Claims associate work from home jobs - 109 jobs

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

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

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

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

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. Not ready to apply? Connect with us for general consideration.

Claims Adjuster I (Worker's Compensation) - Southern Jurisdictions | 100% Remote (WFH) Opportunity Under direct supervision our Claims Adjuster I is responsible for timely and accurate management of workers' compensation claims with low to moderate medical and indemnity benefit exposure and minimal litigation. Preference given to candidates that have experience in FL, TN, MS, KY, AL, AR Essential Duties and Responsibilities * Receives and reviews new claims involving low to moderate medical, indemnity and occasional legal exposure. Caseload may include complex Medical Only claims. * Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action. Completes and maintains accurate claim system data. * Analyzes case facts to establish timely reserves using and building knowledge of medical-related costs and judgment about extent of disability. * Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers. * Accurately evaluates and pays benefits in compliance with statutory and company guidelines. Files appropriate state forms, as needed. * Proactively coordinates or monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure. * Working with supervisor, reviews and analyzes some legal issues. In collaboration with defense attorneys, proactively handles and mitigates exposure to litigation and prices up claims for minor settlements. * Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Requirements * 1 to 2 years of workers' compensation claims experience. * Knowledge of workers' compensation laws, regulations and statutes. * Excellent communication and customer service skills and knowledge of an imaged environment. * Self-motivated with excellent analytical, problem solving and decision-making skills. Strong ability to multi-task and prioritize. Certification * Must meet certification within state-mandated timeframe and maintain any required license through continuing education. * WCCP, AIC, ARM, CPCU or other insurance certification preferred. Education * Bachelor's degree or the above experience preferred. 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: $48,000 - $65,000 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

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.

Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues-not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.). Primary Responsibilities: Claims Management: - Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid. - Determine what was paid, what was denied, and why. - Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc. Payer Interaction: - Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard. - Understand and navigate multiple contracts. - Utilize BCBS portal to follow up and resolve outstanding claim issues. Analytical Review: - Differentiate between pricing errors vs. payment errors. - Accurately price claims based on contract terms and identify variances. Scope of Work: - Outpatient facility claims ONLY - Technical denials ONLY We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements - High school diploma or equivalent - Outpatient hospital billing experience - Experience with facility claims follow-up & appeals handling o Experience with UB04 forms o This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.) - Strong experience working with BlueCross BlueShield CareFirst and/or BlueCard o Familiarity using payer portal, their escalation process, how to read and interpret contracts - Experience meeting a productivity standard of following up on ~55 claims per day. - Knowledgeable of ICD + CPT Codes - Attention to Detail: o Must be able to spot errors and inconsistencies in claims and contracts. - Analytical Thinking: o Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly. - Independent & Fast Learner - Tech Savvy (Excel, Teams, etc.) and experience working fully remotely - Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

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

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

If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we're hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a Catastrophe Claims Adjuster II. A qualified candidate will have strong estimating skills, can comfortably handle high severity losses, and distill complex information for customers. You'll be able to effectively communicate and negotiate across multiple parties, including customers, contractors, and public adjusters. This is a desk-based adjusting position. If you're interested in joining our growing Claims team, we'd love to hear from you. What you'd be doing: Investigate and document property claims, including policy review, recorded statements, assigning inspections, updating reserves, preparing or reviewing estimates, and negotiating settlements Communicate claim updates and decisions verbally and in writing Handle claims in compliance with all applicable regulations and internal processes Provide technical expertise and serve as an SME for Claims-related projects Act as a resource for less experienced staff Support catastrophe response as needed, to include potential overtime and deployment Any other duties needed to help drive our purpose and fulfill our values We're looking for someone who has: 3+ years of property claims experience Estimating skills Excellent written and verbal communication skills Strong organizational abilities Empathetic interpersonal skills Adjuster licensed in home state or holds a non-resident license if license not required; meets requirements for licensing in additional states as needed Highly preferred candidates also have: Field claims experience Experience in catastrophe-focused environments Professional designations About the Claims team at SageSure: On SageSure's Claims team, you'll be doing more than investigating and resolving losses. From the ground up, you'll be pioneering a best-in-class claims handling approach that leverages transformative technology to support our customers, agents and employees. As a part of this customer-focused, process-oriented team you will be the face of SageSure, helping our policyholders through some of their most trying times. Whether you hold a formal leadership role or are a key team player, you'll coach, mentor and engage with those around you in ways that bring out the best in people and effect change. You can easily distill complex processes in ways those outside the industry can understand and know the importance of aligning communication tools to customer preferences. You thrive on setting and exceeding expectations, and know building relationships, not completing transactions, is the heart of the insurance business. About SageSure: Named among the Best Places to Work in Insurance by Business Insurance for four years in a row (2020-2023), SageSure is one of the largest managing general underwriters (MGU) focused on catastrophe-exposed markets in the US. Since its founding in 2009, SageSure has experienced exceptional growth while generating underwriting profits for carrier partners through hurricanes, wildfires, and hail. Available in 16 states, SageSure offers more than 50 competitively priced home, flood, earthquake, and commercial products on behalf of its highly rated carrier partners. Today, SageSure manages more than $1.9 billion of inforce premium and helps protect 640,000 policyholders. SageSure has more than 1000 employees working remotely or in-office across nine offices: Cheshire, Connecticut; Chicago, Illinois; Cincinnati, Ohio; Houston, Texas; Jersey City, New Jersey; Mountain View, California; Marlton, New Jersey; Tallahassee, Florida; and Seattle, Washington. SageSure offers generous health benefits and perks, including tuition reimbursement, wellness allowance, paid volunteer time off, a matching 401K plan, and more. SageSure is a proud Equal Opportunity Employer committed to building a workforce that reflects the spectrum of perspectives, experiences, and abilities of the world we live in. We recognize that our differences make us strong, and we actively seek out diverse candidates through partnerships with organizations, institutions and communities that represent various backgrounds. We champion belonging and inclusion for all identities, including, but not limited to, race, ethnicity, religion, sexual orientation, age, veteran status, ability status, gender, and country of origin, striving to create a culture where all individuals feel valued, respected, and empowered to bring their authentic selves to work. Our nimble, highly responsive culture nurtures critical thinkers who run toward problems and engineer solutions. We relentlessly pursue better outcomes by investing in the technology, talent, and tools that position us to succeed in demanding markets. Come join our team! Visit sagesure.com/careers to find a position for you.

":"* 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. ","

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

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.

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.

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.

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!

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

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