Claims representative jobs in Baton Rouge, LA - 24 jobs

Integral part of helping Louisiana thrive through efficient and consistent handling of injured workers claims. Investigating assigned claims through completion. Provides unparalleled customer experience for all our stakeholders. Major Areas of Accountability General Participates in a formal training program to develop the knowledge and skills to handle insurance claims involving work-related accidents. Is responsible for the well-being of hundreds of Louisiana employees who are injured. Examine claims forms and other records to determine insurance coverage. Interview or correspond with our policyholders, claimants, witnesses, physicians, or other relevant parties to complete investigation. Investigate facts of loss to determine extent of injury. Review and understand police reports, medical treatment records, medical bills, and other insurance documents during the duration of the claim. Adjust reserves or provide reserve recommendations to establish the value of the claim consistent with corporate policies. Negotiate claim settlement opportunities. Confer with legal counsel on claims involving litigation. Takes initiative and manages personal claim caseload in accordance with processes and procedures with a focus on individual, team and departmental goals. Seeks opportunities for improvement and continued learning Maintains required LA Workers' Compensation Adjuster License. Performs other job duties as needed by the department Personality/Working Style Strong character Alignment with company values, mission, and vision Trustworthy and honest Decisive Curious and persistent Passion for innovation Willingness to learn Adaptive to changing (tolerance for ambiguity) Desire to collaborate to achieve corporate goals Strong communicator Effective communication skills Empathetic listener and open-minded Commitment to accountability Education and Experience Education Required: Bachelor's degree and a minimum of 2 years handling of workers' compensation claims, or 4 years of experience as an insurance claims adjuster. OR High School Diploma/GED with 2 years handling of workers' compensation claims and 4 years of experience as an insurance claims adjuster. Active Louisiana Workers' Compensation Adjuster License required prior to start or obtained within seven (7) business days after start date. Skills Required: Communication, computer literate, math, judgement and problem-solving skills.

CENCO is a leading provider of property claims solutions, partnering with top insurance carriers to deliver efficient, accurate, and timely adjusting services. We are currently looking for experienced Daily Property Claims Adjusters to support residential and commercial claims throughout Baton Rouge and surrounding Louisiana communities. This role is ideal for adjusters seeking consistent assignments and the flexibility of independent fieldwork. Key Responsibilities: Conduct on-site inspections of property damage caused by wind, hail, water, fire, and other covered events. Document damages thoroughly with detailed reports and quality photographs. Prepare accurate repair estimates using Xactimate or Symbility. Communicate professionally with policyholders, contractors, and insurance carriers. Manage claim files efficiently and meet required deadlines. Requirements: Licensing: Must hold an active Louisiana adjuster license. Software Skills: Experience with Xactimate or Symbility is preferred. Tools & Equipment: Reliable transportation, ladder, laptop, and basic field tools. Work Ethic: Self-motivated, organized, and capable of working independently. Availability: Must be able to accept and complete assignments promptly. Why Work with CENCO? Steady claim volume in the Baton Rouge region Competitive pay with reliable, on-time compensation Strong internal support and efficient claims processes If you're a dependable adjuster ready for steady daily work and a chance to grow with a respected industry leader, we'd love to connect with you!

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.

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.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Responsibilities * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. Qualifications * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

About Us At Elevate Claims Solutions, we are dedicated to supporting the unique skill sets and career goals of our Independent Adjusters. Our commitment to continuous improvement and meaningful work ensures that you can make a real difference in the lives of those you serve. What We Offer: Career Development: We prioritize your growth by seeking your feedback on how we can support your professional journey. Diverse Opportunities: Work with a variety of carriers, allowing you to expand your skills and network. Clear Expectations: Benefit from guidelines that clearly outline carrier requirements, ensuring you know what to expect. Continuous Feedback: Engage in real -time Quality Assurance and formal quarterly coaching sessions to refine your skills and highlight strengths. Expert Guidance: Collaborate with a team of seasoned industry professionals who provide valuable insights and support. Job Description Responsibilities: Evaluate exterior and minor interior property damage. Draft detailed damage descriptions, including measurements and materials used. Fill in basic scope sheets. Utilize Xactanalysis software effectively. Requirements: Current, active Xactimate license with experience writing estimates for both residential and commercial damages. Flexibility to maintain a non -traditional work schedule to accommodate the needs of insureds and carriers. Strong written and verbal communication skills, with an emphasis on clear and timely communication. Proficient in various claims management systems and strong technological skills. Ability to manage workload independently and exercise good judgment. Openness to receiving and providing constructive feedback. Background screening eligibility and current active licenses as required. Join Us If you're ready to elevate your career in a supportive and dynamic environment, we want to hear from you! Let's work together to make a meaningful impact.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Experience: 3 years of medical revenue cycle experience Education: High School Diploma Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Analysis and Collaboration Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Experience: 3 years of medical revenue cycle experience Education: High School Diploma Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Analysis and Collaboration Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis.

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 Specialty Loss Adjuster **Embark on an Exciting Career Journey with Sedgwick Specialty** **Job Location** **: USA, Mexico, Brazil and strategic locations globally** **Job Type** **: Permanent** **Remuneration** **: Salaries can range from** **_$40,000.00USD to $250,000.00USD_** **taking into account skills, experience and qualifications.** **We have a number of fantastic opportunities for Specialty Loss Adjusters across the US, Mexico and Brazil and a number of key locations** We are looking for a variety of skill sets at all levels. Whether you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your skills and grow with a company that values innovation, excellence, and employee satisfaction. Are you ready to be a part of providing a differentiated and best of class proposition to clients whilst working with like-minded colleagues? Sedgwick Specialty is thrilled to announce that we are investing in growth across Natural Resources, Property, Casualty, Technical and Special Risks and Marine. As we expand our operations, we are seeking individuals who are passionate about making a difference to the Adjusting industry. **As a member of the Specialty platform, you will have the opportunity to:** + Work with a wide range of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team of professionals who are dedicated to delivering exceptional results + Utilise state-of-the-art technology and resources to streamline processes and enhance efficiency + Receive ongoing training and development opportunities to further enhance your skills and knowledge in the marine industry + Enjoy a flexible work arrangement that allows you to maintain a healthy work-life balance while contributing to our global success **The skills you will have when you apply:** + **Qualified** : it is important to us that you are either accredited, on your way to be accredited or qualified by experience + **Insurance claims experience:** it is imperative that you have experience working on insurance claims within you respective field. Full claims life cycle experience is a must + **Great communicator:** you will be constantly working with policy holders, brokers, carriers and various third parties, so being able to communicate accurately important. Providing an excellent customer service with our clients in mind. Able to approach issues empathetically + **Commercially minded:** An understanding of how the industry operates and where the role of a Loss Adjuster fits in. Being able to negotiate. Understanding how to market your services is a big advantage **What we'll give you for this role:** 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 annual salaries can range from _$40,000.00 to $250,000.00USD._ 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. Always Accepting Applications. **This isn't just a position, it's a pivotal role in shaping our industry** At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education. Together, we're not only reshaping the insurance landscape, we're building a legacy of talent. Come and be a catalyst for change within our industry. **Next steps for you:** **Think we'd be a great match? Apply now -** ** we want to hear from you.** As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation. After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person). \#LI-HYBRID 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**

A company built to serve you. It's your career, Shelter it! Casualty Adjuster $23.82 - $33.38 minimum starting pay Job Level: Individual Contributor Shelter maintains broad salary ranges for its roles in order to account for variations in geographic location, education, training, skills, relevant work experience, business needs and market demands. Please remember that this range is the starting base pay only and does not consider other components that make up the total rewards package for the position. What You Will Be Doing: Investigate, analyze, evaluate and settle insurance claims involving liability issues and bodily injury losses. Perform complete liability, coverage, and bodily injury investigations. Determine validity of claims, verify coverage, establish value of losses and negotiate settlements within limits of authority, consistent with established procedures and legal and contractual obligations. Coordinate claims handling of multiple adjusters. Due to the duties and responsibilities of this position, a Credit Bureau Report and Criminal Background Check may be ordered on final candidates. What We're Looking For: Investigative, analytical, organizational and decision-making skills Understanding of medical terminology Superior skills in negotiation, communication and customer service Ability to learn through on-the-job training/training courses and obtain multi state licensing Strong skills in technology Efficient in time management to maintain schedules and deadlines Ability to perform the essential functions of the position, with or without a reasonable accommodation Shelter's uncompromising commitment to excellence doesn't stop with our customers. We recognize our employees are what make us a premier organization in the insurance industry. Shelter Employees enjoy such benefits as: Health, Dental, Voluntary Vision and Prescription Drug Insurance Savings and Profit Sharing 401(k) Paid Time Off for Sick and Personal Leave, Vacation and Holidays Vitality Wellness Program "Dress for Your Day" Dress Code Flexible Scheduling And much more! #IND1# If interested, please apply by: 01/21/2026

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. **POSITION PURPOSE** Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Analyzing, investigating, and resolving problem cases; executing recovery processes; and completing special projects. Accountable for complying with all laws and regulations that are associated with duties and responsibilities. **NATURE AND SCOPE** + This role does not manage people + This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS + Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist II must be in contact with personnel in other Units:Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices.Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans. **QUALIFICATIONS** **Education** + High School Diploma or equivalent required **Work Experience** + 2 years in medical claims processing required + Coordination of Benefits (COB) processing experience preferred **Skills and Abilities** + Strong analytical ability, that includes strong logical, systemic, and investigates thinking. + Strong oral and written communication skills and human relations skills are necessary. + Working knowledge of relevant PC software. + Ability to prioritize multiple streams of work effectively. **Licenses and Certifications** + None Required **ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS** + Reviews, researches, and makes necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction. + Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) in order to process both coordinated and non-coordinated claims correctly. Requesting of medical records may be required. + Communicates, both orally and in writing, with internal and external contacts in order to provide necessary and accurate information for the establishment of sound claim records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc. + Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction. + Researches, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to $1,000.00. + Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability. + Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability. + Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation). + May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction. **Additional Accountabilities and Essential Functions** _The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions_ + Perform other job-related duties as assigned, within your scope of responsibilities. + Job duties are performed in a normal and clean office environment with normal noise levels. + Work is predominately done while standing or sitting. + The ability to comprehend, document, calculate, visualize, and analyze are required. **An Equal Opportunity Employer** **All BCBSLA EMPLOYEES please apply through Workday Careers.** PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) **Additional Information** Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact ********************* for assistance. In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. _Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner._ _Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results._ **JOB CATEGORY:** **Insurance**

Join SAVARD Personnel Group - where your skills are valued! Key Requirements: We are hiring anexperienced workers' comp claims adjustor in Baton Rouge. Strong problem-solving and analytical skills. Excellent communication and interpersonal skills. Ability to work independently and as part of a team. Familiarity with safety protocols and claims management software. Valid driver's license and willingness to travel to job sites as needed. Investigate and document claims, including gathering evidence, interviewing claimants, and assessing damages. Conduct on-site inspections and assessments to evaluate the extent of damage and determine athe ppropriate course of action. Coordinate with safety teams and clients to ensure compliance with relevant regulations and protocols. Shifts: Monday to Friday - 8:00 AM to 5:00 PM Occasional over time and weekends as needed Duration: Temporary to Permanent How to Apply: Apply & Receive offers NOW! Download Savard 24/7 App! Call us at ************ Job ID# 47853060

All Job Postings will close at 12:01a.m. CST (1:01a.m. EST) on the specified Closing Date (if designated). If you close the browser or exit your application prior to submitting, the application progress will be saved as a draft. You will be able to access and complete the application through "My Draft Applications" located on your Candidate Home page. Job Posting Title: Claims Coordinator Position Type: Professional / Unclassified Department: LSUAM FA - Ops - RIS - RM - Data (Tiffany Mason (00065406)) Work Location: 0310 LSU Student Union Pay Grade: Professional : Job Summary: The Claims Coordinator provides administrative and clerical support for the Office of Risk Management's claims management program. This position assists in the intake, tracking, and documentation of claims across Workers' Compensation, Liability, Property, International Travel, and other specialty coverages. The Claims Coordinator ensures accurate record keeping, timely communication with departments and third-party administrators (TPAs), and assists in processing payments and reports. The position also provides limited departmental administrative support, including asset inventory, supply management, and general office coordination. Job Responsibilities: 50%-Claims Administration Support: Maintains claim files and records for all lines of coverage. Assists with claims intake, data entry, correspondence, and report preparation. Ensures timely submission of claims documentation to TPAs, insurers, and internal stakeholders. Tracks claim status and follows up on outstanding items. 15%- Communication and Coordination: Serves as a primary point of contact for departmental claim inquiries. Coordinates with faculty and staff to obtain needed claim information and assists in responding to requests from university departments, TPAs, and insurers. 15%- Financial and Payment Processing: Assists with processing claim payments, reimbursements, and account reconciliations. Prepares payment documentation and verifies transaction accuracy under the direction of the Assistant Director of Claims Management. 10%-Reporting and Data Entry: Maintains claims databases and updates reports with current claim information. Assists in compiling data for internal reports, dashboards, and audits. 5%-Departmental Administration: Provides general administrative support to the Office of Risk Management, including property inventory, supply ordering, scheduling, and other clerical duties. 5%-Training and Office Support: Assists with scheduling meetings, preparing training materials, and supporting departmental initiatives. Performs other duties as assigned to support risk management operations. Minimum Qualifications: Bachelor's degree. Experience in an office setting or detail-oriented environment. LSU values skills, experience, and expertise. Candidates who have relevant experience in key job responsibilities are encouraged to apply- a degree is not required as long as the candidate meets the required years of experience specified in the . This position is emergency and operation essential and may be required to report to campus in times of emergency and/or closure or asked to work during an official closure. Preferred Qualifications: Bachelor's degree with 1 year of experience. Experience in claims administration, insurance, or risk management support desirable. Experience handling confidential information and working in a fast-paced, detail-oriented environment is required. Familiarity with database systems, spreadsheets, and financial reconciliation preferred. Preferred Certifications/Licenses: Associate in Claims, Associate in Risk Management Certified Risk Management Charter Property and Casualty Underwriter. Additional Job Description: Special Instructions: Please submit cover letter, resume, transcripts, any licenses required for the position and 3 references. For questions or concerns regarding the status of your application or salary range, please contact Tiffany Mason at ************ or ****************. Posting Date: December 3, 2025 Closing Date (Open Until Filled if No Date Specified): April 2, 2026 Additional Position Information: Background Check - An offer of employment is contingent on a satisfactory pre-employment background check. Benefits - LSU offers outstanding benefits to eligible employees and their dependents including health, life, dental, and vision insurance; flexible spending accounts; retirement options; various leave options; paid holidays; wellness benefits; tuition exemption for qualified positions; training and development opportunities; employee discounts; and more! Positions approved to work outside the State of Louisiana shall be employed through Louisiana State University's partner, next Source Workforce Solutions, for Employer of Record Services including but not limited to employment, benefits, payroll, and tax compliance. Positions employed through Employer of Record Services will be offered benefits and retirement as applicable through their provider and will not be eligible for State of Louisiana benefits and retirement. Essential Position (Y/N): Y LSU is an Equal Opportunity Employer. All candidates must have valid U.S. work authorization at the time of hire and maintain that valid work authorization throughout employment. Changes in laws, regulations, or government policies may impact the university's ability to employ individuals in certain positions. HCM Contact Information: For questions or concerns related to updating your application with attachments (e.g., resumes, RS:17 documents), date of birth, or reactivating applications, please contact the LSU Human Resources Management Office at ************ or email **********. For questions or concerns regarding the status of your application or salary ranges, please contact the department using the information provided in the Special Instructions section of this job posting.

This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve. **ESSENTIAL RESPONSIBILITIES** + Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs. + Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards. + Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable. + Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template. + Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation. + Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures. + Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization. + Maintains accurate claim records. + Other duties as assigned or requested. **EDUCATION** **Required** + High School Diploma/GED **Substitutions** + None **Preferred** + Bachelor's degree **EXPERIENCE** **Required** + 5 years of relevant, progressive experience in health insurance claims + 3 years of prior experience processing 1st dollar health insurance claims + 3 years of experience with medical terminology **Preferred:** + 3 years of experience in a Stop Loss Claims Analyst role. **SKILLS** + Ability to communicate concise accurate information effectively. + Organizational skills + Ability to manage time effectively. + Ability to work independently. + Problem Solving and analytical skills. **Language (Other than English):** None **Travel Requirement:** 0% - 25% **PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS** **Position Type** Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely **_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ **_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ **Pay Range Minimum:** $22.71 **Pay Range Maximum:** $35.18 _Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at ***************************** California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J273755

Investigates, evaluates, and proactively manages assigned claims of variable complexity through final disposition. Investigates coverage and compensability issues. Handles lost time claims to include high IWIS claims, high exposure claims, as well as claims for assigned special accounts. Will have increased reserve and settlement authority limits. Handling of claims to include medical case management, litigation management, return to work and settlement where necessary. Serves as a resource and mentor to members of the department. Uses technology and systems to manage claims, to include document management, utilization review, and pharmacy management. Claims assigned will be handled independently under general direction according to the established policies, procedures, and precedents. Major Areas of Accountability Serve as dedicated claims representative to handle special customer service requirements for assigned accounts. Proactively manage litigated claims with in-house legal or outside counsel with focus on timely resolution and/or settlement. Evaluate and settle all claims with settlement potential within increased authority limits and present claims exceeding authority levels to executive claims committee for resolution of large exposure claims. Responsible for investigating and determining coverage, compensability, and subrogation and second injury fund potential, as well as resolving unique coverage issues where coverage may involve multiple carriers or claims involving employers' liability exposure. Manage occupational disease claims and any other claims involving extraordinary claim issues, to include high IWIS claims and other high exposure claims. Manage personal caseload effectively to mitigate exposure within controllable claim cost objectives. Develop cost containment strategies for large claims and make recommendations for productive case outcomes. Document claim files in accordance with quality review standards and complete reinsurance reporting on high exposure claims. Approach job in a conscientious, mature fashion demonstrating a sense of responsibility. Exhibit an ethical manner of conduct and keep sensitive information confidential. Demonstrate a willingness to contribute whatever is necessary to get the job done. Investigate larger more complex workers' compensation claims following sound claims handling techniques in accordance with company claim philosophy and quality assurance standards. Establish and maintain appropriate file reserves with increased authority limits that accurately reflect file exposure in accordance with company file reserving procedures. In addition to continuous communication with injured workers, medical providers, plaintiff attorneys and defense attorneys, also provides an appropriate level of customer service to policyholders and agents and promptly responds to resolve complaints or claim problems. Resource for and mentor to less experienced claims representatives. Provides other job duties as dictated by office circumstances. Personality/Working Style Strong character Alignment with company values, mission, and vision Trustworthy and honest Decisive Curious and persistent Commitment to accountability Passion for innovation Willingness to learn Adaptive to changing (tolerance for ambiguity) Desire to collaborate to achieve corporate goals Strong communicator Effective communication skills Ability to navigate difficult conversations Empathetic listener and open-minded Focus on customer service and stakeholder experience Analytical skills Mathematics/analytical background Investigation skills Negotiation skills Problem solving skills Time management skills Education and Experience Education Bachelor's degree and four years handling workers' compensations claims. OR High School Diploma/GED with eight years of insurance claims handling experience, four of which being workers' compensation claims. Active Louisiana Workers' Compensation Adjuster License required prior to start or obtained within seven (7) business days after start date. Experience Minimum of two years as a Claims Representative strongly preferred CPCU, ARM, AIC preferred

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 Rec Marine Adjuster **PRIMARY PURPOSE** **:** To investigate and process marine claims adjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement. + Receives and reviews new claims and maintains data integrity in the claims system. + Reviews survey reports and insurance policies to determine insurance coverage. + Prepares settlement documents and requests payment for the claim and expenses. + Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required. **Experience** 3 years or more of Marine Adjusting preferred. **Skills & Knowledge** + Strong oral and written communication skills + PC literate, including Microsoft Office products + Good customer service skills + Good organizational skills + Demonstrated commitment to timely reporting + Ability to work independently and in a team environment + Ability to meet or exceed Performance Competencies **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** **:** + Must be able to stand and/or walk for long periods of time. + Must be able to kneel, squat or bend. + Must be able to work outdoors in hot and/or cold weather conditions. + Have the ability to climb, crawl, stoop, kneel, reaching/working overhead + Be able to lift/carry up to 50 pounds + Be able to push/pull up to 100 pounds + Be able to drive up to 4 hours per day. + Must have continual use of manual dexterity **Auditory/Visual** **:** Hearing, vision and talking 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. 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**

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.