Claims representative jobs in Colton, CA

Work directly with regional Claims Managers to supervise employees in the assigned claims office. This includes assisting with recruiting, hiring and management of required staff. Supervise, evaluate, train, discipline and support staff. Ensure that supervised staff follows policies and procedures to ensure company compliance with regulatory standards, company policies and procedures, and best practices. Assist the manager in the day to day operations of the assigned office. Must be able to handle multiple jurisdictions with strong California experience or knowledge. RESPONSIBILITIES: Monitor the production and measure the performance of claims staff for full compliance with procedure manual and adopted best practices. Assign new claims and when necessary transfer existing claims to appropriate adjusters based on expertise of adjuster. Assist claims manager with training in claims related topics. Address claims related concerns and issues directly with the claims manager. Complete regular claim reviews for each assigned employee and address any concerns that may be identified, including but not limited to: timely determinations, accurate calculations of wages and benefits, statutory and regulatory compliance, reserve adequacy, subrogation, claim investigations, surveillance, litigation management, subsequent injury fund, reinsurance/excess insurance reporting and assist adjusters in addressing all topics. Assist in the development and implementation of work performance standards for claims adjusters. Ensure claims adjusters are responding to telephone calls, e-mails and correspondence timely and effectively. Complete annual performance evaluations of each assigned adjuster in accord with adopted procedures and best practices. Work directly with clients, brokers, agents, and employers in the explanation of claims related services for policy holders. When required, work directly with state regulators to address claims questions, complaints, and audits to ensure full compliance with applicable laws, regulations and directives from the regulator(s). Timely address concerns with injured workers, medical providers and employers. Other related assignments as assigned. Eligible for remote or hybrid work arrangement. QUALIFICATIONS: High school diploma or GED required Bachelor's degree or equivalent experience preferred Minimum of 5 years claims management experience. Insurance industry knowledge required Excellent technical skills associated with claims management Strong organizational skills Strong oral and written communication skills

Job Title: Claims Analyst Duration: 12 + Months Contract Job Location: Chino, CA, 91710 (Onsite) Pay Rate: $23-25/hr on W2 Ensures that complaints are resolved effectively and without delay and that those not resolved at the entity organization level have been escalated and taken into account in the competent entities. Drive Customer Centricity - for the entity. What do you get to do in this position? - Ensure that complaints are resolved effectively and without delay and those not resolved have been escalated to the appropriate entity - Collaborate with other organizations in order to contain, correct, and prevent problems affecting customers - Utilize I2P tools to process claims on a timely basis - Ensure that Complaint process is supported with warm loop - Share critical customer feedback information with management and all employees at all levels of meetings and on information boards - Work in collaboration with continuous improvement engineer - Update Logistics dashboard Key Responsibilities: - Act as the Customer Experience advocate. - Drive Customer Centricity in entities. - Ensure the Customer Experience is measured according to the Business priorities. - Define and follow-up the improvement action plan and priorities with the Business stakeholders. - Ensure that Customer dissatisfactions are solved quickly and effectively through containment, correction and prevention steps. Qualifications: We know skills and competencies show up in many ways and can be based on your life experience. If you do not necessarily meet all the requirements that are listed, we still encourage you to apply for the position. This job might be for you if: - Excellent verbal and written communication skills, listen effectively and solicit input from others. - Excellent organizational skills including the ability to handle multiple demands and assignments, the ability to prioritize tasks effectively and efficiently, and drive issues/ tasks to closure - Candidate must be a self-starter, highly motivated, and results driven. - Strong problem-solving skills and experience with root cause analysis and implementation of corrective action for process related concerns. - Proficiency with MS Office suite of products, especially Power point and Excel. - Ability to work effectively in a group setting as well as independently.

This is a hybrid position; the work location will be determined based on the selected candidate's proximity to one of our offices. Duties/Responsibilities + Provides customer service support to lenders, borrowers, insureds, claimants and all internal and customers. + On occasion, takes claim information via telephone, fax, e-mail, or regular mail and creates a record of loss in the appropriate claim system. + Verifies the claim coverage and reviews submitted claim forms for completeness and accuracy. + Sends instructions to the field personnel regarding claim file issues. + Utilizes the claim systems to assist customers with inquiries. + Enters notes into the claim system regarding conversations or incidences with customers. + Directs the efforts of the field adjuster. + Provides any required functions relating to the Claims Department at the direction of management. + Reviews reports from the field adjusters to ensure that the information and interpretation of the policy language are correct. + Corrects any errors seen in the field reports. + Interprets policy language and applies that policy language to loss situations. + Enters claim and expense payments into the systems that are within their authority. + Composes denial letters based upon the facts of the files as it relates to potential coverage issues. + Provides any required functions relating to the Claims Department at the direction of management. + Participation in audits of claim files. + Works with other departmental internal personnel on special projects. + Will be required to manage their own pending/case load. Required Skills & Experience + 4-8 years of relevant claims handling experience + Proper licensing + Strong customer service skills, including the ability to manage demanding requests + Experience in commercial property preferred + Willingness to help others on our team About Tokio Marine Highland Tokio Marine Highland Insurance Services (TMH) is a leading property and casualty underwriting agency. We offer a broad suite of tailored specialty risk management solutions, including private flood, fine art and lender-placed products. At TMH, it's all about our clients. Nationwide, our customers rely on our trusted, industry-leading coverages, supported by compliance expertise, superior claims management and the highest caliber of service. Founded in 1962, TMH is a wholly owned company of Tokio Marine Kiln, one of the largest carriers in the Lloyd's of London insurance market and a member of the Tokio Marine Group. TMH has operating centers in Chicago, Il, Frisco, Texas, Miami, Fla., and South Pasadena, Calif. If you're looking to advance your career, TMH is the perfect professional home. At TMH, you'll have a chance to innovate with the world's leading businesses, put your expertise into action on major projects, and work on game-changing initiatives. You'll also make long-lasting professional connections through sharing different perspectives, and you'll be inspired by the best. Tokio Marine Highland, LLC (TMH) is an Equal Opportunity Employer. TMH's success depends heavily on the effective utilization of qualified people, regardless of their race, ancestry, religion, color, sex, national origin, sexual orientation, gender identity and/or expression, disability, veteran status, or any characteristic protected by law. As a company, we adhere to and promote equal employment opportunities for all. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is TMH's policy to provide reasonable accommodation when requested by qualified individuals with disabilities during the recruitment process, unless such accommodation would cause an undue hardship. To make an accommodation request, please contact *****************************.

About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: • Data enter paper claims into EZCAP. • Review and interpret provider contracts to properly adjudicate claims. • Review and interpret Division of Financial Responsibility (DOFR) for claims processing. • Perform delegated duties in a timely and efficient manner. • Verify eligibility and benefits as necessary to properly apply co-pays. • Understands eligibility, enrollment, and authorization process. • Knowledge of prompt payment guidelines for clean and unclean claims • Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims. • Meets daily production standards set for the department. • Prepares claims for medical review and signature review per processing guidelines. • Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business. Maintains good working knowledge of system/internet and online tools used to process claims • Good knowledge of CPT/HCPCS/ICD-10, and Revenue Codes, including modifiers. • Assist customer service as needed to assist in claims resolution on calls from providers. • Research authorizations and properly selects appropriate authorization for services billed. • Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. • Coordinate Benefits on claims for which member has another primary coverage • Run monthly reports. • Review pre and post check run. • Regular and consistent attendance • Other duties as assigned QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE: • High School Diploma or GED required. • 1 to 3 years of previous experience in a health plan, IPA or medical group. • Strong understanding of the benefit process including member services or customer service. • Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). • Able to navigate difficult situations with empathy, discretion, and professionalism. • Strong understanding of Senior Medicare Advantage Health plans. • Able to explain member benefits, answer questions and concerns using a “Customer Service First” attitude. • Able to live our mission, vision, and values, • Bilingual in another language (written and oral) preferred.

Energy: Forget about blending in. That's not our style. We're the risk-takers, the trailblazers, the game-changers. We're not perfect, and we don't pretend to be. We're raw, unfiltered, and a bit unconventional. But our drive is unrivaled, just like our athletes. The power is in your hands to define what success looks like and where you want to take your career. It's not just about what we do, but about who we become along the way. We are much more than a brand here. We are a way of life, a mindset. Join us. A day in the life: As a Bottler Claims Representative at Monster Energy, you'll be at the heart of the action, processing, validating, and coding promotional invoices with the precision of a high-speed racer! Get ready to rev up your data-entry skills and keep the promotions engine running smoothly. Your role is all about ensuring everything flows seamlessly, just like the thrilling rush of a Monster Energy drink! The impact you'll make: Review, validate, and process distributor invoices in accordance with company policies and procedures. Requires frequent communication with distributors and the Sales Team to obtain necessary supporting documentation and approvals. Verify invoice program details, ensure accuracy, compliance, and adherence to promotional execution or contractual agreements. -->> Collect, organize, and maintain supporting documents required for invoice validation and/or support in SAP, Vistex, Sales Force and or other source locations. Accurately code and enter invoice details into SAP, Vistex, Sales Force, and or other source locations, to ensure proper GL coding and reporting. Identify discrepancies or errors in claims and work with relevant teams to resolve issues efficiently. Ensure all claims adhere to company policies, industry regulations, and audit requirements. Maintain accurate and up-to-date records of processed claims for tracking and audit purposes. Identify opportunities to enhance efficiency and accuracy in claims processing workflows. Work closely with internal teams, including Finance and Sales and Chain Claims, to support business objectives and streamline operations alongside any additional ad hoc duties. Who you are: Prefer a Bachelor's Degree in the field of --Accounting, Math, Business Administration, or other related field of study Additional Experience Desired: Minimum 1 year of experience in Accounts Payable position Additional Experience Desired: Minimum 1 year of experience in processing vendor invoices, data entry, account reconciliation Computer Skills Desired: Proficiency with Microsoft's office desktop solutions (Intermediate Excel a must - Test Scores required), Teams, Outlook, SharePoint, SAP or other accounting technology a plus. Preferred Certifications: N/A Additional Knowledge or Skills to be Successful in this role: Typing, 10 Key desired Monster Energy provides a competitive total compensation. This position has an estimated hourly rate of $17.00 - $23.00 per hour. The actual pay may vary depending on your skills, qualifications, experience, and work location.

DETAILS Claims Supervisor Department: Workers' Compensation Reports To: Division Claims Manager FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Division Claims Manager ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a Claims Supervisor to support our Southern California Workers Compensation department. Management that lives less than 36 miles from the Orange, CA office AND have a direct report in the office, are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Southern California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. Employee work a 37.5-hour work week with the ability to work a flex schedule with every third Monday or Friday off. As a Claims Supervisor, you'll play a pivotal role in leading and collaborating with Athens management to achieve exciting company goals, run insightful reports, and streamline processes. You'll make impactful daily claims decisions, review files for accuracy, and approve payments that exceed examiner authority. Additionally, you'll ensure top-notch file handling, accurate claims coding, and meet unit closing goals. You'll be the guiding force for your team, planning, organizing, delegating workloads, supervising daily activities, providing training, and offering valuable guidance. In client management, you'll address policy and claims issues, build and maintain strong relationships, attend key meetings, ensure compliance with client instructions, and document interactions, always acting in the client's best interest. Join us and make a difference every day! PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Claims Leadership Work with Athens management to achieve company initiatives and performance goals Consistently strive to improve and streamline current processes Authorize release of payment and settlement Make daily claims decisions regarding plan of action, handling of payment, etc. Review claim files for accuracy Run various reports with an eye for accuracy and confidentiality Approve payments and reserve increases when they rise above Examiner's authority level Work collaboratively with internal and clients' senior management as well as with attorneys to draft settlements and assist with litigation strategies Provide timely information to clients, attorneys, doctors, investigators and injured workers with strong, professional communication Discuss appropriateness of medical treatment with medical case manager Assure consistent and accurate claims coding is occurring on the team Ensure quality file handling and resolution. This includes meeting unit closing goals, verifying proper reserves, providing thorough claims analysis and guiding to correct resolution Use flexibility when working in demanding and changing situations Employee Management Effectively plan, organize and delegate workload for optimal results and to ensure time commitments are met Supervise daily activities of the team by monitoring progress, ensuring compliance with policies, and promptly addressing any issues or conflicts Identify, coordinate, coach, and perform training with staff to improve performance and increase their growth and knowledge in claims Participate in the interview process, onboarding and training of new hires Provide general guidance to the team by offering support and advice on work-related issues, fostering a positive work environment, encouraging professional development, and reviewing performance through evaluations, feedback, goal setting, and identifying areas for improvement Provide direct feedback and use sound coaching techniques to solve disciplinary or workflow problems. Manage and document employee relations issues at all levels. Work in conjunction with Human Resources to ensure performance issues are managed in a timely and consistent manner Regularly lead organized and collaborative staff unit meetings, including both remote and on-site employees Maintain an open-door policy and an approachable attitude, and foster open communication with staff Client Management Work with clients with issues regarding policies, programs and/or claims Manage existing client relationships by being accessible, making regular service calls, and proactively identifying and solving potential problems Attend client meetings, internal meetings, and workers' compensation meetings both virtual and in-person Ensure notepads and diaries are set and completed timely in accordance with client handling instructions and Athens Best Practices and have meaningful action plans and information and are concise and well-written Obtain audit results meets or exceeds best practice standards of Athens and client Display integrity and always acts in the best interest of the client Document client meeting notes in appropriate shared location Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions. Provide direct supervision for 6-10 employees, typically consisting of Senior Claims Examiners, Future Medical Claims Examiners, Claims Examiners, Assistant Claims Examiners and Assistant Claims Examiner Trainees. Attend on-site Leadership Summit at Athens Concord headquarters every 18 months (including overnight) Fiscal Responsibilities Review and approve direct report's monthly expense reports Ensure that all expenditures are in the best interest of the Company Use effective monitoring and reporting mechanisms to control expenses without lowering quality Search for and implement hidden cost improvements Obtain, maintain, and demonstrate an understanding of wage and hour laws as applicable for employees Ensure timely, accurate review and approval of timecards for your staff on payroll processing days. ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) Administrators Certificate from Self-Insurance Plans. If not already obtained, the Administrators Certificate from Self-Insurance Plans will be required within one year of employment Completion of IEA or equivalent courses Solid and in-depth knowledge of workers' compensation laws, policies, and procedures 3+ years' recent workers compensation claims handling experience at a high level 5+ years' experience in a Workers' Comp claims lead or supervisor position preferred At least 2 years Claims Supervisory experience required Proficiency in determining case value and negotiating settlements Prior Third-Party Administrator (TPA) experience preferred Understanding of medical and legal terminology Strong attention to detail and organizational skills and the ability to research and resolve problems and meet multiple deadlines and to plan and effectuate short- and long-range Company and department objectives. Proficiency at applying business and technical acumen by understanding how the business works and how technology supports business initiatives. Leverages technology for self and staff to improve efficiency. Partnering with team to ensure on time task completion; done through delegation and leading by example, executing tasks rather than just instructing them to execute tasks Handles stressful situations and deadline pressures well Must demonstrate accuracy and thoroughness in work product Effectively influences people to achieve unit and organizational objectives Must be flexible, adaptable, and positive. Exhibit passion and energy to ensure that all employees are respected and treated in a manner consistent with Athens Values. Able to plan, prioritize and organize claims workload for a unit Skilled at presenting in small and large group settings Ability to create reports as required, using the report writing tools available or creating custom documents. Skilled at developing and maintaining effective relationships with others (co-workers, customers, vendors, management, and other key stakeholders) to achieve organizational goals Embrace the leadership role and can be counted on to help senior management drive towards the desired results and to exceed goals successfully. Able to interpret information from multiple sources and draw logical conclusions; consults others based on analysis of data; able to think strategically and use data findings to consult others for improved business results. Negotiating skills Mathematical calculating skills Exercise independent judgment and analytic ability in solving complex and sensitive problems Highly developed verbal and written communication skills with strong attention to detail Computer processing skills, including the ability to leverage technology for self and staff to improve efficiency Proficient in Microsoft Office Suite Ability to type quickly, accurately and for prolonged periods Ability to learn additional computer programs ClaimsXpress program experience preferred but not required Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Valid Driver's license and availability for travel including in office file reviews and meetings APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $67,000.00 - $110,600.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign-on bonus! LOCATION REQUIREMENT: This position services Insureds/Agents in Riverside County or Northwest Los Angeles County. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. For the Riverside County location, ideal locations include Riverside, Redlands, Jurupa Valley, Moreno Valley, Beaumont, Grand Terrace, Colton, Bloomington, Rialto, and surrounding areas. For the Northwest Los Angeles County location, ideal locations include Culver City, Inglewood, Santa Monica, Los Angeles, Beverly Hills, Van Nuys, Sherman Oaks, Burbank, Glendale, Pasadena, and surrounding areas. Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Handles 1st party property claims of moderate severity and complexity as assigned. + Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May provides mentoring and coaching to less experienced claim professionals. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelors Degree preferred. + General knowledge of estimating system Xactimate preferred. + Customer Service experience - preferred + Interpersonal and customer service skills - Advanced + Organizational and time management skills- Advanced + Ability to work independently - Intermediate + Judgment, analytical and decision making skills - Intermediate + Negotiation skills - Intermediate + Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate + Investigative skills - Intermediate + Ability to analyze and determine coverage - Intermediate + Analyze, and evaluate damages -Intermediate + Resolve claims within settlement authority - Intermediate + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED required. + A minimum of one year previous outside property claim handling experience or successful completion of Travelers Outside Claim Representative training program required. + Valid driver's license required. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

We're always looking for diverse, talented, service-oriented people to join our exceptional team. Loan Adjuster II The pay range for this position is listed below. Our pay ranges are built to allow for candidates with various levels of skill and experience to be considered, as well as for room for growth and tenure achieved in a role over time. Typical new hire salary offers fall within the minimum to midpoint of a pay range for many candidates. Any offer extended to a candidate will be based upon their unique set of knowledge, skills, education, and experience as well as internal equity. Pay Range: $22.00 - $31.90 Scheduled Weekly Hours: 40 What You'll Be Doing Collects on loans of all stages of delinquency made by the Credit Union where timely payments are not being received. Communicates with Members using advanced skills to identify the true cause of non-payment and provides a personalized options to each Member. * Works on all delinquency stages through inbound/out-bound calling, letters, and other approved methods, collects past due payments and/or negotiates payment arrangements or repayment plans to resolve delinquent loans or negative shares by identifying reason for delinquency and offering appropriate options to Members. * Documents all conversations and collections activity in collection systems. May be responsible for funding of workout loans or working collections reports, such as the available money letter report. * Maintains adherence to all federal and state regulations and credit union policies. * Performs file maintenance of delinquent accounts to reflect agreed upon collection activities. Processes adjustments to Member loans as needed, including but not limited to, due date changes, opening/closing lines of credit, closing negative accounts, and payment plan maintenance. * Recommends Members with delinquent accounts for work out loans, deferments, reages, reduced payments, repossession and charge-off. Refers complex situations to the appropriate resources to ensure timely resolution. * May provide suggestions for streamlining departmental and credit union operations. When assigned helps to complete projects and reports related to the department. * May perform more advanced research and analysis on accounts, may skip trace and perform asset searches. Additional Job Functions * Performs other duties as assigned * Complies with regulatory compliance and assigned training requirements including but not limited to BSA regulations corresponding to their specific job duties. Failure to do so may result in disciplinary and other employment related actions Qualifications * High School Diploma or GED required 3-5 years of previous related experience required Previous financial institution or credit union experience preferred Knowledge, Skills, and Abilities * Knowledge of bankruptcy laws, FDCPA, TCPA and SCRA * Excellent verbal and written skills. * Uses active listening skills to determine the Member's hardship and provides appropriate solution. * Ability to multi-task * Intermediate computer and typing skills * Experience with inbound/outbound phone system preferred * Conflict resolution and negotiation skills SchoolsFirst FCU is committed to Diverse, Equitable, and Inclusive Hiring At SchoolsFirst FCU we are dedicated to building and growing a diverse, inclusive, and authentic Dream Team, so if you're excited about a position or wanting to make a career change but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. Many skills are transferrable and you may be just the right candidate for the position, or for other roles we are working on. SchoolsFirst Federal Credit Union is committed to fostering, cultivating, and preserving a culture of diversity and inclusion. SchoolsFirst FCU is an equal opportunity employer and prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibits discrimination against all individuals based on their race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, political affiliation, or genetic information. This organization participates in E-Verify.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific accounts(s). This position enjoys a flexible, hybrid work schedule and is available in Plano TX, Brea CA, Downers Grove IL or Portland OR CNA office. JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. * Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols. * Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim. * Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May perform additional duties as assigned. Reporting Relationship Typically, Manager or above Skills, Knowledge & Abilities * Developing basic knowledge of the commercial insurance industry, products and claim practices. * Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service. * Ability to develop collaborative business relationships with both internal and external work partners. * Able to exercise independent judgement, solve basic problems and make sound business decisions. * Analytical mindset with critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Adaptable to a changing environment * Ability to value diverse opinions and ideas Education & Experience: * High school Diploma required. Associates or Bachelor's Degree preferred. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Prior claim handling, or business experience in the insurance industry and/or customer service is preferred. #LI-Hybrid #LI-KA1 In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $47,000 to $78,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Earn an Annual Salary Up to $97,344! Salary negotiable commensurate with qualifications The Risk Management Department is recruiting for a Liability Claims Representative who will administer liability claims from inception to resolution. Liability Claims Representatives conduct office and field investigations and research applicable laws, codes, and resolutions to determine the extent of County liability. Liability Claims Representatives also prepare reports of findings and make recommendations on the settlement or denial of claims, attend settlement conferences and mediations, and monitor all court actions and attorney representation. For more detailed information, refer to the Liability Claims Representative job description. This excellent opportunity for career growth also offers a lucrative compensation and benefits package! To review job-specific benefits, refer to: * Benefits by Occupational Unit (BbOU) Summary - Technical & Inspection * Employee Benefits * County Memoranda of Understanding (MOU) * The County also offers an alternative Modified Benefits Option (MBO) that provides a wage differential for qualifying classifications. A hybrid telework schedule may be offered upon satisfactory work performance. Some departments may also offer a 9/80 schedule, where incumbents enjoy a nine-day biweekly schedule. CONDITIONS OF EMPLOYMENT Pre-Employment Process: Prior to appointment, applicants must successfully pass a background check, including fingerprinting, verification of employment history, and physical exam/drug test. Travel: Travel throughout the county may be required. Employees will be required to make provision for transportation. Mileage reimbursement may be available. At the time of hire, a valid California Class C driver license and proof of automobile liability insurance must be produced and maintained for the individual providing the transportation. Sponsorship: San Bernardino County is not able to consider candidates who will require visa sponsorship at the time of application or in the future. Experience: Three (3) years of full-time experience adjusting tort liability claims or equivalent complex liability claims experience from inception through closure. The ideal candidate will have five (5) years of complex litigated claims adjusting experience (i.e., serious bodily injury or wrongful death) at all phases of the process in a public sector environment. The ideal candidate should also possess an adequate mix of experience, education, professional insurance training; preferably in liability claims management and demonstrate strong leadership and interpersonal communication skills. College and/or insurance education coursework is also highly desirable. Examination Procedure: There will be a competitive evaluation of qualifications based on the information provided in the Application and Supplemental Questionnaire. You are encouraged to include detailed descriptions of your qualifying experience and skills, as only the most highly qualified applicants will be referred to the department. Do not refer to a resume, as it will not be reviewed. Application Procedure: Please complete and submit the online employment application and supplemental questionnaire by 5:00PM Friday, December 12, 2025. To ensure timely and successful submission of your online application, please allow ample time to complete and submit your application before the posted filing deadline. Applicants will be automatically logged-out if they have not submitted the application and all required materials prior to the posted deadline. Once your application has been successfully submitted, you will receive an onscreen confirmation and an email. We recommend that you save and/or print these for your records. Please note, if you do not receive an onscreen confirmation and an email acknowledging our receipt of your application, we have not received your application. All communications regarding the selection process will be via e-mail. Applicants are encouraged to check their e-mail frequently to learn additional information regarding this recruitment. Check your Government Jobs account for notifications. Update your firewalls to allow e-mails from San Bernardino County through governmentjobs.com. Update your Spam, Junk, and Bulk settings to ensure it will not spam/block/filter communications from e-mail addresses with the following domain "@hr.sbcounty.gov". Finally, be sure to keep your personal information updated. Taking these steps now will help ensure you receive all communications regarding this recruitment. If you require technical assistance, please follow the link to review the Government Jobs online application guide or contact their Toll-Free Applicant Support line at **************. Please note that Human Resources is not responsible for any issues or delays caused by the internet connection, computer or browser used to submit the application. EEO/ADA: San Bernardino County is an Equal Employment Opportunity (EEO) and Americans with Disabilities Act (ADA) compliant employer, committed to providing equal employment opportunity to all employees and applicants. ADA Accommodation: If you have a disability and require accommodations in the testing process, submit the Special Testing Accommodations Request Form within one week of a recruitment filing deadline. Veterans' Preference: Eligible veterans and their spouses or widows/widowers who are not current County employees may receive additional Veterans' Preference points. For details and instructions on how to request these points, please refer to the Veterans' Preference Policy. Review important Applicant Information and the County Employment Process for more information

Healthcare Talent is assisting our client in hiring a Supervisor, Claims (CQI) for their Claims Department. The Claims Supervisor oversees the day-to-day operations of the Quality Analyst (QA) staff in the Continuous Quality Improvement (CQI) Unit of the Claims Department. This position is responsible for ensuring adherence to regulatory and internal guidelines in conjunction with company policies and procedures as they apply to claims processing and adjudication. Our client has a unique business philosophy; their goal is to provide employees with a place to excel - while really creating something meaningful in their work. This philosophy has helped them grow into an award-winning company. Employees are provided with room for advancement, competitive compensation, and an excellent benefit package. Job Description Position Responsibilities • Train, audit and supervise all QA staff to ensure adherence to the Medi-Cal and Medicare processing guidelines. Identify any new learning opportunities for staff (i.e. new desktops). • Monitor staff to ensure department turn-around times for claims auditing are met. Ninety five percent (95% of all claims must be paid or denied within 30 calendar days and 100% within 60 days from date of receipt to date of financial run. • Must serve as a back up to claims processing when needed to ensure the department turn-around times are met and maintain inventory within 21 days on hand. • Responsible for prompt communication with staff. Must schedule monthly unit meetings to go over any changes to programs or training issues; schedule monthly one-on-one meetings with staff to go over their monthly progress regarding their success factors (production, quality, etc). • Plan work for staff, assign daily claims and determine priorities of work done by staff. • Set or recommend work performance standards. • Review work procedures and recommend or change procedures to be more time/cost efficient. • Assist with interviewing job applicants and make recommendations for hire as needed. • Train, evaluate, and provide performance feedback to staff. • Conduct employee counseling/corrective interviews with the assistance of Human Resources. • Conduct claims presentations as assigned. • Other projects and duties as assigned. Qualifications Required Skills • Diffuse emotional situations with employees and/or provider representatives. • Interact with peers face-to-face, over the phone and in writing in a manner that is professional and productive. • Influence others using a positive approach. • Provide clear, concise instruction to individuals of varying skill levels. • Troubleshoot problem areas. • Encourage and utilize suggestions and new ideas. • Manage and keep track of multiple tasks. • Remain objective when dealing with emotional topics or when having to give feedback to staff. • Establish and maintain effective working relationships with all levels of staff, other programs, agencies, and the general public. • Effectively utilize computer and appropriate software and interact as needed with company claims processing systems. • Speak and write clearly and concisely. • Encourage the professional performance and development of subordinate staff. • Plan, organize and prioritize work. Required Experience Experience & Education • High school diploma or equivalent is required; some college preferred. • 3+ years of experience in a managed care environment that would have developed the knowledge and abilities listed. • Substantial practical knowledge and understanding of relevant business practices and applicable regulations/policies. • Previous experience in directing the work of others (i.e. training, responding to questions, etc.) and supervisory experience are preferred. • Demonstrated ability to work closely and often with others. Knowledge of: • Principles and techniques of effective supervision. • Technical area(s) of medical claims administration, including medical terminology, CPT, ICD-9 codes and HCPCS codes. • Medi-Cal and Medicare program guidelines. • Benefit interpretation and administration. • Department reports, their purpose and how to interpret them. • Department procedures, policies and expectations. • Fundamental principles of writing and grammar, including proper report and correspondence format, correct spelling and proper word usage, grammar, punctuation, and sentence structure. • Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Additional Information If you feel that you have the skills we require, please respond to this posting with your contact information and your resume in a Word document. We look forward to hearing from you today! ************************ *********************************

Job Description Workers' Compensation Claims Supervisor - Lead a Dynamic Team in Glendale reporting to the Glendale office 3 times a week We're seeking an experienced and motivated Workers' Compensation Claims Supervisor to join our team in Glendale, CA. As a Supervisor, you'll lead a team of 7, including 5 Claims Adjusters and 2 Claims Assistants, providing guidance, mentorship, and performance feedback to ensure exceptional claim handling and adherence to company standards and regulations. Our Mission: To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives. Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes. Our Goal: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients. Your Impact: Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance Ensure all claims are handled in accordance with relevant statutes and company guidelines Address personnel issues promptly and decisively, keeping management informed of corrective action Foster a collaborative and productive team environment focused on excellence in claim resolution Our Offer: Competitive salary and benefits package, including medical, dental, vision, and 401(k) Opportunity for professional growth and advancement in a dynamic organization Collaborative work environment with a team dedicated to workers' compensation excellence Interested? Get in Touch: To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following: Apply to this posting Call me directly at ************ Email ************************ We look forward to hearing from you! “Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.” Powered by JazzHR AUrIYySxmm

Job DescriptionDescriptionJob Title: Claims Analyst Department: Ops - Claims Ops About the Role: We are currently seeking a highly motivated Claims Analyst. This role will report to the Director - Claims and enable us to continue to scale in the healthcare industry. What You'll DoClaims Review & Processing: Conduct comprehensive review and analysis of pended or denied claims for billing accuracy, contract compliance, and adherence to claims processing guidelines Process and adjudicate non-institutional and institutional claims for multiple lines of business (e.g., Medicare, Medi-Cal, Commercial, etc.) Validate provider contracts, fee schedules, pricing configurations, and ensure updates are properly reflected in the system Research, adjust, and resolve complex claim issues such as duplicate billing, unbundling of services, incorrect coding, or payment discrepancies Review claims utilizing ICD-10, CPT, and HCPCS codes to confirm proper billing and medical necessity Verify member eligibility and coordination of benefits, including Medicare primary and other secondary coverage Identify and escalate claims with high financial or compliance risk for management review Data & Systems Management: Validate system configuration that it's pricing claims correctly Collaborate with configuration team if after testing configuration needs to be updated Collaborate with contract with full intent of DOFR and contract rates Maintain claim documentation and ensure system-generated errors are corrected prior to adjudication Monitor and process claim exception and reconciliation reports as assigned Analytical & Project Responsibilities: Analyze trends in claim denials, payment discrepancies, and provider performance to identify process improvement opportunities Develop and maintain dashboards, reports, and KPIs to measure claims accuracy, timeliness, and financial impact Support cross-functional initiatives and operational projects to improve claims efficiency and compliance Assist in the development and implementation of new workflows, tools, and system enhancements Participate in project planning meetings, contributing subject matter expertise in claims operations and system configuration Collaboration & Communication: Serve as a liaison between Claims Operations, Provider Contracting, Finance, and IT departments to ensure alignment on claims processes and issue resolution Communicate project progress, risks, and deliverables to leadership and stakeholders Foster collaborative relationships across departments to drive process standardization and operational excellence General: Maintain required production and quality standards as defined by management Support special projects and ad-hoc assignments related to claims and operational efficiency Contribute to team success by sharing knowledge and supporting continuous improvement initiatives Regular attendance and participation in on-site and virtual meetings are essential job requirements Other duties as assigned Qualifications High School diploma or equivalent experience required, Bachelor's degree preferred Minimum 2 years experience as a Medical Claims Analyst or 7 years previous experience examining claims Strong knowledge of CPT, HCPCS, ICD-10, and claims adjudication processes Advanced skills in Microsoft Excel, Word, and familiarity with project management tools Strong analytical, organizational, and documentation skills. Environmental Job Requirements and Working Conditions Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754. The target pay range for this role is between $75,000.00 - $95,000.00. This salary range represents our national target range for this role.

We're looking for a thoughtful and detail-oriented Senior Claims Specialist to join our Orange County team. In this role, you'll manage a caseload of medical malpractice claims, support litigation activities, and help guide Claims Specialist I and II team members. This position is ideal for someone who enjoys careful investigation, structured problem-solving, and working collaboratively in a supportive, professional environment. Responsibilities: Manage medical malpractice claims and direct defense counsel in alignment with established guidelines and procedures. Handle increasingly complex cases involving higher financial exposure. Conduct thorough investigations: interview members, review medical records, gather expert input, evaluate case details, and prepare summaries. Prepare accurate case evaluation reports for review committees and discretionary authority. Participate in litigation activities such as discovery plans, mediations, MSC, and negotiations (with supervision as needed). Monitor arbitrations and provide consistent updates to members and defense counsel. Maintain accurate and timely documentation in the claims database. Track all case developments and ensure proper coding and organization in the OnBase system. Support the training and development of Claims Specialist I and II colleagues. Qualifications: Bachelor's degree from a four-year college or university. Relevant legal or medical education background (or equivalent experience). 5+ years of medical malpractice claims management experience, or 3+ years of general claims experience. Strong analytical, communication, organizational, and documentation skills. Ability to manage sensitive information and complex cases with professionalism and care.

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.

JOB TITLE: Senior Claims Examiner DEPARTMENT: Claims Services Carl Warren & Company is a leading nationwide Third-Party Administrator (TPA) founded in 1944. Carl Warren has been a trusted partner specializing in property and casualty claims management, subrogation recovery, and litigation management for private and public sectors, insurance companies, and captives. Our clients count on us to care for their needs when the unexpected happens. Our culture is derived from the people that create it. We are not different in what we do. We are different in how we do it. Our culture helps us collaborate, unite, and create a diverse workforce. Our people are at the core of our purpose, vision, mission, and values. We offer competitive compensation and a comprehensive benefits package: • 401k + employee match • Medical, dental, vision, life, and disability insurance • Paid Time Off (PTO) • Paid Holidays • Paid Sick leave • Professional development programs • Work-life quality and flexibility Visit us online at ****************** RESPONSIBILITIES • Executes client/Carl Warren strategies to achieve claims quality, customer service, and operational objectives. • Proactively work claims to ensure file quality meets Carl Warren & Company Claim Handling Guidelines and client requirements. • A high level of productivity measured according to the age and complexity of the assigned caseload. • Maintains a timely diary of claims. • Consistently achieves audit scores of 90% and above. • Focuses on providing the client with an outstanding work product. • Provides excellent customer service to internal and external customers. • Develops strategies for claims resolution with file notes reflecting clarity, focus, control/management, and momentum. • Identifies/utilizes vendors and effectively manages the vendors to achieve satisfactory results on both the expense and indemnity costs. • Up to 25% travel for field work and court appearances. QUALIFICATIONS • Four or more years handling auto and/or general liability claims for a standard auto and/or general liability insurance carrier • Two or more years' experience handling litigated claims with a well-developed understanding of the litigation process • College degree preferred • Strong claim evaluation skills with the ability to identify the issues involved, formulate an action plan, assess liability, evaluate the damages involved, and put a settlement number on the claim and explain why • Strong negotiation skills • Must be able to function and support others in a team environment • High level of personal responsibility and pride in work product Salary up to $105,000

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.

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description Examines claims data and conducts investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjusts and manages claims within the limit of assigned authority. Experience with California Workers Compensation jurisdiction is required for this role. High preference for candidates in the West Coast. What you will do for C&F: Must be well versed in California Compensation statute claims. Receives lost time and complex medical only assignments. Verifies and determines applicability of coverage. Initiates 24-hour contact with employer, employee and 48-hour contact with attending physician. Handles catastrophic claims with supervisory oversight. Conducts telephone investigations as required by company claims handling manual and procedures. Evaluates and adjusts claims within the limits of authority. Consults with Claim Manager on those claims where assistance and consultation is needed. Makes assignments to nurse case management when indicated, monitoring their billing and performance. Sets reserves for anticipated exposure up to authority limits. Completes mandatory Reserve Worksheets. Establishes reserves requiring complex analysis with lifetime pharmacy and cost inflation. Coordinates return to work (RTW) and sets target dates. Maintain diaries on maximum three (3) month intervals. Documents files in the claims system. Reviews medical bills for causal relationship, medical bill charges for appropriateness and approves payments. Adheres to special account handling (SHI) instructions. Attends account meetings by telephone and in-person. Manages litigation on the files. What you will bring to C&F: College degree, B.A. or equivalent experience. 3+ years of experience handling workers compensation claims required, 5+ years preferred. Strong organizational skills. Good time management skills. Foreign language communications a plus. Excellent verbal and written communication skills are essential. Strong aptitude and knowledge of Microsoft Office programs and the ability to quickly learn new programs. Will abide by departmental policies and procedures, including authority levels, to comply with C&F's risk management controls. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $55,800.00 to a maximum of $104,900.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-AV1 #LI-Remote

Protect the magic by preventing and mitigating risk across the Disneyland Resort. The Risk Management Services team-encompassing both Guest Claims and Workers' Compensation-strives to create a workplace where incidents and claims are eliminated through proactive care and thoughtful support. The Guest Claims Administrator provides timely and professional property and casualty claim services for guests at Disneyland Resort and Aulani, A Disney Resort and Spa, ensuring exceptional guest experiences while protecting Disney's brand and assets. This role is responsible for conducting onsite investigations, assessing liability exposure, and resolving claims directly with guests and attorneys. You will maintain clear and professional communication in sensitive situations, accurately document and report claim information, and support departmental initiatives and process improvements. The Guest Claims Administrator will report to the Sr Manager, Guest Claims and sits in Anaheim, CA. Responsibilities: Deliver immediate liability claim services for guests at Disneyland Resort and Aulani, A Disney Resort and Spa, ensuring exceptional guest experiences and upholding Disney brand standards. Conduct thorough onsite investigations of incidents, assess liability exposure, and determine appropriate resolutions. Resolve claims directly with guests and attorneys, balancing customer service with risk management considerations. Maintain clear and professional communication while representing the brand in sensitive or complex situations. Develop and deliver presentations, briefings, and training sessions for leaders and team members across the Resort. Collaborate on departmental initiatives, projects, and continuous improvement efforts to meet organizational goals. Serve on a monthly on-call rotation, responding promptly to incidents after hours as required. Demonstrate flexibility, professionalism, and sound judgment in handling escalated or unexpected situations. Required Qualifications: 3 + years of experience in property and casualty insurance, including claims handling, scene investigations, claim evaluation, and negotiation, preferably with experience in park operations and knowledge across multiple lines of business. Ability to manage multiple priorities, meet deadlines under pressure, and maintain strong organizational skills and attention to detail. Proficiency in learning and using automated claims administration and management systems. Basic understanding of medical and legal terminology. Proficient in Windows-based applications, including Outlook, Word, Excel, and PowerPoint. Strong communication skills, including delivering presentations to leaders at all levels (including executives) and producing clear, concise, professional written summaries, memos, and reports. Demonstrated relationship-building, negotiating, and influencing skills, with the ability to solve problems and make decisions independently. Ability to handle confidential information with discretion. Strong partnership, mentoring, and training skills. Preferred Qualifications: Knowledge of Disneyland Resort and Aulani, A Disney Resort and Spa, operations, and guest experience expectations. Experience resolving complex claims directly with guests and attorneys. Experience mentoring, coaching, or delivering training/presentations to cross-functional teams. Familiarity with claims administration software and reporting tools. Experience driving process improvements in claims or guest service operations. Required Education: Bachelor's Degree in Business, Risk Management, Insurance, Finance, or a related field or equivalent work experience. Preferred Education: Master's Degree in Business Administration, Risk Management, or related field. Professional certifications in claims, insurance, or risk management (e.g., CPCU, AIC, ARM). Additional Information Benefits and Perks: Disney offers a rewards package to help you live your best life. This includes health and savings benefits, educational opportunities, and special extras that only Disney can provide. Learn more about our benefits and perks at **************************************** About The Walt Disney Company Walt Disney Parks and Resorts U.S., Inc. is an equal opportunity employer. Applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status or any other basis prohibited by federal, state or local law. Disney fosters a business culture where ideas and decisions from all people help us grow, innovate, create the best stories and be relevant in a rapidly changing world. The hiring range for this position in Anaheim, CA is $72,000.00 to $96,500.00 per year. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's geographic region, job-related knowledge, skills, and experience among other factors. A bonus and/or long-term incentive units may be provided as part of the compensation package, in addition to the full range of medical, financial, and/or other benefits, dependent on the level and position offered. Job Posting Segment: Other Support Job Posting Primary Business: Risk Management (DLR) Primary Job Posting Category: Ops Guest Claims Employment Type: Full time Primary City, State, Region, Postal Code: Anaheim, CA, USA Alternate City, State, Region, Postal Code: Date Posted: 2025-10-15