Claims Adjuster
Claims representative job in Farmingdale, NY
Network Adjusters is seeking skilled insurance claims adjusters with experience in General Liability and/or Construction Defect for a third-party liability Construction Defect Claims Adjuster position. In this role, you will manage third-party Construction Property Damage and Liability Insurance claims of varying complexity and severity, specifically within construction development and subcontractor programs.
CONSTRUCTION DEFECT ADJUSTER RESPONSIBILITES:
Knowledge of General Liability and Construction Defect claims.
Provide superior customer service to meet the needs of the insured, claimant, all internal and external customers, including carrier clients.
Fulfill specific client requirements including reporting of claim details and analysis.
Review and analyze coverage and apply policy conditions, provisions, exclusions and endorsements.
Recognize and apply jurisdictional issues that impact the claim (i.e.: negligence laws, financial responsibility limits, immunity, etc.)
Investigate facts to determine liability, other sources of recovery as appropriate by contacting and interviewing appropriate parties.
Manage 3rd party property damages, bodily injury and other claims requiring specialized investigation and utilization of external experts in accordance with local laws.
Effectively manage litigated claims & assigned defense or coverage counsel.
Establish and maintain appropriate claim and expense reserves in a timely fashion.
Develop and continually update a plan of action for file resolution including maintaining an effective diary.
Document claim file activities in accordance with established procedures.
Write denial letters, reservation of rights, tenders and other routine and complex correspondence to insureds and claimants.
Confer with higher level technical claim personnel for guidance and direction to ensure files are handled properly.
Determine settlement amounts based on independent judgment, application of applicable limits and deductibles.
Negotiate settlements within authority limits.
Identify subrogation opportunities.
Meet all quality standards and expectations based on Best Practices.
Assure compliance with state specific regulations.
Effectively manage multiple competing priorities to ensure timely payment, follow-up and claim resolution.
CONSTRUCTION DEFECT ADJUSTER QUALIFICATIONS:
2-5 years of experience in claims handling (preferably 3rd party - general liability).
College/Technical degree or equivalent business experience.
Obtain Adjusters licenses as required to meet business need.
Complete continuing education to maintain licenses.
Strong verbal and written communication skills.
General software skills including MS Word, Outlook and Excel.
Customer service and empathy skills.
Solid analytical and decision-making skills in order to evaluate claims and make sound decisions.
Excellent negotiation skills and ability to effectively handle conflict.
Strong organization and time management skills.
Ability to multi-task and adapt to a changing environment.
Attention to detail, ensuring accuracy.
Strong investigative skills and creativity to achieve optimal results.
Ability to maintain confidentiality.
CONSTRUCTION DEFECT ADJUSTER BENEFITS:
Training/Development and growth opportunities
401(k) with company match / Retirement planning
Paid time off / Company paid holidays
Comprehensive health plans including dental and vision coverage
Flex spending account
Company paid life insurance
Company paid long term disability
Supplemental life insurance
Opportunity to buy into short term disability
Strong work/family and employee assistance programs
This role is located in Farmingdale, NY; no remote or hybrid offers are available at this time.
The starting salary for this position is $75,000 - $100,000, depending on factors such as licensure, certifications, and relevant experience. Become a part of a dynamic, energetic workforce in which you can make a difference.
Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All of our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.
Forensic Construction Claims Manager
Claims representative job in New York, NY
New York, New York
This role is Hybrid.
Interested in the legal/dispute side of construction projects? CPMI is seeking Financial Forensic Claims Managers and Senior Managers. These team members will work closely with Principals of the firm in preparation and evaluation of financial construction claims on a variety of construction projects. Responsibilities include developing conclusions/opinions for contract dispute analysis and resolution, as well as technical research and oversight of team members.
Capital Project Management, Inc. (CPMI) is an independent consulting firm that specializes in the analysis, resolution, and prevention of complex construction disputes with an emphasis on schedule/delay/disruption analyses and related damages calculations. CPMI has been successfully serving the construction industry for 25 years handling more than a thousand projects in virtually every type of capital construction, worldwide. Our professionals regularly address complicated multipart claims in all sectors of the construction industry - from commercial buildings, stadiums, and industrial plants to environmental projects, public works, and defense contracts. We thoroughly evaluate technical, scheduling, cost, quality, and other critical issues, develop dispute resolution strategies, assist in settlement negotiations and mediation, and provide concise, credible expert witness testimony if the case goes to trial. (*****************
Responsibilities
Analyze documents, identifying issues, developing chronologies, and histories.
Conduct detailed technical and legal research as required.
Utilize project records, including financial records to identify project costs, project overruns, or sub-activity costing.
Develop databases for equipment, material, labor, change orders, etc., from project records. Utilize databases to support or contradict various project assumptions.
Evaluate financial records, including financial statements, claims, and project cost records.
Prepare summaries, including charts and graphics to present findings.
Summarize efforts and findings in narratives, including proper grammar with minimal edits.
Prepare documents, exhibits and reports for trial.
Assist clients with document production, depositions and trial preparation as required.
Organize, index and maintain project documents.
Develop and utilize document databases.
Education/Qualifications:
Undergraduate degree
A CPA and/or CFE certification is preferred, but others will be considered with relevant experience.
Preferred Skills:
Excellent communication (written and verbal), mathematical, and organizational skills
Proficient knowledge of PC environment and related software including Microsoft applications such as Word, PowerPoint, and Excel
Proficient in developing and analyzing dynamic spreadsheets
Ability to work in a team as well as independently
Ability to produce high quality work product under strict deadlines
Ability to work in a high-paced, multi-task environment with attention to detail
Flexibility in handling assigned tasks and engagements due to deadline and task priority changes
High level of interpersonal skills
High level of quantitative and qualitative research and analytical skills
Hard working, eager to learn, and motivated to succeed
Fluency in English required and other languages considered as a plus
Benefits/Perks
401k plan with company contribution
Comprehensive medical insurance
Competitive market salary with performance bonus
Continuing education reimbursement opportunities
Capital Project Management, Inc. is an Equal Opportunity Employer. All eligible candidates are invited to apply. For more information, please visit our website at *****************
Auto Claim Representative, I
Claims representative job in Melville, NY
**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**
$55,200.00 - $91,100.00
**Target Openings**
4
**What Is the Opportunity?**
This role is eligible for a sign on bonus up to $10,000
Be the Hero in Someone's Story
When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most.
As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner.
In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process.
**What Will You Do?**
+ Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations.
+ Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates.
+ Determine claim eligibility, coverage, liability, and settlement amounts.
+ Ensure accurate and complete documentation of claim files and transactions.
+ Identify and escalate potential fraud or complex claims for further investigation.
+ Coordinate with internal teams such as investigators, legal, and customer service, as needed.
+ Insurance License: 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.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree.
+ Three years of experience in insurance claims, preferably Auto claims.
+ Experience with claims management and software systems.
+ Strong understanding of insurance principles, terminology with the ability to understand and articulate policies.
+ Strong analytical and problem-solving skills.
+ Proven ability to handle complex claims and negotiate settlements.
+ Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants.
**What is a Must Have?**
+ High School Diploma or GED required.
+ A minimum of one year previous Auto claim handling experience or successful completion of Travelers Auto Claim Representative training program is 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 ******************************************************** .
Claims Adjuster
Claims representative job in Rochester, NY
Claims Adjuster
Salary :$75 K to $85 K
Benefits Yes
Bonus No
Must-Haves
1
2-4 years of adjudicating worker's compensation and general liability claims at a high volume
2
Risk management experience
3
Associates Degree in Business, Risk Management or related field
Nice-To-Haves
1
Experience managing a third party insurance agent like Traveler's insurance
Job Description
Are you a skilled professional with 2-4 years of experience in Worker's Compensation? We're seeking a dynamic and knowledgeable individual to join our team and make a significant impact in incident claim liability mitigation through collaborative efforts with internal and external stakeholders and managing high case loads
Key Responsibilities:
Conduct thorough investigations into worker's compensation claims.
Assess and analyze claim information to ensure accurate and fair settlements.
Collaborate with internal teams and external stakeholders for effective claims resolution.
Stay updated on industry regulations and compliance standards.
Provide expert guidance and support to ensure a smooth claims process.
Qualifications:
Associates degree in Business, Risk Management or related field is required
2-4 years of hands-on experience primarily in Worker's Compensation and General liability claims.
In-depth knowledge of claim investigation and settlement processes.
Familiarity with relevant laws, multi-state regulations, and industry best practices.
Strong analytical and problem-solving skills.
Excellent communication and interpersonal abilities.
Bonus Points:
Experience working at an insurance firm, especially with Travelers.
What We Offer:
Exciting and challenging work environment.
Competitive compensation package.
Opportunities for professional growth and development.
Flexible work schedule
Much more!
If you're passionate about making a difference in Worker's Compensation and have the experience to match, we want to hear from you! Join us in ensuring a safe and fair workplace for all.
Apply today by sending your resume. Let's build a safer and healthier workplace together!
Personal Insurance Claims Representative
Claims representative job in Schenectady, NY
Job Description
At Community Financial System, Inc. (CFSI), we are dedicated to providing our customers with friendly, personalized, high-quality financial services and products. Our retail division, Community Bank, N.A., operates more than 200 customer facilities across Upstate New York, Northeastern Pennsylvania, Vermont and Western Massachusetts. Beyond retail banking, we also offer commercial banking, wealth management, investment management, insurance and risk management, and benefit plan administration.
Just as our employees are committed to helping our customers manage their finances, we're committed to our employees. After all, they make it happen for our customers every day.
To ensure our people can enjoy long and successful careers here at CFSI, we offer competitive compensation, great benefits, and professional development and advancement opportunities. As an equal-opportunity workplace and affirmative-action employer, we celebrate and support a diverse workplace for the benefit of all: our employees, customers and communities.
Responsibilities
We are seeking an experienced Insurance Claims Representative to join our team. The successful candidate will be responsible for managing and processing claims for personal lines insurance policies, such as home, auto, and liability insurance in addition to commercial policy holder claims. The role requires a person who is detail-oriented, empathetic, and able to work under pressure. The successful candidate will help to coordinate the claims process with internal and carrier stakeholders, providing guidance, support and information.
Review and investigate personal lines claims, including property, auto and liability claims
Review and interpret insurance policy language, endorsements, and exclusions to determine coverage and limitations.
Communicate with policyholders, agents, brokers, underwriters, and other relevant parties to gather necessary information and documents
Determine coverage and liability of claim
Develop and execute a plan to resolve the claim in a timely and efficient manner
Evaluate damages and negotiate settlements with claimants and other parties involved
Document and maintain accurate records of claim status and updates
Provide excellent customer service to policyholders and agents throughout the claims process
Participate in training and development opportunities to enhance knowledge of the insurance industry and claims management
Maintain proficient knowledge of, and demonstrate ongoing compliance with all laws and regulations applicable to this position, ensure ongoing adherence to policies, procedures, and internal controls, and meet all training requirements in a timely manner
Qualifications
High school diploma or equivalent; associate or bachelor's degree in related field preferred
Minimum of 2 years experience in commercial and personal insurance claims processing
Valid Property & Casualty License or willingness to obtain is required
Prior experience with Epic Agency Management system is desired
Strong Analytical and problem solving sills
Excellent written and verbal communication skills
Ability to work independently and as part of a team
Proficiency in Microsoft Office and claims management software
Attention to detail and strong organizational skills
Knowledge of insurance laws and regulations
Ability to handle confidential information with discretion
Customer service experience preferred
All applicants must be 18 years of age or older
Complex Liability Claims Specialist - Commercial General Liability
Claims representative job in New York
The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier.
Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago.
What you will do
The Specialist will be responsible for the management and effective resolution of high exposure, complex liability claims in multiple jurisdictions. The ideal candidate will have considerable experience in effectively negotiating settlements via mediation and direct negotiations, managing and directing litigation, conducting coverage and additional insured evaluations, and drafting coverage position letters. Experience handling complex commercial general liability is required.
Key responsibilities
* Responsible for thorough evaluation of coverage and proactive investigation, reserving, negotiating and managing the defense of complex liability claims in multiple jurisdictions.
* Manage all claims in accordance with Utica National's established claim procedures.
* Draft and present claim reviews to supervisor and upper management that provide full evaluation of coverage, liability and damages associated with claim, proposed plan to resolve claim and sufficient basis and support for authority requests above the Complex Liability Claims Specialist's individual monetary authority level.
* Maintain timely and accurate claim reserves in accordance Utica National's reserving philosophy.
* Effectively manage litigation process including appropriate assignment of defense panel counsel, monitoring of defense counsel's work product and working with defense counsel to efficiently and fairly resolve claims.
* Participate as appropriate in litigation activities including settlement negotiations, depositions, conferences, hearings, alternative dispute resolution sessions and trials.
* Maintain effective communications with insureds, claimants, agents, and other representatives involved in the claims cycle.
* Achieve the service standard of "excellent" during all phases of claims handling.
* Stay abreast of legal trends, case law, and jurisdictional environment and its impact on handling claims within the jurisdiction.
* Responsible for analyzing and communicating changes in law, regulation, and custom to ensure consistent quality claim handling.
What you need
* Four year degree or equivalent experience preferred.
* Minimum of 5 years of commercial casualty claims handling experience working with high complexity litigated casualty claims.
* Proven experience negotiating claims and active participation in alternative dispute resolution practices.
* Experience with general liability, additional insured considerations and complex coverage determinations.
Licensing
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.
Salary range: $103,300 - $136,400
The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.
Benefits:
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
* Medical and Prescription Drug Benefit
* Dental Benefit
* Vision Benefit
* Life Insurance and Disability Benefits
* 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
* Health Savings Account (HSA)
* Flexible Spending Accounts
* Tuition Assistance, Training, and Professional Designations
* Company-Paid Family Leave
* Adoption/Surrogacy Assistance Benefit
* Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
* Student Loan Refinancing Services
* Care.com Membership with Back-up Care, Senior Solutions
* Business Travel Accident Insurance
* Matching Gifts program
* Paid Volunteer Day
* Employee Referral Award Program
* Wellness programs
Additional Information:
This position is a full time salaried, exempt (non-overtime eligible) position.
Utica National is an Equal Opportunity Employer.
Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
#LI-HL1
Trucking Claims Specialist
Claims representative job in New York, NY
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ "Superior" by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
* Competitive compensation
* Healthcare benefits package that begins on first day of employment
* 401K retirement plan with company match
* Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
* Up to 6 weeks of parental and bonding leave
* Hybrid work schedule (3 days in the office, 2 days from home)
* Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
* Tuition reimbursement after 6 months of employment
* Numerous opportunities for continued training and career advancement
* And much more!
Responsibilities
Berkshire Hathaway GUARD Insurance Companies is seeking a Trucking Claims Specialist to join our P&C Claims Casualty team. This role will report to the AVP of Claims and is responsible for investigating and resolving commercial auto liability and physical damage claims, with a focus on trucking exposures. The ideal candidate will bring strong analytical skills, sound judgment, and a commitment to delivering high-quality claims service.
Key Responsibilities
* Investigate and resolve commercial auto liability and physical damage claims involving trucking exposures.
* Review and interpret policy language to determine coverage and consult with coverage counsel when needed.
* Manage a caseload of moderate to high complexity and exposure, applying effective resolution strategies.
* Communicate with insureds, claimants, attorneys, body shops, and law enforcement to gather relevant information.
* Collaborate with defense counsel and vendors to support litigation strategy and recovery efforts.
* Ensure claims are handled accurately, efficiently, and in alignment with service and regulatory standards.
* Participate in file reviews, team meetings, and ongoing training to support continuous learning.
Salary Range
$95,000.00-$145,000.00 USD
The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Qualifications
* Minimum of 3 years of trucking industry experience.
* Experience with bodily injury and/or cargo exposures.
* Familiarity with trucking operations, FMCSA/DOT regulations, and multi-jurisdictional claims practices.
* Strong analytical and negotiation skills, with the ability to manage multiple priorities.
* Proven ability to manage sensitive and high-stakes situations with accuracy and professionalism.
* Possession of applicable state adjuster licenses.
* Juris Doctor (JD) preferred; alternatively, a bachelor's degree or equivalent experience in insurance, risk management, or a related field.
Auto-ApplyInsurance Claims Specialist
Claims representative job in Ronkonkoma, NY
Job Description
The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.
DUTIES AND KEY RESPONSIBILITIES:
Claims Management and Oversight
Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
Respond to inquiries and concerns regarding new and existing claims
Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
Compliance and Reporting
Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
Monitor claim trends and identify risk mitigation opportunities.
Financial Coordination and Invoicing
Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
Work with finance team to place and monitor appropriate reserves and allocate funds.
Data Analytics and Reporting
Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
Collaboration and Communication
Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
Provide regular updates to management on claims status, strategic initiatives, and risk trends.
Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.
QUALIFICATIONS:
3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
Associate's degree required.
Excellent customer service skills
Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
Exceptional interpersonal, verbal, and written communication skills
Proven customer relationship and conflict resolution skills
Ability to develop and maintain strong working relationships with internal and external parties
Strong attention to detail and accuracy in data entry and record keeping
Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.
Claims Specialist
Claims representative job in New York, NY
Why Shiftsmart We're building the Amazon of labor. We're a labor platform pairing end-to-end workforce management technology with a rapidly growing global network of 5M flexible workers to create scalable labor solutions for the largest companies and government agencies in the world like Circle K, Pepsi, Walmart, Starbucks and more. Our unique business model fractionalizes jobs down to shifts and makes it easy for workers to work across multiple companies through a digital marketplace. We're one of the fastest-growing startups in the country. We've grown 2-3x each year since we started, paid over $130M in wages to hourly workers, and raised $120M+ from top-tier investors including D1 Capital & Imaginary Ventures…and we're only getting started.
Mission:
The mission of the Privacy and Compliance function is to ensure Shiftsmart processes and policies adhere to relevant legal and regulatory requirements and ensure positive & safe experiences for both users, clients, and company. You will be directly contributing in helping create and maintain a resource for both customers and users to assist with any privacy or legal related requests.
This role is based in New York City (HQ) with typically 4+ days in office
Outcomes:
This role will handle a diverse array of incidents and issues, but should always focus on solving for clarity, thoroughness, and risk mitigation.This position will evolve over time but some of your early responsibilities will include:
* Gather, organize, and analyze information related to incidents and escalated complaints.
* Support the creation of comprehensive written investigative reports based on gathered data.
* Perform initial analysis of all escalated incidents and complaints, considering factors such as location, type of task, and the nature of the issue.
* Coordinate closely with the Customer, Support, and Operations teams to compile relevant data, records, and other evidence necessary for investigative reports.
* Maintain a robust tracking system to monitor the outcomes of all escalations and investigated cases.
* Meet response time SLAs for communicating with partners, law enforcement contacts, and customer contacts.
Competencies:
* Experience: You have 1-2 years of experience in employee relations, as a claims analyst, or in an investigatory role with the potential, motivation and ambition to grow and thrive in a fast-paced environment.
* Communication: You have excellent communication skills and enjoy helping people feel heard, know how to ask the important questions, and analyze the relevant information into a report
* Results driven: Takes pride in & has a track record of hitting or exceeding targets; persists in accomplishing objectives despite obstacles or setbacks. You thrive in an environment where success is measured in metrics and improvement
* Collaboration: Ability to work closely with all areas of the company to be a problem solver. This role will handle a diverse array of incidents and issues, but should always focus on solving for clarity, thoroughness, and risk mitigation.
* Highly organized: You plan, organize and execute in a highly structured way & relish bringing formality to ambiguity, ruthlessly prioritize, and feel organization is second nature to you.
* Independent: Able to function with a high-level of autonomy once given a playbook.
Compensation philosophy
To provide greater transparency we share base salary ranges, which are based on role and level benchmarked against similar stage, high growth companies. Offers are determined based on multiple factors including skills, work experience, and relevant credentials.
In addition to competitive salaries and meaningful equity we offer the following benefits:
* Comprehensive healthcare coverage: We cover 100% of employee premiums for medical, dental, and vision care (60-75% for dependents)
* 401(k) match program: We match 100% on the first 3% of your contributions and 50% on the next 2% for a maximum match of 4%
* Generous, fully paid parental and family leave policies
* Pre-tax commuter benefits
* Collaborative office with fully stocked kitchen @ 1 World Trade in Manhattan
Equal opportunity employer
Shiftsmart is committed to creating a diverse environment and is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Operating Principles @ Shiftsmart
Inspired by Leadership Principles @ Amazon
Execution Is Binary
We #GetShiftDone. We take immense pride in both the quality of our work and our relentless determination to deliver on our commitments. If we say we are going to do something, we do it.
We own the outcome with an unstoppable mindset through the finish line and are impatient to move the ball forward. This means we work really hard, execute with urgency, and ruthlessly challenge timelines for anything important. As a result, we do not defer responsibility to other teams or individuals. Instead, we take the problem as far as we can and only when needed ask others for help.
Each time a crisis or opportunity emerges we take the hill as one team, because we are allergic to the words "it can't be done".
Missionaries, Not Mercenaries
We before me. We believe in our mission to build a better world for workers. We understand why our work matters and take seriously how it impacts our customers and our partners. This belief permeates everything we do from the strategic to the mundane.
We are energetic, ambitious, and want to win. We constantly raise the standards for ourselves and everyone around us. We show up for our customers, our partners, and most importantly our teammates, and make every effort to build lasting relationships with each of them.
We do not measure success based on our titles or the size of our empires. This also means we put the needs of the business before the details of our job descriptions. Rather than fight for a bigger piece of the pie, we fight to grow the entire thing and recognize this is how to grow our careers too.
Inputs > Outcomes
We work really hard. Fundamentally changing how labor works is not easy. It often requires long days, late nights, and weekends to deliver on our commitments. We lean into this challenge.
We focus on the process. We think in terms of value chains and appreciate that a bad process with a good outcome is simply dumb luck.
We lead with data. We use facts, not fiction, to build narratives and make decisions. To do this we prepare written memos in advance and resist the urge to engage in endless water cooler what ifs, because we value the time and attention of our teammates.
We hire and develop the best. When we decide to hire a new team member, we do so because we believe they will increase the talent density on our team. We view ourselves as leverage maximizers rather than inconvenience reducers and strive to increase the output of everyone we interact with.
Honesty Over Harmony
We share the truth even when it is painful. We do not, however, share the truth callously to hurt people's feelings or make them look bad. We also assume positive intent. If someone is not delivering in a way that we need, we ask them and tell them before assuming the worst.
We embrace mutual feedback. As people leaders we care more about our team's growth and success than how much others like us. As individuals we seek, accept, and apply feedback. We do not give or take feedback personally because we understand it enables us to learn and grow.
We tell the truth to ourselves. We reject a pollyannaish view of our world. Instead if something isn't going well that we are responsible for, we call it out. And when someone calls out their own truth that may be less optimal, we don't punish them for it.
We have the meeting in the meeting. If something is broken or we disagree, we call it out and say something in the moment even if it feels uncomfortable to do so. This means that if something is broken, we do not just accept it and complain later.
Invent & Iterate
We are ********************* categorically reject the phrase "that is how it's always been done", and constantly discover new and better ways to do more with less. This means we are resourceful and often do things that don't scale, only to create ways to scale them later. We're builders.
We think BIG. At every level of the company, we embrace big, hairy, audacious, and transformative goals. We fear lack of progress and incremental thinking more than failing to deliver or falling short of an audacious goal. We believe courage means to try without fear and learn without ego.
We do not let perfect get in the way of better. When faced with the choice we prioritize delivering something, even if imperfect, over endless debate and alignment. We embrace good mistakes.
Global Risk Solutions Claims Specialist Development Program (January, June 2026)
Claims representative job in East Syracuse, NY
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-ApplyLicensed Body Shop Adjuster
Claims representative job in Clifton Park, NY
Award Winning Toyota of Clifton Park has an immediate opening for a Licensed Body Shop Adjustor. Our shop is staffed by an amazing group of qualified and long standing technicians. Our body shop is extremely busy and we need additional help! Apply today if you have a history of success in the Collision Center repair field and want to work for an award winning dealership in the Capital District!
Benefits
Medical and Dental
401K Plan
Paid time off and vacation
Growth opportunities
Paid Training
Family owned and operated
Long term job security
Responsibilities
Understand, keep up-to-date with and comply with federal, state and local regulations that affect Body Shop operations such as hazardous waste disposal. Right-to-Know and environmental updates
Write and manage all estimates in the body shop from beginning to end
Establish and maintain good working relationships with several insurance adjusters
Present self as a role model by demonstrating leadership and commitment to the customer, dealership, and manufacturer
Take the initiative to exceed customer satisfaction, even if it requires overcoming obstacles
Perform multiple tasks simultaneously
Prioritize work to ensure that deadlines are met
Other responsibilities as assigned by dealership General Manager
Qualifications
Must have adjuster license
High school diploma or the equivalent
Proven track record of successful estimator positions
Excellent communication, supervisory and managerial skills
Working knowledge of body repair methods
Proficient knowledge of dealership's computer systems
Must have valid in-state driver's license and have and maintain an acceptable, safe driving record, and safe driving habits in order to drive both customer vehicles and a demonstrator vehicle
Must be a team player with impeccable honesty and integrity
Maintain a high level of professional personal appearance and conduct
We are an equal opportunity employer and prohibit discrimination/harassment 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.
Auto-ApplyClaims Specialist
Claims representative job in New York, NY
We are seeking a highly skilled and detail-oriented Claims Specialist with expertise in handling No-Fault, Worker's Compensation and all other medical insurance claims. The ideal candidate must have 3+ years experience and will have a thorough understanding of regulatory requirements and processes associated with these types of claims, along with excellent communication and problem-solving skills. Must be available for employment Monday-Friday for 9a-5p employment.
Responsibilities:
Manage and process No-Fault insurance claims, including reviewing claim submission, verifying coverage, and ensuring compliance with regulatory guidelines.
Handle Worker's Compensation claims from initial filling through resolution, including investigating incidents, gathering relevant documentation, and coordinating with legal counsel as needed.
Conduct through investigation into claim validity, including medical records, and other relevant documentation.
Communicate effectively with claimants, insurance adjuster, and other stakeholders to facilitate the claims process and resolve issues in a timely manner.
Maintain accurate and up-to-date claim files and documentation, ensuring compliance with internal policies and regulatory requirements.
Obtain and verify insurance information for patients, including primary and secondary coverage, policy numbers, group numbers, and policy holder information.
Liase with insurance companies and third-party payers to confirm coverage details, policy benefits, and pre-authorization requirements.
Collaborate with medicalbillingteam to ensure accurate timely submission of claims and pre-authorizations.
Resolve insurance related issues and discrepancies, including denials and rejections, through effective communication and follow-up with insurance carriers.
Educate patients on insurance benefits, coverage limitations, and financial responsibilities, providing assistance with insurance inquiries and concerns.
Verify patient insurance coverage and eligibility.
Assist patients with insurance-related inquiries, explaining coverage details, copays, deductibles, and out-of-pocket expenses.
Prepare and submit insurance claims and billing statements.
Maintain confidentiality of patient information and ensure compliance with HIPAA regulations in all administrative activities.
Qualifications:
3+ years experience with medical insurance claims
Thorough understanding of regulatory requirements and processes
Excellent communication and problem-solving skills
Transactional Risk Claims Specialist
Claims representative job in New York, NY
Who are we?
Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
Classification: Exempt/Full-time
Reports to: Head of Claims for Transactional Risk
Travel: 0-15%
Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team.
The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
Assist with entering claim data into operational systems.
Assist with quality control and performance management, to ensure high-quality claim handling.
Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
Perform other duties as assigned.
Key requirements
Bachelor's degree required and law degree preferred.
Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
Ability to manage multiple competing priorities.
Ability to adapt to evolving regulatory and legal environments.
Complete assigned tasks correctly, on time and able to learn quickly.
Self-motivated and demonstrating attention to detail.
Be able to work independently for extended periods.
Excellent written and verbal communication skills as well as general business understanding.
Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
Our successes have all come from someone brave enough to try something new
We support each other in the small everyday moments and the bigger challenges
We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
*Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
Auto-ApplyClaims Specialist
Claims representative job in New York, NY
SourceProSearch is seeking a Claims Specialist with 1-2 years of experience to work in our New York office. The ideal candidate should be comfortable with technology and platforms. This position requires at least 2 days per week in the office.
Job Responsibilities:
Format documents and communications for clients.
Liaise between third-party vendors and the firm.
Review documents (release/document verification) for production to defense counsel for quality control.
Calendaring and entry of case info into the database.
Perform intake and initial filtering of client inquiries.
Preparation of submissions involving large volumes of individual claims.
Run and analyze client data reports.
Organize documents and communications with clients.
Ensure that case documents accurately reflect a client's individual information.
Keep track of communications or developments relating to client cases and deadlines that may be applicable to individual clients.
Prepare and send client communications.
Communicate with clients telephonically, on occasion.
Work with attorneys to plan data gathering and settlement update workflows.
Analyze and summarize client inquiries to identify trends and patterns requiring further action.
Assist with the development of processes and technological systems for addressing large volumes of client interactions.
Skills/Requirements:
Proficient in the use of Microsoft Word and Excel.
Familiarity with Filesite preferred.
Familiarity with client management systems or databases preferred.
Strong technical skills and ability to quickly learn new litigation support software.
Strong written and oral communication skills and strong interpersonal skills.
Must possess great attention to detail.
Must possess analytical and critical thinking skills.
Strong organizational and time-management skills.
Ability to work independently while understanding the importance of teamwork.
Ability to manage workload consisting of multiple tasks.
The work shift for this position is 9:30 am-5:30 pm, five days a week, but the applicant must be willing and available to work overtime, both evening and weekends, when necessary.
****************************
Transactional Risk Claims Specialist
Claims representative job in New York, NY
Who are we? Howden is a global insurance group with employee ownership at its heart. Together, we have pushed the boundaries of insurance. We are united by a shared passion and no-limits mindset, and our strength lies in our ability to collaborate as a powerful international team comprised of 23,000 employees spanning over 56 countries.
People join Howden for many different reasons, but they stay for the same one: our culture. It's what sets us apart, and the reason our employees have been turning down headhunters for years. Whatever your priorities - work / life balance, career progression, sustainability, volunteering - you'll find like-minded people driving change at Howden.
* Classification: Exempt/Full-time
* Reports to: Head of Claims for Transactional Risk
* Travel: 0-15%
* Salary: $150,000.00-$215,000.00
Role overview
DUAL North America is seeking a Transactional Risk Claims Specialist for the Claims team.
The Transactional Risk Claims Specialist role will support the Head of Claims for Transactional Risk in the management of claims under Representations & Warranties Insurance (RWI) policies. Private equity and strategic buyers in M&A deals seek policies to protect them from risk on the target companies they acquire. This role encompasses assisting the Head of Claims with substantive claim handling, along with data entry and electronic file organization-type tasks to support the RWI practice.
This position anticipates an approximate 65/35 split between substantive claim handling and electronic organization-type responsibilities, respectively, to start. This position is intended to provide the ability to grow within the role, including to assume greater responsibility over time.
Role responsibilities
* Assist the Head of Claims for Transactional Risk in the end-to-end claims management process for RWI claims, from claim notice to conclusion.
* Assist with entering claim data into operational systems.
* Assist with quality control and performance management, to ensure high-quality claim handling.
* Collaborate with a variety of constituents including underwriters, carrier partners, and advisors, to address complex claim issues and foster strong relationships with carrier partners and brokers.
* Assist with the development and implementation of strategic initiatives to optimize claims processes and enhance operational efficiency by leveraging data analytics, industry trends, and best practices.
* Enforce compliance standards and uphold regulatory requirements, internal controls, and service level agreements with carrier partners.
* Perform other duties as assigned.
Key requirements
* Bachelor's degree required and law degree preferred.
* Minimum of 2 years of experience in insurance claims handling. Prior experience with RWI policies is strongly desirable.
* Familiarity with contract law and relevant legal principles related to insurance claims, particularly in the context of mergers and acquisitions.
* Demonstrated ability to develop and execute strategic plans, in both the context of individual claims and broader operational initiatives.
* Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
* Ability to manage multiple competing priorities.
* Ability to adapt to evolving regulatory and legal environments.
* Complete assigned tasks correctly, on time and able to learn quickly.
* Self-motivated and demonstrating attention to detail.
* Be able to work independently for extended periods.
* Excellent written and verbal communication skills as well as general business understanding.
* Must be able to remain in a stationary position 50% of the time, with occasional movement in the office (if applicable) to access cabinets and equipment.
* If you do not meet all the qualifications for this role, we still encourage you to apply, as we are always looking for diverse talent to join our growing team.
What do we offer in return?
A career that you define.
Yes, we offer all the usual rewards and benefits - including medical, dental, vision, a wide variety of wellbeing offers, competitive salary, unlimited PTO, 401k with company match, paid volunteer days and more.
What you might not expect is a job where everyone has a voice, where volunteering in the community is part of the day job, and where everyone is encouraged to play a part towards our sustainability goals. We want people who want to make a difference - not just in the workplace, but in the industry and in the wider community.
Our culture: people first
Our core values dictate how we live and work. We're a group with independence and people at its heart and we're a home for talent with a unique culture: the biggest small company in the world.
The focus on being a people-first business has always been at the very heart of the group; Our vision was to create an independent business with a unique culture and one that would survive and thrive as a business controlled by the people working for it. And finding the most talented and entrepreneurial people to join the group has been and will continue to be key.
Diversity and inclusion
At DUAL, we consider our people our chief competitive advantage and, as such, we treat colleagues, candidates, clients and business partners with equality, fairness and respect, regardless of their age, disability, race, religion or belief, gender, sexual orientation, marital status or family circumstances.
What do we offer in return?
A career that you define. At Howden, we value diversity - there is no one Howden type. Instead, we're looking for individuals who share the same values as us:
* Our successes have all come from someone brave enough to try something new
* We support each other in the small everyday moments and the bigger challenges
* We are determined to make a positive difference at work and beyond
Reasonable adjustments
We're committed to providing reasonable accommodations at Howden to ensure that our positions align well with your needs. Besides the usual adjustments such as software, IT, and office setups, we can also accommodate other changes such as flexible hours* or hybrid working*.
If you're excited by this role but have some doubts about whether it's the right fit for you, send us your application - if your profile fits the role's criteria, we will be in touch to assist in helping to get you set up with any reasonable adjustments you may require.
* Not all positions can accommodate changes to working hours or locations. Reach out to your Recruitment Partner if you want to know more.
Permanent
Auto-ApplyCyber Claims Specialist
Claims representative job in New York
We are seeking a Complex Cyber Claims Specialist to join our team of dedicated professionals in the insurance industry. As a Complex Cyber Claims Specialist, you will be responsible for handling complex cyber claims for our clients. The ideal candidate for this position will have several years of cyber claims handling experience (JD preferred but not required).
Responsibilities:
Investigate and evaluate complex cyber claims to determine coverage and liability.
Analyze legal and technical issues related to cyber claims.
Work with attorneys, experts, and other professionals to resolve complex claims.
Develop and maintain strong relationships with clients, brokers, and underwriters.
Provide guidance and support to other claims professionals.
Ensure compliance with company policies and procedures.
Monitor trends and developments in the cyber insurance industry.
Requirements:
Several years of cyber claims handling experience, (JD is preferred but not required).
Strong analytical and problem-solving skills.
Excellent communication and interpersonal skills.
Ability to work independently and as part of a team.
Familiarity with insurance policies and coverage.
Knowledge of cyber risk and related legal issues.
Strong attention to detail and organizational skills.
Ability to handle multiple tasks and priorities.
Benefits:
We offer a competitive salary dependent upon experience, a bonus anywhere from 10-20%, flexible work schedule, and great benefits including medical, dental, vision, life insurance, and 401(k) retirement plan. The work week is 35 hours.
If you are looking for an exciting opportunity to join a leading international insurance carrier and work with a team of dedicated professionals, we encourage you to apply for this position.
Complex Claims Specialist - MPL
Claims representative job in New York
Job Type:
Permanent
Build a brilliant future with Hiscox
Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required.
Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you'll get the opportunity to learn multiple insurance products and interact with business leaders across the organization.
Please note that this position is hybrid and requires two (2) days in office weekly. Position can be based in the following locations:
Manhattan, NY
West Hartford, CT
Atlanta, GA
Chicago, IL
The Role:
The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also:
Adjusts and resolves complex to severe claims that includes all phases of litigation
With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
Reviews and analyses claim documentation and legal filings
Drives litigation best practices to lead defense strategy on litigated files
Mentors Claim Examiners
Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
Identifies emerging exposures and claims trends
Identifies suspected fraudulent claims and tracks with special investigations unit
Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
Develops content and conducts training for claims team and underwriters as requested
The Team:
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox's strong brand built on a long history of outstanding claims handling.
Requirements:
8+ years of claims handling experience or 7-8 years litigation experience. (A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.)
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Advanced knowledge of coverage within the team's specialty or focus
Advanced knowledge of litigation process and negotiation skills
Experience in mentoring and training other claims examiners
Excellent verbal and written communication skills
Advanced analytical skills
B.A./B.S degree from an accredited College or University preferred
Additional Factors Considered
Ability to act a subject matter expert within team Demonstrated ability to work with minimal oversight Experience attending and leading mediations, arbitrations and trials Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars.
What Hiscox USA offers
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short- term disability and long-term disability coverage
24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
Paid parental leave
4-week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees' mental health and wellbeing
2023 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks
Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox
As an international specialist insurer we are far removed from the world of mass market insurance products. Instead we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things.
We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions.
Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places. Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch.
About Hiscox US
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
Diversity and flexible working at Hiscox
At Hiscox we care about our people. We hire the best people for the job and we're committed to diversity and creating a truly inclusive culture, which we believe drives success. We also understand that working life doesn't always have to be ‘nine to five' and we support flexible working wherever we can. No promises, but please chat to our resourcing team about the flexibility we could offer for this role.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary range $100,000 - $155,000
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.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-AJ1
Work with amazing people and be part of a unique culture
Auto-ApplyClaims Specialist
Claims representative job in Buffalo, NY
FLSA Status: Non-Exempt Starting Rate: $19.50 per hour The Claims Specialist is responsible for maintaining, entering, and following up on all client medical insurance and financial information. The position prepares claim data for transmission to Medicaid, Medicare, and Managed Care plans. A Claims Specialist will organize billing and rebilling materials as well as create and analyze reports from the billing system to provide feedback to program sites. The Claims Specialist is responsible for maintaining positive and professional client and external insurance agency relations.
POSITION RESPONSIBILITIES
* Enters, updates, and verifies client data from service documents.
* Using Medicaid EMEVS or E-PACES verifies client Medicaid information.
* Tracks client referrals and authorizations in system.
* Prepares claim batches for transmission to Medicaid, Medicare, and 3rd party payers.
* Maintains claims batch reports.
* Posts client payments to the service level.
* Posting and mailing of client statements.
* Produces and analyzes routine reports in a timely manner.
* Reviews and processes payer denials.
* Performs all other duties as assigned.
QUALIFICATIONS
* High school diploma or equivalency plus a minimum of two years paid experience in medical insurance billing. -OR- Associates degree in Business Administration plus a minimum of 1 year paid experience in medical insurance billing.
* Completion of medical billing certification preferred.
* Experience working with clients to assist with their medical insurance co-payments/deductibles and other related medical billing inquiries required.
* Experience following up with medical insurance companies regarding clients claims and submitting medical insurance claims.
* Experience balancing a cash drawer/cash reconciliation.
* Knowledge of OMH, DOH, Medicaid, Medicare, and TPA regulations.
* Strong ability to utilize common office technology/software including the use of the Microsoft Office Suite (Excel and Outlook mainly)
* Ability to organize and maintain billing materials.
* High attention to detail.
* Ability to take initiative, make appropriate decisions, and solve problems with autonomy
* Ability to perform routine arithmetic computations.
* Excellent communication skills with all levels of staff
Some things you can look forward to:
* Welcoming, team environment, that inspires you to thrive and be your BestSelf!
* Rewarding work experience!
* Generous paid time off
* Flexible schedule
* Multiple and diverse health insurance options
* Many other unique lifestyle & personal insurance options
* Tuition reimbursement
* CASAC certification tuition support
* Career growth and advancement opportunities
* We look forward to telling you more!
Claims Specialist
Claims representative job in Williamsville, NY
Full-time Description
We're looking for a Claims Specialist who is ready to take ownership of complex claim adjudication tasks within our Flex administration programs, including Section 125, 129, 132, 105(h), and more. In this role, you'll play a key part in ensuring accuracy, efficiency, and an exceptional experience for our customers and clients. If you enjoy detailed work, problem-solving, and making a meaningful impact behind the scenes, this is a great opportunity to grow your expertise.
Key Responsibilities
Accurately process claims within established timelines
Review and complete claim adjustment requests
Research claim reversal requests to determine approval or denial
Manage debit card dispute workflows, including fraudulent or disputed transactions
Provide clear and professional responses to routine phone and written inquiries related to claim processing
Issue manual adverse determination letters, notifying participants of required information or appeal rights in accordance with plan rules
Adjudicate transactions that fail auto-review and determine whether additional documentation is needed
Requirements
High School Diploma or equivalent
Knowledge of ERISA guidelines preferred
Strong written and verbal communication skills with excellent attention to detail
Ability to manage multiple priorities using strong organizational and time-management skills
Comfortable interacting with customers, colleagues, and management and responding to questions clearly and professionally
Self-starter who can work independently in a fast-paced environment with critical deadlines
An Equal Opportunity Employer.
Salary Description 16.00 - 18.00
Pharmacy Claims Adjudication Specialist
Claims representative job in Buffalo, NY
We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Buffalo, NY. 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 $21.00 an hour and up Sign-On Bonus: $5,000 for employees starting before February 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