Claims Director remote jobs

Scheduled Hours 40 Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management. Job Description Primary Duties & Responsibilities: * Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files with guidance of legal counsel. Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; evaluates liability and financial exposure, approves expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value. Attends mediation, arbitration, and/or trial. * Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carriers, and when applicable, coordinates with external agency investigations, i.e., professional Board inquiries. Responds to general claim inquiries. * Establishes indemnity and expense reserves based on the reserving policy. Negotiates settlements within authority. Reviews and approves defense counsel related invoices and expenses. * Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation. Arrange for attorneys to attend depositions with physicians when necessary. Mentors less experienced claims managers. * Performs other duties as assigned. Working Conditions: Job Location/Working Conditions * Normal office environment Physical Effort * Typically sitting at a desk or a table Equipment * Office equipment The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: Bachelor's degree Certifications/Professional Licenses: No specific certification/professional license is required for this position. Work Experience: Analyzing Or Interpreting Medical Or Other Technical Evidence That Compares In Level Of Complexity To Medical Treatment (5 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job Preferred Qualifications: * Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered. * General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care. * Knowledge of methods and techniques of individual case study, recording and file maintenance. * Seven years' experience in medical malpractice claims management. Preferred Qualifications Education: No additional education unless stated elsewhere in the job posting. Certifications/Professional Licenses: No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: No additional work experience unless stated elsewhere in the job posting. Skills: Analytical Thinking, Defining Problems, Detail-Oriented, Disease Diagnosis, Disease Management, Group Presentations, Injury Treatment, Joint Commission Regulations, Organizational Savvy, Patient Safety, Report Preparation Grade G13 Salary Range $65,900.00 - $112,700.00 / Annually The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email **************************** or call the dedicated accommodation inquiry number at ************ and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal * Up to 22 days of vacation, 10 recognized holidays, and sick time. * Competitive health insurance packages with priority appointments and lower copays/coinsurance. * Take advantage of our free Metro transit U-Pass for eligible employees. * WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness * Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family * We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We've got you covered. * WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: ****************************** EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University's policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information. Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment - fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.

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 adjusters 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 As a Director of Commercial Transportation Claims at Reserv, you will be responsible for a team of Claims Professionals overseeing a wide variety of Commercial Transportation claims, including but not limited to Trucking, Garage Keeper, Specialty Vehicle, Rideshare/TNC, and Delivery claims. We want your background and experience to drive operational effectiveness, with a focus on leveraging technology and analytics to improve efficiency and performance in the Commercial Transportation space. In this role, you will play a critical part in working with your team, customers, and clients to ensure high-quality standards are maintained, while adhering to regulatory requirements and both internal and external contractual SLAs. This position requires exceptional leadership skills and a strong understanding of state and federal transportation rules and regulations, ideally with experience managing or handling large, complex claims portfolios. Who you are Highly motivated and growth-oriented Subject matter expert. You have deep technical and subject matter experience in the world of commercial transportation claims, including coverage and litigation. Experienced in reviewing and analyzing contracts Tech-oriented. You are excited by the prospect of building a tech-driven claims organization while delivering an excellent service and have proven results leveraging technology and analytics Passionate claims professional who cares about their team, the customer, and their experience Empathetic leader. 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 challenge existing assumptions and find ways of leveraging technology and the talents of your team to address problems Curious. You want to know the whole story so you can make the right decisions early and be decisive when it counts. Problem solver. You have the ability to take a ‘deep dive' into the details of the business while staying focused on the big picture Anti-status quo. You don't just wish things were done differently, you action on it Communicative. You are comfortable with and understand the importance of phone communications throughout the claims process And did we mention, a sense of humor. Claims are hard enough as it is. What we need We need you to do all the things typical to the role: Manage a unit of Commercial Transportation claims professionals at the management and desk level. Be consistently dependable in achieving or exceeding goals and overcoming obstacles Implement and maintain best practices for claims handling, including: claim intake, investigation, evaluation, settlement, and recovery Monitor and analyze claims data to identify trends, patterns, and areas for process improvement Align team with client and customer expectations of the claims process Serve as a resource for escalated claims Responsible for accuracy and adequacy of all aspects of claim reserving Develop and implement strategies to mitigate fraudulent claims and ensure compliance with legal and regulatory requirements Foster a positive work environment, promote teamwork, and encourage professional growth and development Execute on performance management; attract, hire, retain and provide high level of training Collaborate with internal teams, such as Account Management, Compliance, and Claim Operations, to resolve complex or escalated claims-related issues Establish and maintain strong relationships with external stakeholders, including policyholders, agents, brokers, and legal representatives Prepare and present comprehensive claims reports, metrics, and analysis to clients and customers; advise clients on claim trends and loss mitigation Requirements Bachelor's degree in insurance, business administration, or a related field; relevant certifications (e.g., CPCU, AIC) as well as a JD are a plus 10+ years in insurance claims management experience in Commercial Transportation Minimum of 5 years of experience concentrated in commercial claims, ideally with: 5+ years management experience with preference for experience managing in a remote environment 5+ years of detailed coverage analysis and policy interpretation is a plus Active home state adjusters license Comfortable with technology and the ability to evolve the claims systems and processes to drive better efficiencies and outcomes Demonstrated commitment to quality, accuracy, and attention to detail Integrity, ethics, and a strong sense of accountability in handling confidential and sensitive information 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 Work from anywhere to facilitate your work life balance paired with frequent, regular corporate retreats to build team cohesion, reinforce culture, and have fun 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!

Oak View Group Oak View Group is the global leader in venue development, management, and premium hospitality services for the live event industry. Offering an unmatched, 360-degree solution set for a collection of world-class owned venues and a client roster that includes the most influential, highest attended arenas, convention centers, music festivals, performing arts centers, and cultural institutions on the planet. Position Summary Working in conjunction with the VP, Risk Management: The Claims Director position has a responsibility to manage the day-to-day and long-term operations of the OVG Corporate International Insurance Claims Department. This role pays an annual salary of $115,000-$140,000 and is bonus eligible Benefits for Full-Time roles: Health, Dental and Vision Insurance, 401(k) Savings Plan, 401(k) matching, and Paid Time Off (vacation days, sick days, and 11 holidays) This position will remain open until January 9, 2026. Responsibilities Manages, plans, and coordinates insurance claims process to control risks and losses. Duties & Responsibilities Team leadership: Guide and manage a team to achieve high-level claims operations, claims vendors, TPA's Policy and claims procedures establishment: Create and maintain policies and procedures for the management of claims occurring across the organization that are consistent with the corporate claims strategy and loss control. Claims management: Oversee the claims process, including coverage reviews, claim verification, and adjudication. Manage the administration of general liability, errors & omissions, property, workers' compensation, cyber and vehicle claims to ensure that claims are being settled fairly, consistently, and in the best interest of the company. Collaboration: Work collaboratively with insurance brokers, carriers and project teams to ensure overall compliance with the company's Risk Management goals, policies and procedures. Financial Management: Timely, accurate payment and adjudication of claims Process improvement: Set up a process of continuous improvement. Develop and implement processes to increase the efficiency and effectiveness of the claims department. Customer service: Ensure that internal and external customers receive excellent service Claims representation: Represent the department and company Claims advice: Provide professional advice to customers, senior management, and departments on all aspects of the claim management and reporting Risk management: Assist with the development of the organization's risk management process. Identification of new opportunities for lowering the total cost of risk. Communication: Articulate complex concepts and issues through oral and written communications and consult with senior management in establishing corporate policies and procedures to manage and control corporate claims risks. Other duties as assigned. Qualifications Candidate Requirements: 10+ years of P&C claims management experience with a claims department, insurance carrier or TPA Extensive knowledge of commercial insurance claim operations and insurance coverage. Bachelor's degree in insurance, Accounting, Business Administration or equivalent. Strong PC skills (MS Office Suite). Knowledge of risk management practices, policies and programs. Excellent written communication, negotiation and presentation skills. Ability to relate well to others both inside and outside the organization and build effective business relationships. Demonstrated analytical ability, leadership and problem-solving skills. Strong written verbal communication skills. Ability to exercise sound judgement and work independently and in a team environment Ability to lead projects and process design and lead and direct the work of others. Must demonstrate consistency, accuracy and follow through. Must demonstrate a customer service mindset Ability to work under tight time constraints, handle sensitive data and multi-task so that deadlines can be met. Highly organized and able to prioritize and manage time efficiently with the ability to handle stress in a fast-paced, deadline driven environment. Empathetic, resilient, ability to flourish in a fast-paced environment Any of the following certifications are a plus: CCP, CPCU, RPLU, ARM, CISR, AU, PMP Claims management experience on all commercial lines of insurance a plus International claims experience a plus Strengthened by our Differences. United to Make a Difference At OVG, we understand that to continue positively disrupting the sports and live entertainment industry, we need a diverse team to help us do it. We also believe that inclusivity drives innovation, strengthens our people, improves our service, and raises our excellence. Our success is rooted in creating environments that reflect and celebrate the diverse communities in which we operate and serve, and this is the reason we are committed to amplifying voices from all different backgrounds. Equal Opportunity Employer Oak View Group is committed to equal employment opportunity. We will not discriminate against employees or applicants for employment on any legally recognized basis (“protected class”) including, but not limited to veteran status, uniform service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other protected class under federal, state, or local law.

Oak View Group Oak View Group is the global leader in venue development, management, and premium hospitality services for the live event industry. Offering an unmatched, 360-degree solution set for a collection of world-class owned venues and a client roster that includes the most influential, highest attended arenas, convention centers, music festivals, performing arts centers, and cultural institutions on the planet. Overview Working in conjunction with the VP, Risk Management: The Claims Director position has a responsibility to manage the day-to-day and long-term operations of the OVG Corporate International Insurance Claims Department. This role pays an annual salary of $115,000-$140,000 and is bonus eligible Benefits for Full-Time roles: Health, Dental and Vision Insurance, 401(k) Savings Plan, 401(k) matching, and Paid Time Off (vacation days, sick days, and 11 holidays) This position will remain open until January 9, 2026. Responsibilities Manages, plans, and coordinates insurance claims process to control risks and losses. Duties & Responsibilities Team leadership: Guide and manage a team to achieve high-level claims operations, claims vendors, TPA's Policy and claims procedures establishment: Create and maintain policies and procedures for the management of claims occurring across the organization that are consistent with the corporate claims strategy and loss control. Claims management: Oversee the claims process, including coverage reviews, claim verification, and adjudication. Manage the administration of general liability, errors & omissions, property, workers' compensation, cyber and vehicle claims to ensure that claims are being settled fairly, consistently, and in the best interest of the company. Collaboration: Work collaboratively with insurance brokers, carriers and project teams to ensure overall compliance with the company's Risk Management goals, policies and procedures. Financial Management: Timely, accurate payment and adjudication of claims Process improvement: Set up a process of continuous improvement. Develop and implement processes to increase the efficiency and effectiveness of the claims department. Customer service: Ensure that internal and external customers receive excellent service Claims representation: Represent the department and company Claims advice: Provide professional advice to customers, senior management, and departments on all aspects of the claim management and reporting Risk management: Assist with the development of the organization's risk management process. Identification of new opportunities for lowering the total cost of risk. Communication: Articulate complex concepts and issues through oral and written communications and consult with senior management in establishing corporate policies and procedures to manage and control corporate claims risks. Other duties as assigned. Qualifications Candidate Requirements: 10+ years of P&C claims management experience with a claims department, insurance carrier or TPA Extensive knowledge of commercial insurance claim operations and insurance coverage. Bachelor's degree in insurance, Accounting, Business Administration or equivalent. Strong PC skills (MS Office Suite). Knowledge of risk management practices, policies and programs. Excellent written communication, negotiation and presentation skills. Ability to relate well to others both inside and outside the organization and build effective business relationships. Demonstrated analytical ability, leadership and problem-solving skills. Strong written verbal communication skills. Ability to exercise sound judgement and work independently and in a team environment Ability to lead projects and process design and lead and direct the work of others. Must demonstrate consistency, accuracy and follow through. Must demonstrate a customer service mindset Ability to work under tight time constraints, handle sensitive data and multi-task so that deadlines can be met. Highly organized and able to prioritize and manage time efficiently with the ability to handle stress in a fast-paced, deadline driven environment. Empathetic, resilient, ability to flourish in a fast-paced environment Any of the following certifications are a plus: CCP, CPCU, RPLU, ARM, CISR, AU, PMP Claims management experience on all commercial lines of insurance a plus International claims experience a plus Strengthened by our Differences. United to Make a Difference At OVG, we understand that to continue positively disrupting the sports and live entertainment industry, we need a diverse team to help us do it. We also believe that inclusivity drives innovation, strengthens our people, improves our service, and raises our excellence. Our success is rooted in creating environments that reflect and celebrate the diverse communities in which we operate and serve, and this is the reason we are committed to amplifying voices from all different backgrounds. Equal Opportunity Employer Oak View Group is committed to equal employment opportunity. We will not discriminate against employees or applicants for employment on any legally recognized basis (“protected class”) including, but not limited to veteran status, uniform service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other protected class under federal, state, or local law.

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities Ready to Lead Complex Healthcare Data Integrations That Power Enterprise Excellence? We're seeking a strategic, technically adept professional who can serve as technical and analytical lead for managing complex healthcare claims data integrations across multiple platforms and partners. As our Senior Claims Integration Specialist, you'll oversee the end-to-end lifecycle of claims ingestion, transformation, and validation while mentoring team members and optimizing integration workflows. What makes this role different: ✓ Technical leadership: Configure, design, and optimize integration workflows while leading root-cause analysis for data anomalies ✓ Mentorship opportunity: Guide junior team members on best practices in claims data management and automation ✓ Cross-platform expertise: Ensure data quality, compliance, and operational stability across Personify's entire claims ecosystem ✓ Strategic impact: Combine technical proficiency with strategic mindset to enhance process efficiency, scalability, and accuracy What You'll Actually Do Lead carrier partnerships: Serve as primary liaison with healthcare carriers to establish and maintain data exchange partnerships while communicating and enforcing universal data specifications. Manage data ingestion: Collaborate on analysis of inbound healthcare claims data feeds to identify and triage validation or data quality issues using SQL and transformation logic. Optimize integration workflows: Map carrier-specific data fields into company's universal data model while implementing ingestion processes ensuring data integrity and compliance with internal standards. Troubleshoot complex issues: Understand and troubleshoot ingestion pipelines, resolving data quality issues and ingestion failures while diagnosing root causes of data anomalies. Ensure system accuracy: Verify claims data is accurately processed and routed to all relevant internal systems including client servicing platforms, analytics tools, and operational dashboards. Implement quality controls: Execute robust data validation, reconciliation, and quality control processes while monitoring ingestion performance and proactively resolving discrepancies. Maintain comprehensive documentation: Create and maintain requirement documentation including business rules, file mapping, and transformation process specifications for all inbound claims files. Collaborate strategically: Partner with product, operations, technology, data engineering, and architecture teams to support downstream use cases and optimize database structures. Qualifications What You Bring to Our Mission The educational foundation: Bachelor's or Master's degree in Health Informatics, Information Systems, Business/Statistics/Information Science, or related field 3+ years experience in healthcare data integration, claims processing, or payer-provider data exchange The technical expertise: Strong understanding of healthcare claims formats (EDI 837, NCPDP, proprietary formats) and wide variety of claims formats and coding standards (CPT, ICD, DRG) Strong SQL skills with ability to write and tune complex queries against large-scale datasets Proven experience managing external partnerships and internal cross-functional teams Familiarity with data warehousing, ETL tools, and cloud-based data platforms is plus The strategic competencies: Data architecture mastery: Design and optimize data models to support scalable ingestion and integration of healthcare claims data Schema translation expertise: Translate complex or varying carrier-specific schemas into normalized structures aligned with enterprise data standards Cross-functional collaboration: Work effectively with carriers and internal departments to ensure claims data is structured for downstream applications Industry standards knowledge: Knowledge of industry standard specifications such as FHIR, HL7, and EDI preferred The professional qualities: Excellent communication and project management skills Self-motivated with critical thinking and problem-solving abilities Strong understanding of data governance, master data management (MDM), and data quality frameworks preferred Proven ability to bridge technical and business domains to deliver data-driven solutions Experience with claims data reconciliation and migration projects preferred Experience working in or with analytics-focused organizations, data consultancies, or enterprise data platforms preferred Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary plus that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $68,000 to $85,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for 10% target bonus/variable compensation as well as health, dental, vision, mental health and other benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. Pets Best is seeking a Supervisor, Claims Processing who will report to the Manager, Claims. The Supervisor, Claims Processing is responsible for leading a team of non-exempts for the Claims Processor group. Providing leadership, coaching and development. You will own full supervisory and administrative responsibilities for the team members, and also share with other leaders the responsibility overall for a positive, friendly culture in the department that is customer-centric, productive, and contributes to the growth of the business. Job Location: Remote - USA Main Responsibilities: Directly responsible for leading your team to success - driving performance management, ensure accuracy of claims processes, and ensuring your team is equipped to provide a positive customer/client experience Ensure appropriate risk for the business - ensuring your team is familiar with and understands the importance of following operating instructions including compliance requirements Drive results by ensuring that your team is meeting or exceeding performance targets via OKR/KPI coaching and leadership Inspiring and connecting with each team member - cultivating an environment of trust, teamwork and personal ownership. Partnering with each team member to understand and help support their personal development Project management - initiating, planning and executing on key business initiatives Be a business partner - ability to understand and relate to the business objectives and provide strategic vision and a high-quality solutions. Learning, staying abreast and complying with all claim's compliance laws, rules and regulations. Assists with claims processing function duties as needed to maintain daily turnaround time Performs other duties as assigned. Basic Qualifications: Bachelor's degree or in lieu of a Bachelor Degree, a High School Diploma/GED and a minimum of 3 years experience in a veterinary clinic or like setting; such as a practice manager, Lead Veterinary Technician, Animal Science Research, etc. 3+ years clinical veterinary experience with a proficiency in medical terminology. Leadership experience - Minimum of 2 years of proven experience leading a team - Be prepared to share with us some specific examples of how you've inspired your team and driven performance using qualitative and quantitative results Flexible - The hours for this role are between 6 AM & 9 PM EST with a weekend rotation each quarter as manager on duty (comp day provided M-F the week prior). This role could include some weekend shift as well as work on holidays.1-year relevant experience and/or claims experience within a clinic or hospital 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 #petsbest All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. **$20k Sign-on Eligible** **(Open to remote work location if outside designated Arch office) Position Summary Responsibilities include, actively managing and effectively overseeing large exposure and complex general/auto liability and trucking claims (primary, umbrella and excess) direct handled by Third-party Administrators (“TPA's”) and supporting Arch business stakeholders. Please note this role does require managing any direct reports but is responsible for managing the claims & TPA process. Responsibilities Deliver industry leading technical claim handling/oversight, claim outcomes, business support and customer service. Make claim services an Arch competitive advantage Collaborate with TPA team members, Arch Claim Account Managers (“CAM's”) and other claim professionals to proactively develop and effectively execute on appropriate claim resolution strategies Work closely with underwriters, Legal, Operations, claim professionals, and other Arch functions, to ensure timely and effective communication consistent with Arch Claims' Procedures, striving to achieve optimum claim outcomes Effective and timely communication with insureds and brokers; making exceptional customer service a top priority Coverage analysis, investigation, liability and damage evaluation, timely and accurate indemnity and expense reserving (within specific granted authority), litigation management, vendor management, settlement negotiations, including use of structure settlements where appropriate, and claim resolution Effective claim file documentation, claim coding and diary management Retain and work closely with defense and coverage counsel to create and execute on litigation/coverage strategies and budgets. Analyze and pay legal bills, consistent with claims specific strategy/budget and Arch Claims Litigation Management Guidelines Effective and timely claim reporting (verbal and written) to other claim professionals/management and business stakeholders, per Arch Claims Procedures Attend mediations, trials, other proceedings and meetings Maintains all required state adjustor licenses Assist CAM's and others with TPA management and oversight to include: o TPA claim staff training relating to Arch processes, procedures, expectations, reporting, technical claim handling, litigation/vendor management, legal/regulatory developments, customer service and other topics that may arise o Sharing of claim handling/customer service best practices o Assistance with claim file reviews and claim audits o Regular meetings with TPA claims staff Experience & Required Skills Trucking, construction, emergency service/medical professional liability claim handling experience is a plus TPA management/oversight experience is a plus Excellent customer service skills and service minded Strong analytical and problem-solving skills Strong negotiation skills Exceptional communication (written and verbal), collaboration, influencing, listening, and interpersonal skills to effectively develop productive working relationships both within and outside Arch Able to process large amounts of complex information, distill it down to key issues and decision points and concisely communicate the information verbally and in writing Able to effectively lead strategic discussions and leverage technical knowledge to make sound, cost-effective decisions and recommendations Able to work well independently and in a highly collaborative team environment Adaptable and able to succeed in a rapidly changing workplace Strong Microsoft Excel, PowerPoint and Word skills Willing and able to travel approximately up to 10% of time Education Bachelor's degree required; Juris Doctorate preferred Minimum of 10 years commercial general/auto liability claim handling experience, including responsibility for complex and large exposure claims, or insurance defense/coverage practicing attorney with similar law firm experience #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $145,000 - $160,000/year Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.

*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k

Cottingham & Butler Claims Services was built upon driven, ambitious people like yourself. “Better Every Day” is not just a slogan, it is a promise we make to ourselves and our clients. We are looking to add an experienced Claims Supervisor to our team. As a Claims Supervisor, you will be responsible for: Management - supervising a team of Auto/Liability Adjusters, coordinating their training and development, and ensuring they develop to their fullest capabilities and provide the same high level of service. Compliance - ensures that claims handling is conducted in compliance with applicable statutes, regulations and other legal requirements, and that all applicable company procedures and policies are followed. Claims - investigating, taking statements, estimating damages, determining liability, denying claims, subrogation, litigation, etc. The ideal candidate for this position will have 5+ years of commercial auto liability adjusting experience and 1-5 years of management experience. Do you think this might be a fit for you? Send us your resume - we'd love to talk! Pay & Benefits Salary - Flexible based on your experience level. Most Benefits start Day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/ Defined Contribution (1-year waiting period) PTO/ Paid Holidays Company-paid ST and LT Disability Maternity Leave/ Parental Leave Company-paid Term Life/ Accidental Death Insurance About the company At Cottingham & Butler, we sell a promise to help our clients through life's toughest moments. To ensure we keep that promise, we hold ourselves to a set of principles that we believe position our clients and our company for long-term success. Our Guiding Principles are not just words on paper, they are a promise we make to ourselves and our clients. These principles have become a driving force of our culture and share many common themes with the values of our clients. First, we hire and develop amazing people that have an insatiable desire to succeed, are committed to learning, and thrive on challenges. Secondly, we pride ourselves on serving our clients' best interests through quality service, innovative solutions, and constantly evaluating our performance. Third, we have embraced and are guided by the theme of "better every day" constantly pushing ourselves to be better than yesterday. Ultimately, we get more energy from the future we are creating for our people, our clients, and our company than from our past success. As an organization, we are very optimistic about the future and have incredibly high expectations for our people and our performance. We also understand that our growth is fueled by becoming better, not bigger - growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.

Full-time Description Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service. Our company values can best be described with ABLE: to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success. What You'll Do Under moderate supervision of Management, the Claims Supervisor performs the essential functions of the position, which includes but is not limited to supervising a team of Claims Representatives and Claims Support Specialists. Ensure that the team meets service standards and performs essential functions at or above the quality and service standards of Aspire General Insurance Company. DUTIES AND RESPONSIBILITIES: · Review of automobile claim investigations. · Make handling recommendations and provide directions to subordinates. · Ensure ongoing adjudication of claims within company standards and industry best practices and regulations. · Determine, recommend and grant authority for settlement and payment processes. · Responsible for overall file handling and work product quality of subordinates. · Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation. · Assist in the operations of the claims department, including making recommendations and implementing an organizational structure adequate for achieving the department's goals and objectives. · Maintain a documented system of claims policies, systems, procedures and workflows to ensure smooth operations. · Provide feedback to Management on process and system improvement initiatives for the department. · Report to Management as soon as there is an awareness of any issues or concerns which may be detrimental to the department or Company; recommend policies and procedures to Management regarding quality issues that may arise. · Staff Training-Foster a highly focused training and development environment within the Claims Department. · Complies with state and federal laws, Department of Insurance criteria, insurance carrier criteria and follows and enforces Aspire General Insurance Company and partner's policies, procedure and work rules. · Communicate and provide timely notification to the Human Resources Department for all things related to employee attendance, punctuality or possible leave related situations. · Provide timely and thorough documentation for all things related to employee performance, training, recognition and/or coaching. · Evaluate subordinates' performance and administer personnel actions as required in coordination with human resources department. Ensure the Department has adequate scheduling, including time-off requests, work shift management, etc Assist to identify, recruit, hire and develop top talent. · Ability to achieve targeted performance goals Maintain that sensitive information regarding employees and the Company is kept confidential Regular and predictable punctuality and attendance. · Other duties as necessary. Requirements · Three plus years' experience in Property and Casualty insurance industry. · Must have a clear understanding of insurance industry practices, standards and terminology. · Experience in handling subrogation, property damage and injury claims required. · Must be able to pass a background check. · Must have the ability to work in a high volume, fast-paced environment while managing multiple priorities. · Must have a disciplined approach to all job-related activities. · Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills. · Must have strong keyboard skills as well as proficiency in Windows and MS Office products. INTER-RELATIONSHIP COMPONENT: Ability to develop excellent working relationships with Staff, Partners, Clients and outside agencies. Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of goodwill, indicative of a professional environment and atmosphere. Ability to be a team player and work cohesively with other Aspire General Insurance and Partner Companies' staff to achieve company goals. Able to represent the Company in a professional manner and contribute to the corporate image. Able to consistently provide excellent service. WORKING CONDITIONS: This is an exempt position which complies with an alternative work schedule when applicable. This work environment is fast-paced, and accuracy is essential to successful task completion. The office is that of a highly technical company supporting a paperless environment. Travel may be required. Requires extended periods of computer use and sitting. This is a remote position. Benefits: Medical, Dental, Vision, HSA*, PTO, 401k, Company observed Holidays Individuals seeking employment at Aspire General Insurance Services LLC are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation in accordance with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements. *Dependent on plan selected Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, location, etc. Salary Description $80,000-$100,000 Annually

CURE Auto Insurance is a leading direct writer of auto insurance in New Jersey, Pennsylvania, and Michigan. CURE offers a great working environment, competitive salary, and comprehensive benefits package which includes health and dental coverage, life and disability insurance, 401k with generous company match, and much more! This position is dedicated to overseeing the administration of claims activities within the Bodily Injury claims department. Strategically manages the disposition of litigated and/or non-litigated claims, ensures complete and sound claim settlements, legal reviews and investigations in accordance with state and company policies and procedures. Responsible for establishing reserve recommendations in cases exceeding individual authority. Responsible for the selection, training, development and performance of personnel as well as performance reviews and day-to-day supervision of all bodily injury claims related staff. Provides input to strategic decisions that affect the functional area of responsibility. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. Essential Job Functions: Guides and manages the performance and professional development of staff through coaching and mentoring, including performance evaluations. Assist in evaluating current processes to streamline production and workflow. Maintain all Bodily Injury department reports, forms and letters for accuracy and relevant up-to-date information. Identify trends and create reports to manage those trends. Work with upper management in evaluating trends and answering any related questions. Lead department meetings to communicate issues, changes, company business and department progress. Performs regular file reviews and audits to determine compliance with best practices. Proactively assess claim processes and develop strategies to maintain or improve performance. Manage and set priorities on the daily operations of the department, manage employee performance to achieve unit, department and company goals and report as needed to upper management. Implement policies to manage compliance requirements with claim handling guidelines and ensure good faith claims handling. Direct adjusters on proper reserving and payments when over their authority. Work closely with in-house and external counsel. Monitor and report on performance of outside vendors. Contributes to project reviews and assists in designs for projects both within claims and as assigned. Participates in long-range departmental planning and provides input to operational decisions. Accountable for team performance and results. Adhere to all Federal and State laws and regulations. Perform special projects and other duties as assigned. Requirements: Minimum 5 years direct claims handling and experience working with all levels of claim complexity. Minimum 2 years of management or manager role experience with demonstrated ability to coach, direct and develop individuals. Demonstrated and in-depth knowledge of application insurance coverage, state laws, regulations, policies, and practices. Self-motivated and able to grasp new concepts quickly. Must have strong time management and organizational skills. Exceptional interpersonal skills. Strong oral communication skills. Ability to multitask and adapt to changing needs. Openness to feedback and a strong desire to learn. Education Requirements: High School Diploma or GED equivalent required. A Bachelor's degree from an accredited four-year college or university is a plus. Benefits Comprehensive health benefits including medical, dental and vision coverage Generous paid time off (PTO days, sick days, and holidays) Flexible spending options with FSA & HSA plans Life and AD&D insurance 401(k) with company match Voluntary benefits such as legal services, pet insurance, and identity & fraud protection 24/7 Employee Assistance Program (EAP) for employees and their families Fun, engaging in-office events that support our culture Physical Actions/Environment: Required job duties consist of prompt and regular attendance, ability to frequently move about the office to coordinate work with others; standing, sitting and typing for extended periods; and lifting and/or carrying up to 5 lbs. Ability to frequently communicate with others in-person, on the phone/virtually, and in writing. Ability to read, understand, process and evaluate large amounts of technical information and make related, informed decisions. Starting Salary: $90,000 - $110,000 Schedule: We offer flexible work hours between 8:00 AM and 5:00 PM, and employees can choose a schedule that works best for them-8:00 AM-4:00 PM, 8:30 AM-4:30 PM, or 9:00 AM-5:00 PM. While we aim to support individual preferences, final schedules may be adjusted based on business needs to ensure great coverage and teamwork. We offer a hybrid work schedule: team members work onsite 4 days per week and have the flexibility to work remotely 1 day per week. Location: Princeton, NJ We recruit, hire, employ, train and promote, and compensate individuals based on job-related qualifications and abilities. We respect the dignity and worth of each individual and are committed to an employment environment that is free from all forms of employment discrimination. CURE Auto Insurance provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, pregnancy, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Disclaimer: This reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. This job description may be subject to change at any time. Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Job Description HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ************************** How YOU will make a Difference: The Claims Operations Manager will oversee the end-to-end processing of healthcare claims. The manager is responsible for leading the HMA Claims Operations staff and their daily work requirements. Leveraging metrics and forecasts; they prioritize workload and resourcing to maximize operational production in partnership with vendor resources and liaisons. The manager will lead a team responsible for claims intake, pricing, adjudication, coordination of benefits and issue resolution while driving operational excellence What YOU will do: Direct supervisory responsibilities: Manages and coaches individual contributor's performance and quality. Assess and manages claims inventory: Tracks and manages inventory trends and proactively adjusts resource levers as needed to maximize productivity Manage daily operations of claims processing, ensuring accuracy, timeliness, and compliance with healthcare policies and federal guidelines Create daily updates for management team flagging production rates, critical issues and areas of escalation in real time Monitor and resolve pricing discrepancies impacting claims adjudication and provider payments. Lead initiatives to improve pricing workflows, automation, and system performance. Vendor auditing &QA: Leads vendor audits and manages reporting to ensure vendor quality. Apply subject matter expertise to the business of claims processing and operations Manage to vendor agreements, proactively identify and flag issues, escalate appropriately Develop and maintain workflows and documentation specific to claims processing. Train and coach staff and vendors on claims processes as needed Motivate talent: Ability to motivate and lead team members and vendors in accordance with HMA values and objectives Talent planning: Proactively review and assess talent. Continually develop and/or recruit talent to meet objectives Requirements Knowledge, Experience and Attributes: Bachelor's Degree or equivalent work experience Minimum 5 years' of claims operations experience, self-funded health plan experience is a plus Minimum 2 years' of people leading experience Experience with claims platforms such as HealthEdge, Mphasis, or Facets Knowledge of CPT, HCPCS, ICD-10 coding, and reimbursement methodologies. Strong understanding of provider contract terms, fee schedules, and pricing models (e.g., DRG, APC, RBRVS). Proven ability to manage and develop a team of highly skilled staff Proven ability to manage and interact with vendors to support execution of work within the SLA's established Benefits Compensation: The base salary range for this position in the greater Seattle area is $100,000-$123,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.) HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit

Claims Manager (Professional Liability) Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk . As a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider for our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share. YOU WILL Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes. Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you. Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution. Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters). Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards. Support our data collection efforts and models by effectively using our Agentic Claim Experience (ACE) system to fully and accurately capture critical details about each claim assigned to you. Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments. Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems. Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision. YOU HAVE At least 10 years of professional experience, with at least 5 years of experience litigating or managing professional liability claims. Previous carrier experience is a plus. Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred. Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire. Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed. High level of personal initiative and leadership skills. Exceptional time management, problem solving and organizational skills. Comfort and skill operating in a paperless claims environment. Familiarity with Google Workplace is preferred, but not required. Willingness to quickly adapt to change and use creative thinking and data-driven insights to overcome obstacles to resolution. Strong communication skills, both verbal and written. Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%). WHO YOU WILL WORK WITH Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group. Jaclyn Vogt, Senior Claims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College. Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims. WHAT WE OFFER Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan. Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members. 401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement. Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay. Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it. Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year. Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories. Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.) Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests. Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise. No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones. Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart. COUNTERPART'S VALUES Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others. Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met. Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal. Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected. Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there. Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life. Our estimated pay range for this role is $150,000 to $180,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience. We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives. We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is looking for an experienced Claims Specialist supporting Disability and Leave Management claims to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required. Key Job Responsibilities * Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved * Communication via telephone, email, and text with employees, employers, attorneys, and others * Review and interpret medical records, utilizing resources as appropriate * Complete financial calculations * Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication * Apply contract/policy provisions to ensure accurate eligibility and liability decisions * Demonstrate and apply analytical and critical thinking skills * Verify on-going liability and develop strategies for return-to-work opportunities as appropriate * Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication * Leverage a broad spectrum of resources, materials, and tools to render claims decisions * Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards * Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities * Work independently as well as within a team structure * Deliver refresher trainings as appropriate to the claim team * Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review. * Prepare reports for management on claim outcomes and performance metrics. * Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. * Oversee the ongoing management of complex, high-priority or escalated cases and callers. The base salary range for this position is $60,000 - $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program Required Qualifications * Bachelor's degree or equivalent work experience * 3 disability claims administration experience * Prior leadership experience as a team lead or manager * Exceptional customer service skills * Maintains positive and effective interaction with challenging customers * Strong knowledge of disability and leave laws and regulations * Ability to handle sensitive information with confidentiality and professionalism * Group Disability Claims experience * Prior experience managing Paid Family Leave for multiple state Preferred Qualifications * Experience working with the Fineos Claim Management System * Exceptional written and oral communication skills demonstrated in previous work experience * Excellent organizational and time management skills with ability to multitask and prioritize deadlines * Ability to manage multiple and changing priorities * Detail oriented; able to analyze and research contract information * Demonstrated ability to operate with a sense of urgency * Experience in effectively meeting/ exceeding individual professional expectations and team goals * Demonstrated analytical and math skills * Ability to exercise critical thinking skills, risk management skills and sound judgment * Ability to adapt, problem solve quickly and communicate effective solutions * High level of flexibility to adapt to the changing needs of the organization * Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment * Continuous improvement mindset * A commitment to support a work environment that fosters diversity and inclusion. * Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word Skills Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. #LI-Remote ABOUT EQUITABLE At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.

Key Responsibilities: * Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. * Review newly reported claims and log them on the pending claims log. * Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. * Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. * Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. * On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. * Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. * Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. * Handle and log specific State and NAIC policy locator searches. * Mentor and support third-party claims administration staff. * Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. * Work on special projects and other duties as assigned by the Claims Manager. * Perform quarterly claim audits focusing on third-party claim handling. * Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. * Handle Department of Insurance claim complaints or requests in a timely and professional manner. * Stay current on all laws, regulations, and industry updates that impact claim handling and compliance * Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. * Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights * Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact * Support M&A activity, if applicable Qualifications: * 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: * Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. * Ability to meet deadlines while performing multiple functions. * Proficient in MS Office applications and the Internet. * Ability to proactively analyze and resolve problems. * Attention to detail. * Flexibility and willingness to adapt to changing responsibilities. * Excellent written communication, interpersonal and verbal skills. * Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. * Proactive and outside-the-box thinker. * Independent and organized work style. * Ability to maintain strong performance while working remotely and independently, if applicable. * Strong judgment and discretion when handling highly confidential business, employee, and customer information. * Team player and creative, critical thinker highly desired. Licenses + Certifications: * Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. * Legal or Paralegal Certifications optional but useful Essential Functions: * This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. * Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. * Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. * Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. * When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. * Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: * Salary Range: $70,720 - $91,520 * Medical Insurance: Choose from a variety of plans to fit your healthcare needs. * Dental Insurance: Coverage for preventive, basic, and major dental services. * Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. * Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. * Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. * 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. * PTO and Sick Time accrue each pay period: Take time off when you need it * Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate

The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. Review newly reported claims and log them on the pending claims log. Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. Handle and log specific State and NAIC policy locator searches. Mentor and support third-party claims administration staff. Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. Work on special projects and other duties as assigned by the Claims Manager. Perform quarterly claim audits focusing on third-party claim handling. Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. Handle Department of Insurance claim complaints or requests in a timely and professional manner. Stay current on all laws, regulations, and industry updates that impact claim handling and compliance Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact Support M&A activity, if applicable Qualifications: 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. Ability to meet deadlines while performing multiple functions. Proficient in MS Office applications and the Internet. Ability to proactively analyze and resolve problems. Attention to detail. Flexibility and willingness to adapt to changing responsibilities. Excellent written communication, interpersonal and verbal skills. Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. Proactive and outside-the-box thinker. Independent and organized work style. Ability to maintain strong performance while working remotely and independently, if applicable. Strong judgment and discretion when handling highly confidential business, employee, and customer information. Team player and creative, critical thinker highly desired. Licenses + Certifications: Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. Legal or Paralegal Certifications optional but useful Essential Functions: This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: Salary Range: $70,720 - $91,520 Medical Insurance: Choose from a variety of plans to fit your healthcare needs. Dental Insurance: Coverage for preventive, basic, and major dental services. Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. PTO and Sick Time accrue each pay period: Take time off when you need it Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Claims Division is seeking a Property Claims Account Manager (CAM) to join the Programs Claim Team. In this role, the incumbent will actively manage and effectively oversee assigned business accounts for commercial property claims handled by third party administrators. Responsibilities Work with our TPA's to ensure proper claims handling and service delivery, this includes: Performing technical claims oversight on claims with an expected value over $50,000 Attend mediations and trials Granting reserve and settlement authority on cases above the TPA's authority Making coverage determinations and reviewing Reservation of Rights and coverage disclaimer letters as prepared by the TPA Completing claims audits at TPA branch claims offices or online Handling or facilitating administrative tasks between Arch and the TPA to ensure seamless service delivery to the client Providing overall portfolio management of the book. Data, analysis, trending and action planning related to audits or other findings. Responsible for Portfolio Management of assigned programs, which includes providing support to program-level CAM and Programs Underwriting team in understanding key drivers of activity and loss trends for assigned programs. Ensure timely reporting of large losses and anticipated development Coordinate capture of CAT event data for assigned programs Contribute claim insights to underwriting product development initiatives Provide monthly updates to stakeholders on claim key performance indicators Proactively review pending TPA files for potential oversight intervention Act as the Arch Property claims contact for assigned Property accounts written by Programs, which includes: Participating in client set-up meetings Participating in telephonic as well as in person claims reviews Participating in mid-term meetings Helping to resolve any claims or service issues that arise Conduct periodic Quality Assurance Audits of TPA performance consistent with claim handling guidelines and collaborate with TPA on action plans for improvement Work with Underwriting and Risk Control to assist in the risk selection process, which includes: Provide feedback on any claims, legal or jurisdictional issues Addressing potential solutions to current claims or service problems Participating in meetings with brokers and/or prospective accounts/program managers Identifying loss trends on an account or book of business level Conducting due diligence reviews on new TPA's Collaborate with other internal business units such as Finance, IT and Legal on any issues, trends or projects that arise Address state and federal regulatory issues (state insurance department audits/complaints, etc.) Experience & Required Skills Minimum of ten (10) years' working experience overseeing and managing First Party Commercial Property claims. Proper Adjuster Licenses in all applicable states Ability to handle high severity Commercial Property claims Working knowledge & expertise with multiple jurisdictions Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint, Word and Power BI. Exceptional communication (written and verbal), influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines Strong problem-solving, analytical, organizational, and time management skills Ability to take part in active strategic discussions Ability to work independently and in a team environment Willing and able to travel 25% Education Bachelor's degree preferred; in lieu of degree, 15 years of working and managing first party commercial property claims experience #LI-SW1 #SW-REMOTE Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. 14400 Arch Insurance Group Inc.

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Claims Examiner. The Claims Examiner will be managing insurance claims for our policyholders with low to moderate severity and complexity. The Claims Examiner must have the experience and technical knowledge needed to manage a case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party bodily injury and property damage claims involving low to moderate complexity from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 5+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with willingness to expand licenses as needed. #LI-BM #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.

Follow up on insurance denials and aged claims, submit claims to secondary payers, and ensure accurate billing information is submitted. Answer all information requests from those payers, and trace all claims to those payers making sure they have been paid or denied appropriately in a timely manner. Re-submit claims to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as necessary and resolve aged insurance balances. Act as resource for billing office staff. Providence caregivers are not simply valued - they're invaluable. Join our team at Swedish Health Services DBA Swedish Medical Group and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications: + 2 years medical (or healthcare) insurance follow up experience. Why Join Providence Swedish? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Swedish is the largest not-for-profit health care system in the greater Puget Sound area. It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Whether through physician clinics, education, research and innovation or other outreach, we're dedicated to improving the wellbeing of rural and urban communities by expanding access to quality health care for all. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern. Requsition ID: 395637 Company: Swedish Jobs Job Category: Claims Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Multiple shifts available Career Track: Admin Support Department: 3908 PHYSICIANS BILLING WA Address: WA Seattle 1730 Minor Ave Work Location: Swedish Metropolitan Park East-Seattle Workplace Type: Remote Pay Range: $26.30 - $40.25 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.