Claims Associate remote jobs

The Workers Comp Legal Claims department is looking for a Worker's Compensation Subrogation Representative I. Reporting to the Supervisor, Workers' Compensation Legal Subrogation, the Worker's Compensation Subrogation Representative is responsible for the daily management and resolution of Workers' Compensation Subrogation Claims in New Jersey. Leveraging technical expertise, the Worker's Compensation Subrogation Representative will be tasked with efficient handling of negotiations and resolution of Workers' Compensation liens while collaborating with other departments and policyholders to proactively share knowledge and expertise. Demonstrate flexibility and pursue challenging tasks. Schedule: Monday through Friday, with work from home opportunities after training is complete. Specific hours are subject to selected start time between 8am-9am pending supervisory approval Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job. Manage the negotiation and resolution of New Jersey Workers' Compensation liens; Interface with internal and external stakeholders, including policyholders, attorneys and insurance carriers; Produce lien correspondences, review of policy and litigation documents relative to third party actions, ensure quality claim documentation; Evaluate New Jersey Workers' Compensation claims and identify subrogation potential; Assist in onboarding and training of subrogation team members; Support Workers' Compensation Claims as needed Required Qualifications: Knowledge, skills & abilities, experience, minimum & desired education, certification and/or license requirements. Experience in Workers' Compensation Claims; Demonstrated skills in MS Word, Excel and other applications; Ability to accurately organize and examine legal and claims documents; Strong verbal and written communication skills with strong attention to detail and customer service; Strong organizational skills with the ability to manage competing priorities; Ability to work independently and collaboratively; Must have the ability to prioritize and proactively manage a large case load; Preferred Qualifications: Workers' Compensation claims or legal experience preferred; Subrogation experience preferred Compensation: Salary is commensurate with experience and credentials. Pay Range: $49,871-$57,881 Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses. Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.

Title: 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.

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

Company Details Berkley Small Business Solutions (BSB) is committed to providing small business customers with the next generation of small business solutions, including offering operational, underwriting, and marketing opportunities. We offer insurance products to Small Business Owners for transportation and other main street businesses. We leverage underwriting expertise, data, and analytics, and automation for risk assessment, selection, pricing retention. We champion our customers, distribution always seeking a smarter way to provide a more efficient and better user experience. We are a proud member of W. R. Berkley Corporation, one of the largest commercial lines property casualty insurance holding companies in the United States. With the resources of a large Fortune 500 corporation and the flexibility of a small company, we exclusively work with select independent agents to bring technology solutions that help them build their business. Responsibilities The position is responsible for handling low-complexity claims involving physical damage, property damage, total loss, fuel spills, medical payments, and cargo damage resulting from commercial auto claims. This position will work closely with insureds and stakeholders to ensure timely and accurate claims resolution and provide exceptional customer service. Customer Service Act with urgency in establishing initial and subsequent contact with all parties and key stakeholders. Update appropriate parties as needed, providing new facts as they become available and explaining impact of those facts upon the liability analysis and settlement options. Collaborate with vendors to ensure timely appraisal and evaluation of damages. Coverage Analyze coverage by applying policy information to facts or allegations of each loss. Communicate coverage decisions to insured and stakeholders and update coverage analysis as new facts warrant it. Ensure compliance with jurisdictional requirements, including timeliness of communicating coverage disposition. Data Integrity Maintain discipline in securing and updating information throughout the life of the claim. Ensure data is complete and comply with statutory requirements for reporting. Reserving Establish and maintain appropriate initial, subsequent loss, and expense reserves. Ensure supporting rationale for each reserve is documented within the electronic claim file. Act with urgency in collaborating with internal stakeholders regarding significant changes within claim reserving. Investigation Directly investigate each claim through prompt and strategic contact with appropriate parties including policyholders, witnesses, claimants, law enforcement agencies, agents, medical providers, and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders. Take recorded and/or written statements when appropriate. Evaluate all claims for recovery potential. Directly handle recovery efforts and/or engage and direct Company resources for recovery efforts. Evaluation and Resolution Utilize diary management system to ensure all claims are handled timely and in compliance with jurisdictional requirements and Company guidelines. Collaborate with external vendors, e.g., appraisers and independent adjusters. Manage total loss claims process including vehicle appraisal procedures, diminished value, vendor networks, subrogation demands, salvage procedures and heavy equipment appraisals. May perform other functions as assigned. Remote work arrangements may be considered for qualified candidates who are open to travel as needed. Qualifications 1+ years of casualty claim handling experience; trucking experience preferred. Excellent interpersonal and communication skills. Strong problem-solving and organizational skills. Computer proficiency, including working knowledge of Microsoft Office products. Previous experience in customer service role, or a related field, is preferred but not required. Willingness to learn and expand knowledge. Position will require that Claims Representative obtain independent adjuster's licenses for all states that have requirement, including but not limited to: AL, CT, GA, FL, ME, MS, NY, NC, SC, TN, TX. Licenses must be obtained within 90 days of hire and require course work, testing, and background checks that may include fingerprinting Education College degree preferred or equivalent work experience. Additional Company Details **************************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. • Salary Range: 75k - 90k • Eligible for annual discretionary bonus • Benefits: Health, Dental, Annual Bonus Potential, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

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.

Workers' Compensation Claim Consultant 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 don't just process claims-we support people. As a leading Third Party Administrator and a certified Great Place to Work , we offer manageable caseloads, employee ownership, and a collaborative culture. Our employee-owners are empowered to grow, contribute, and make a meaningful impact. 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. Performance is measured by accuracy, timeliness, and client satisfaction, with a focus on no penalties, current diary management, complete documentation, and timely payments. Responsibilities 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 Required 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 What We Offer Employee Stock Ownership Plan (ESOP): We're employee-owned, so your success is our success. Comprehensive Benefits Package: Includes medical, dental, vision, life insurance, disability, and 401(k). Generous Time Off: 4 weeks of paid time off in your first year, plus 10 paid holidays. Career Growth: Structured training, career progression pathways, and opportunities to advance within CCMSI. Supportive Environment: Manageable caseloads and a collaborative, team-focused culture. 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, our Core Values guide how we work: integrity, client service, employee ownership, continuous improvement, collaboration, and enthusiasm for what we do. #CaliforniaAdjuster #WorkersCompensation #ADRClaims #InsuranceCareers #ClaimsConsultant #CaliforniaJobs #RemoteAdjuster #SIPCertified #InsuranceProfessionals #ClaimsManagement #CareerGrowth #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Remote We can recommend jobs specifically for you! Click here to get started.

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. Summary: In this role you will be responsible for investigating, evaluating and negotiating settlement of assigned Commercial General Liability Property Damage claims in accordance with best practices to promote retention or purchase of insurance from Grange Enterprise. 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, allowing for the handling of more complex claims with minimal supervision. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business partner relationships with agents, insureds and Commercial Lines through regular and effective 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. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assist 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 of claims experience. Bachelor's degree preferred. For property focused role, at least two (2) years handling commercial general liability property claims handling exposures or frontline property claims handling experience preferred. Preference to those candidates with Construction Defect experience. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Demonstrated ability to interact with customers and agents 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.

TITLE: Marine Claims Consultant DEPARTMENT: EIMC REPORTS TO: Team Leader or Director of Marine Claims STATUS: Regular, full-time; exempt SUMMARY OF JOB PURPOSE EIMC, an Engle Martin company, is an independent marine consulting services company providing supply chain loss control and claims investigation expertise to insurers, brokers, 3PLs and industrial partners. The Marine Consultant effectively determines and communicates the extent of loss or damage associated with ocean marine claims in a variety of business classes. PRIMARY JOB RESPONSIBILITIES Independently opens and handles assigned cases within basic limits of complexity. Identifies, recommends, and pursues appropriate mitigation strategy with supervisory oversight as necessary. Expands knowledge base to include broader analysis of terms, clauses, and coverage. Independently selects appropriate company templates as required based on independent recognition of client requirements. Routinely produces clear, concise, and grammatically correct reports which require minimal review/editing; defers to senior level team members for assistance. Engages in peer review with others as directed. Reviews time and expenses with attention paid to estimates and client intent. Pursues and completes Lloyds Agency Module 3: Cargo Claims & Recoveries credentialing. Develops a higher-level understanding of market levers and influences. Granted supervised authority to communicate with clients beyond routine case correspondence; demonstrates timely reliability to clients. Attends company meetings and trainings with enthusiasm. Identifies potentially valuable case studies from personal field experience and works with management to share those cases through supervised contributions to presentations. Establishes and maintains positive working relationships with other members of the organization across departments, divisions, and locations. Maintains the confidentiality of proprietary and sensitive information, exercising sound judgment and discretion in any disclosure of information related to EM, EIMC, and its endeavors. Adheres to all applicable State Insurance Regulation requirements and other applicable laws, regulations, and standards. REQUIRED EDUCATION & EXPERIENCE Bachelor's degree preferred Prior experience in ocean marine claim adjusting or other insurance-related work preferred DESIRED KNOWLEDGE, SKILLS & ABILITIES Ability to understand claims adjudication process Excellent written and verbal communication skills Ability to manage multiple priorities and meet deadlines Passionate about providing exceptional customer service Skilled in analyzing, interpreting, and reporting pertinent information, discerning the essential from the non-essential Strong research and investigative skills Conflict resolution and persuasion abilities Organized and detail oriented Excellent problem solving and critical thinking skills Ability to work both independently and as part of a team WORKING CONDITIONS Work is conducted primarily in a remote location or in an indoor office environment with protection from weather conditions and with exposure to noise typical of an office or administrative setting. PHYSICAL ACTIVITIES AND REQUIREMENTS Work requires light lifting (10 - 20 lbs.), standing, walking, stooping, kneeling, reaching, fingering (keyboarding) and repetitive hand motion, grasping, talking, and hearing at normal speaking levels. Work requires visual acuity to read and prepare data and figures, type words and numbers, view information on a computer terminal, read, operate office machines, and determine the accuracy and thoroughness of work.

At Lendbuzz, we believe financial opportunity should be more personalized and fair. We develop innovative technologies that provide underserved and overlooked borrowers with better access to credit. From our employees to our dealers, partners, and borrowers, we've built a company and a culture around a resolute belief in the promise and power of diversity. We value independent and critical thinking. As an Insurance Claims Associate, you will play a pivotal role in working towards maximizing the financial recoveries for Lendbuzz. You will ensure that our clients receive the support and assistance they need to navigate auto insurance claims effectively. You will also ensure that Insurance companies pay us and our customers promptly and accurately. This role will require cross functional collaboration with various internal and external stakeholders. Your attention to detail, strong communication skills, and commitment to customer satisfaction will contribute to our continued success.Key Responsibilities: Assist clients in the initiation of auto insurance claims, providing guidance and support through the initial reporting process Follow up with insurance companies to check on status of claims and troubleshoot any hold ups / blockers in their processing Gather and review all necessary documentation related to insurance claims, including accident reports, policy details, and other relevant information Verify the accuracy and completeness of claims, ensuring they meet company and industry standards Serve as a primary point of contact for clients, insurance providers, and third parties involved in the claims process. Maintain clear and timely communication to keep all stakeholders informed Work with insurance providers to process claims efficiently and accurately, following up on any outstanding issues or discrepancies Provide exceptional customer support to clients, addressing their questions and concerns while ensuring a seamless claims experience Maintain detailed and organized records of claims, correspondence, and associated documentation Assist in the resolution of claims issues, including coverage disputes, repair estimates, and settlements Identify opportunities to enhance our claims process and provide feedback for process improvement Key Requirements: Bachelor's degree or equivalent experience in a relevant field preferred 1+ years of experience in the insurance industry preferred Previous experience in auto insurance claims or a related field is preferred Proficiency in both English is required, ability to also speak Spanish and/or Portuguese is preferred Strong interpersonal and communication skills Detail-oriented with excellent organizational abilities Customer service focussed with a commitment to delivering a positive experience Ability to work independently and as part of a team Adept at problem-solving and conflict resolution Adherence to ethical and professional standards in the insurance industry We believe: Diversity is a competitive advantage. We celebrate our differences, and are better when we have a variety of experiences, viewpoints, and backgrounds. Compassion is a strength. We care about our customers and look to build long-term relationships with them. Simplicity is a key feature. We work hard to make our forms and processes as painless and intuitive as possible. Honesty and transparency are non negotiable. We incorporate these traits in all of our interactions. Financial opportunity belongs to everyone. We work every day to improve lives by extending this opportunity. If you believe these things too then we would love to hear from you! A Note on Recruiting Outreach We've been made aware of individuals falsely claiming to represent Lendbuzz using lookalike email addresses (eg @ lendbuzzcareers.com ). Please note that all legitimate emails from our team come from @ lendbuzz.com . We will never ask for sensitive information or conduct interviews via messaging apps.

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. PetPartners, a subsidiary of IPH, is an ensemble of seasoned industry experts who are working to strip away all the complexities that don't add real value to pet insurance coverage. We're delivering solutions that make it easy for employers to offer this sought-after benefit in a way that's painless and worry-free - a truly one-of-a-kind approach to pet insurance. Job Summary: PetPartners is seeking a Claims Adjuster- Associate who will report to the Supervisor, Claims. The Claims Adjuster- Associate is responsible for investigating, evaluating, and settling insurance claims. This role also determines policy coverage for the claimed loss and appropriate compensation amount. Job Location: Remote- USA Main Responsibilities: Works closely with veterinary hospitals, and policyholders to evaluate and review a pet's medical history to determine a baseline of health. Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy. Updates Explanation of Benefits (EOB), pays and closes claim. May order medical records from providers. May communicate with clients and providers during treatment. Performs other duties and responsibilities as assigned. Basic Qualifications: 1 year relevant experience working in a veterinary clinic Education: Must meet one of the following requirements: Associate's Degree or equivalent work experience (One-year relevant experience is equivalent to one year college); or Certified Veterinary Technician (CVT) Registered Veterinary Technician (RVT) Licenses/Certifications Must have and maintain Adjusters license or must obtain within 90 days of hire Only United States residents will be considered for this role Expected Hours of Work: This is a full-time position: Days and hours to be determined by needs of business. Hours to be determined between employee and director. #li-Remote #PPI 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)

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. 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 Claims Adjuster (Workers' Compensation) | 100% Remote Opportunity (covering the states of - GA, SC, NC, and VA) Must have experience in one or more of the following states: Georgia, South Carolina, North Carolina, Virginia General Summary Using claims system automation and capabilities, the Medical Only 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 claims involving no or minimal lost time from work. Under direct supervision, may handle a small number of fast-track indemnity claims that have low exposure or complexity. Communicate 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 fraud or abuse throughout the course of the claim. Reviews claims for closure and proactively takes action to guide claims in that direction. Other duties as assigned. Requirements Minimum of 1 year general office experience or equivalent combination of education and experience. Minimum 6 months experience working in workers' compensation insurance environment or an equivalent combination of education and qualifying experience. Experience in one or more of the following states: - GA, SC, NC, and VA Working knowledge of medical terminology 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. Always conduct business with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality. Claims Insurance industry experience preferred. Education / Certifications If State Certification is required, must meet certification within the state mandated time frame. AIC, ARM, or CPCU certification Preferred, not required Must have High School Diploma or GED equivalent. 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 Hourly Pay Rate: $20.00 - $26.00 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":"TX","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-11-18","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. ","

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Claims Associate will key claims, handle incoming mail from various sources, upload and route work to the appropriate queues within the claims processing system. The Claims Associate is responsible for some of the pre-processing claims queues and will key Health Insurance Claim Forms (HCFA), Uniform Bill 04 (UB), Superbills, vision, and dental claims. This role will ensure that all necessary documentation is received in order to key claims and will reject documents received for individuals who are not Fund participants. ESSENTIAL JOB FUNCTIONS AND DUTIES * Screens claims for completeness to insure all required information is received * Keys all claim types processed by the Fund * Adjudicates pre-processing claims according to established productivity and quality goals * Utilizes the claim processing system and the eligibility system to select patient information and route claims to the appropriate personnel for adjudication * Handles daily incoming hard copy documents, returned mail and electronic documents which includes opening, sorting, scanning & uploading images into the Javelina claim system for processing * Identifies documents sent to UHH in error and forwards to the PPO vendors for handling or if necessary returns to members and/or providers * Monitors inventory aging reports to insure claims are processed within time requirements. Processes claims on a first in, first out basis regardless of complexity or difficulty * Meets or exceeds established productivity and quality objectives * Responds to written inquiries sent to the Claims Mail email box when appropriate or forwards to the appropriate claims team for handling * Responds to Mailroom personnel questions regarding the Claims Department mail and advises how it should be handled * Demonstrates the Fund's Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth ESSENTIAL QUALIFICATIONS * 2 ~ 3 years of related experience minimum * Minimum of 1 year of healthcare and medical terminology experience preferred * Proficiency in medical terminology, ICD 10 and CPT coding, and experience or exposure to health claim processing is required * Experience with working an automated claim processing system is preferable * Prior experience in an office production environment with quality goals especially related to healthcare benefits administration is preferred * Prior experience with eligibility verification, coordination of benefits, medical provider selection, medical coding and subrogation is preferred Salary range for this position: Hourly $17.49 - $21.38. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a flexible hybrid work-from-home arrangement. This means you are responsible for initial training in office, plus approx. one day a week in office, Oak Brook IL. We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP). #LI-Hybrid

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. 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.

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 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. **Role Responsibilities** + 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 **Required Skills/Experience** + 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. **Preferences** + Amisys &/or Xcelys Preferred + Time management with the ability to cope in a complex, changing environment + Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities + Previously performing - in P&Q work environment; work from queue; remotely **Must be able to work 7am - 4 pm CST online/remote (training is required on-camera).** \#LI-NorthAmerica 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 - $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.