefits package, the final offer amounts will depend on a variety of factors, including the candidate's geographic location, prior relevant experience, and their knowledge, skills, and abilities. *These benefits do not apply to internship roles. Why Join IMA? We've built a reputation for putting our associates first What if we told you that you could be an integral part of an entrepreneurial, expanding company, develop lasting relationships, earn competitive benefits, plus claim part ownership? It's this unique ownership business model that makes working at IMA so appealing. We work in teams. We sell in teams. We win and prosper as a team We provide support systems and resources that enable each of our associates to focus on what they do best. And as an independent company based in the Midwest, we're big enough to write business all over the world and small enough to implement your ideas quickly. We are recognized nationally as a leader in our industry 2020-2023 Business Insurance Magazine Best Places to Work in Insurance 2023 Inc. Magazine's Best Workplaces 2023 Denver Business Journal's Best Places to Work 2022-2023 Connecticut Top Work Places 2021-2023 Inc. 5000's List of Fastest Growing Companies 2019-2022 Civic 50 Colorado Honoree Recognizing 50 Most Community-Minded Companies 2022-2023 Kansas City Business Journal's Best Places to Work 2021-2023 Charlotte Business Journal's Best Places to Work 2021-2023 Los Angeles Business Journal's Best Places to Work 2021-2023 The Salt Lake City Tribune Top Work Places 2021-2022 Puget Sound Business Journal's Washington's Best Workplaces 2021-2022 Wichita Business Journal's Best Places to Work, #1 in extra-large category 2021 Dallas Business Journal's Best Places to Work 2021 Alaska Journal of Commerce's Best Workplaces in Alaska This Job Description is not a complete statement of all duties and responsibilities comprising this position. The IMA Financial Group, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, The IMA Financial Group, Inc. complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

Fetch Pet Insurance, a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and health advice. Put simply, Fetch makes vet bills affordable. We offer a comprehensive product that does not have any restrictions based on breed, age, or size. We are believers in helping pets get through their bad days but also focus on extending the good days. How do we do that? - through a wide portfolio of products + offerings, which include Fetch Health Forecast, our pet health and lifestyle blog, The Dig, and our partnerships with Project Street Vet and animal no-kill shelters across North America. Our business is growing and we are looking for compassionate professionals that want to join a team that works hard and celebrates success! You will have an opportunity to hone your skills and develop new skills as you learn the ins-and-outs of Fetch pet insurance and support our pet parents. Your success is our success! RESPONSIBILITIES. Adjudicate assigned claims in accordance with the Terms & Conditions of the individual pet's policy Review medical records, lab results, invoices, and claims forms for complete and thorough assessment Process claims determinations to include assessment and payment for submitted claims Verify claims coverage through in-depth knowledge of policy Terms & Conditions Consult with treating veterinary practices regarding medical records evaluation and necessary documentation Maintain an average quality assurance score above department minimums Complete assigned tasks within compliance deadlines Maintain an average productivity rate above department minimums Provide feedback on process opportunities to further strengthen SOPs REQUIRED SKILLS. Comprehensive understanding of disease processes and veterinary medical terminology Ability to read and interpret veterinary medical records and invoices Ability to identify chronic and acute medical conditions Adapt quickly in a fast-paced, ever-changing environment and operate multiple computer systems simultaneously Work independently in a remote capacity, while also fostering teamwork and collaborating with others Superior communication skills for collaboration with team members and support from managers Demonstrated problem solving skills and ability to work through complex medical/vet-related scenarios affecting a pet's diagnosis and/or treatment plan QUALIFICATIONS. Minimum of five years experience as a veterinary technician Bachelor's degree in veterinary science OR CVT or equivalent preferred Property and Casualty Adjuster license in good standing preferred Complete and pass state adjuster licensing Be reliable with good attendance Able to work a minimum of 42 hours per week, with occasional weekends and extra hours as needed WORK-FROM-HOME SET-UP. Subscription to reliable high-speed internet connection (minimum of 100 Mbps download and 30 Mbps upload speed) A quiet, dedicated place to work in your home that is not easily disrupted by background noises or distractions Office workspace must be large enough to accommodate two 19” dual monitors, laptop, mouse, keyboard, and headset Ability to set up and connect (with instructions and remote IT team assistance) equipment that is shipped to your home -ABOUT FETCH- Fetch is a high-growth, Warburg-Pincus portfolio company. We are a passionate group of 200+ employees and partners across the U.S. and Canada dedicated to helping pets live their best lives. We have two offices (New York City, NY, and Winnipeg, Canada), and we currently provide security to over 360,000 pet parents. We don't just accept differences - we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. We are proud to be an equal opportunity employer. We recruit, hire, pay, grow and promote no matter of gender, race, color, sexual orientation, religion, age, protected veteran status, physical and mental abilities, or any other identities protected by law.

":"* This is a full-time, remote position working from 9:45am to 6:15pm CST American Guardian Warranty Services, Inc. (AGWS), an affiliate of Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In this role you will work remotely and be responsible for investigating, evaluating and negotiating minor to complex vehicle repair costs to accurately determine coverage and liability. You will take inbound calls to determine coverage based on contracts in order to appropriately resolve customer issues. Responsibilities will include, but are not limited to: -\tAnswering inbound calls -\tProvide information about claim processing and explain the different levels of contract coverage and terms -\tAccurately establish, review and authorize claims -\tEntering claim and contract information into the AGWS' system A home office package will be provided for this position. This includes two computer monitors, a laptop, keyboard and mouse. ","job_category":"Customer Service","job_state":"TX","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-12-18","zip":"75201","position_type":"Full-Time","salary_max":"55,000. 00","salary_min":"50,000. 00","requirements":"2+ years of experience as an automotive mechanic within a service department, dealership, or independent shop~^~2+ years of experience adjusting automobile mechanical claims~^~ASE certification is a plus~^~Must have a quiet designated work space to work from home~^~Must have reliable internet with at least a download speed of 50mbps~^~Must be able to work effectively under pressure in a fast paced environment~^~Strong communication skills~^~Strong organizational and multi-tasking skills~^~High school diploma","training":"On the job","benefits":"We strive to offer an environment that provides our associates with the right balance between work and family. We offer a comprehensive benefits package including: - Medical, dental, vision, life insurance, and a health savings account - 401(k) with up to 6% matching - Professional development and training - Promotion from within - Paid vacation and sick days - Eight paid holidays - Referral bonuses Reynolds and Reynolds promotes a healthy lifestyle by providing a non-smoking environment. Reynolds and Reynolds is an equal opportunity employer. ","

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role Come join an amazing and collaborative team! We are seeking a highly organized and customer-focused General Liability Adjuster to join our team. The successful candidate will be responsible for speaking to customers on the phone, educating and helping the customer work through their claim to the best possible outcome. Your role will also be responsible for handling an inventory of claims, triaging critical claims, and delivering service to all constituents of the claim. The ideal candidate has a willingness to work through a design process that supports the quickest claim resolution with the best outcome. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. **While this position may not be open just yet, we are looking ahead. Submit your application to stay on our radar for future roles as we are growing quickly! Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, you have a sense of humor. Claims are hard enough as it is. You are collaborative and a team player. What we need We need you to do all the things typical to the role: Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests Gather necessary information from customers to initiate the claim and explain policy, coverage, and appropriate course of action Manage an inventory of claims, analyze coverage and identify any potential coverage issues. Establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim Ability to handle all aspects of general liability claims not limited to but including Slip and Falls, Habitational, Risk Transfer, Construction, and New York Labor Law Ensure compliance with specific state regulations, policy provisions, and standard operating procedures Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority Provide input for continuous development of claims guidelines, best practices, and process improvements Oversee and direct outside investigative service providers, client counsel and investigative services to resolve the claim while closely with the client. Engage in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications Requirements Bachelor's degree. JD, Professional insurance designations strongly preferred. Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license Minimum of 5 years of experience ideally with; General Liability (Premise, Habitational, Auto, Garagekeepers, BOP's, Dwelling) Construction Liability. Employers Liability. Liquor Liability/Dram Shop. Complex claims involving litigation. Policy interpretation. Drafting Reservation of Rights letters, coverage declinations. Third-party bodily injury. Third-party litigated bodily injury/property damage. Willing to obtain all licenses within 45 days, including completing state required testing Knowledge of state regulations, policy provisions, and standard operating procedures Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Ability to collaborate with colleagues within and outside your department Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy after 8 months of continuous work Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Medical Only Workers' Compensation Claims Adjuster | 100% Remote Opportunity - California Must have experience in California Using claims system automation and capabilities, the Medical Only workers' compensation Claims Adjuster is responsible for timely and accurate management of a high volume of workers' compensation claims requiring minor or simple medical treatment and escalating them or moving them efficiently to closure. Essential Duties and Responsibilities Receives and reviews information related to new work comp insurance claims involving no or minimal lost time from work. Under direct supervision, may handle a small amount of fast-track indemnity claims that have low exposure or complexity. Communicates with injured workers, employers, and medical providers to obtain necessary additional information and evaluate claims for exceptions or escalations. Confirms or determines coverage and compensability as needed within state statutes and claims best practices. Reviews and responds to mail, emails, telephone calls and faxes from employers, providers, and injured workers within 24 hours. Reviews and responds to mail, emails, telephone calls and faxes from employers, providers and injured workers. Takes action to handle communication within established best practices and statutory requirements. Maintains ongoing professional communications with all internal and external customers. Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed. Manages or coordinates medical treatment and communicates with providers in a timely manner to continue to move the claim forward. Reviews medical bills and makes appropriate determinations. Reviews case facts to identify and report possible fraud or abuse throughout course of claim. Reviews claims for closure and proactively takes action to guide claims in that direction. Requirements Minimum of 1 year general office experience or equivalent combination of education and experience. Excellent written and oral communication, customer service and telephone skills. Knowledge of MS Office software and an imaged environment. Demonstrated ability to understand and adhere to statutes, regulations and company policies and practices. Demonstrated skills in multi-tasking and prioritizing, adhering to deadlines and completing assignments. Conducts business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality. Claims industry experience preferred. Working knowledge of medical or insurance terminology preferred. Education: High school diploma or equivalent required. Certification If State certification or license is required, must meet certification within Work Environment: Remote: This role is a remote (work from home (WFH) opportunity, and only open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace. Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $20.00 - $26.00/hr and a comprehensive benefits package, please follow the link to our benefits page for details! ********************************************************* About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply. Work Schedule Remote Monday through Friday, 8:30 AM to 5:00 PM EST Must be able to work 8am - 5pm Eastern Standard Time Responsibilities Claims Review and Processing Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. Critical Analysis Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. Timely Processing Ensure prompt claims processing to meet client standards and regulatory requirements. Identify and resolve any barriers using effective problem-solving strategies. Issue Resolution Collaborate with internal departments to proactively resolve discrepancies and issues. Use analytical skills to identify root causes and implement solutions. Confidentiality Maintenance Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. Detailed Record Keeping Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. Trend Monitoring Analyze and report trends in claim issues or irregularities to management. Assist Team Leads with reporting to contribute to continuous process improvements. Audit Participation Engage in audits and compliance reviews to ensure adherence to internal and external regulations. Critically evaluate and recommend process improvements when necessary. Mentoring Mentor and train new claims processors as needed. Requirements High school diploma or equivalent. Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. Billing experience doesn't count towards years of experience qualification Familiarity with ICD-10, CPT, and HCPCS coding systems. Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker's compensation claims is a plus). Strong attention to detail and accuracy. Ability to interpret and apply insurance program policies and government regulations effectively. Excellent written and verbal communication skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Ability to work independently and collaboratively within a team environment. Commitment to ongoing education and staying current with industry standards and technology advancements. Experience with claim denial resolution and the appeals process. Ability to manage a high volume of claims efficiently. Strong problem-solving capabilities and a customer service-oriented mindset. Flexibility to adjust to the evolving needs of the client and program changes. Benefits 401(k) with employer matching Health insurance Dental insurance Vision insurance Life insurance Flexible Paid Time Off (PTO) Paid Holidays What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Are you looking for an opportunity to join a claims team with a fast growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available for a Workers Compensation Claims Technician. Claims Technicians obtain essential information in order to process routine workers' compensation claims with on-going medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identify potential problems and make claim referral decisions. GRS North America Claims is excited to announce our go forward strategy to provide employees with the flexibility to include an option to work from home full-time. Candidates who are selected for this position will be trained remotely. You will be required to go into the office twice a month if you reside within 50 miles of one a specified office. Please note this policy is subject to change. Responsibilities: Conduct investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with claim specific on-going medical management. Provides on-going medical case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and medical treatment. Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Arranges Independent Medical Exam and Peer Review as necessary. Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers). Authorizes payment of medical payments and/or medical treatment. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units. Qualifications High school diploma plus 1-3 years' of related customer service experience or applicable insurance knowledge. Licensing required in some states. Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

The Claims Quality Review Technician is responsible for performing detailed quality reviews of processed claims to ensure accuracy and compliance with eligibility rules, benefits paid, client requirements and applicable legislative and regulatory guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Reviews processed claims, including hospital, medical, dental, vision, prescription and time loss to confirm accuracy and appropriate adjudication of benefits. Identify and document quality trends, provide feedback, and assist management in monitoring processing performance against established standards. Reviews and interprets new benefit plans and/or benefit plan changes, develops resource materials and acts as a resource for staff. Conducts training for new and current employees on claims adjudication, contract language, benefit interpretation, claims QR process and departmental procedures. Collaborate with internal partners to resolve complex claim issues and support continuous improvement. Performs other duties as assigned. Minimum Qualifications High school diploma or GED required 5+ years of related experience, including claims processing, training and/or claims quality review. Strong understanding of claims processing guidelines and benefit plan structures, and regulatory requirements. Demonstrated analytical, research, and problem-solving abilities with strong attention to detail. Working knowledge of CPT, HCPC and ICD-10 coding Proficiency in Microsoft Word, Excel and Outlook. Preferred Qualifications Experience working in a Taft-Hartley environment Prior quality assurance or audit -focused experience Familiarity with automated claims platforms. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Department: Claims Schedule: Monday to Friday; 4-6 hours daily Salary: Commensurate based on experience and qualifications About Responsive Founded in 2007 and headquartered in Plantation, Florida, Responsive is a leading provider of personal auto insurance in Florida. We collaborate with thousands of agents from the most respected insurance agencies to deliver world-class service and claims experiences. Responsive stands for making auto insurance simple, affordable, and hassle-free; a promise we deliver through innovation, feedback, and a commitment to excellence. What You'll Do As a Claims Adjuster, you'll guide customers through the claims process with empathy and expertise. From investigating coverage to resolving disputes, you'll handle claims from start to finish while maintaining strong relationships with customers and stakeholders. Responsibilities include: Investigating, evaluating, and resolving insurance claims. Reviewing policies to verify coverage and address coverage issues. Managing customer interactions with professionalism and accuracy. Responding to demands, requests, and questions with clear, well-documented communication. Collaborating with attorneys, medical providers, and other stakeholders. Maintaining detailed and timely records. Ensuring compliance with federal, state, and company regulations. Other duties as assigned Requirements What We're Looking For Education: Bachelor's degree. Licensing: Active Florida 6-20 All Lines Adjuster License. Language Skills: Fluent in Spanish and English (written and verbal proficiency required). Skills: Strong analytical, problem-solving, and communication skills. Proficiency in Microsoft Office. Experience: Customer-focused with experience in high-volume environments that require time management and attention to detail. Minimum of 2 years of experience as an auto property damage claims adjuster Mindset: Self-motivated, team-oriented, and adaptable. Our Culture Responsive is a dynamic, inclusive workplace where integrity, innovation, and collaboration thrive. We foster an environment where employees are encouraged to: Adapt: Embrace change and continuously improve. Collaborate: Work transparently and respectfully with others. Engage: Show curiosity and a commitment to serving customers and teammates. Be Data-Driven: Leverage insights to drive decisions and improvements. Responsive provides equal employment opportunities (EEO) to all employees and applicants, fostering a diverse and inclusive workplace. #claimsadjuster

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees are key factors in our company's growth, market presence and our ability to help our clients stay a step ahead of the competition. By hiring, the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. NTT DATA is seeking to hire a **Remote Claims Processing Associate** to work for our end client and their team. **NOTE** : This is a US based, W-2 project. All candidates will be paid through NTT DATA only. Pay Rate: $18/hr 100% Remote, we provide equipment **In this Role the candidate will be responsible for:** + Processing of Professional claim forms files by provider + Reviewing the policies and benefits + Comply with company regulations regarding HIPAA, confidentiality, and PHI + Abide with the timelines to complete compliance training of NTT Data/Client + Work independently to research, review and act on the claims + Prioritize work and adjudicate claims as per turnaround time/SLAs + Ensure claims are adjudicated as per clients defined workflows, guidelines + Sustaining and meeting the client productivity/quality targets to avoid penalties + Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. + Timely response and resolution of claims received via emails as priority work + Correctly calculate claims payable amount using applicable methodology/ fee schedule **Requirements:** + 1-3 year(s) hands-on experience in **Healthcare Claims Processing** + 2+ year(s) using a computer with Windows applications using a keyboard, **navigating multiple screens and computer systems, and learning new software tools** + High school diploma or GED. + **Previously performing - in P&Q work environment; work from queue; remotely** + Key board skills and computer familiarity - + **Toggling back and forth between screens** /can you navigate multiple systems. + Working knowledge of MS office products - Outlook, MS Word and **MS-Excel** . + Must be able to work **7am - 4 pm CST** online/remote (training is **required on-camera** ). + Effective **troubleshooting where you can leverage your research, analysis and problem-solving abilities** + **Time management with the ability to cope in a complex, changing environment** + **Ability to communicate (oral/written) effectively** in a professional office setting **Preferred Skills & Experiences:** + Amisys &/or Xcelys Preferred **About NTT DATA** NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize and transform for long-term success. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure and connectivity. We are one of the leading providers of digital and AI infrastructure in the world. NTT DATA is a part of NTT Group, which invests over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. Visit us at us.nttdata.com (************************* Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is $18.00/hour. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. NTT DATA endeavors to make ********************** (**********************/en) 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 us at **********************/en/contact-us . This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here (**********************/en/compliance#eeos) . If you'd like more information on your EEO rights under the law, please click here (**********************/en/compliance#know-your-rights) . For Pay Transparency information, please click here (**********************/en/compliance#ppnp) .

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Pets Best, a subsidiary of IPH, is building a digital first pet e-commerce platform with the aim of connecting key market services such as adoption, lost pet and insurance to make pet care easy. Job Summary: Pets Best is seeking a Claims Processing Specialist who will report to the Supervisor, Claims. Claims Processing Specialists are responsible for reviewing invoices and pet medical documents and determining coverage in compliance with the current Underwriter's policy. Job Location: Remote - USA Main Responsibilities: Review individual policies to make an eligibility determination with high degree of accuracy Contact with internal departments as well as veterinarians and clinic staff Ensure compliance guidelines are met with both internal policies and procedures and contractual commitments Work independently and with others on a virtual team Drive a “Great Place to Work” culture, attend and participate in team meetings as well as engagement events Use PC based programs to enter data into claims system, communicate with leaders and teammates, and organize information Create and issue claim decisions to pet parents using proper spelling, grammar, and punctuation in line with the policy terms Calculate invoice totals, discounts, and tax rates Perform other duties and/or special projects as assigned Qualifications: High school diploma or equivalent 3+ years recent clinical veterinary experience (dog and cat) as a veterinary assistant, veterinary technician or veterinarian Knowledge of veterinary terms, abbreviations and conditions. Knowledge of medical conditions and associated symptoms, procedures, treatments, secondary conditions and pharmaceuticals used in veterinary medicine Knowledge of canine and feline breeds, anatomy and associated predispositions to illness. Ability to read and interpret medical diagnoses via medical records review both written and digital. Ability to work cross functionally with our internal and external resources Ability to handle multiple projects concurrently Ability to navigate Windows OS, Google Chrome, and corresponding applications Demonstrable Microsoft Office proficiency: Word, PowerPoint, Excel, Outlook, Teams Strong writing skills: organization, spelling, grammar and punctuation Strong mathematical and problem-solving skills #LI-Remote #petsbest All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)