Claims Associate remote jobs - 126 jobs

Join a well-established insurance agency with a 30-year legacy and a powerful commitment to ethical, honest insurance solutions. They are actively seeking an experienced Workers' Compensation Claims Representative! You will drive success by investigating and evaluating claims, expediting payments, and ensuring proper documentation. Grow your expertise with a team ready to invest in your long-term professional development. What's in it for you? Earn an annual salary of $70,000 - $90,000+, depending on your experience Comprehensive benefits package including Medical, Dental, and Vision insurance 401(k) plan Generous Paid Time Off (PTO) and paid company holidays What we need from you: 3-5+ years of experience in workers' compensation claims Certifications as a Workers Compensation Claims Administrative (WCCA) and Workers Compensation Claims Professional (WCCP) are preferred but not required Knowledge of Worker's Compensation guidelines, Medicare coding, and compliance obligations. Microsoft Office and other database management systems The Position: Assisting with new claims from opening until satisfactory completion, evidence, and fact-gathering surrounding claims Ensuring claims coding is true and accurate Claim files must be accurately recorded in the system Assuring all claims have a workable plan of action Reviewing billing summaries Identifying any signs of fraud and making proper referrals for further investigation Pursue subrogation when necessary and offer superior customer service to all parties involved Apply now! Why Insurance Relief™? As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance Relief™ works with brokers, carriers, and third-party administrators to locate and place the best people for positions ranging from entry-level to senior management. We invest the time to truly understand what you want to accomplish and then do our best to find meaningful opportunities.

At Plymouth Rock Assurance, our Claims team embodies the traits of Understanding, Engaging, and Energetic, serving as the first point of contact for our policyholders who have experienced an automobile incident. As a Claims Representative, you will become part of a fast paced, rewarding, and diverse team that appreciates the importance of a healthy work/life balance. We are looking for high potential individuals to join our fast-track claims unit with an in-depth training program, so no prior insurance experience is needed for this role. Many of our Claims Representatives have benefited from internal growth opportunities and have secured more senior Claims or Supervisor level roles within our company. Apply now and start your career at Plymouth Rock! We are currently a Hybrid work environment- 4 days in the Boston office and 1 day work from home. Here Is What You Will Do Customer-centric employee: Conveying a calm, caring attitude, you will provide best-in-class service to customers while processing new claims. Understanding and providing Empathy is key to this role. Collaborative partner: Working with internal and external partners, you'll support policyholders while their claims are being processed. Energetic worker: In our fast-paced environment, you will handle customers' needs-quickly, effectively and in a friendly, caring manner. Problem solver: No day is predictable; you'll utilize out-of-the-box, creative thinking to resolve a wide variety of claims challenges and customer issues. Clear communicator: You'll provide policyholders with the information they need by clearly setting expectations and outlining next steps. Accessibility: Being available for customers via email, text, or phone to walk them step-by-step through the auto claim process and explain existing coverage. Here Is What You Will Bring To The Table A history of working customer service facing roles, hospitality, or retail, with previous call center experience a plus. Being on the phone consistently throughout the day is a requirement of the role. Excellent organizational and time management skills. Being able to pivot through different applications throughout the day. Prioritizing your day and staying organized is key. An associate or bachelor's degree preferred. Willingness to continue learning about products, procedures, and technical systems as you grow in this role. Why work for us Grow personally and professionally through our collaborative team environment Gain support and guidance to expedite proficiency through our mentor program 4 weeks accrued paid time off + 9 paid national holidays per year Onsite Free Parking LinkedIn Learning Courses 12-week Training Program Tuition Reimbursement Low cost and excellent coverage health insurance options (medical, dental, vision) Robust health and wellness program and fitness reimbursements Auto and home insurance discounts 2:1 Matching gift opportunities Annual 401(k) Employer Contribution (up to 7.5% of your base salary) Company sponsored social events Various Paid Family leave options including Paid Parental Leave Salary Range: The pay range for this position is $45,000 to $50,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. About The Company The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

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 required If not licensed, willingness to obtain state licensing or certification where required within 30 days of employment 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

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

Job DescriptionTitle: Casualty Claims Representative Reports To: Claims Manager Department: Property/Casualty and Workers' Compensation (PC/WC) SET SEG is looking for a Casualty Claims Representative who will be responsible for the investigation, negotiation, adjustment, and resolution of designated PC claims. This position reports to the Claims Manager. WHO WE ARE School Employers Trust (SET) is a non-profit company that was created after a monumental shift in school funding happened in 1965. SET, which began in 1971, served as an employee benefits association focused on offering comprehensive and affordable employee benefit solutions to Michigan public schools and their employees. Two years later, its partner organization School Employers Group (SEG) was formed to administer compensation and fringe benefits for SET. As schools were faced with more challenges related to insurance, SEG evolved and grew into a company that provides workers' compensation and property/casualty services for Michigan public schools. Today, SET SEG continues to expand and find creative ways to meet the specialized needs of its members. This, coupled with a superior member experience, is why SET SEG has maintained its position as an industry leader in the school insurance market. We value those who proactively solve challenges, simplify the complex, thrive in a fast-paced setting, have a customer-first mentality, and seek a collaborative and inclusive work environment. We are also listed on the Business Insurance Best Places to Work. We offer 100% employer paid insurance (medical, dental, and vision), Paid Time off (PTO), and paid parental leave. Our passion is delivering peace of mind to Michigan public schools and we look for team members who are motivated by our cause. To learn more, visit: ******************* WHO YOU ARE You are energized by working with a collaborative team and industry peers to support Michigan public schools through their challenges. You seek understanding and are motivated to tackle projects and problems with the customer in mind. You anticipate needs and preempt challenges and concerns, delivering increasingly relevant customer experiences over time. You value a culture that is rooted in mutual respect, where you can learn from different perspectives and roles. Primary Responsibilities: Manages, investigates, evaluates, negotiates, and adjusts assigned claims in adherence to guidelines within authority Ensures adequacy of reserves and recommends reserve increases on cases in excess of authority Monitors outside investigators and performs outside investigations when assigned. Provides oversight of medical, legal damage estimates, and miscellaneous invoices to determine if they are reasonable and related to designated claims Negotiates any disputed bills or invoices for resolution Assigns litigated claims to approved law firms and/or individual attorneys and monitors progress Follows a uniform system of reserving by reviewing incoming litigation, establishing initial reserves and completing reserve reports Negotiates settlements in accordance with claim handling standards while also considering member preferences when appropriate Attends facilitations/mediations as assigned Manages diary system to move losses to conclusion in a timely manner Participates in strategy sessions with internal business units such as Underwriting and Loss Control Other duties as assigned by the Claims Manager Required Qualifications: Bachelor's Degree plus two years of experience adjusting general liability and professional liability claims or an equivalent combination of education and experience Must have knowledge of coverage, liability, and complex claims handling procedures Ability to handle complex case-related tasks in a fast-paced and changing environment Excellent interpersonal skills and the ability to work in a strong team environment Must be highly organized and detail oriented Must be dependable, reliable, and able to achieve high levels of professionalism when handling cases and interacting with school district representatives and their employees, attorneys, families of injured and fellow employees Must be able to create and maintain high levels of confidentiality when dealing with proprietary information and sensitive situations Must have strong cognitive and analytical skills Ability to initiate, receive, understand, and reply to written and oral communication (verbal, written, telephone, e-mail, etc.) Ability to travel and work remotely on a periodic basis Physical Demands / Work Environment Several hours per day at a sit/stand desk, average mobility to move around an office environment; able to spend several hours per day at a computer. Occasional in-state travel may be required. Punctual, regular, and consistent attendance is required. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Powered by JazzHR 6mnEbh2mom

Medical Claims Associate The Claims Business Associate will perform all the duties necessary to ensure group members and providers receive proper payment of policy benefits in a timely manner, while providing excellent customer service. · Duties include but are not limited to: · Receive pending claims for evaluation and processing. · Enter and/or review claims data in the claims administration system and adjudicate claims. · Accurately code explanation of benefits. · Maintain claims and task procedural, financial, and timing standards. · Adjudicate pending claims. · Review claims and research as needed. · Process claims received. Experience: 3+ years claims processing experience. A working knowledge of ICD10, CPT codes and HIPAA guidelines; knowledge of medical terminology. This is a fully remote position. RequirementsGreat Communication Skills 8 week training - no gaps

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.

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

Summary: This position is responsible for investigating, evaluating and negotiating settlement of assigned large loss Commercial Auto Body Injury Claims in accordance with best practices and to promote retention or purchase of insurance from Grange Enterprise. If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. What You'll Be Doing: Pursuant to line of business strategies and good faith claim settlement practices, investigates, evaluates, negotiates, and resolves (within authorized limits) assigned claims. Demonstrates technical proficiency, routinely handling the most complex claims with minimal manager oversight. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business relationships with agents, insureds and Commercial Lines partners through regular, effective and insightful communications. May include face-to-face as needed. Will be the “point person” (when required) for certain identified large customer accounts where specialized communication and handling are required. Regularly develops and mentors other associates. Assists leadership in advancing the technical acumen of the department through the development of formal and informal training and resources. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assists other departments (when required) with investigations. May be assigned general liability claims during high volume workload periods. Demonstrates effectiveness and efficiencies in managing diary system and handling workload with limited supervision or direction. What You'll Bring To The Company: High school diploma or equivalent education plus five (5) years claims experience with at least three (3) years of Commercial Casualty experience. Experience in General Liability preferred. Bachelor's degree preferred. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Requires excellent decision-making ability, a broad depth of experience and technical competence and capacity to manage work to meet time sensitive deadlines. Demonstrated ability to interact with internal and external customers in a professional manner. State specific adjusters' license may be required. About Us: Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent). Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave. Who We Are: We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength. We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow. Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals. Our Inclusive Culture Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth. Together, we use our individual experiences to learn from one another and grow as professionals and as people.  We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.

Our Company: At AssuranceAmerica, we are more than a unique blend of insurance assets. We believe in creating a culture where every associate can learn and grow. We strive to create a work environment to meet associate needs and we are determined to achieve excellence in everything we do. This is an opportunity to join a dynamic team in a company that is a leader in the minimum limits auto insurance space and functions with a small company, entrepreneurial style. This position will require someone with an understanding that one needs to have a “roll up your sleeves” attitude to help make things happen. Job Summary: The Claims Adjuster Trainee will complete a series of Self-Study courses, classroom training and On The Job training to prepare for promotion to Adjuster Level 1 position. In addition, the Claims Adjuster Trainee will complete the necessary pre-requisite course work required to take and pass the Georgia Resident Adjuster Property and Casualty examination. The Claims Adjuster Trainee is responsible for investigating, reserving, negotiating and settling assigned property and casualty claims within provided authority. Ensures that all assigned claims are resolved timely and fairly in accordance with the policy contract based on the damages presented. The Claims Adjuster Trainee will work with minimal authority under direct supervision. Job Responsibilities: • Complete required training courses with a successful score • Obtain State of Georgia Resident Adjuster Property and Casualty license and maintain license through completion of state mandated Continuing Education. • Provide quality service to all parties involved in assigned claims. • Conduct thorough investigations into coverage, liability and damages for assigned claim in accordance with Claims Best Practices. Qualifications: Required • Bachelor's degree • Ability to pass State of Georgia Resident Adjuster Property and Casualty licensing exam. Preferred • Bilingual (Spanish) Core Competencies: • Attention to detail and ability to multi-task. • Excellent verbal and written communication skills. • A high degree of motivation and team orientation. • Strong computer skills. • Desire to develop new skills and grow in career. Our Values: We are direct, results driven, and dedicated to the success of the business and each other. In addition, we operate against these five key values, reflected in how we work with each other every day: • Honor: We do what is right, even when no one is looking. We play by the rules; integrity is of utmost importance. • Discipline: We are most efficient and resourceful in how we work… striving to be better than our competition. • Common Sense: We are relentlessly logical. We value an approach to our business that acknowledges the obvious and errs on the side of simplicity. • Financial Strength: Fundamental to our prosperity is an ever-vigilant focus on rigorous financial discipline. These practices enable us to navigate through all business cycles. • Dedication: We demonstrate a deep-seated respect for our Associates and customers. We listen and respond as best we can - for without them, our business would not exist. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time , with or without reason or notice by either the employer or the associate. AssuranceAmerica is an Equal Opportunity Employer

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

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.

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.

":"* 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":"AZ","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-12-18","zip":"85001","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. ","

As a Claims Specialty Adjuster, you will provide efficient and effective disposition of assigned claims through timely investigation, evaluation, and negotiation. This adjuster works well under moderate supervision using company best practices. They must execute files within their authority to make appropriate decisions regarding coverage, settlement, and liability. The Specialty Adjuster handles claims involving fire, theft, vandalism, marine, specialty products, coverage, collision (1st and 3rd), various other comprehensive losses and a variety of complex claims. This position investigates coverage, evaluates, and settles damages and effectively resolves claims to conclusion in a timely manner. In this role this adjuster is responsible for taking recorded statements, reviewing policies for coverage, settling claims including total losses and writing Reservation of Rights and Coverage disclaimer letters, when appropriate. The person in this role takes ownership of their personal brand, stays professional and works well individually and within a dynamic team atmosphere. Ready to get in the driver's seat? Join us! What you'll do Makes timely and appropriate contacts with necessary parties, determines, and completes appropriate level of investigation for coverage determination. Determines exposure, establishes adequate initial reserves, and makes timely adjustment to reserve(s) as required. Determines settlement value and negotiates proper settlement of claims within authority. Provides recommendations for settlement and disposition of claims exceeding authority level. Pursues subrogation when appropriate. Handles first party auto property damage losses and occasionally third-party property damage losses. Demonstrates strong negotiating skills Controls expenses and expense reserves on storage, towing, appraisals, vendors, or legal counsel Problem solves complaints or questions Demonstrating technical learning and skill Exemplifies strategic agility Submit timely large loss reports and occasional Large Loss reporting Authority/Accountability Level: A Specialty Adjuster is capable of analyzing and determining exposure for fire, theft, vandalism, and a variety of complex claims. This person must exercise discretion to identify and resolve coverage issues, identify potential fraud, and settle losses as appropriate. A Specialty adjuster will process approximately 600-800 lines annually and is responsible for reporting out to various departments within the business. This Job Is Responsible for Producing the Following Results: Maintaining stellar customer service tracked through company measurements Handles claims for fire, vandalism, theft, complex coverage in personal lines Meets or exceeds individual goals to help the department reach its targets Making appropriate coverage and/or settlement decisions Setting timely reserves Consistently produces quality work product Completing thorough investigations in order to determine coverage, liability, and settlement Analyzes facts to justify the assistance of SIU, O&C's, or legal counsel Ability to take quality recorded statements from many parties Identifies Red Flags Ability to write accurate Reservation of Rights letters and Coverage declinations Manages expenses Pursues recovery as applicable Fueling engagement within the team and department This might describe you Must be detail oriented and show a high level of accuracy Excellent verbal and written communication skills Knowledgeable in insurance products and expertise Exercise decisiveness and execution within their authority Must have ability to work individually and as a team Ability to maintain confidential information Strong problem-solving skills Strong time management and organizational ability Must possess a keen interest in self-development Needs to be reliable, accountable, and trustworthy Must be able to motivate and lead others Demonstrate proficiencies with computer software & multitasking Must maintain impeccable attendance Must be licensed and bondable Familiarity of public company requirements, including Sarbanes Oxley and key regulations, if applicable. Other things to note This position is open to U.S. remote work. Say hello to Hagerty Hagerty is an automotive enthusiast brand and the world's largest membership organization. Along with being a best-in-class provider of specialty insurance for enthusiasts, Hagerty is also home to the Hagerty Drivers Foundation, Garage + Social, Hagerty Drivers Club, Marketplace and so much more. Committed to saving driving for future generations, each and every thing Hagerty does is dedicated to the love of the automobile. Hagerty is a rapidly growing company that values a winning culture. We provide meaningful work for and invest in every single team member. At Hagerty, we share the road. We are an inclusive automotive community where all are welcomed, valued and belong regardless of race, gender, age, or car preference. We are united by our shared passion for driving, our commitment to preserve car culture for future generations and our desire to make a positive impact in the world. If you reside in the following jurisdictions: Illinois, Colorado, California, District of Columbia, Hawaii, Maryland, Minnesota, Nevada, New York, or Jersey City, New Jersey, Cincinnati or Toledo, Ohio, Rhode Island, Vermont, Washington, British Columbia, Canada please email ********************** for compensation, comprehensive benefits and the perks that set us apart. #LI-Remote EEO/AA US Benefits Overview Canada Benefits Overview UK Benefits Overview If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description The Executive Specialist will handle a regular diary of primary and excess Third-Party Privacy, Cyber, Media, Miscellaneous Professional Liability, and Technology E&O claims. These claims involve a high degree of technical evaluation and often include complex issues. Experience in Professional Liability (E&O) claims is required. The Executive Specialist will be expected to analyze and resolve such claims, including determining coverage, assessing potential exposure in a timely and accurate manner, and steering the litigation and/or negotiations through resolution. This position will add to a growing department, and will report to an Executive Risk Claims Manager. This position has a flexible workplace location for the right candidate, including with the ability to work remotely (other than occasional travel) or with a hybrid in-office/remote presence in the Jersey City, NJ, Morristown, NJ, Chicago, IL or other C&F office nationwide. What you will do: Accountable for the full handling and control of all claim matters assigned from inception through resolution, including: timely coverage analysis and letter writing; investigation; evaluation; reserve adequacy and timeliness; diary maintenance; management of defense and coverage counsel; reinsurance reporting; and claim disposition. The adjustment of these claims may require occasional in-person attendance at mediations, settlement conferences and trials.. Consistent prompt evaluation of potential exposure present as to all claims assigned as well as an ability to adapt to changing circumstances as claims develop. An ability to segregate potentially significant claims possessing considerable exposure from straightforward claims. Ability to consider and formulate a possible resolution strategy at the earliest possible opportunity, including setting appropriate and timely reserves and communicating with defense counsel, insureds or others to successfully achieve such strategy. Claim presentations, both written and oral, will be required on a regular basis to bring management up to speed, obtain authority and/or formulate appropriate action plans on difficult claims. Superior customer service to policyholders, agents, and others encountered during the claims handling process is expected. Where needed, the Executive Specialist may market claim services and coordinate and participate in presentations to customers or potential customers, including in support of C&F's underwriters. Attend conferences at various locations in the United States at the request of management. May work on special projects, as assigned. What you will bring to C&F: 3+ years of experience handling Third-Party Cyber, Media, Miscellaneous Professional Liability and/or Technology E&O claims, with opportunities for more experienced adjusters, and salary will be commensurate with experience. Candidates with experience in other professional liability lines will be considered on a case-by-case basis. Juris doctor preferred. Must possess multiple state adjuster licenses. Demonstrated presentation skills. Exceptional organizational skills. Outstanding interpersonal skills and the ability to deal effectively with support staff, claims staff, underwriting peers, actuaries, policyholders and senior management. Travel required for occasional in-person attendance at mediations, settlement conferences, trials and industry conferences. Experience with Microsoft Office suite of programs. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know. Belonging at C&F, is a mindset. It's about fostering a culture of inclusion and connection, where everyone feels valued, heard, and empowered to thrive and where our social impact efforts help strengthen the communities where we live and work. For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $110,000.00 to a maximum of $180,000.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-BS1 #LI-REMOTE

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. 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. For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy. NTT DATA currently seeks a **Coordination of Benefits Associate** to join our team for a **remote** position. **Role Responsibilities** + Use multiple sources in researching the potential of dual coverage and determining which Insurance is primary. + Update Claims System according to Member insurance + Making outbound call to other Insurance companies to verify coverages + Take up additional training/ new assignments or projects that may come up as per client needs. + Meet/ exceed required performance measures such as quality and productivity standards + Meet/ exceed process SLAs + Successfully complete the required regulatory and compliance requirements such as the HIPAA. + Successfully complete all organizational and client training requirements + Understand how work impacts results for their area as well as other processes. + Demonstrate knowledge of internal operations and develops relationships to facilitate workflow. + Knowledge of related regulations and standards. + Strong understanding of current processes and procedures and may identify opportunities for improvement. + Additionally, resources may have to do overtime and work on weekend's basis business requirement. **Required Skills/Experience** + High school Diploma or equivalent. + 3+ years of medical claims or eligibility experience + 5+ years of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, leverage internet search engines, and other web-based applications. + 5+ years of experience with the Microsoft Office suite that required daily usage of Outlook, Excel and Word. + Ability to type 40 WPM + Required schedule availability for this position is Monday-Friday (08:00am to 08:00pm CST/EST) . The shift timings can be changed as per client requirements. + Typing and Computer skills assessment 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. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. 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 also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com. NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. 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/hourly )** . 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. This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits. \#LI-NorthAmerica

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!

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. 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