Claims representative jobs in Daly City, CA

**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** $52,600.00 - $86,800.00 **Target Openings** 2 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. 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. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. 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?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (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 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 attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + 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. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. 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?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic + Verbal and written communication skills -Intermediate + Attention to detail ensuring accuracy - Basic + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic + Analytical Thinking - Basic + Judgment/ Decision Making - Basic + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree 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 ******************************************************** .

About Us: The Greenspan Co./Adjusters International is the leading Public Insurance Adjusting firm with locations in California, Nevada, and Arizona. We advocate for the insured during times of crisis, navigating them through the complex and tedious insurance claims process. We aim to be the gold standard in customer service, and we've helped thousands of residential and commercial clients with their claims for over 70 years. Job Summary: We are seeking a Senior Claims Adjuster for our San Jose office. This role is a full time position with base salary plus commission. The Senior Claims Adjuster role will have the following responsibilities but not limited to: will investigate commercial and residential property claims, evaluate damages, determine coverage, set accurate cost estimates, control the insured's exposures and losses, manage consultants, and achieve a prompt, fair and equitable settlement according to fair claims handling requirements. Additionally, negotiate settlement of claims with varying complexity and perils. If you're an independent adjuster or a staff adjuster who wants to do the right thing for the policy holder and work to help homeowners and business owners rebuild after a catastrophe, we are the right team to join! The Senior Claims Adjuster will have the following duties & responsibilities but not limited to: Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin, and extent of loss losses. Reviews & utilizes financial statements to adjust complex residential and/or business interruption losses. Conduct on-site appraisal or direct independent adjuster to determine facts relevant causation, damages and exposures Engages and manages team members as required to assist in determining facts, causation, damages and exposure; monitors the costs to ensure they are reasonable and necessary. Establishes and maintains accurate loss cost estimates and reserves for each claim for reporting, financial records, and other purposes. Keeps the clients and others informed about the claim's status with clear, timely and accurate written/oral communications. Effectively communicates in writing on moderately complex coverage issues with minimal review and coaching. Determines depreciate of claim. Meet time requirements of the policy and fair claims handling practices. Effectively negotiate settlement of claims of varying complexity and perils. Achieves a prompt, fair, and equitable settlement of a claim, where there is policy liability. Keeps the electronic claim file properly documented with accurate, clear and timely information and reports that reflects the adjustment activities and substantiates any payments made. Provide guidance to inexperienced team members and may act as a mentor to other entry level adjusters. Qualifications: 10 years plus experience in an insurance company handling residential & commercial property and casualty claims required 2 years' experience handling losses in excess of $ 200,000.00 required Bachelor's degree required Must have a valid CA Driver License Ability and willingness to travel to the site of catastrophe for assignments. Capability to build and maintain positive relationships Ability to train and mentor less experienced team members Ability to write business correspondence, produce accurate work, manage projects and vendors; and use core applications/spreadsheets Empathetic and Compassionate advocate for policy holder Someone invested in protecting and defending the best interests of the claimant The ability to be an avid listener and a conscientious member of our team Compensation: Competitive salary (Base plus commission package worth $150k to $175k per year) Company Offered Benefits: Health, Dental, Vision Coverage 401K ESOP LTD Coverage Find out how you can become a dynamic part of our growing team and employee owned company.

DETAILS Senior Claims Examiner Department: Workers' Compensation California Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 12 Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor 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 full-time Senior Claims Examiner to support our workers compensation offices and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. 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: Establish contact with employer to review issues Respond to inquiries from the employer, employee, doctors, and attorneys Establish and maintain appropriate reserves Review legal correspondence and medical reports Evaluate and approve medical procedures and treatment Administer benefits and ensure appropriateness of all payments Investigate coverage, liability, and monetary value of claim Review medical and legal bills for appropriateness Discuss appropriateness of medical treatment with medical case manager Determine compensability Monitor and assist litigation Negotiate settlement of claim, liens, rehabilitation plans, etc. Prepare and present reports to clients Appropriately close claims Help resolve client billing and payment inquiries Investigate complaints from injured workers Document and code the claim files and claims system with all relevant information Maintain and update action plans within specified time frames Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks Contact with employers, employees, attorneys, doctors, vendors, and other parties Provide customer service and support to clients and claimants Work collaboratively with attorneys to draft settlements and assist with litigation strategies Negotiate settlements Authorize and negotiate cost of medical treatment and supplies Internal communication with staff Prepare professional, well written correspondence and other communications 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 Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained 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) 3+ years recent workers compensation claims handling experience required At least 5 years of workers compensation claims experience preferred Solid knowledge of workers compensation laws, policies, and procedures' Completion of IEA or equivalent courses Proficiency in determining case value and negotiating settlements Understanding of medical and legal terminology Mathematical calculating skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs 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. Ability to attend occasional in office meetings or file reviews 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

Are you ready to make a real difference in healthcare? MIEC is searching for a dynamic Claims professional to join our passionate team and play a pivotal role in protecting medical professionals and advancing patient safety! Whether you step into the role of Claims Analyst or take on the expanded responsibilities of Claims & Patient Safety Specialist, you'll be at the heart of our mission-opening, investigating, managing, and resolving incident and claim files for our valued policyholders. But that's just the beginning! As an Analyst or Specialist in our Claims Department, you'll go beyond claims management, partnering directly with groups and individual policyholders to deliver innovative Patient Safety & Risk Management services. You'll help shape safer healthcare environments, drive impactful change, and become a trusted advisor to those who count on us most. Join MIEC and be part of a team that's redefining excellence in claims and patient safety-where your expertise, initiative, and commitment truly matter. Get a sneak peek into MIEC's mission-driven, collaborative culture by following this link. LOCATION: This position is remote, with a preference for candidates located in Southern California, with limited travel to our main office in Oakland, CA. This position requires some travel from time to time, including overnight stays. COMPENSATION: The hiring salary range of $73,050 to $149,484 will be based on role, experience, and location. Priority will be given to candidates in Southern California, but see hiring ranges below for all locations: * Hiring range for Claims Analyst role: * San Francisco Bay Area and Hawaii: $84,519 to $112,691 * All other locations: $73,050 to $97,400 * Hiring range for Claims & Patient Safety Specialist role: * San Francisco Bay Area and Hawaii: $112,113 to $149,484 * All other locations: $96,900 to $129,200 MIEC offers competitive compensation, commensurate with experience and a comprehensive benefits package. MIEC is an EEO employer; we enjoy diversity in our staff, policyholders and business partners. BENEFITS: * 401(K) + Pension Plan * Health Insurance * Vision and Dental Insurance * Generous Paid Time Off Plans WHAT YOU'LL DO: Whether hired as a Claims Analyst or a Claims & Patient Safety Specialist, your primary duties will be in Claims, where you will: * Respond to first notice of potential claims from policyholders and handle advice calls, gathering preliminary information and providing appropriate advice for action. * Collaborate with the Claims team to identify and evaluate insurance coverage issues, and to develop, prepare and implement appropriate negotiation/case resolution strategies. * Obtain and review records, interrogatories, depositions, consultant reports, and attorney reports; coordinate discovery with defense counsel; monitor file status, reserves, legal landmarks and billings. * Prepare documentation, reports, and correspondence with policyholders, claimants and attorneys. * Submit incident, claim and suit files for opening; manage and close files in a timely manner. * Exercise strong judgment in settling cases within authority and develop indemnity and expense reserve recommendations above defined authority level. * Study trends and current developments within the medical malpractice industry in the states in which MIEC operates, and nationally. Proactively share information within the department about the trends and current developments, including relevant court cases. * Participate in seminars, trainings, meetings, and Board meetings, when requested. If hired as a Claims & Patient Safety Specialist, you will also: * Collaborate with MIEC's Patient Safety & Risk Management (PSRM) staff to provide specialized internal and external services addressing existing member groups and new business, including large medical groups and hospitals. * Apply principles of healthcare risk management, such as incident reporting and investigation, risk analyses, and policies/procedures, to further develop PSRM services which can be applied in all healthcare settings. * Collect, analyze, and compare MIEC data to present evidence-based information to members, utilizing data from various healthcare and medical malpractice claims sources including Candello - Solutions by CRICO, the MPL Association Data Sharing Project, and Preverity. * Coordinate and conduct Claims Prevention Surveys for policyholders. * Manage active matters involving unanticipated patient harm through MIEC's RESTORE communication and resolution program; work with MIEC policyholders to support effective patient communication, disclosure, and/or apology discussions. * Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials. * Participate in the conception and completion of special projects. Requirements WHO YOU ARE: * An experienced team member with a demonstrated expertise in the handling of medical malpractice claims and a solid understanding of Patient Safety Risk Management (PSRM) services and products, and the ability to address general PSRM questions or refer to the appropriate discipline. * A flexible collaborator who has a demonstrated customer service focus with all levels of internal and external stakeholders. * An enthusiastic and self-directed contributor who is skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines. * An inquisitive analytical thinker with good judgement, professional initiative, and strong research skills. * An excellent communicator, with strong written, verbal, and interpersonal communication skills and ideally with proficiency in medical terminology. Additionally, a candidate hired for the Claims & Patient Safety Specialist role would need: * An understanding of clinical systems. * Knowledge of hospital policies and procedures, and governmental healthcare regulations. * Ability to analyze medical records and quality issues. WHAT YOU'LL BRING: Education: * A Bachelor's degree (BA/BS) is required. Licenses/Certification: * A valid driver's license is required. * A Certified Professional in Healthcare Risk Management (CPHRM) designation is preferred. Experience: The ideal Claims & Patient Safety Specialist candidate will join us with a minimum of seven (7) years of experience as a medical professional liability claims representative, risk manager or similar experience in defense of medical professional liability or risk management/patient safety field required. The ideal Claims Analyst candidate will join us with a minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry. Digital Skillsets: Our ideal candidate will be a digitally fluent contributor, comfortable in a range of virtual environments and proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs. About MIEC: MIEC was founded in 1975 in the depths of the malpractice crisis by physicians and their medical societies when insurance was largely unavailable to the healthcare community. As the West's first truly physician-owned medical professional liability insurer, MIEC has always been guided by the desire to protect physicians and other healthcare professionals from malpractice risks and committed to a long-term philosophy of business conduct that ensures such a crisis never happens again. We exist to foster enduring partnerships within the healthcare community by serving members through a philosophy of vigorous protection and high value, delivered by people who care. As a member-owned exchange Headquartered in Oakland, CA, MIEC now insures more than 7,400 physicians and other healthcare professionals in 4 states, with regional claims offices in Idaho, Alaska, and Hawaii. MIEC has consistently adapted to meet the changing needs of healthcare delivery and continually seeks to reinvent medical professional liability through effective partnership, innovative insights, and dynamic risk solutions.

At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design. The Analytics team is a data-driven team focused on unlocking insights that improve member outcomes and drive business performance. Our team sits at the intersection of data, strategy, and execution. The Analytics team reports directly to the Vice President, Data Engineering, Analytics, and AI in Product Development. In this role, you will help with standardizing and scaling all of the analytics deliverables which include reporting and self-serve dashboards leveraging data from claims, eligibility, population health, customer engagement, and digital platforms. You will collaborate across departments, mentor junior analysts, and work directly with business stakeholders and present meaningful insights to clients. If you're passionate about using data to make a meaningful impact in healthcare, you'll find a home here. What you'll do: Design, build, and deliver sophisticated analyses focusing on core metrics from various domains such as claims, eligibility, customer experience, digital engagement, and the complete member journey. Translate business questions into analytic plans and communicate results in a clear, actionable manner to both technical and non-technical audiences. Design logical categorizations for dashboards and views, building scalable and automated reports in Looker and other BI tools to provide self-service insights to the business. Support internal stakeholders (e.g., Product, Customer Success, Marketing, etc.) by generating insights that inform strategy and operational improvements. Proactively identify and execute opportunities to build automated reports and analytical processes, reducing manual effort and increasing reliability. Provide technical mentorship and peer review, including refactoring and optimizing complex code for existing reports to improve performance and scalability. Work closely with the Data Architect and engineering teams to help build and refine the semantic layer, ensuring data models are optimized for analytical use. To be successful in this role, you'll need: A minimum of 5+ years in data analytics, ideally within a related healthcare or health tech field. Requires a track record of success in a high-velocity environment and a strong technical aptitude for simplifying and scaling complex data assets to support long-term standardization. Proven ability to work with complex, large-scale datasets from disparate silos, with a deep focus on healthcare data. Strong SQL skills with a track record of writing efficient, scalable queries for analysis and reporting. To be technically savvy with modern data tools. This includes advanced SQL, hands-on experience with cloud data platforms like Databricks, and expert-level proficiency in BI tools, especially Looker. Demonstrated project management skills, with the ability to prioritize tasks, manage timelines, and drive cross-functional collaboration. Strong communication skills, with the ability to translate technical findings into clear, actionable recommendations for non-technical stakeholders. To champion data governance and quality by conducting audits and validation. This includes the ability to pull and interpret data from EDI files to support claims audits and analysis. A strong functional understanding of the claims adjudication process, from submission to payment. To be self-sufficient, intellectually curious and take ownership for everything you do. Pay Transparency Statement This is a hybrid position based out of one of our offices: San Francisco, CA, Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office two days per week.#LI-hybrid The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at ******************************************** San Francisco, CA Pay Range$120,000-$150,500 USDLehi, UT Pay Range$96,300-$120,500 USDPlano, TX Pay Range$105,575-$132,550 USDWhy Join Us? Mission-driven culture that values innovation, collaboration, and a commitment to excellence in healthcare Impactful projects that shape the future of our organization Opportunities for professional development through internal mobility opportunities, mentorship programs, and courses tailored to your interests Flexible work arrangements and a supportive work-life balance We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. Collective Health is committed to providing support to candidates who require reasonable accommodation during the interview process. If you need assistance, please contact recruiting-accommodations@collectivehealth.com. Privacy Notice For more information about why we need your data and how we use it, please see our privacy policy: *********************************************

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 CategoryClaimCompensation 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$52,600.00 - $86,800.00Target Openings2What Is the Opportunity?This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. 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. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. 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? Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. The on the job training includes practice and execution of the following core assignments: Handles 1st party property claims of moderate severity and complexity as assigned. Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage (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 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 attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. 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. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. 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? Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic Valid passport preferred. What is a Must Have? High School Diploma or GED and one year of customer service experience OR Bachelor's Degree 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 *********************************************************

For this opening, employees will perform daily work duties on a remote basis with any in office visits outlined by management. This position will be required to report in office as outlined by the management team at minimum for team meetings and specific assignments. Candidates must reside within the state of Michigan for hybrid purposes. Michigan APD Claim Representative II - The Auto Club Group Reports to: APD Claim Manager I What you will do: (Primary Duties & Responsibilities) The Auto Club Group is seeking an Auto Claim Representative II who works under normal supervision with an intermediate-level approval authority to handle moderately complex claims within Claim Handling Standards in the field or inside units. Resolve coverage questions, take statements and establish clear evaluation and resolution plans for claims. In this position, you will have the opportunity to: Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim, and initiating documentation in the claim handling system. Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss. Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler. Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential. Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim. Evaluate the financial value of the loss. Approve payments for the appropriate parties accordingly. Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit). Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system. Utilize strong negotiating skills. Employees assigned to Auto Physical Damage ("APD") claim unit will handle moderately complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage. If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. Additional responsibilities may include the following: determining cause of damage, establishing liability, identifying subrogation potential, monitoring repairs and approving car rental expense. May handle simple APD Litigation cases. Supervisory Responsibilities (briefly describe, if applicable, or indicate None): None How you will benefit: Claim Representative II will earn a competitive salary of $60,000- $70,000 annually with annual bonus potential based on performance. Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include: * 401k Match * Medical * Dental * Vision * PTO * Paid Holidays * Tuition Reimbursement II. Required Qualifications (these are the minimum requirements to qualify) Education (include minimum education and any licensing/certifications): * Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience * In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states. * A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members Experience: * One year of experience with: * negotiating claim settlements * securing and evaluating evidence * preparing manual and electronic estimates * subrogation claims, including identifying recovery opportunities * resolving coverage questions * taking statements * establishing clear evaluation and resolution plans for claims Knowledge and Skills: Knowledge of: * Essential Insurance Act (Michigan) * Fair Trade Practices Act as it relates to claims * subrogation procedures and processes * intercompany arbitration/dispute resolution * Negligence Laws and Statutes * No-Fault Law and No-Fault Reform * Collision repair techniques Ability to: * handle claims to the line Claim Handling Standards * follow and apply ACG Claim policies, procedures and guidelines * work within assigned ACG Claim systems including basic PC software * perform basic claim file review and investigations * demonstrate effective communication skills (verbal and written) * demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns * analyze and solve problems while demonstrating sound decision making skills * prioritize claim related functions * process time sensitive data and information from multiple sources * manage time, organize and plan workload and responsibilities * safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc. * research analyze and interpret subrogation laws in various states * travel outside of assigned territory which may involve overnight stay * relocate, work evenings or weekends * strong negotiating skills * MUST RESIDE WITHIN 50 MILES FROM FREMONT MICHIGAN III. Preferred Qualifications Education: * Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience * Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent * CPCU coursework or designation * I-Car 2000 training * CCC training * Xactware Training Work Environment This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy. Important Note: THE ABOVE STATEMENTS DESCRIBE THE PRINCIPAL AND ESSENTIAL FUNCTIONS, BUT NOT ALL FUNCTIONS THAT MAY BE INHERENT IN THE JOB. THIS JOB REQUIRES THE ABILITY TO PERFORM DUTIES CONTAINED IN THE FOR THIS POSITION, INCLUDING, BUT NOT LIMITED TO, THE ABOVE REQUIREMENTS. REASONABLE ACCOMMODATIONS WILL BE MADE FOR OTHERWISE QUALIFIED APPLICANTS, AS NEEDED, TO ENABLE THEM TO FULFILL THESE REQUIREMENTS. Who We Are Become a part of something bigger. The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America. By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance. And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other. We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger. To learn more about AAA The Auto Club Group visit *********** Important Note: ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level. The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements. The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status. Regular and reliable attendance is essential for the function of this job. AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more. Position Summary Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days. Applicants must be currently authorized to work in the United States on a full-time basis. Principle Duties and Responsibilities: Claims Management Manage caseload within established targets and appropriate level. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations. Monitor and ensure timely execution of all statutory deadlines or legal filings as needed. Analyze facts of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines. Identify fraud indicators and actively pursue subrogation opportunities. Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks. Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers. Financial Impact Administration Manage book of claims business (up to $ 2million) with authority to settle/negotiate a single claim within their authority of up to $25,000. Communicate ongoing causes of incidents to Safety and Brands. Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications. Basic Qualifications: Licensed adjuster (as appropriate by jurisdiction) Bachelor's degree or experience handling General Liability claims or equivalent expertise. Thorough knowledge of rules, regulations, statutes, and procedures pertaining to general liability claims. Knowledge of medical terminology involved in complex claims Negotiates resolution of claims of various exposure and complexity Skills and Abilities: Demonstrates relationship building and communication skills, both written and verbal. Highly self-motivated, goal oriented, and works well under pressure. Customer focused solid understanding of legal procedures, processes, practices and standards in the handling of general liability claims Ability to identify problems and effectuate solutions Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail Able to apply critical thinking when solving problems and making decisions. ME/NC/PA/SC Salary Range: $63,440-$95,160 IL/MA/MD/NY Salary Range: $72,880 - $109,320 Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws. #LI-SM1 #LI-Hybrid At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent. Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies. Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work. We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.

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 Workers Compensation Claims Representative Trainee | West Hills, CA (In-Office) Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? A stable and consistent work environment in an office setting. A training program to learn how to help employees and customers from some of the world's most reputable brands. An assigned mentor and manager who will guide you on your career journey. Career development and promotional growth opportunities through increasing responsibilities. A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. OFFICE LOCATIONS Onsite - West Hills, CA ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 4-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. ESSENTIAL RESPONSIBLITIES MAY INCLUDE Attendance and completion of designated classroom claims professional training program. Performs on-the-job training activities including: Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. Adjusting low and mid-level liability and/or physical damage claims under close supervision. Processing disability claims of minimal disability duration under close supervision. Documenting claims files and properly coding claim activity. Communicating claim action/processing with claimant and client. Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. Participates in rotational assignments to provide temporary support for office needs. QUALIFICATIONS Bachelor's or Associate's degree from an accredited college or university preferred. EXPERIENCE Prior education, experience, or knowledge of: • Customer Service • Data Entry • Medical Terminology (preferred) • Computer Recordkeeping programs (preferred) • Prior claims experience (preferred) Additional helpful experience: • State license if required (SIP, Property and Liability, Disability, etc.) • WCCA/WCCP or similar designations • For internal colleagues, completion of the Sedgwick Claims Progression Program TAKING CARE OF YOU Entry-level colleagues are offered a world class training program with a comprehensive curriculum An assigned mentor and manager that will support and guide you on your career journey Career development and promotional growth opportunities A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking 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. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $27.69/hr. 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. #claimsrepresentative #claims #LI-DA1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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.

FLSA Status: Non-Exempt Department: Claims Reports To: Supervisor or Manager of Claims Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. The Claims Analyst II analyzes, processes and adjusts routine and complex facility and professional claims for payment or denial to support the Claims Department operations in a manner that maintains compliance within the Medicare and Medi-Cal regulatory requirements and achieves Claims service-level objectives. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. 1. Follow established Health Plan policies and procedures and use available resources such as provider contracts, Medicare and/or Medi-Cal guidelines and Member Evidence of Coverage (EOC) to analyze, process and adjust routine and complex assigned claims in an accurate and timely manner. 2. Research, identify, resolve and respond to inquiries from internal Health Plan departments regarding outstanding claims-related issues. 3. Assist Claims Supervisor and Manager with pre-check run reports. 4. Maintain and organize all processes related to Third Party Liability (TPL) claims, including communication of relevant information to appropriate parties. 5. Participate in system testing and communicate newly-identified and potential issues to the Claims Supervisor and Manager and provide recommendations for improvement. 6. Process claims refund checks on a weekly basis to ensure accuracy/completeness of information and submit to the Finance Department in a timely manner. 7. Attend and actively participate in daily, weekly, and monthly departmental meetings, training and coaching sessions. 8. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. 1. High School Diploma or GED. (R) 2. Minimum two years of claims processing experience in a Health Plan Claims Department. (R) 3. Prior experience with managed care plans, Medi-Cal and/or Medicare programs, and working with underserved populations. (R) 4. Ability to analyze, process and adjust routine and complex assigned claims in an accurate and timely manner. (R) 5. Understanding of professional and hospital reimbursement methodologies, including medical terminology, and working knowledge of CPT, HCPCS, ICD-10, and ICD 9 codes. (R) 6. Understanding of the relationship between the health plans, IPAs, and DOFR. (R) 7. Ability to consistently meet Quality and Productivity Key Performance Indicators by participating in and achieving the Claims Quality standards. (R) 8. Ability to consistently meet Attendance Key Performance Indicator by being punctual and meeting the Claims standards in accordance with the team schedule. (R) 9. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel. (R) 10. Ability to use a keyboard with moderate speed and a high level of accuracy. (R) 11. Working knowledge of QNXT claims processing software. (D) 12. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) 13. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) 14. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) 15. Ability to maintain confidentiality. (R) 16. Ability to comply with SCFHP's policies and procedures. (R) 17. Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: 1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) 2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) 3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) 4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) 5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) 6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels.

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a complex California claims inventory. Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: Consistently provides exceptional customer service. Effectively collaborates with team members from various departments for project and process discussions. Acts as a Subject Matter Expert for the department. Makes recommendations for streamlining processes and adopting the industry's best practices. Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. Provides knowledge transfer across the organization. Continuously seeks to improve technical skills by attending job related training and tracking current case law. Acts as a mentor and provides training for less experienced team members. Prepares and presents claims status reports for internal and external stakeholders. Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? • Challenging work and the ability to make a difference • You will have a voice and feel a sense of belonging • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match • Bonus potential for all positions • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) • 11 paid holidays throughout the calendar year • Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

We're looking for a Claims Adjuster to own and drive the end-to-end claims process. This role will be responsible for managing the end-to-end claims process with a strong focus on accuracy, communication, and timely resolution. You will collaborate closely with Drivers, Operations teams, Insurance Adjusters, Claims Administrators, Legal partners, and CloudTrucks leadership. In addition, you will maintain comprehensive claim files, track key metrics, and provide reporting that helps the business understand claim trends and exposure. Who you are * Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. * Empathetic and patient. You approach every interaction with understanding and care. * Strong sense of urgency. You act quickly and decisively, maintaining momentum at all times. * Creative. You can find the right exit ramp for the resolution of the claim that is in the insured's best interest. * Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. * Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. * Anti-status quo. You don't just wish things were done differently, you act on it. What you'll do * Oversee the claims processing function, ensuring efficient and accurate handling of claims with a robust documentation process. * Lead the evaluation of claims and negotiate settlements, setting an example for the team in terms of prompt and fair resolution. * Analyze claims data to identify trends and develop proactive strategies to reduce future incidents. * Provide input on annual insurance renewals. * Remain current on state and federal laws relating to trucking litigation and trends within the claims industry and remain compliant * Be available to handle after-hours emergencies. * Prepare and present regular reports on claims data, providing insights and recommendations for improvement. * Analyzing and reviewing insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim to assist TPA and underwriters in evaluating a claim. Experience * Bachelor's degree or equivalent experience * 5+ years of claim handling experience (commercial claims a plus) * Understand transportation coverages, contractual risk transfer and additional insured forms * Strong communication and collaboration with multiple stakeholders with a sense of urgency * Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines About CloudTrucks CloudTrucks is a virtual trucking carrier in the multi-billion dollar trucking space. Core to this industry are over 3.5M truck drivers. They move more than 70% of all goods transported around the U.S., yet operate in a highly fragmented industry with huge opportunities for products, services and automation. We strive to deliver solutions that help truck drivers operate with much greater efficiency, increase their revenue, and offload business complexity. We are looking for uniquely exceptional people to join us on our journey as we massively scale into an industry-defining business. We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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.

WHAT WE'RE LOOKING FORBerkshire Hathaway Homestate Companies has an immediate opportunity for an experienced workers compensation adjuster. We're looking for self-starters who can work under minimum direction, can achieve defined results, and are willing to accept ownership for their work product. This Claims Professional is responsible for the management of a caseload of workers compensation indemnity claims from inception to resolution, performing initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration to injured workers, and coordination of medical care and legal process, while maintaining the highest level of service to our insureds. ESSENTIAL RESPONSIBILITIES Conducts the investigation of reported claims via three-point contact calls to determine coverage, compensability and severity, and to gather all other relevant information, documenting all relevant information thoroughly and escalating the investigation for further investigation when appropriate. Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines. Calculates and administers benefits in accordance with statutory requirements, including timely issuance of appropriate notices and filings. Develops and updates a Plan of Action for the successful resolution of each claim; timely updates Plan as new information is obtained. Makes prompt, sound decisions on issues that arise in claims based on the best information available, ensuring that work is performed in accordance with Company standards, training, supervisory direction, and applicable laws. Timely escalates issues/red flags to Supervisor and/or appropriate internal team. Ensures that the actions of all other professionals involved in claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim. Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently. Accurately and thoroughly prepares litigation referrals, AOE/COE investigation referrals, and MSA referrals for submission to vendor; obtains proper approval from Management. Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates settlement of claims. Fosters a positive and close working relationship with partner company staff, including the Call Center, Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal. Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers. Collaborates with Adjusting staff and relevant interdepartmental personnel on special projects focused on process efficiency. Ensures continual education requirements are met. REQUIRED QUALIFICATIONS EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred. DESIGNATION: Designated as a Claims Adjuster or Experienced Claims Adjuster per the California Code of Regulations and has completed the minimum required continuing education credits to adjust workers compensation claims for the State of California; Self-Insured certification a plus. EXPERIENCE: Minimum of three years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers' compensation carrier required Maintains qualifying educational criteria to adjust workers' compensation claims for the State of California; Self-Insured certification preferred. Inquisitive, critical thinker; agile learner with adaptive, smart time management skills. To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications (highly proficient in Excel preferred), and be proficient on applicable databases, systems and vendor software programs. WHAT WE OFFER Work-Life Balance Work From Home Program (up to 2 days per week) Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support Modern Office Setting Free On-Site Fitness Facility Free downtown shuttle route Two-minute walk from Walnut Creek BART Station Three-minute car ride from CA-24 and I-680 Free On-Site Garage Parking Paid Time Off Paid Holidays Retirements Savings Match Group Health Insurance (Medical, Dental, and Vision) Life and AD&D Insurance Long Term Disability Insurance Accident and Critical Illness Insurance Flexible Savings Accounts Paid Community Volunteer Day Employee Assistance Program Tuition Reimbursement Program Employee Referral Program Diversity, Equity and Inclusion Program ABOUT USWith more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts. At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace-something we truly value. We've created an approachable and collaborative atmosphere. Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.

Title: Supervisor, Claims Department: Claims Bargaining Unit: NBU Grade: N/A Exempt Hours per Week: 40 The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with Company guidelines, client needs, and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Provides daily leadership and supervision to staff consistent with Company values and mission. Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements. Develops staff through performance management, goal setting, training, and effective employee relations. Maintains current knowledge of assigned Plan(s) and effectively applies knowledge; p rovides oversight of processing activities to ensure compliance. Optimizes workflows/processes, tools, and staff allocation to ensure efficient and cost-effective day to day operations. Troubleshoots customer/client service issues and assists in the successful implementation of new clients. Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy. Develops and distributes resource documents as needed. Based on location needs, may provide advanced technical review and support of claims processing. Provide technical review of all types of claims including large dollar and complex claims to validate benefit allowance and category. Investigate, evaluate, and report on advanced cases for third-party recovery including stop-loss, accident, medical malpractice, subrogation, and Worker's Compensation. Compiles documents, records, and data for external audits, as requested. Assists in the development and documentation of departmental SOP's. Performs other duties as assigned. Minimum Qualifications High school diploma or GED. Four years of experience processing complex health and welfare claims in a third-party administrator. One year of experience in a lead or supervisory role. Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes. Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc. Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly. Highly developed sense of integrity and commitment to customer satisfaction. Ability to communicate clearly and professionally, both verbally and in writing. Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities. Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment. Computer proficiency including Microsoft Office tools and applications. Preferred Qualifications Experience working in a multi-employer or Taft-Hartley environment. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ****************************** , and we would be happy to assist you. Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location. Compensation: $80,000/annually Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a complex California claims inventory. * Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. * Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. * Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. * Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. * Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: * Consistently provides exceptional customer service. * Effectively collaborates with team members from various departments for project and process discussions. * Acts as a Subject Matter Expert for the department. * Makes recommendations for streamlining processes and adopting the industry's best practices. * Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. * Provides knowledge transfer across the organization. * Continuously seeks to improve technical skills by attending job related training and tracking current case law. * Acts as a mentor and provides training for less experienced team members. * Prepares and presents claims status reports for internal and external stakeholders. * Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. * Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. * Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? * Challenging work and the ability to make a difference * You will have a voice and feel a sense of belonging * We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match * Bonus potential for all positions * Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) * 11 paid holidays throughout the calendar year * Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims

Supervision of the Medi-Cal customer service outreach functions. Ensures delivery of the highest level of provider claims training to medical providers and the community. Responsibilities Coordinates with Claims Resolution Coordinators (CRCs) to develop provider educational/training materials for all Partnership lines of Prepares a quarterly and monthly plan of action for the Director, identifying key provider outreach targets and plan of Prepares production statistics and related reports for the Director's revie Collaborates with Claims Customer Service Manager to identify provider abrasion issues. Leads group provider trainings or individual provider settings. Reviews monthly reports and tracks claims trends for provider educational opportunit Presents to Director with findings and recommendations for ongoing, long term resolutions to Identifies items to address the “provider hassle factor.” Prepares a post-visit report for Director to include visit results, expectations of provider and Partnership, with required follow-up pla Reviews, strategies and tactics for more effective communication to provider billing staff with CRC Recommends changes for more efficient communication. Reports system issues to Claims Configuration staff and/or IT Assists Provider Relations Manager and Representatives in the review, research, and resolution of complex provider inquiries, appeals, and Coordinates with CRCs, Claims, and Provider Relations, the development and maintenance of ongoing educational materials and tips for inclusion on the Partnership Reviews and drafts PR newsletter articles related to claims issues identified during provider training and research. Interviews and participates in the selection of qualified candidates for CRCs. All other duties as as assigned. SECONDARY DUTIES AND RESPONSIBILITIES Leads or participates in special projects and assignments as needed. Participates in provider meetings, both on and off site as required. Qualifications Education and Experience High School diploma or equivalent, minimum two (2) years of supervisor experience in a claims environment; or equivalent combination of education and experience. Special Skills, Licenses and Certifications Thorough knowledge of CPT, HCPCs procedure coding, and ICD-9 diagnostic coding. Knowledge of medical terminology. Expertise in automated claims procedures and related problems resolution. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and manage staff to effectively complete assignments within established timeframes and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills. Work Environment And Physical Demands Must be able to work in a fast-paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan's policies and procedures, as they may from time to time be updated. HIRING RANGE: $93,690.86 - $117,113.58 IMPORTANT DISCLAIMER NOTICE The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities Benefit interpretation and analysis of EOCs across multiple health plans Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories Analysis of authorization rules and Division of Financial Responsibility (DOFR) Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) Assist with maintenance of benefit requirements and configuration decisions and policies and procedures Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance Other duties as assigned Requirements 5+ years of experience in benefits and claims in Managed Care, delegated model setting Experience with benefit analysis and/or quality assurance College degree in healthcare (preferred) or equivalent experience/knowledge Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. Experience with Epic Tapestry (preferred) Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities Knowledge of how benefit configuration relates to claims adjudication and payment processes. Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. Experience with testing, reviewing, and validating benefit plans Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer