Claims representative jobs in Bakersfield, CA - 792 jobs
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Claim Investigator
Claims Technician
Senior Auto Claims & Risk Analyst
Futureshaper.com
Claims representative job in San Francisco, CA
A leading autonomous driving technology company is seeking a Claims Analyst to support their Risk & Insurance Team. This hybrid role involves developing strategies and processes for handling unique claims related to autonomous vehicles while coordinating with various stakeholders. The ideal candidate will have over 7 years of experience in insurance claims, advanced communication skills, and a proven ability to investigate and triage complex claims. Competitive salary and benefits package provided.
#J-18808-Ljbffr
$75k-131k yearly est. 3d ago
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Senior PMM - Insurtech & Claim Automation
Hover 4.2
Claims representative job in San Francisco, CA
A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits.
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$80k-129k yearly est. 5d ago
Daily Property Field Adjuster
Alacrity Solutions
Claims representative job in South Lake Tahoe, CA
Alacrity Solutions
Independent Contractor
Daily Property Field Adjuster
Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy equipment, and casualty claims management services. Our staffing capabilities, temporary housing services, managed repair network, and subrogation services support a fully integrated solution for all your needs from first notice of loss through completion of repairs. By assembling the best service providers through strategic acquisitions and relying on the right talent, Alacrity Solutions provides consistent, professional, and scalable services throughout the entire claim handling and resolution process. To learn more, visit .
The objective of a Daily Property Field Adjuster is to provide excellent claim handling services for our clients regarding daily claim work within your area which can include multiple perils.
Contract Requirements Include:
A contract will be issued within 24 hours of accepting your first claim assignment with Alacrity. This IA contract will include pay details and other pertinent information regarding your work as an independent contract with Alacrity. A completed contract is required to issue pay.
Skills & Requirements/Licensure:
MUST live within 50-100 miles of posted location and willing to travel to location.
Minimum 2-3 years property field adjusting experience.
Independent adjusting license in your home state (area of work), or a designated home state license if residing in a non-licensing state.
Experienced in wind, hail, theft, fire, water losses and other perils preferred.
Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities.
Willing and able to climb roofs.
Computer and Phone System Requirements:
Smart Cell Phone able to access to internet.
Xactimate and/or Symbility proficient with current subscription
Working Laptop computer with reliable high-speed internet
Digital camera and other miscellaneous items necessary to perform adjuster responsibilities.
Working Conditions / Physical & Mental Demands:
The physical demands described here are representative and must be met by the independent contractor to successfully perform this job.
100% travel is required within designated working territory based on the location of assignments received.
Normal office or field claims environment. Ability to operate a motor vehicle for up to 8 hours daily, repeatedly entering and exiting the vehicle. Must be able to make physical inspections of auto loss sites. Must be able to work outdoors in all types of weather. Available to work catastrophic loss events. A willingness to work irregular hours and to travel with possible overnight requirements a plus.
Why Choose Alacrity?
Flexibility: Self-determined Scheduling
Diversity Statement
Alacrity is an equal opportunity employer and is committed to providing employees with a work environment free of discrimination and harassment. All decisions pertaining to an employee's employment are made without regard to race, color, religion, sex (including sexual orientation, pregnancy, childbirth), gender, gender identity or expression, age, national origin, ancestry, physical or mental disability, medical condition, reproductive health decisions, veteran's status, genetic information, creed, marital status, disability, citizenship status, or any other characteristic protected by applicable law.
How Long We Retain Personal Information:
We will keep your personal information for as long as necessary to fulfill legitimate business purposes and in accordance with applicable laws.
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$55k-75k yearly est. 3d ago
Claims Investigator
Apex Investigation
Claims representative job in Antioch, CA
About the Company
For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss.
About the Role
The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports.
This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role.
Key Responsibilities
Case Management & Communication
Receive, review, and manage assigned cases from start to completion.
Communicate professionally with clients, claimants, witnesses, and other involved parties.
Provide timely case updates and correspondence in accordance with company guidelines via CaseLink.
Maintain objectivity and professionalism in all interactions.
Investigative Field Work
Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings.
Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires.
Perform scene and neighborhood canvasses, including walking on varied terrain.
Meet with treating physicians and medical offices as required.
Travel to designated locations, including overnight stays when necessary.
Respond to rush cases within business hours when required.
Documentation & Reporting
Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis.
Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired.
Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements.
Prepare and submit comprehensive investigative reports within 72 hours of final update submission.
Evidence & Records Handling
Retrieve records from agencies and entities both in-person and remotely.
Take clear photographs and video when necessary and label all electronic files accurately.
Securely collect, store, and maintain custody of evidence when required.
Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure.
Additional Responsibilities
Identify and recommend additional investigative services outside the scope of the original assignment when appropriate.
Work overtime as needed to meet case demands and deadlines.
Maintain an efficient, safe, and organized telecommuter workspace.
Physical & Work Environment Requirements
Ability to sit for extended periods performing computer-based work and report writing.
Ability to stand for extended periods while conducting interviews and canvasses.
Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment).
Ability to operate digital audio recording equipment.
Qualifications
Experience with workers' compensation claims and investigative processes.
Strong written and verbal communication skills.
Ability to work independently, manage time effectively, and meet strict deadlines.
Willingness and ability to travel up to (but not limited to) 150 miles per assignment.
Possession of a personal credit card with available balance for reimbursable business expenses.
Proficiency with case management systems; CaseLink experience preferred.
Access to a personal scanner for document upload and record handling.
Preferred Qualifications
Prior experience conducting recorded statements and field investigations.
Experience with process service assignments.
Familiarity with evidence handling and documentation standards.
Background in insurance investigations or a related field.
$48k-67k yearly est. 2d ago
Claims Adjuster III, Agriculture
Amtrust Financial 4.9
Claims representative job in Fresno, CA
Requisition ID 2025-19590 Category Claims - Agriculture Type Regular Full-Time
Works independently to manage Workers' Compensation cases, including complex and catastrophic claims.
Note commercial Workers' Compensation experience in California is required.
Responsibilities
DISTINGUISHING CHARACTERISTICS:
Administers complex non-litigated and litigated workers' compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits. Provides technical guidance, mentoring and support to claims assistants and clerical staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions. Reasonable accommodation may be made for individuals with disabilities.
The functions of this job include but are not limited to;
Set up claims and make timely three point contacts
Ensure the privacy and security of Protected Health Information (PHI)
Analyze claim, investigate and estimate proper reserves
Develop and maintain relevant plan of action
Set up and maintain timely benefit payments (Includes wage statement calculation and diary management)
Identification and pursuit of subrogation
Timely review and maintenance of incoming mail
Timely response to Request for Authorization or referral for Utilization Review
Consistent communication and claim reviews with all parties, including our Claims Services Account Manager in relation to brokers and policy holders.
The agricultural accounts are generally higher volume policies, fast-paced and seasonal, and special handling is oftentimes required.
Timely evaluation of reserve adequacy
Proactively maintaining current status of claims
Identify, rate and reserve for possible permanent disability
Evaluate claim for settlement purposes
Timely excess Carrier Reporting
Close cases in a timely and expedient manner
Other duties as may be assigned
Must be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise.
Qualifications
Requires 3 to 5 years of commercial Workers' Compensation experience
Any combination equivalent High School graduation and/or two year community college or experience in business or closely related field.
Litigated and non-litigated claims experience required.
Basic mathematical skills required for calculations and ratings.
Knowledge and understanding of workers' compensation claims administration required.
Through knowledge of Self-Insurance regulations, Case Law, Labor Code.
Must possess strong time management, organization and problem solving skills.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.
Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness.
Ability to effectively present information to top management.
Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.
Must be able to negotiate.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Must be Current on Worker's Compensation education training hours.
Your employer reserves the right to modify the description of the duties and the requirements of this job at any time upon reasonable notice.
The expected salary range for this role is $87,600-$95,000.00.
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
#LI-GH1
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
Connect With Us!
Not ready to apply? Connect with us for general consideration.
$87.6k-95k yearly 3d ago
Claims Specialist - Workers Compensation - Roseville, CA
PMA Companies 4.5
Claims representative job in Roseville, CA
As a member of our Claims team, utilize your knowledge of Workers Compensation Claims to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.
Responsibilities:
Promptly investigates all assigned claims with minimal supervision, including those of a more complex nature
Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
Alerts Supervisor and Special Investigations Unit to potentially suspect claims
Ensures timely denial or payment of benefits in accordance with jurisdictional requirements
Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure
Negotiates claims settlements within granted authority
Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
Works collaboratively with PMA nurse professionals to develop and execute return to work strategies
Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome
Maintains a working knowledge of New York jurisdictional requirements and applicable case law for each state serviced
Demonstrates technical proficiency through timely, consistent execution of best claim practices
Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
Authorizes treatment based on the practiced protocols established by statute or the PMA Managed Care department
Assists PMA clients by suggesting panel provider information in accordance with applicable state statutes.
Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
#LI-Remote
Requirements:
Requirements:
Must possess CA License and experience
Bachelor's degree and/or four or more years of equivalent work experience required in an insurance related industry required
SIP certification preferred, ability to obtain required
Associate in Claims (AIC) Designation or similar professional designation desired
License required or ability to obtain license within 90 days of employment in mandated states
Familiarity with medical terminology and/or Workers' Compensation
Working knowledge of Workers Compensation regulations, preferably jurisdiction-specific
Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
Compensation:
PMA is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $71,300 to $82,600. Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.
$71.3k-82.6k yearly 3d ago
Claims Technician
Insight Global
Claims representative job in Calabasas, CA
Insight Global is currently hiring a Claims Technician for a client located in the Woodland Hills, CA area. This role will start as a 6-month contract, but will have the opportunity for extension or conversion based on performance! The ideal candidate will have at least 6 months to a year of experience in an office environment and strong administrative and computer skills. This position will require working fully onsite M-F during standard work hours! The Claims Assistant is the foundation of the claims process and as such is responsible for performing support activities that meet expected standard process and productivity guidelines. They are part of a team, and as such, is responsible for maintaining professional and positive rapport with all team members to provide quality support to the Claims Department.
Responsibilities
• Complete assigned daily claims support activities timely and accurately (whether as primary or backup role) according to Markel Service Standards. Including but not limited to; setting up first notices of loss according to established guidelines and routing documents and new losses accurately either via email or through document management system.
• Maintain understanding of departmental service standards, guidelines, processes and procedures.
• Strong phone skills necessary - ability to effectively communicate with customers over the phone, ensuring a clear and positive interaction
• Work effectively in a team environment to include participation on projects and testing initiatives.
• Strong PC skills, especially in Word, Excel, Outlook and paperless working environment
• Comfortable with high volume workloads, multiple priorities and productivity standards
$36k-47k yearly est. 4d ago
Claims Examiner
JT2 Integrated Resources
Claims representative job in Oakland, CA
JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions.
We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims.
This position is available for either remote or in office work.
Minimum Requirements
Three (3) years of claims management experience
Bachelor's degree from an accredited college or university preferred.
Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM.
Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims.
Duties and Responsibilities
Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards.
Prepare accurate and timely issuance of benefits notices and required reports within statutory limits.
Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits.
Ensure timely payment of benefits, bills and appropriate caseload and performance goals.
Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data.
Monitor, report, and assign claims for fraud potential and subrogation possibilities.
Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws.
Prepare and present claims summaries to clients during file reviews.
Train and direct Claims Assistants to meet goals and deadlines.
Review and approve priority payments and other documents from Claims Assistants.
Performs other duties as assigned
Knowledge, Skills, and Abilities
Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions.
Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits.
Strong skills with use of general office administration technology, including Microsoft Office Suite and related software
Excellent verbal and written communication skills
Excellent interpersonal and conflict resolution skills
Excellent organizational skills and attention to detail
Excellent interpersonal, negotiation, and conflict resolution skills
Strong analytical and problem-solving skills
Ability to act with integrity, professionalism, and confidentiality, at all times
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
JT2 Integrated Resources 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, gender identity or expression, or any other characteristic protected by federal, state or local laws.
$34k-57k yearly est. 2d ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claims representative job in Irvine, CA
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$35k-44k yearly est. 3d ago
Claims Examiner
Pacer Group 4.5
Claims representative job in Whittier, CA
Job Title : Claims Examiner
Duration: 13 weeks
Schedule Shift: Monday-Friday | 7:00 AM - 3:30 PM (Day Shift)
5x8s-Hour, 40 hours/week
Pay Rate: $28/hour
Description:
PIH Health Physicians is seeking experienced Claims Examiners to support claims adjudication and payment processing for HMO patients. This role reports directly to the Claims Manager and requires hands-on experience with medical claims reimbursement.
EDUCATION/EXPERIENCE/TRAINING
Required:
Minimum 2 years of verified claims adjudication experience
Experience in ambulatory, acute care hospital, HMO, or IPA environments
Must have claims reimbursement experience
Must have DOFR
Must have processed laboratory claims
High school diploma or GED required (physical proof must be available)
Knowledge of managed care and office automation systems
Strong attention to detail and compliance standards
DUTIES AND RESPONSIBILITIES
Process, adjudicate, and pay UB-92 and HCFA-1500 medical claims
Review claims from affiliated medical groups and hospitals
Ensure compliance with timeliness and payment accuracy guidelines
Apply payment methodologies for:
Professional (MD) services
Hospital services
Skilled Nursing Facilities
Ancillary services
Interpret provider contract reimbursement terms
Identify non-contracted providers for potential Letters of Agreement
Maintain accurate data entry within managed care systems
Ensure compliance with commercial, senior, and Medi-Cal claim requirements
$28 hourly 2d ago
Adjuster II - LA
Tokio Marine Group 4.5
Claims representative job in Los Angeles, CA
Marketing Statement:
TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
Process and adjust ocean and inland marine claims.
Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
Review survey reports or supporting documentation for determining loss.
Determine whether coverage exists for loss.
Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
Handle tasks that require a high level of organization and attention to detail.
Conclude all settlement agreements.
Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
Such responsibility may include direct recovery handling.
Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
Participate in training seminars and additional technical training courses.
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
College degree preferred
Strong PC skills, including Word and Excel
Strong written and oral communication skills
Auto industry experience preferred
Minimum 3 years claims handling experience.
Ability to work as part of a team
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.
$34-47 hourly Auto-Apply 44d ago
Publishing - Content Claiming Specialist
Create Music Group 3.7
Claims representative job in Los Angeles, CA
Create Music Group is currently looking for a Youtube Publishing Administrator to join our Publishing Department. This role is responsible for ensuring complete delivery of our publishing content, as well as maintaining internal systems and metadata to company standards. This is a full-time position located in our Hollywood office.
YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for artists and labels.
REQUIREMENTS:
1-3 years work experience
Excellent communication skills, both written and verbal
Internet culture and social media platforms, especially YouTube
Conducting basic level research
Organizing large amounts of data efficiently
Proficiency with Mac OSX, Microsoft Office, and Google Apps
PLUSES:
Strong understanding of the online video market (YouTube, Instagram, TikTok)
Bilingual - any language, although Spanish, Mandarin, and Russian is preferred
RESPONSIBILITIES:
Watching YouTube videos for several hours daily
Content claiming
Uploading and defining intellectual assets
Administrative metadata tasks
Researching potential clients
Staying on top of accounts for current client roster
You are required to bring your own laptop for this position.
BENEFITS:
Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included.
TO APPLY:
Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste
Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.
$44k-75k yearly est. Auto-Apply 60d+ ago
Independent Insurance Claims Adjuster in Bakersfield, California
Milehigh Adjusters Houston
Claims representative job in Bakersfield, CA
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
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$53k-67k yearly est. Auto-Apply 60d+ ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims representative job in Bakersfield, CA
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.
$54k-66k yearly est. Auto-Apply 1d ago
Public Adjuster
The Misch Group
Claims representative job in Los Angeles, CA
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
$75k-100k yearly 17d ago
Public Adjuster I
Allied Public Adjusters Inc.
Claims representative job in Newport Beach, CA
Job DescriptionOur Company: At Allied Public Adjusters (APA), our North Star is clear: we envision a world where every property loss is settled truthfully and equitably. Since 1997, weve worked on behalf of policyholders to demand whats right using technical expertise, field investigations, and uncompromising quality. We empower policyholders with the most skillful representation, while ensuring that carriers have the information they need to do whats right.
Our team is a dedicated group of professionals committed to ensuring individuals receive fair insurance settlements. We combine licensed expertise with an in-house assortment of legal professionals, construction estimators, accountants, and adjusters. At Allied, were not just about claims; were about people. Join us as we advocate for transparency, equity, and the rightful interests of our community.
Core Values:
We Show Up with G.R.I.T.:
Go-Getters, Relationship Builders, Intelligent Experts, Truth Champions
Every day. In every role. Through every decision and every moment of every engagement. This is the ethos that defines us. So, lets define it for one another.
Role:
APA is currently expanding and is looking for motivated individuals to come onboard as public adjusters. The Public Adjuster I is a professional claims handler who advocates for the policyholder in appraising and negotiating a claimant's insurance claim throughout the claim process. The PA works well in a rapid paced environment, model behaviors that reflect APAs core values and reports to a Managing Public Adjuster. The purpose of a PA I is to develop foundational skills in claims handling, client communication, and documentation while supporting more senior adjusters. The PA I will learn to manage claims with structured guidance.
Responsibilities:
Assist in managing assigned claims with support and guidance
Learn and apply policy interpretation and coverage fundamentals
Promptly handle claims that are assigned, creating a positive client experience
Conduct onsite inspections (with direction or supervision as necessary)
Capture photos and measurements to accurately measure losses
Prepare detailed scope and cost estimates (including using experts when needed)
Investigate claims thoroughly and present strong cases to negotiate settlements for clients.
Follow internal processes, documentation standards, and timelines
Maintain timely client communication and expectations
Draft reports and claim documentation
Properly document claim files pursuant to company standards
Effectively and efficiently utilize support teams such as legal, engineering, and leadership where needed to resolve claims and maximize value for our clients
Be a good team player and assist others where needed. This may include mentoring junior staff members in various situations.
Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
Qualifications:
02 years claims, construction, property, insurance, legal, or related experience
State Public Adjuster License (or ability to obtain)
Strong writing, organization, follow-through, and professionalism
Understanding of the insurance Industry standards, policies applicable laws and regulations
Construction knowledge and experience
Within your first year, you will have:
Built and manage a full and dynamic case load with timely movement on each claim
Achieve strong claim outcomes for clients
Demonstrate relentless advocacy while maintaining professionalism
Maintain excellent communication standards : proactive client updates, clear expectations, well documented outreach
Build trust and strong relationships with clients to produce high client satisfaction and referral feedback
Meet or exceed claim cycle time standards while balancing quality and urgency
Produce audit-ready files with complete documentation
Collaborate effectively with company departments to drive results
Demonstrate strategic, clear intentioned claim critical thinking
Show ownership mentality by treating every claim like it matters in a proactive manner
Demonstrate resilience and persistence, and embrace objections and denials
Contribute positively to the company culture and results
Key Performance Indicators:
Client satisfaction scores
Response & follow-up timeliness
Documentation accuracy
Claim cycle time
Learning progression benchmarks
Financial goals
Benefits:
Salary: Salary: $80,000- 105,000 annually plus up to 10% bonus
401(k) with 3% non-elective contribution.
Health, dental and vision insurance. Along with voluntary selections as well.
Generous paid holidays and paid time-off.
Opportunities for career advancement and professional growth.
Car and phone allowance, if needed.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
$80k-105k yearly 13d ago
Adjuster II - LA
Tokio Marine North America, Inc. (TMNA
Claims representative job in Los Angeles, CA
Marketing Statement: TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
* Process and adjust ocean and inland marine claims.
* Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
* Review survey reports or supporting documentation for determining loss.
* Determine whether coverage exists for loss.
* Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
* Handle tasks that require a high level of organization and attention to detail.
* Conclude all settlement agreements.
* Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
* Such responsibility may include direct recovery handling.
* Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
* Participate in training seminars and additional technical training courses.
* Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
* College degree preferred
* Strong PC skills, including Word and Excel
* Strong written and oral communication skills
* Auto industry experience preferred
* Minimum 3 years claims handling experience.
* Ability to work as part of a team
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.
$34-47 hourly Auto-Apply 43d ago
Auto Claims Specialist I (Manheim)
Cox Enterprises 4.4
Claims representative job in Riverside, CA
Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $19.90 - $29.81/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program.
Job Description
At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto.
That's where you come in.
We're looking for an Auto Claims Specialist I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details!
Benefits
* We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies.
* We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans.
* How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program.
* 10 days of free child or senior care through your complimentary Care.com membership.
* Generous 401(k) retirement plans with up to 6% company match.
* Employee discounts on hundreds of items, from cars to computers to continuing education.
* Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance.
* Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so.
* We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well.
At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits.
What You'll Do
From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include:
* Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines.
* Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making.
* Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases.
* Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution.
* Uses appropriate levels/limits of financial approval authority to resolve cases.
* Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information.
* Prepares and facilitates communication for resolution via telephone, email, and in-person discussion.
* Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold.
* Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements.
* Engages with supervisor/manager to determine if escalation is required.
* Performs other duties as assigned.
Who You Are
You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications:
Minimum
* A high school diploma or GED and less than 2 years of related experience.
* Accuracy and attention to detail.
* Organizational and time management skills.
* The ability to adapt in a fluid and changing environment.
Preferred
* 1+ years of automotive or body shop experience.
* Claims adjuster experience.
Cox is a great place to be, wouldn't you agree? Apply today!
Drug Testing
To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited.
Benefits
Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave.
About Us
Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.
Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.
$19.9-29.8 hourly Auto-Apply 15d ago
Pre-SIU Adjuster
Aspire General Insurance Company
Claims representative job in Rancho Cucamonga, CA
Job DescriptionDescription:
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.
JOB SUMMARY:
Under the direction of the Pre-SIU Supervisor, the Pre-SIU Adjuster is responsible for conducting the initial investigation of automobile claims involving perils with a high propensity for fraud. These include fire, theft, vandalism, hit while parked, catalytic converter theft, and other suspicious loss types. The Adjuster identifies potential fraud indicators, ensures timely and well-documented investigations, and refers appropriate cases to the Special Investigations Unit (SIU) for further handling. This role is structured as a career development path into a full SIU Investigator position.
DUTIES AND RESPONSIBILITIES:
Performs tasks such as:
Social media investigations.
ISO and TransUnion database searches.
Vehicle locator searches. d. Vehicle history reports.
Obtain phone records.
Credit checks.
Background checks.
Other tasks as needed.
Investigate, evaluate, and resolve automobile claims related to:
Theft
Fire/Arson
Hit while parked
Catalytic converter theft
Sandstorm damage
Vandalism
Water/Flood Damage
Vermin/Rodent Claims
Identify potential fraudulent claims, including:
Suspicious vandalism claims.
Suspicious vehicle theft claims.
Suspicious fire losses.
Suspicious injury claims.
Suspicious hit while parked claims
Any other suspicious claims.
Document investigations and findings.
Ensure ongoing adjudication of claims within company standards, industry best practices, and all state and federal regulations.
Comply with state and federal laws, Department of Insurance criteria, insurance carrier criteria, and follow company policies, procedures, and work rules.
Produce grammatically correct and clearly written correspondence including letters, memos, reports, and claim file documentation.
Maintain regular and predictable punctuality and attendance.
Attend fraud-related presentations/seminars/meetings and inform company management of important information learned at these events.
Perform other duties as necessary.
Requirements:
QUALIFICATIONS AND SKILLS:
Three or more years of experience in the Property and Casualty insurance industry handling automobile claims.
Clear understanding of insurance industry practices, standards, and terminology.
Ability to pass a background check.
Disciplined approach to all job-related activities.
Strong foundation of personal organization, sound decision-making, analytical skills, interpersonal and customer service skills.
Ability to work in a fast-paced environment while managing multiple priorities simultaneously.
Ability to achieve targeted performance goals.
INTER-RELATIONSHIP COMPONENT:
Ability to develop excellent working relationships with staff, clients, partners, and outside agencies.
Effective and friendly communication conducive to teamwork and professionalism.
Ability to work cohesively with other company partners and staff to achieve company goals.
Represent the company in a professional manner and contribute to the corporate image.
Consistently provide excellent client service.
WORKING CONDITIONS:
This is a non-exempt position that complies with the alternative work schedule when applicable.
May require mandatory overtime as deemed appropriate by management.
The office environment is highly technical, supporting a paperless environment.
Travel may be required.
Fast-paced work environment where accuracy is essential to successful task completion.
Requires extended periods of computer use and sitting.
Benefits: Medical, Dental, Vision, 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
$51k-70k yearly est. 2d ago
Claims Examiner l
Mid-Cal Labor Solutions
Claims representative job in Bakersfield, CA
About the role Under management direction, responsible for reviewing and processing all types of medical and facility claims from contracting and non-contracting providers and from subscribers and enrollees for payment in an accurate and timely manner. Responsible for applying correct contract benefits, policies and procedures.
This position is responsible for claims auditing and payment functions for a Knox-Keene licensed health maintenance organization (HMO).
Essential Duties and Responsibilities
Resolve system suspended claims for:
* PCPs
* Labs
* Radiology
* Less complicated specialists
* Physical Therapy
•Deny inappropriate claims following policy guidelines.
• Prepare claims that must be routed to other departments for further review.
• Review difficult claims with guidance from Claims Supervisor.
• Responsible for identifying billing errors and possible fraudulent claims submissions.
• Obtain eligibility verification and other health insurance coverage by Internet or POS.
• Responsible for correct manual calculation of benefits when applicable.
• Responsible for identifying possible CCS eligible claims for further investigation.
• Report overpayment refund requests on SharePoint log
• Maintain productivity and quality in accordance with established guideline.
• Perform other job-related duties as required.
• Regular Predictable attendance.
• Adheres to all company policies and procedures relative to employment and job responsibilities.
Employment Standards:
* High School Diploma from an accredited school or equivalent.
* Minimum of one (1) year medical Claims Examiner processing experience.
* Individual must have good organizational skills and the ability to make good decisions.
* Knowledge of: Computerized on-line data entry systems; organizational structure of medical claims processing; medical terminology; HCPCS, CPT & ICD-10 coding, UB04 and CMS1500 forms.
* Ability to: Adapt to a rapidly evolving work environment; work independently; communicate with a variety of personnel and providers.
DISCLAIMER:
The listed position purpose, job duties, responsibilities, competencies, skills, essential functions, education factors are the minimum purposes, duties, responsibilities, competencies, skills, essential functions, and education factors for the position. The requirements and conditions listed in this are not exclusive of the tasks that an employee may be required to perform. Company reserves the right to revise this job description at any time, and to require employees to perform other tasks as circumstances or condition of its business considerations or work environment change.
How much does a claims representative earn in Bakersfield, CA?
The average claims representative in Bakersfield, CA earns between $31,000 and $59,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Bakersfield, CA