Claims representative jobs in Akron, OH - 94 jobs

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers . If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $67,000.00 - $110,600.00 What Is the Opportunity? This position is responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment process. This may include interpreting and applying laws and statutes for multiple state jurisdictions. Claim types include moderate complexity Bodily Injury claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. What Will You Do? Customer Contacts/Experience: Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions. Coverage Analysis : Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for moderate complexity Bodily Injury liability claims in assigned jurisdictions. Verifies the benefits available, the injured party's eligibility and the applicable limits. Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security, Workers Compensation or others relevant to the jurisdiction. Consults with Unit Manager on use of Claim Coverage Counsel. Investigation/Evaluation: Investigates each claim to obtain relevant facts necessary to determine coverage, the extent of liability, damages, and contribution potential with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. Takes recorded statements as necessary. Utilizes evaluation documentation tools in accordance with department guidelines. Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings. Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit. Reserving: Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities in accordance with established procedures to resolve claim in a timely manner. Negotiation/Resolution: Determines settlement amounts, negotiates and conveys claim settlements within authority limits to claimants or their representatives. Recognizes and implements alternate means of resolution. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to claimants. Handles both unrepresented and attorney represented claims. May manage litigated claims on appropriately assigned cases. Develops litigation plan with staff or panel counsel, track and control legal expenses. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Insurance License: In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. Perform other duties as assigned. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Bachelor's Degree. 2 years bodily injury liability claim handling experience. General knowledge and skill in claims handling and litigation. Basic working level knowledge and skill in various business line products. Demonstrated ownership attitude and customer centric response to all assigned tasks. Demonstrated good organizational skills with the ability to prioritize and work independently. Attention to detail ensuring accuracy. Keyboard skills and Windows proficiency, including Excel and Word - Intermediate. Verbal and written communication skills - Intermediate. Analytical Thinking- Intermediate. Judgment/Decision Making- Intermediate. Negotiation- Intermediate. Insurance Contract Knowledge- Intermediate. Principles of Investigation- Intermediate. Value Determination- Intermediate. Settlement Techniques- Intermediate. Medical Knowledge- Intermediate. What is a Must Have? One-year bodily injury liability claim handling experience or comparable liability claim handling experience, or successful completion of Travelers Claim Representative training program is required.

The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.

IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.

The Claims Senior Representative-Property Field serves as a technical expert on claims adjusting. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Property Claims resolves first party personal, commercial, and agriculture property claims, including structural damage, business and personal property, and business income losses. This role is not eligible for visa sponsorship. Job Responsibilities Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, legal climate, potential exposure, and damages, and makes decisions on claim resolution. Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker. Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies. Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets. Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards. Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience. Identifies and refers all claims to management for further handling and assignment instructions. Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations. Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing. Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines. Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel. Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation. Interprets complex and detailed documents such as contracts, legal documents, insurance regulations and policies as needed. Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices. Adjusting first party homeowners and commercial property claims. Efficient in use of Xactimate to evaluate first party property claims. For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned. May be required to travel for extended periods to fulfill storm duty responsibilities. Job Qualifications 4+ years of Claims Handling experience. Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience. For field roles only: Valid driver's license and a driving record that conforms to company standards. Location Remote Licenses and Certifications Certified Professional Claims Management (CPCM) (preferred) Behavioral Competencies Collaborates Communicates Effectively Customer Focus Decision Quality Nimble Learning Technical Skills Account Management Claims Investigations Claims Adjustment Financial controls Case Management Customer Relationship Management Project Management Business Process Improvement Auditing Data Analysis and Reporting This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

Job Description Fleet Response's mission is to provide innovative and effective service to our clients and to maintain a high standard of professionalism and partnership in an environment that fosters opportunity, integrity, and excellence. Our mission would not be possible without an environment that is created from mutual trust and respect, coupled with a commitment to diversity, equity & inclusion Our commitment to diversity, equity & inclusion aligns with our corporate values and is supported at the highest levels in the Company. Diversity helps to drive new business, fuel innovation, and attract and retain the best employees. It makes a difference in the workplace, marketplace, and community advancing the way we live and work. Are you interested in joining a fast growing and customer focused company that is constantly rated as one of the Top Workplaces in Northeast Ohio? Do you feel that hard work should pay off and you value things like workplace flexibility, career advancement opportunities, a positive culture, and a genuine feeling that you belong to a team? If so, you would be perfect for Fleet Response. Fleet Response specializes in providing services to corporations who self-insure physical damages to their fleets. Built from an insurance background with an eye for detail, Fleet Response prides itself on offering a variety of customized services to all our clients. Fleet Response is currently seeking qualified candidates to work virtually or at our corporate office, for the following position: Third Party Sr. Claims Representative. The Third Party Sr. Claims Representative is responsible for the day to day management of client accident claims from assignment through completion. The Third Party Sr. Claims Representative typically manages 3rd party claims, including repair and rental management, claimant communication, and client communication. Confirms coverage and liability are properly in order prior to assisting 3rd party customers with repairs and/or rental and proactively works with client. Provides operational input and guidance as needed to teammate and works with the Claims Supervisor and Claims Manager to ensure client and customer parameters and expectations are consistently met by the team. Job Summary: Fleet Response is currently seeking qualified candidates to work virtually or at our corporate office, for the following position: Third Party Sr. Claims Representative. A Third-Party Sr. Claims Representative manages the most complex, high-exposure claims, requiring significant independent judgment, a strategic mindset, advanced technical expertise, and exceptional negotiation skills. They manage claims with complex coverage, liability, damage issues, often involving sensitive customer interactions filed by a third-party claimant against our clients from initiation to closure. This role often involves mentoring the Third Party Claims Specialist. Essential Duties and Responsibilities Includes, but is not limited to, the following: First Notice of Loss (FNOL): Review and send loss notices to clients per client parameters. Administrative Support: Performing general administrative tasks such as mailing documents, creating documents, uploading documents, gathering documents, setting up tows & handling a shared inbox. Information Gathering: Contacting various parties to obtain missing or additional information required for claim processing & verification. Verify Coverage: Review the claim to ensure that the claim is covered. Investigate & Determine Liability: Conduct thorough investigations to establish fault, or liability, for an incident. This includes interviewing the client, claimant, witnesses, and other involved parties, and reviewing police reports and other documentation. Identify Potential Fraud: watch for any signs of fraudulent activity, such as staged accidents or overstated claims, and refer suspicious cases to a Special Investigation Unit (SIU). Mitigating Cost: It is a fundamental duty aimed at controlling expenses while ensuring fair and prompt resolution of claims. Assess Damages: Evaluate the extent of damage, which can include property damage, repairs, total loss, loss of wages, loss of use, rental, towing, diminished value & out-of-pocket expenses. Determine Total Loss vs Repair: Evaluate if the cost of repairs exceeds the value of the vehicle or property and handle the claim toward a total loss settlement if necessary. Manage Repairs: Monitor the progress of repairs to ensure the repairs are being completed timely and accurately. Manage Total Loss Claims: Perform detailed market research to determine the actual cash value (ACV) of a totaled vehicle. This involves analyzing vehicle history, local market comparable, and salvage value. Manage Rentals: verify coverage, explain terms, initiate rental arrangements, advise on non-covered events, rental duration, authorize extensions. Review and Authorize Supplements: Review additional repair costs submitted and approve payment while following guidelines. Ensure Compliance: Adhere to all federal and state laws and regulations governing the claims process. Maintaining Licensing: Maintain insurance adjuster licensing as required in all states. Communication: This requires clear, professional communication and strong interpersonal skills with all parties involved in the claim, including but not limited to peers & leadership. Negotiate Settlements: Determine an appropriate settlement amount based on liability and damage assessment, then negotiate a resolution with the claimant, client or legal counsel. Maintain Claim Files: Ensure that all claim activity, notes, and correspondence are thoroughly and accurately documented. Set Reserves: Set and maintain appropriate financial reserves for each claim to ensure funds are available for potential settlement payments. Process Payments: Process timely & accurate payments for vehicle repairs, total loss settlements, and other covered expenses. Workload and Metrics: Effectively manage a high volume of claims and meet key performance indicators (KPIs), such as average claim processing time, closure rates, and customer satisfaction scores. Finalize & Close Claims: Ensure all necessary steps are completed, and all paperwork is filed before finalizing and closing the claim. Developing: Responsible for actively accepting, acting on, and implementing coaching and feedback to improve professional performance and development. Mentor & Train: Responsibilities may include mentoring a team member and assisting in training. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Education/Experience: Associate degree (A.A.) or equivalent from a two-year college or technical school, or 2-4 years of related experience; combination of education and experience may be considered. Industry Experience: Prior experience in automotive, fleet management, claims management, or vehicle re-marketing strongly preferred. Third-party claims handling experience preferred. Licensing: Ability to obtain and maintain insurance adjuster licensing as required in all states. Key Skills & Competencies: Strong oral and written communication, including the ability to simplify complex information and negotiate effectively with claimants, attorneys, and clients. Ability to analyze liability, assess damages, and evaluate complex claims accurately. Customer service and empathy, maintaining professionalism in difficult or emotional situations. Attention to detail with meticulous documentation and record-keeping. Proficiency with claims management systems and Microsoft Office. Strong investigative, analytical, and problem-solving skills. Ability to multi-task, prioritize, and manage a high volume of claims effectively. Knowledge of insurance principles, coverage, and legal/regulatory compliance is a plus. Mathematical/Analytical Skills: Calculate property depreciation, repair/replacement costs, and claimant lost wages. Evaluate multiple bids or vendor quotes to ensure fair settlements. Physical Requirements: Primarily sedentary work with occasional light lifting (up to 10 lbs). Close visual acuity for computer work, reading, and documentation. Ability to communicate clearly in person and via phone. Preferred Traits: Strong initiative and self-motivation. Dependable, punctual, and team-oriented. Adaptable to changing regulations, processes, and claim scenarios. Work Schedule A variety of flexible work arrangement schedules are available, with the ability to work from home as part of your schedule, after completion of training. This position works Monday through Friday, 8:00 AM until 5:00 PM. Additional Benefits: Competitive compensation and PTO 401(k) with employer contribution Medical, dental, vision, life, and disability insurance Several voluntary benefit options A flexible work environment with remote options post-probation

The Claims Specialist is responsible for providing prompt, effective assistance to clients and third parties reporting and settling claims with our agency. They also act as a liaison between the agency and carriers and assist others in the agency with service regarding claims activity. ESSENTIAL JOB RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty adequately. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reports loss/claim information to the appropriate carrier the same day it is received. Gives prompt and courteous service on a same-day basis to all clients. Takes first reports of claims. Organizes claim information on forms and submits claim to appropriate carrier. Sets expectations of the claim process including time frames, deductibles, restoration companies and adjustors. Follows up with insurance companies for the timely and accurate settlement of losses. Responds to customers' inquiries and questions regarding the status of loss within 24 hours of inquiry. Follows all systems, procedures, and insurance company regulations. Authorizes claim payments within agency authority. Coordinates, as necessary, any activities between clients and claim adjusters. Complete weekly and monthly reports of claims notifications and updates. Notifies risk advisor and/or management of severe losses over $100,000. Provides updates to management and or appropriate risk advisor/customer service for clients with severe or frequent losses. Deals promptly and with full integrity with all carrier claims personnel, responding within 24 hours to any request for action or information Qualifications REQUIREMENTS: Knowledge, Skills, and Ability Extensive knowledge of claims procedures and insurance coverage Ability to satisfy the needs of the customer, both internal and external, needs little assistance from others in this endeavor Strong negotiating, decision-making, and relationship building skills Excellent customer service and teamwork skills Ability to interact with employees, customers and vendor companies Working knowledge of computer software packages including Microsoft Word, Excel and Outlook programs Ability to use general office equipment, including a computer, calculator, typewriter, fax machine, copier and telephone Ability to learn and perform new duties and responsibilities Education or Experience High school diploma. Bachelor's degree preferred. Must be willing to work toward industry designations Requires current driver's license Working Environment/ Physical Activities General office work environment. Requires regular use of arms, hands, and fingers. Frequently required to sit for extended periods of time, reach with arm and hands, stand, walk, stoop, talk and hear. Required to lift and/or move up to 10 pounds. Ability to work during regular business hours (8:00am-5:00pm), if required. Travel as needed. HIPAA Compliance This position may have access to Protected Health Information (PHI) and Electronic Protected Health Information (ePHI). An employee will be responsible for following the guidelines of the HIPAA Confidentiality Agreement. Note: This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with this job. The employee is expected to perform those duties listed as well as other related duties directed by management.

Founded in 2003, Roundstone is not your typical insurance company. We're on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employees. Role Description We are seeking a detail-oriented Medical Stop Loss Adjuster to join our team. In this role, you will be responsible for evaluating and processing stop loss claims to ensure accurate and timely payments. You will assess claim validity, verify coverage, and determine appropriate reimbursement. The ideal candidate will have a strong understanding of medical terminology, insurance policies, and claims processing, along with excellent analytical and communication skills. This role requires a commitment to maintaining high standards of accuracy and efficiency in a fast-paced environment. Key Duties & Responsibilities: Review and audit claims submissions within authority level for accuracy and completeness and determine appropriate reimbursement. Timely process claims in an accurate manner, communicate with third-party administrators, and ensure proper cost containment. Manage inventory of pended claims according to department metrics. Maintain appropriate reserve records on claims. Actively participate in team meetings and training. Skills and Qualifications: Knowledge of Health Care services, policies, procedures and systems. 3+ years of experience with intake of Medical, Dental, Vision claims Certified in Medical Terminology I, II and ICD9/10 knowledge Precise attention to detail Excellent verbal communication, collaboration, and written skills Strong organizational and time management skills; handles multiple workstreams with deadlines simultaneously Proficiency in Microsoft Office (Word, Excel); Proficiency in claims administration systems such as Javelina, ESL or similar. Better Benefits: We're leaders in our industry, so naturally, we look out for our employees' best interests with a robust benefits package. Roundstone employees are eligible for: Medical, dental and vision benefits Annual bonus Parental Leave Dependent care 100% match up to max allowable PTO beginning on Day 1 Tuition reimbursement Health work/life balance Hybrid office schedule 401(k) plan with company match Employee Assistance Program On-site gym with personal trainer access Life insurance and short term disability insurance More About Roundstone Headquartered in Rocky River, Ohio, Roundstone is proud to be a Northeast Ohio Top Workplace as recognized by The Plain Dealer and cleveland.com , based on anonymous employee feedback. We foster a supportive, values-driven culture where employees feel engaged, valued, and celebrated. Roundstone has also been named an Inc. 5000 award recipient for eight consecutive years, reflecting our continued growth and success. Our Core Values Live well: Be healthier and bring positive energy to all you do. Work smarter: Get things done, better. Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start. Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know. Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey: ***************************************** Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

The Claims Senior Representative-Property Field serves as a technical expert on claims adjusting. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Property Claims resolves first party personal, commercial, and agriculture property claims, including structural damage, business and personal property, and business income losses. This role is not eligible for visa sponsorship. Job Responsibilities * Determines whether proper coverage exists for the type of claim assigned. * Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, legal climate, potential exposure, and damages, and makes decisions on claim resolution. * Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker. * Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies. * Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets. Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards. * Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience. * Identifies and refers all claims to management for further handling and assignment instructions. * Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations. * Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing. * Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines. * Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel. * Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation. * Interprets complex and detailed documents such as contracts, legal documents, insurance regulations and policies as needed. * Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices. * Adjusting first party homeowners and commercial property claims. * Efficient in use of Xactimate to evaluate first party property claims. * For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned. May be required to travel for extended periods to fulfill storm duty responsibilities. Job Qualifications * 4+ years of Claims Handling experience. * Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience. * For field roles only: Valid driver's license and a driving record that conforms to company standards. Location Remote Licenses and Certifications * Certified Professional Claims Management (CPCM) (preferred) Behavioral Competencies * Collaborates * Communicates Effectively * Customer Focus * Decision Quality * Nimble Learning Technical Skills * Account Management * Claims Investigations * Claims Adjustment * Financial controls * Case Management * Customer Relationship Management * Project Management * Business Process Improvement * Auditing * Data Analysis and Reporting This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. EEO Statement: Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Public Entity Liability | Ohio Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Enjoy flexibility and autonomy in your daily work, your location, and your career path. This role is open to a work-at-home, remote, telecommuter setting in Ohio, with occasional travel required. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** No day is ever the same assisting our public entity clients with their claims! If you are an agile examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims, we want to talk to you! This examiner will primarily handle liability for Ohio/Nebraska and the following lines of coverage: General Liability, Auto Liability, Employment Practices Liability, Law Enforcement Liability and Public Officials Liability. **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Assesses liability and resolves claims within evaluation. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is _$80,000 to $95,000 USD annual salary_ . Bonus eligible role. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. \#LI-REMOTE #claimsexaminer #remote Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

CENCO Claims is seeking Daily Property Claims Adjusters to handle field assignments throughout Cleveland and the Northeast Ohio area. This is a field-based role offering consistent claim flow, schedule flexibility, and strong operational support so you can stay focused on inspections and reporting. What the Role Looks Like: Complete on-site property inspections for losses related to wind, hail, water, fire, and other covered events Capture clear, thorough photo documentation and inspection notes Write and submit accurate estimates using Xactimate or Symbility Communicate professionally with policyholders, contractors, and carrier partners Manage assigned claims efficiently while meeting submission timelines What You'll Need: Active Ohio adjuster license (or designated home state license) Familiarity with Xactimate; Symbility knowledge is helpful Reliable transportation, ladder, laptop, and standard field equipment Strong attention to detail and clear written communication Ability to accept assignments and submit reports promptly Why Work with CENCO? Consistent daily claim volume in the Cleveland metro area Competitive per-claim compensation with reliable payment Flexible field work with independence Responsive internal team and straightforward systems Opportunity for ongoing assignments If you're looking for steady field work and a dependable claims partner, CENCO Claims would be glad to connect.

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. **Position Summary** As a Senior Litigation Adjuster in Risk Management, you will be responsible for managing litigation against CVS and overseeing outside counsel defending CVS in premises lawsuits filed throughout the United States. Responsibilities Include: - Utilizing legal skills and knowledge to oversee and manage complex premises lawsuits against CVS from the initiation of suit through resolution. - Analyzing case files and internal materials and utilizing resources across CVS to investigate and discern key issues in each case. - Developing and implementing a litigation strategy in each case to most efficiently resolve or defend that case. - Assessing the value of all cases through investigation of the pertinent allegations, evaluating the defenses and issues present in each case, and setting appropriate financial reserves. - Reviewing discovery responses, pleadings, motions, etc. drafted by defense counsel. - Providing reporting to key internal stake holders and leadership on case developments. - Developing relationships with internal colleagues for fact-finding and key litigation activities. - Participating in internal meetings and attending mediation and trial as necessary to oversee and assist in the defense or resolution of cases. **Required Qualifications** - 2+ years of litigation experience, ideally with a law firm or as a litigation adjuster with a large self-insured company or insurance carrier. - Ability to travel and participate in legal proceedings, arbitrations, trials, etc. **Preferred Qualifications** - Experience overseeing or defending premises litigation. - Litigation experience at a law firm, and/or significant experience overseeing litigated claims for an insurance carrier or corporation, including mediation experience and trial exposure. - Experience overseeing and answering written discovery, reviewing pleadings and case filings. - Ability to influence and work collaboratively with senior leaders, CVS's in-house legal counsel and outside defense counsel. - Ability to positively and aggressively represent the company at mediation, arbitration and trial. - Ability to work independently and in an environment requiring teamwork and collaboration. - Ability to navigate difficult situations and communicate effectively with both internal and external groups. - Excellent organizational and time management skills and ability to handle a full docket of litigated claims. - Strong written and verbal communication skills, ability to summarize complex issues in a concise, cogent manner. - Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook) with a proven ability to learn new claims software programs and systems. **Education** - Verifiable Bachelor's degree or equivalent work experience required. - JD degree highly desired. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 02/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

The Claims Senior Representative-Property Field serves as a technical expert on claims adjusting. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Property Claims resolves first party personal, commercial, and agriculture property claims, including structural damage, business and personal property, and business income losses. This role is not eligible for visa sponsorship. Job Responsibilities Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, legal climate, potential exposure, and damages, and makes decisions on claim resolution. Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker. Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies. Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets. Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards. Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience. Identifies and refers all claims to management for further handling and assignment instructions. Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations. Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing. Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines. Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel. Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation. Interprets complex and detailed documents such as contracts, legal documents, insurance regulations and policies as needed. Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices. Adjusting first party homeowners and commercial property claims. Efficient in use of Xactimate to evaluate first party property claims. For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned. May be required to travel for extended periods to fulfill storm duty responsibilities. Job Qualifications 4+ years of Claims Handling experience. Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience. For field roles only: Valid driver's license and a driving record that conforms to company standards. Location Remote Licenses and Certifications Certified Professional Claims Management (CPCM) (preferred) Behavioral Competencies Collaborates Communicates Effectively Customer Focus Decision Quality Nimble Learning Technical Skills Account Management Claims Investigations Claims Adjustment Financial controls Case Management Customer Relationship Management Project Management Business Process Improvement Auditing Data Analysis and Reporting This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

This role requires residency in Ohio or Indiana. The Casualty Claims Specialist manages high-exposure, multifaceted insurance claims requiring advanced skills in coverage analysis, litigation management, legal and medical document review, and negotiation to achieve economical, defensible resolutions. These roles involve working with minimal supervision, potentially mentoring others, and demands significant experience in complex claims handling and litigation. Salary Grade (13) 77,432 -98,727 -120,022 This role is responsible for determining coverage, assessing liability, establishing and adjusting reserves, evaluating claims, managing litigation, and negotiating settlements within assigned authority limits across multiple lines of business, including Homeowners, Personal Auto, Commercial Auto, Commercial Liability, Businessowners and Farm Liability. The Claims Specialist conducts thorough investigations to determine liability for all involved parties while delivering exceptional customer service that protects policyholders and safeguards company assets. Demonstrating strong expertise and sound judgment in complex matters, the Claims Specialist may serve as a subject matter expert and manages a designated caseload of casualty losses in compliance with company standards and applicable regulatory requirements (IC 27-4-1 / ORC 3901-1-54). Experience in analyzing, adjusting, and settling litigated claims under Homeowners, Personal Auto, Business Auto, Commercial General Liability, Businessowners, and Farm policies. Salary Grade (13) ESSENTIAL DUTIES AND RESPONSIBILITIES The following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. Coverage/Investigation/Liability - Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness. Damages - Determines the value of the physical damage of property, automobiles, or injuries through physical inspections and use of appropriate tools. Obtains all necessary documentation to support claim evaluation. Recognizes claim file exposures and escalates appropriately. Reserving/Reporting - Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. Completes appropriate reports so that the status of the claim is clearly documented at all times. Determines need for, and engages independent adjusters, cause and origin experts. independent medical examiners or other experts (e.g. reconstructionist, engineer). Proficiently and proactively handle the claim file through various phases of litigation. Independently review the applicability of coverage and civil law as well as local statutes. Attend mandatory and court ordered litigation events: mediation, pre-trial, trial. Keeps abreast of existing and proposed legislation, court decisions and trends and experience pertaining to coverage, liability and damages. May analyze the impact upon claims policies and procedures and advises Claims Management. Participates in or leads special projects and mentors others, as needed. Initiate prompt and effective communication with all parties having legal or contractual interest in claim presented Capable of drafting clear and concise letters and other correspondence. Accountable for security of financial processing of claims, as well as security information contained in claims files. Confers directly with policyholders on coverage and resolution issues pursuant to Home Office instructions. Prepare claims for trial, comply with trial alert procedures and notify/update reinsurance when appropriate. Participate in training programs, conferences and departmental and intra-departmental meetings. May be required to be on-call, on a limited basis, for afterhours emergencies Any other duties deemed necessary by supervisor or management. SUPERVISORY RESPONSIBILITIES None QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE College Degree or Equivalent Experience At Least 3 years as a Sr. Claim Representative or equivalent preferred Excellent Written and Verbal Communication Skills Excellent Interpersonal Skills Superior Organizational Skills Efficient Time Management skills Ability to Demonstrate effective negotiation skills LANGUAGE SKILLS Excellent verbal and written communication skills. The individual must be able to effectively and clearly communicate with agents, insureds, departmental and company personnel via telephone, fax, e-mail, one-on-one dialogue and small group presentations in a professional manner. REASONING ABILITY The position requires the individual to apply common sense, understanding, reasoning and sound educated judgement coupled with sound Claims training and experience to properly evaluate and analyze claims for recommended action within assigned authority levels. CERTIFICATES, LICENSES, REGISTRATIONS IIA, AIC, or CPCU are highly preferred PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees are required to sit at a workstation to perform various PC functions. Additionally, the employee is required to devote substantial time to telephone communication. While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee frequently is required to use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. Employees may be required to travel from time to time. This may require extended periods of time sitting in a vehicle. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Claim Specialist is responsible for the proper handling of claims. Each Claim Specialist will be assigned a specific work cubicle station and or other individual work areas. The workstation will be located adjacent to other similar workstations. The workstation has the necessary equipment to perform the position duties including personal computer, telephone, file space, and needed work table space. The environment is reasonably quiet with needed interaction between other team members, immediate supervisor, and other Company staff. Moderate noise level from telephone calls is expected.

Fortune Brands Innovations, Inc. is an industry-leading home, security and digital products company. We're focused on exciting opportunities within the home, security and commercial building markets. Our driving purpose is to elevate every life by transforming spaces into havens. We believe our work and our brands can have incredibly positive impacts for not just our business and shareholders, but for people and the planet, too. At Fortune Brands, we're building something big. We're advancing exciting innovations in all of our products and processes. We're delivering trust, dependability, sustainability, and style. To make it all happen, we've transformed our workplace into an environment where smart, ambitious people have the support to reach their fullest potential. When you join Fortune Brands, you become part of a high-performing team empowered to think big, learn fast and make bold decisions. We support an inclusive culture where everyone is encouraged be their authentic selves, and where our differences and unique perspectives are a key strength. Explore life at Fortune Brands here. Job Description The Associate Claims Analyst processes, negotiates, and settles product liability claims for FBIN products globally. RESPONSIBLIITIES: Independently manage assigned claims throughout the claim lifecycle Analyze and process product liability claims Evaluate claims for validity and proper valuation Collaborate with technical experts to execute product testing Validate cause of claim against known or unknown defects and review findings with FBIN technical experts Open VOC or CAPA requests as necessary Develop strategies to manage claims to an appropriate and timely resolution Negotiate claim settlements up to designated authority level Close and process claims in a timely fashion Receive claims through various channels including phone, email, mail, worklist or the contact center Open claims by creating tickets within the claims management system while ensuring accurate and detailed documentation Communicate with claimants to gather information including photographs, statements, and evidence Regularly communicate with external stakeholders including insurers, attorneys, sales reps, builders, plumbers, retailers, wholesalers, and consumers Receive, process, and store evidence Support team and cross functional projects and continuous improvement efforts Monitor claim trends to mitigate future risk Travel to customer sites to support claims-related activities as necessary Qualifications 5+ years of experience in claims management Excellent written and verbal communication skills for interacting with all levels of staff, customers, suppliers, and operations Proficient in processing and communication tools: SAP, Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, Teams, and internet navigation Ability to manage multiple tasks and priorities in fast paced, changing environment Ability to travel up to 10% PREFERRED QUALIFICATIONS: Bachelor's Degree Additional Information Fortune Brands believes in fair and equitable pay. A reasonable estimate of the base salary range for this role is Hiring Pay Range: $40,000 USD - $66,000 USD. Please note that actual salaries may vary within the range, or be above or below the range, based on factors including, but not limited to, education, training, experience, professional achievement, business need, and location. In addition to base salary, employees will participate in either an annual bonus plan based on company and individual performance, or a role-based sales incentive plan. At Fortune Brands, we support the overall health and wellness of our associates by offering comprehensive, competitive benefits that prioritize all aspects of wellbeing and provide flexibility for our teammates' unique needs. This includes robust health plans, a market-leading 401(k) program with a company contribution, product discounts, flexible time off benefits, adoption benefits, and more. We offer numerous ERGs (Employee Resource Groups) to foster a sense of belonging for all associates. Fortune Brands is built on industry-leading brands and innovation within the high-growth categories of water, outdoors and security. The Company makes innovative products for residential and commercial environments, with a growing focus on digital solutions and products that add luxury, contribute to safety and enhance sustainability. To learn more, visit our website at fbin.com. Equal Employment Opportunity Fortune Brands is an equal opportunity employer. Fortune Brands evaluates qualified applicants without regard to race, color, religion, sex, gender identity or expression, national origin, ancestry, age, disability/handicap status, marital status, protected veteran status, sexual orientation, genetic history or information, or any other legally protected characteristic. Reasonable Accommodations Fortune Brands is committed to working with and providing reasonable accommodations to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application or interview process, please contact us at [email protected] and let us know the nature of your request along with your contact information. Important Notice: Protect Yourself from Fraudulent Job Postings To protect yourself from fraudulent job postings or recruitment scams, please note that Fortune Brands job postings are exclusively hosted on our website at fbin.com/careers via our SmartRecruiters platform. Fortune Brands will never request banking information or sensitive personal details until an offer of employment has been accepted and the onboarding process begins.

Confident Staff Solutions is a leading staffing agency in the healthcare industry, specializing in providing top talent to healthcare organizations across the country. Our team is dedicated to helping healthcare facilities improve patient outcomes and achieve their goals by connecting them with highly skilled and qualified professionals. Overview: We are offering a HEDIS course to individuals looking to start working as a HEDIS Abstractor. Once the course is completed, we will connect you with hiring recruiters looking to hire for the upcoming HEDIS season. HEDIS Course: Includes - Medical Terminology - Introduction to HEDIS - HEDIS Measures (CBP, LSC, CDC, BPM, CIS, IMA, CCS, PPC, etc) - Interview Tips Self-Paced Course https://courses.medicalabstractortemps.com/courses/navigating-hedis-2026

Job Description McGregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home. We are seeking a highly motivated and dedicated Junior Claims Analyst to join our team at PACE. As a Junior Claims Analyst, you will be responsible for supporting the administration and operation of the McGregor PACE health plan. This role contributes to the efficiency of claims processing by reviewing documentation, analyzing claim details, and assisting with daily tasks. Location: THIS IS A HYBRID ROLE Pay Range - $22.00-$24.00 Responsibilities: Prepare all claims appeals for review by the Director of Health Plan Operations. Code the IBNR (Incurred but Not Reported) report by identifying the appropriate accounts within the Monthly Paid Claims report Monitor enrollments and disenrollments using the Daily Transaction Reply Report (DTRR) and communicate results for follow-up. Update the rosters folder on SharePoint with participant subsidy letters. Review the claims listed on the Pend reports to see if they meet contracted terms and release for payment when verified. Verify that the End-Stage Renal Disease (ESRD) payments reported on the Monthly Membership Report (MMR) align with the total number of participants receiving these services. Communicate discrepancies as needed. Research external providers' inquiries regarding accuracy and status of payments. Prepare the weekly authorization manifest and submit it to our third-party claims administrator. Process, review, and summarize scheduled claim detail reports as well as ad-hoc requests. Complete other duties assigned by the Senior Claims Analyst or Director of Health Plan Operations. Minimum Qualifications: High School diploma (required). Strong verbal and written communication skills (required). Excellent customer service and organizational skills (required). Proficiency in Windows, Word, Excel, and PowerPoint (required). Reliable transportation (required). Preferred Qualifications: Associate's degree (preferred). Healthcare and/or industry experience (preferred). Strong analytical and problem-solving skills (preferred). A keen eye for detail when reviewing documentation and ensuring accuracy in claims processing systems (preferred).

The Associate Claims Analyst processes, negotiates, and settles product liability claims for FBIN products globally. RESPONSIBLIITIES: * Independently manage assigned claims throughout the claim lifecycle * Analyze and process product liability claims * Evaluate claims for validity and proper valuation * Collaborate with technical experts to execute product testing * Validate cause of claim against known or unknown defects and review findings with FBIN technical experts * Open VOC or CAPA requests as necessary * Develop strategies to manage claims to an appropriate and timely resolution * Negotiate claim settlements up to designated authority level * Close and process claims in a timely fashion * Receive claims through various channels including phone, email, mail, worklist or the contact center * Open claims by creating tickets within the claims management system while ensuring accurate and detailed documentation * Communicate with claimants to gather information including photographs, statements, and evidence * Regularly communicate with external stakeholders including insurers, attorneys, sales reps, builders, plumbers, retailers, wholesalers, and consumers * Receive, process, and store evidence * Support team and cross functional projects and continuous improvement efforts * Monitor claim trends to mitigate future risk * Travel to customer sites to support claims-related activities as necessary