Stop Loss Claims Clerk
Claims representative job in Oakbrook Terrace, IL
Claims Clerk
Full TimeSME/Specialist
Oakbrook Terrace, IL, US
Salary Range:$50,500.00 To $57,500.00 Annually
The Claims Clerk will be responsible for accurate, timely screening and distribution of incoming electronic claims correspondence. This role will aid the Analysts in timely processing of the claims and help secure a manageable turnaround time for the entire Claims Department. This position will report to the Claims Manager.
Essential Elements
Manage the Secure File Transfer Portal (SFTP) site ensure all reporting received is processed in a timely manner
Download and pivot reports from Power BI, to locate all possible medical and prescription claims.
Identify and review claims data ensuring data integrity
Distributing claim requests for processing
Convert the PDF claims received into an Excel Template for the Claims Analyst to upload and process
Additional duties as assigned
Requirements
Education and Certifications
Associates degree or commensurate experience required
Experience
Excel, Microsoft Office Suite, Power BI, Clerical functions
Travel Required
May need to travel to the home office quarterly
Hybrid workplace
Automotive Claims Adjuster
Claims representative job in Oak Brook, IL
We are First Chicago Insurance Company! We currently have offices in Bedford Park, IL, (about one mile south of Chicago Midway Airport), as well as Richardson, Texas (Dallas area). Due to our significant growth, we are pleased to announce that we have a new Claims office in Oak Brook, IL!
If you are an experienced Non-Standard Auto CLAIMS PROFFESSIONAL (with many years of auto and especially nonstandard auto related experience) we'll make sure you are COMPENSATED AS A PROFFESSIONAL!!
We are seeking experienced Non-Standard Auto Liability Claims Specialist to join our new office in Oak Brook!
This talented individual must possess previous experience in the investigation, determination of coverage, prompt evaluation of both First- and Third-Party auto property damage claims with an eye towards prompt, courteous and economical resolution of both First and Third Party related property damage claims.
DUTIES & RESPONSIBILITIES:
Review and determine course of action on each file assigned, utilizing technical knowledge and experience for the purpose of supporting final disposition of a loss
Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage liability, status and damages that are applicable for each claim
Honor/decline/negotiate first and third-party liability claims upon completion of coverage/policy investigation and analysis of damages and liability
Work directly with internal and external customers to develop evidence and establish facts on assigned claims
Organize, plan and prioritize work activities to keep up with current assignments and to ensure prompt conclusion of claims
Prepare and present claim evaluations for the appropriate settlement authority
Notify the Underwriting Department of any adverse information uncovered in the course of the investigation
Familiarity with unfair claim practices in states where we do business
Conduct business with vendors in a professional manner while maintaining a reasonable expense factor and upholding the company's reputation for quality service
Provide customer service both to internal and external customers
Handle other duties as assigned
QUALIFICATIONS REQUIRED:
Minimum 2-3 years previous auto insurance or other auto related experience A MUST!
Non-Standard Auto claims handling experience a plus!
Excellent analytical, organizational, interpersonal and communication (verbal, written, phone) skills
General working knowledge of policies, file procedures, state rules and regulations
Ability to pass written examinations where required by state statutes to become a licensed Claims Adjuster
Preferred:
Prior claims experience
Ability to use on-line claims system
Bi-lingual a plus!
First Chicago Insurance Company provides a competitive benefits package to all full- time employees. Following are some of the perks First Chicago employees receive:
Competitive Salaries
Flexible Work Schedules
Remote and Hybrid
Commitment to your Training & Development
Medical and Dental
Telemedicine Benefit
401k with a generous company match
Paid Time Off and Paid Holidays
Tuition Reimbursement Training Programs
Wellness Program
Fun company sponsored events
And so much more!
Claims Specialist, Lawyers Professional Liability
Claims representative job in Chicago, IL
Do you have experience handling Lawyers Professional Liability or other Professional Liability claims? Are you motivated by working in a collaborative environment? If so, this role may be for you! We are looking for a strategic thinker with leadership skills to join our U.S. Lawyers Claims team.
About the Role
This role has responsibility for handling Lawyers Professional Liability claims while also supporting internal and external customers. You will manage a caseload of claims from receipt to final resolution. Our team works closely with the U.S. Agents Claims team, and you may have the opportunity to handle Agents Claims, as well.
Additional key responsibilities include:
* Maintain strong client focus by aggressively and proactively analyzing issues, providing support, and assuring client satisfaction in a timely fashion.
* Complying with legal and regulatory requirements, investigate, evaluate, and settle claims, applying technical knowledge and people skills to reach fair and prompt claim resolution.
* Complete detailed reviews of claim related issues, including coverage, liability, and damage assessments, and document the claim file appropriately.
* Set and maintain appropriate and timely indemnity and expense reserves.
* Formulate and execute negotiation and resolution strategies.
* Evaluate claims data to assist with identifying claim trends.
* Support Underwriting in connection with Claims information and consultation on coverages.
* In this role, you will be working with other Claims Handlers dedicated to working on Lawyers Professional Liability Claims. Our team also handles other types of claims, including U.S. Agents claims, and has a strong emphasis on quality and customer service.
About the Team
We are a highly skilled, professional, and experienced claims team. Our department works closely with colleagues in Client Markets, Underwriting, Products, Actuary, and HR and we collaborate with various offices throughout the US and other places in the world. We are proud to deliver unparalleled customer service to our business partners and clients. We are looking for a new colleague to help us continue to raise the bar!
About You
Focused, self-motivated, and a confident professional with a hardworking sales mindset to develop insights, propose solutions, and build growth opportunities for clients and Swiss Re. You are a proactive and well-organized decision maker who works well both independently and as part of a team. You also have the following:
Additional requirements include:
* Bachelor's degree or equivalent industry experience.
* 3+ years' Claims handling experience or equivalent industry experience.
* Possess solid coverage, liability, damage investigation, evaluation, and claims resolution skills.
* Excellent negotiation skills.
* Excellent customer service skills and experience collaborating with underwriters, clients, brokers, and internal and external business partners.
* Strong data analytic skills.
* Experience with handling claims in a paperless environment.
* Interest in developing leadership and management skills.
* Possess, or willing to obtain, adjuster licenses as needed for various jurisdictions.
* Ability to successfully deliver the Swiss Re Claims Commitment.
Our company uses a hybrid work model requiring a minimum of three days in the office each week, with the option of working onsite full-time if preferred.
The estimated base salary range for this position is $84,000 to $140,000. The specific salary offered for this or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation.
About Swiss Re
Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.
Keywords:
Reference Code: 136177
Nearest Major Market: Chicago
Job Segment: Liability, Claims, Underwriter, Accounting, Actuarial, Insurance, Finance
Auto and GL Claim Specialist
Claims representative job in Chicago, IL
Multi-Line Claim Specialist (Auto and GL)
Schedule: Monday-Friday, 8:00 AM-4:30 PM CT Compensation: $75,000-$85,000 annually
At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.
Reasons you should consider a career with CCMSI:
Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.
The Multi-Line Claim Specialist position is responsible for the investigation and adjustment of assigned general liability claims. This position may be used as an advanced training position for promotion consideration for supervisory/management positions. The position is also accountable for the quality of multi-line claim services as perceived by CCMSI clients and within our corporate claim standards.
Responsibilities
Investigate, evaluate and adjust multi-line claims in accordance with established claim handling standards and laws.
Establish reserves and/or provide reserve recommendations within established reserve authority levels.
Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated multi-line claims. Negotiate any disputed bills or invoices for resolution.
Authorize and make payments of multi-line claims in accordance with claim procedures utilizing a claim payment program in accordance with industry standards and within established payment authority.
Negotiate settlements in accordance within Corporate Claim Standards, client specific handling instructions and state laws, when appropriate.
Assist in the selection, referral and supervision of designated multi-line claim files sent to outside vendors. (i.e. legal, surveillance, case management, etc.)
Review and maintain personal diary on claim system.
Assess and monitor subrogation claims for resolution.
Compute disability rates in accordance with state laws.
Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the multi-line claim adjustment process.
Provide notices of qualifying claims to excess/reinsurance carriers.
Compliance with Corporate Claim Handling Standards and special client handling instructions as established.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Excellent oral and written communication skills.
Initiative to set and achieve performance goals.
Good analytic and negotiation skills.
Ability to cope with job pressures in a constantly changing environment.
Knowledge of all lower level claim position responsibilities.
Must be detail oriented and a self-starter with strong organizational abilities.
Ability to coordinate and prioritize required.
Flexibility, accuracy, initiative and the ability to work with minimum supervision.
Discretion and confidentiality required.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
10+ years liability claim experience is required.
Bachelor's Degree is preferred.
Experience with handling injury claims.
Computer Skills
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
Adjusters license may be required based upon jursidiction.
AIC, ARM or CPCU Designation preferred.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Object Handling Categories
Work requires the ability to sit or stand up to 7.5 or more hours at a time.
Work requires sufficient auditory and visual acuity to interact with others.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
CCMSI offers a comprehensive benefits package, which will be reviewed during the hiring process. Please contact our hiring team with any questions about compensation or benefits.
Visa Sponsorship:
CCMSI does not provide visa sponsorship for this position.
ADA Accommodations:
CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team.
Equal Opportunity Employer:
CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment.
#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #ClaimsJobs #LiabilityAdjuster #RemoteJobs #InsuranceCareers #ChicagoJobs #LI-Remote
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Auto-ApplyBranch Claims Representative
Claims representative job in Cedar Rapids, IA
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated claims trainee to join our team. This job handles entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job includes training and development completion of the Company's claims training program for the assigned line of insurance and requires the person to:
Investigate, evaluate, and settle entry-level insurance claims
Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products
Learn and comply with Company claim handling procedures
Develop entry-level claim negotiation and settlement skills
Build skills to effectively serve the needs of agents, insureds, and others
Meet and communicate with claimants, legal counsel, and third-parties
Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment
Study, obtain, and maintain an adjuster's license(s), if required by statute within the timeline established by the Company or legal requirements
Desired Skills & Experience
Bachelor's degree or direct equivalent experience with property/casualty claims handling
Ability to organize data, multi-task and make decisions independently
Above average communication skills (written and verbal)
Ability to write reports and compose correspondence
Ability to resolve complex issues
Ability to maintain confidentially and data security
Ability to effectively deal with a diverse group individuals
Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage
Continually develop product knowledge through participation in approved educational programs
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-KC1 #LI-Hybrid
Auto-ApplyClaims Adjuster Trainee
Claims representative job in Hiawatha, IA
Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a claims adjuster trainee, you'll learn how to help customers get back on the road after an accident. This is not a field position, which means you'll be building relationships with customers over the phone. In a fast-paced environment, you'll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and insurance contracts so you can confidently and independently adjust claims.
This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like.
Duties & responsibilities (upon completion of training)
* Determine coverage
* Determine liability (who's at fault for the damages)
* Interview customers, claimants, and witnesses
* Partner with appraisers/estimators to manage vehicle repairs
* Negotiate with customers and other insurance carriers and resolve claims
Must-have qualifications
* Three years of work experience OR
* Bachelor's degree OR
* Two years work experience and an associate degree
Schedule: Monday - Friday, 8:30 am - 5:30 pm during training; 8:00 am - 5:00 pm during onboarding; 9:00 am - 6:00 pm after onboarding.
Location: Clive, Davenport, Hiawatha, or Sioux City, IA claims offices
Compensation
* Once you complete training and pass any necessary testing requirements, your salary will be $54,000-$57,500/year, however, during training, you'll be paid hourly based on your annual salary.
* Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance
Benefits
* 401(k) with dollar-for-dollar company match up to 6%
* Medical, dental & vision, including free preventative care
* Wellness & mental health programs
* Health care flexible spending accounts, health savings accounts, & life insurance
* Paid time off, including volunteer time off
* Paid & unpaid sick leave where applicable, as well as short & long-term disability
* Parental & family leave; military leave & pay
* Diverse, inclusive & welcoming culture with Employee Resource Groups
* Career development & tuition assistance
Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership.
Equal Opportunity Employer
For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************
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Claims Specialist II - WC
Claims representative job in Cedar Rapids, IA
UFG is currently hiring for a Claims Specialist II to work with our Workers Compensation team. This individual's primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to occasional high complexity claims to resolution in accordance with claims best practices.
The Claims Specialist II - Workers Compensation role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with low to moderate levels of supervision. A strong desire to advance one's professional development is essential to this role.
Essential Duties & Responsibilities:
* Review claim assignments to timely determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers' compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action.
* Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes.
* Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution.
* Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Develop knowledge of how to conduct medical and legal research.
* Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery.
* Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions.
* Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction.
* Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution.
* Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Develop knowledge of Medicare settlement obligations.
* Assess and periodically re-assess the nature and severity of injury or illness. Design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate with others on plans of action to mitigate impacts.
* Assess and periodically re-assess claim file reserves adequacy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs.
* Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses.
* Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Emphasis is placed on seeking opportunities to overcome resolution barriers.
* Comply with statute specific claims handling practices and reporting requirements.
* Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure.
* Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities.
* Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers.
* Demonstrate interest in one's own career development and interest in supporting peers with their development.
Job Specifications:
Education:
* High school diploma required.
* Post-Secondary education or Bachelor's degree preferred.
Licensing/Certifications/Designations:
* Meet the appropriate state licensing requirements to handle claims.
* Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program.
* Within 3 years of hire, complete the Workers' Compensation Law Associate (WCLA) certification program.
* Willingness to pursue other professional certifications or designations requested.
Experience:
* 3+ years of general work experience.
* 5+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field.
Knowledge:
* General knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing.
Skills and Abilities:
* Service-Oriented Mindset
* Clear and Concise Communication
* Analytical and Critical Thinking
* Attitude of Collaboration and Curiosity
* Proactive Decision-making and Problem-solving
* Time management and Sense of Service Urgency
* Demonstrate mentorship within the team
* Actively demonstrate engagement in executing on claims initiatives
Working Conditions:
* Working remote from home or general office environment.
* Occasionally the job requires working irregular hours.
* Infrequent overnight travel and weekend hours may be required.
Pay Transparency Statement:
UFG Insurance is committed to fair and equitable compensation practices. The base salary range for this position is $59,622 - $78,637 annually, which represents the typical range for new hires in this role. Individual pay within this range will be determined based on a variety of factors, including relevant experience, education, certifications, skills, internal equity, geography and market data.
In addition to base salary, UFG Insurance offers a comprehensive total rewards package that includes:
* Annual incentive compensation
* Medical, dental, vision & life insurance
* Accident, critical Illness & short-term disability insurance
* Retirement plans with employer contributions
* Generous time-off program
* Programs designed to support the employee well-being and financial security.
This pay range disclosure is provided in accordance with applicable state and local pay transparency laws.
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and skills required. Additional tasks and requirements may be assigned, as necessitated by business need. UFG retains the right to modify the description of this job at any time.
Independent Insurance Claims Adjuster in Cedar Rapids, Iowa
Claims representative job in Cedar Rapids, IA
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.
Auto-ApplyField Claims Adjuster
Claims representative job in Cedar Rapids, IA
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.
Auto Property Damage Claims Specialist
Claims representative job in Oak Brook, IL
Job Description
Are you unhappy at your present job?
?
Is it time for a change?
Are you an experienced Auto Liability Claims Specialist looking to join a growing company where you will be rewarded for your hard work, and have future upward career growth opportunities?
If you answered YES to the above, it's time to talk to Warrior Insurance Network!
We offer:
Competitive Salaries
Excellent benefits
Growth opportunities!
Apply only if you consider yourself a career professional who loves to work, because we work hard here!
We have openings in our Bedford Park, IL and Oak Brook, IL offices!
If you are an experienced Non-Standard Auto CLAIMS PROFESSIONAL (with many years of auto and especially nonstandard auto related experience) we'll make sure you are COMPENSATED AS A PROFESSIONAL!!
This talented individual must possess previous experience in the investigation, determination of coverage, prompt evaluation of both First- and Third-Party auto property damage claims with an eye towards prompt, courteous and economical resolution of both First and Third Party related property damage claims.
DUTIES & RESPONSIBILITIES:
Review and determine course of action on each file assigned, utilizing technical knowledge and experience for the purpose of supporting final disposition of a loss
Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage liability, status and damages that are applicable for each claim
Honor/decline/negotiate first and third-party liability claims upon completion of coverage/policy investigation and analysis of damages and liability
Work directly with internal and external customers to develop evidence and establish facts on assigned claims
Organize, plan and prioritize work activities to keep up with current assignments and to ensure prompt conclusion of claims
Prepare and present claim evaluations for the appropriate settlement authority
Notify the Underwriting Department of any adverse information uncovered in the course of the investigation
Familiarity with unfair claim practices in states where we do business
Conduct business with vendors in a professional manner while maintaining a reasonable expense factor and upholding the company's reputation for quality service
Provide customer service both to internal and external customers
Handle other duties as assigned
QUALIFICATIONS REQUIRED:
Minimum 4 years previous auto liability and auto PD claims experience A MUST!
Non-Standard auto claims experience a plus but not required.
Excellent analytical, organizational, interpersonal and communication (verbal, written, phone) skills
General working knowledge of policies, file procedures, state rules and regulations
Ability to pass written examinations where required by state statutes to become a licensed Claims Adjuster
On-Site position.
Preferred:
Prior claims experience
Ability to use on-line claims system
Bi-lingual a plus!
Warrior Insurance Network (WIN) provides a competitive benefits package to all full- time employees. Following are some of the perks Warrior Insurance Network (WIN) employees receive:
Competitive Salaries
Commitment to your Training & Development
Medical and Dental and Vision Reimbursement
Short Term Disability/Long Term Disability
Life Insurance
Flexible Spending Account
Telemedicine Benefit
401k with a generous company match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Wellness Program
Fun company sponsored events
And so much more!
Estimated Compensation Range: $41,600/year-$75,000/year*
*Published ranges are estimates. Offered compensation will be based on experience, skills, education, certifications, and geographic location.
Job Posted by ApplicantPro
Liability Claims Specialist II
Claims representative job in Waukee, IA
We are looking to add a Liability Claims Specialist to join our Creative Risk Solutions team.
This role will provide high quality claims handling and expertise for all CRS customers. This includes investigating, communicating, evaluating, and resolving auto and general liability claims utilizing the CRS Best Practice of Claim Handling.
Essential Responsibilities:
Articulate and assess coverage for commercial auto and commercial general liability claims.
Adjudication of claims. Investigate bodily injury/liability claims and negotiate settlements when applicable, utilizing our “Best Practices for Claims.” Enter and maintain accurate loss information on a computer system during the claim process.
Set and maintain accurate reserves within reserve authority. Negotiate and process interim and final settlements, within settlement authority.
Research information for responding to questions and complaints posed by our insured's, claimants, agency partners and fronting carriers.
Qualifications:
Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU.
Experience: 2+ years of exposure in the liability claims field. Prior agency involvement preferred.
Licensing: Active adjusters license required
Skills: An ideal candidate should have a fundamental understanding of general and auto liability coverages, along with knowledge of claims processing procedures. Must be able to handle confidential matters with discretion and exercise independent judgment. Proficiency in typing and using various software packages, including Maverick, is also required.
Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience.
Here's a little bit about us:
Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members.
Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as:
Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey!
Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow.
401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for.
Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first.
Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you.
DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish!
Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing.
Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?!
Holmes Murphy & Associates is an Equal Opportunity Employer.
Auto-ApplyRec Marine Adjuster
Claims representative job in Coralville, IA
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Rec Marine Adjuster
**PRIMARY PURPOSE** **:** To investigate and process marine claims adjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement.
+ Receives and reviews new claims and maintains data integrity in the claims system.
+ Reviews survey reports and insurance policies to determine insurance coverage.
+ Prepares settlement documents and requests payment for the claim and expenses.
+ Assists in preparing loss experience report to help determine profitability and calculates adequate future rates.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
+ Travels as required.
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required.
**Experience**
3 years or more of Marine Adjusting preferred.
**Skills & Knowledge**
+ Strong oral and written communication skills
+ PC literate, including Microsoft Office products
+ Good customer service skills
+ Good organizational skills
+ Demonstrated commitment to timely reporting
+ Ability to work independently and in a team environment
+ Ability to meet or exceed Performance Competencies
**WORK ENVIRONMENT**
When applicable and appropriate, consideration will be given to reasonable accommodations.
**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
**Physical** **:**
+ Must be able to stand and/or walk for long periods of time.
+ Must be able to kneel, squat or bend.
+ Must be able to work outdoors in hot and/or cold weather conditions.
+ Have the ability to climb, crawl, stoop, kneel, reaching/working overhead
+ Be able to lift/carry up to 50 pounds
+ Be able to push/pull up to 100 pounds
+ Be able to drive up to 4 hours per day.
+ Must have continual use of manual dexterity
**Auditory/Visual** **:** Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
3A - Process Specialist - Claims
Claims representative job in Des Moines, IA
Process Specialist Claims Examiner In the role of Process Specialist, you will serve as a subject matter expert for the claim team in answering team member questions regarding case specifics and assisting with complicated cases. You will respond to phone and email inquiries related to claims and follow up on any outstanding requirements within a specified timeframe. You will maintain detailed, compliant, and accurate documentation of all claim activity and collaborate with the team to update procedures and develop new procedures as appropriate.
Responsibilities:
Serve as an SME for claim team in answering team member questions regarding case specifics and assisting with complicated cases.
Customer Service Experience - respond to phone and email inquiries related to claims.
Follow up on any outstanding requirements within a specified timeframe.
Maintain detailed, compliant, and accurate documentation of all claim activity.
Collaborate with team to update procedures and develop new procedures as appropriate.
Coordinate special projects as assigned.
Training in new procedures.
Perform quality reviews on claims/letters.
Qualifications:
Basic
High School Diploma or GED Equivalent. Will also consider three years of progressive experience in the specialty in lieu of every year of education.
2 years' experience relevant to the job description
Preferred
Associate or bachelor's degree
3 years' experience analyzing life claims.
Effective written and verbal communication skills
Knowledge of the insurance industry or insurance products/procedures through a combination of experience and/or coursework
Organizational and follow through skills.
Sensitivity to service and quality
Ability to work with confidential information.
Your responsibilities include but may not be limited to
Serve as a SME for claim team in answering team member questions regarding case specifics and assisting with complicated cases.
Customer Service Experience - respond to phone and email inquiries related to claims.
Follow up on any outstanding requirements within a specified timeframe.
Maintain detailed, compliant, and accurate documentation of all claim activity.
Collaborate with team to update procedures and develop new procedures as appropriate.
Coordinate special projects as assigned.
Training on new procedures.
Perform quality reviews on claims/letters.
Note: Applicants for employment in the U.S. must possess work authorization which does not require sponsorship by the employer for a visa (H1B or otherwise).
The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone, email or face to face.
About Us
Infosys McCamish Systems,(*********************************** located in Atlanta, Georgia, is the Life Insurance and Retirement Services subsidiary of Infosys BPM Limited.(******************* Infosys McCamish was started in 1985 as a virtual insurance company and went to market as a commercial services provider in 1995.It has an outstanding business perspective and an exemplary track record that no other outsourcer of business solutions can claim - generating US$16 billion of recurring premium in less than five years as a virtual insurance company. Infosys McCamish has expert technology and outsourcing credentials, along with a proven business model for re-engineering systems and performing back-office services at a reduced cost, while reinforcing accuracy, speed and security. Seven of the top ten US insurers are among Infosys McCamish's many BPM clients. Infosys McCamish has its operations spread across Atlanta GA and Des Moines IA in USA.
U.S. citizens and those authorized to work in the U.S. are encouraged to apply. We are unable to sponsor at this time.
EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/Nationality
Infosys is an equal opportunity employer, and all qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, spouse of protected veteran, or disability.
Public Adjuster
Claims representative job in Des Moines, IA
Department
Insurance & Financial Services
Employment Type
Full Time
Location
Iowa
Workplace type
Hybrid
Compensation
$90,000 - $120,000 / year
Key Responsibilities Skills, Knowledge and Expertise Benefits About The Misch Group Stone Hendricks Group is a direct-hire search firm that brings together years of experience and a diverse range of talent to connect businesses with exceptional job candidates. With a focus on timely and effective recruitment, we understand the power of a well-formed employee base in helping businesses achieve their goals. We offer our services to businesses of all sizes, providing qualified candidates for blue- and grey-collar roles, as well as white-collar and executive positions. The success of our direct-hire search process is driven by our advanced training, proprietary technology, and extensive network across industries. At Stone Hendricks Group, we value integrity and prioritize connectedness, commitment, and candor in our interactions with both employers and job seekers. Our clients consider us trusted advisors, relying on the highly personalized service we provide and our ability to find candidates that are an ideal fit for their unique needs. Choose Stone Hendricks Group for unsurpassed direct-hire search services that match successful organizations with talented job candidates.
Global Risk Solutions Claims Specialist Development Program (January, June 2026)
Claims representative job in Hoffman Estates, IL
Claims Specialist Program
Are you looking to help people and make a difference in the world? Have you considered a position in the fast-paced, rewarding world of insurance? Yes, insurance!
Insurance brings peace of mind to almost everything we do in our lives-from family trips to your first car to weddings and college graduations. As a valued member of our claims team, you'll help our customers get back on their feet and restore their lives when catastrophe strikes.
The details
When you're part of the Claims Specialist Program, you'll acquire various investigative techniques and work with experts to determine what caused an accident and who is at fault.
You'll independently manage an inventory of claims, which may include conducting investigations, reviewing medical records, and evaluating damages to determine the severity of each case. You'll resolve cases by working with individuals or attorneys to settle on the value of each case.
You will have required comprehensive training, one-on-one mentoring, and a strong pay-for-performance compensation structure at a global Fortune 100 company. Make a difference in the world with Liberty Mutual.
Qualifications
What you've got
You have 0-2 years of professional experience.
A strong academic record with a cumulative 3.0 GPA preferred
You have an aptitude for providing information in a clear, concise manner with an appropriate level of detail, empathy, and professionalism.
You possess strong negotiation and analytical skills.
You are detail-oriented and thrive in a fast-paced work environment.
You must have permanent work authorization in the United States.
What we offer
Competitive compensation package
Pension and 401(k) savings plans
Comprehensive health and wellness plans
Dental, Vision, and Disability insurance
Flexible work arrangements
Individualized career mobility and development plans
Tuition reimbursement
Employee Resource Groups
Paid leave; maternity and paternity leaves
Commuter benefits, employee discounts, and more
Learn more about benefits at **************************
A little about us
As one of the leading property and casualty insurers in the country, Liberty Mutual is helping people embrace today and confidently pursue tomorrow.
We were recognized as a ‘2018 Great Place to Work' by Great Place to Work US, and were named by
Forbes
as one of the best employers in the country for new graduates and women-as well as for diversity.
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information, or on any basis prohibited by federal, state, or local law.
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Auto-ApplyPharmacy Claims Adjudication Specialist
Claims representative job in Woodridge, IL
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Woodridge, IL. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $23.00 an hour and up Sign-On Bonus: $5,000 for employees starting before January 1, 2026. We offer a variety of benefits including:
Medical; Dental; Vision
401k with a match
Paid Time Off and Paid Holidays
Tuition Reimbursement
Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections Pharmacy Adjudication Specialists at Onco360...
Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
Document and submit requests for Patient Refunds when appropriate.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
Education/Learning Experience
Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
Skills/Knowledge
Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
Licenses/Certifications
Required: Registration with Board of Pharmacy as required by state law
Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
Claims Specialist III- Workers Compensation
Claims representative job in Cedar Rapids, IA
UFG is currently seeking a Claims Specialist III - Workers Compensation who will be primarily responsible for verifying applicable coverages, conducting timely and thorough research of the facts of a loss, analyzing compensability and evaluating benefits for reserve and settlement, and negotiating medium to high complexity claims to resolution in accordance with claims best practices.
The Claims Specialist III - WC role demonstrates a strong desire to learn and grow, promotes a positive work environment, and embraces a strong service-oriented mindset in support of internal and external customers. This role requires strong communication skills, attention to detail, and the ability to handle multiple tasks efficiently and effectively. It also requires the ability to work independently with a low level of supervision and a high level of accountability. A strong desire to advance one's professional development and the development of others is essential to this role.
Essential Duties and Responsibilities:
Review claim assignments to determine policy coverage, compensability of a claimed injury or illness and facilitation of medical, indemnity and other statutory workers' compensation benefits. If a coverage issue is relevant, review facts with a designated leader or mentor to determine a proper plan of action.
Make prompt, meaningful contact with insureds and their employees to research facts by conducting interviews; securing, understanding and synthesizing information from relevant documents; identifying other relevant parties to a claim; and proactively supporting all parties with their commitment to outcomes.
Establish rapport and an outcome focused relationship with insureds and their employees, as well as other internal and external stakeholders, through consistent on-going contact throughout the recovery process and claim resolution.
Request and analyze medical records to determine compensability according to evidence-based causation by jurisdiction. Have proficiency with conducting medical and legal research.
Interact with medical providers to clearly define medical causation and establish treatment plans focused on recovery.
Promptly and supportively inform insured and employees as well as other stakeholders of coverage and compensability decisions.
Support stay-at-work or return-to-work opportunities for insureds and their employees. Propose and facilitate vocational support when appropriate by jurisdiction.
Identify subrogation potential and document evidence in support of subrogation. Understand the subrogation mechanism and actively partner with internal and external subrogation partners to achieve outcomes with a goal to achieve global resolution.
Identify potential Medicare eligibility and comply with all Medicare Secondary Payor requirements of law. Have strong knowledge of Medicare settlement obligations.
Assess and periodically re-assess the nature and severity of injury or illness and design a plan of action focused on recovery and resolution in accordance with claims best practice guidelines by jurisdiction. Identify factors which could impact successful outcomes and collaborate on plans of action to mitigate impacts.
Assess and periodically re-assess claim file reserves to a high degree of accuracy. This will be achieved through understanding medical diagnoses and care plan developments; thorough analysis of wage information and accurate calculations of indemnity benefits; and by securing and providing job descriptions specific to the employee to medical providers. Promptly identify factors of risk for increased loss and expense costs.
Execute all technical claim handling functions such as documenting facts within the claims management system in a consistent, concise and clear manner; make timely decisions and promptly communicate decisions to stakeholders; process accurate benefit payments; and seek opportunities to mitigate claim handling expenses.
Proactively seek resolution of claims by defining stakeholder outcome expectations early and often, managing processes focused on outcomes and engaging in direct negotiation, mediation, settlement conferences or hearings according to jurisdiction. Proficient with seeking opportunities to overcome resolution barriers.
Comply with statute specific claims handling practices and reporting requirements.
Inform underwriting of increased hazards or unusual circumstances concerning a risk/policy exposure.
Participate in internal and external continuing education opportunities to maintain licensure and develop claim handling skills and abilities.
Demonstrate a supportive attitude and presence within the team by adapting well to change in process or procedure. Share innovative ideas to improve work product and outcomes. Take initiative to identify and learn about areas of professional development. Proactively seek out opportunities to collaborate with peers.
Demonstrate interest in one's own career development and actively support peers with their development.
This role requires a strong understanding of the insurance mechanism and interactions between business functions as well as strong support for initiatives that advance the goals of the enterprise.
Job Specifications:
Education:
High school diploma required.
Post-Secondary education or bachelor's degree preferred.
Licensing/Certifications/Designations:
Meet the appropriate state licensing requirements to handle claims.
Within 1 year of hire, complete the Workers' Recovery Professional (WRP) certification program.
Within 3 years of hire, complete the Senior Workers' Compensation Law Associate (SCLA) designation program.
Willingness to pursue other professional certifications or designations as requested.
Experience:
5+ years of general work experience.
10+ years of workers' compensation claims handling experience or a combination of workers' compensation claims handling experience and experience in a related field.
Knowledge:
Proficient knowledge of insurance, medical and legal concepts is required with a high degree of ability to articulate knowledge verbally and in writing.
Skills and Abilities:
Service-Oriented Mindset
Clear and Concise Communication
Analytical and Critical Thinking
Attitude of Collaboration and Curiosity
Proactive Decision-making and Problem-solving
Time management and Sense of Service Urgency
Demonstrate aptitude for mentorship and leadership
Actively leads execution of claims initiatives
Working Conditions:
Working remote from home or general office environment.
Occasionally the job requires working irregular hours.
Infrequent overnight travel and weekend hours may be required.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and skills required. Additional tasks and requirements may be assigned, as necessitated by business need. UFG retains the right to modify the description of this job at any time.
Engine Adjuster - 2nd Shift
Claims representative job in Lake Zurich, IL
ECHO Incorporated is an industry leader in developing and manufacturing high-performance, professional-grade, handheld outdoor power equipment. With distributors and thousands of dealers across North and South America, ECHO is constantly anticipating the future of the outdoor power equipment industry and the need for environmental sustainability. Working for ECHO means joining a team of people who are committed to collaboration, innovation, creativity, and high-quality products that make us a globally competitive brand.
ECHO is hiring Engine Adjusters for our cutting-edge, climate-controlled facility located in Lake Zurich!
The Engine Adjuster is responsible for adjusting 2-stroke engines to engineering specifications in accordance with written procedures.
2nd Shift M-F 3:15pm-11:30pm!
$18/HR +1 SD = $19/HR
ECHO's benefits include:
11 paid holidays
Extremely affordable medical, dental, and vision insurance
PTO (Paid Time Off)
5% 401K match
Tuition reimbursement
Career advancement growth opportunities
Eligible for a $300 sign-on bonus after 90 days of employment if all qualifications are satisfied
Eligible for a $300 referral bonus upon referring an employee who successfully completes 90 days of employment
Duties/Responsibilities:
Adjusting 2-stroke internal combustion engines to engineering specifications.
Evaluating engine performance and reporting irregularities to the Supervisor.
Regularly checking equipment to ensure tolerances are maintained.
Maintaining tools, fixtures, and benches in a neat and orderly condition.
Recording required data.
Performing various other duties and assignments as requested to support the department and company's overall functioning.
Qualifications:
Working knowledge of 2-stroke engine operations preferred.
Ability to tolerate loud noises even with protective hearing equipment.
Perform high-quality inspection and calibration of engine.
Bilingual Spanish preferred.
Equal Opportunity Employment:
We are an equal opportunity employer. We welcome all applicants.
E-Verification:
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.
Collision Desk Adjuster - Fleet Management
Claims representative job in Rolling Meadows, IL
Join Innovation Group's commitment to #GoingBeyond
Innovation Group provides comprehensive operational support and a range of expert services to the world's leading insurers, brokers, fleet managers and automotive manufacturers. Our 3,300 employees across ten countries deliver exceptional standards on a large scale for over 1,200 clients, saving our global clients tens of millions of dollars annually. Innovation Group helps put their lives back on track. It takes empathy, it takes going above and beyond, it takes building the right relationships and it takes people who want a career. We look to do things differently and we're always searching for people who are up for making an impact.
Innovation Group is seeking a Auto/Collision Desk Adjuster to join our Fleet Management quality and compliance team in Rolling Meadows, Illinois.
You will have the opportunity to:
Complete reviews of adjuster estimates against carrier guidelines and make appropriate suggestions for changes.
Build solid and long lasting relationships with Vendors and Independent Contractors.
Ensure that all services within the Innovation auto division are provided with high quality statistical auditing services highly focused on quality assurance of estimates.
Provide statistical auditing for claims by client and individuals in order to analyze, operational improvements and adherence to client specific estimating guidelines.
Handle all escalation issues related to the quality of the work provided.
What we're looking for:
5 -7 years Auto or Collision experience required.
3 - 5 years Customer Service experience
Collision Industry experience
Previous estimating experience
Account Management experience
Estimating software experience required
Negotiating Skills
Excellent Verbal and Written Communication Skills
At Innovation Group, we value the contributions of our employees. We provide a robust benefits package that includes:
Medical, dental, and vision insurance
Life insurance
Short-term and long-term disability insurance
Flexible spending account options
Health and dependent care saving accounts
17 days of paid time-off per year
Paid sick leave
8 paid holidays
401(k) investment options
Employee assistance programs
Auto-ApplyLead Claims Specialist
Claims representative job in Holstein, IA
Job Description
this is an onsite position in Holstein, IA.
Overall Responsibilities:
The duties of the Claims Specialist Lead are to perform as a mentor and trainer for Claims Specialist team members, along with managing assigned claim territory. Report to Tech Services/Claims Manager on team performance.
Specific responsibilities include, but are not limited to the following:
Train team members on systems and process for claim documentation
Provides assistance to identify production errors for proper claim resolution
Manage and report workload within assigned Claims Specialist team to meet service level standards
Primary contact with Wisconsin production operations personnel for identification and resolution of production and shipping claims for team
Essential Job Functions:
Works with team to minimize errors
Manages daily departmental duties for assigned team
Participate and conduct personnel performance reviews
Processes claims for assigned territory
Participate and facilitate meetings/group function as needed
Participates in claims meetings with production to discuss trends and quality improvement actions
Have advanced understanding of VT product offering, construction, labeling, hardware, fire approvals, STC approvals, and production processes
Functions as a resource for distributors and follows up with customers regarding claims
Assists in sourcing special or subcontracted materials
Works with Management and Sales Service to schedule ship dates for remake doors and accessories
Work closely with Department Manager
Confers with Project Coordinators, Schedulers, Detailers, and Production when appropriate
Supports 5S/lean program keeping work area organized
Available to work 8 to 10 hours per day as required
Observes all safety policies and procedures at all times
Participates and conducts Tech Services team meetings
Assists with charting and reports for the department as needed
Works individually or with team members as assigned, maintaining a positive work environment
Other duties as assigned
Position Requirements
Must be able to work in an office environment during standard business hours
High School Diploma or equivalent
2 to 4 years of relevant work experience
Able to review your own work and the work of others ensuring accuracy of presented data
Able to use and troubleshoot general office equipment including computer data entry (Word, Excel, IFS, VTOL, XA as needed) and other computer functions, telephone, and printers
Self-Motivated
Satisfactory attendance record
Able to deal with multiple problems and tasks effectively and efficiently
Excellent written and verbal communication with internal and external customers
Strong organizational skills, detail oriented and consistently works toward continuous improvement
All team members are expected to follow the Code of Conduct to the highest standards as well as to adhere to the Attendance Policy of VT Industries.
Physical Requirements
Tolerance for sitting long periods of time. Possess finger dexterity to write, type, and use a calculator. Maintain adequate vision to view small print and computer terminal. Ability to speak and hear, walk throughout facilities with occasional light lifting (25 pounds), stooping, kneeling, crouching, and reaching with hands and arms required. Ability to travel between multiple facilities as required to perform core job duties.
The physical demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The physical demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.