Claims Representative
Claims representative job in Bellevue, WA
LHH Recruitment Solutions is seeking an Claims Representative for our client in Bellevue, WA 98008 Our client is a leading asset manager dedicated to helping individuals, financial professionals and institutions design better portfolios.
Title: Claims Representative
Location: Bellevue, WA 98008
Pay: $26.00 - $40/hr
Hybrid: In-office Tuesday, Wednesday, Thursday
Summary
The Claims Representative manages and resolves property/casualty insurance claims efficiently and fairly. This role requires prior adjusting experience and focuses on training candidates on company-specific policies and systems-not basic claim handling. Active state adjuster license(s) are a plus.
Day-to-Day Responsibilities
Investigate and maintain claims: Gather reports, statements, photos, and estimates.
Evaluate claims: Assess coverage, damages, and liability.
Communicate with stakeholders: Policyholders, agents, legal reps; provide updates and explain processes.
Negotiate settlements: Ensure fairness within policy limits.
Document and report: Maintain accurate records for compliance.
Collaborate with other departments: Legal, underwriting, special investigations.
Ensure compliance: Adhere to state regulations and company guidelines.
Deliver excellent customer service: Professional and empathetic communication.
Qualifications
Education: Bachelor's degree not required.
Experience:
6 months to 3 years of property/casualty claims adjusting experience.
Must have verifiable adjusting experience; ready for advanced training.
Position- Claims Representative
📍
Location:
Bellevue, WA 98008
💵
Pay:
$26.00 - $40/hr
Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to ******************************************* The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:
The California Fair Chance Act
Los Angeles City Fair Chance Ordinance
Los Angeles County Fair Chance Ordinance for Employers
San Francisco Fair Chance Ordinance
Outside Property Claim Representative Trainee - Seattle, WA
Claims representative job in Federal Way, WA
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$52,600.00 - $86,800.00
**Target Openings**
2
**What Is the Opportunity?**
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services Insureds/Agents in and around Seattle, Washington. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory.
**What Will You Do?**
+ Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
+ The on the job training includes practice and execution of the following core assignments:
+ Handles 1st party property claims of moderate severity and complexity as assigned.
+ Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
+ Broad scale use of innovative technologies.
+ Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
+ Establishes timely and accurate claim and expense reserves.
+ Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
+ Negotiates and conveys claim settlements within authority limits.
+ Writes denial letters, Reservation of Rights and other complex correspondence.
+ Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
+ Meets all quality standards and expectations in accordance with the Knowledge Guides.
+ Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
+ Manages file inventory to ensure timely resolution of cases.
+ Handles files in compliance with state regulations, where applicable.
+ Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
+ Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
+ Identifies and refers claims with Major Case Unit exposure to the manager.
+ Performs administrative functions such as expense accounts, time off reporting, etc. as required.
+ Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
+ May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
+ Must secure and maintain company credit card required.
+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
+ In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
+ This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred.
+ Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
+ Verbal and written communication skills -Intermediate
+ Attention to detail ensuring accuracy - Basic
+ Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
+ Analytical Thinking - Basic
+ Judgment/ Decision Making - Basic
+ Valid passport preferred.
**What is a Must Have?**
+ High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
+ Valid driver's license - required.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
Associate Claim Rep - Casualty
Claims representative job in Seattle, WA
Join Grange Insurance Association, a well-established leader in the insurance sector for over 130 years! Headquarters in the city of Seattle, with a footprint stretching across six Western states, we've been protecting families, farms, and businesses with unwavering commitment. As you embark on a fulfilling career with Grange, discover why our average employee tenure surpasses a decade. Make your mark with an organization that values quality, service, and the lasting impact you can bring!
This is a hybrid position, requiring 2 days in the Seattle office.
Position Overview:
Casualty Claims Representatives are an essential part of our team, managing the injury and damages portions of claims for Auto, Home Owners and Farm. Incumbents provide the support our customers need, while ensuring claims are resolved swiftly. Casualty Claims Reps analyze and determine the extent of Grange Insurance Association's Coverage and Liability concerning loss and damages on a claim.
Key Responsibilities:
Interpret policies, gather relevant details, and determine the appropriate course of action.
Investigate claims by contacting involved parties, assessing injuries, determining liability, and evaluating unrepresented bodily injury claims.
Negotiate settlements with customers and other insurance carriers.
Work effectively in a hybrid environment (in-office and remote), unless ADA accommodations apply.
Perform additional duties as assigned.
Qualifications:
REQUIRED:
Bachelor's degree and one year of work experience in the insurance industry; preference given to those with background in claims liability
In lieu of a degree, a total of three to five years of work experience, some of which must be claims handling in the insurance industry
Experience and ability to make decisions, problem solve, plan, prioritize and organize
Effective verbal and written communication
Excellent customer service skills
Comprehensive Benefits:
Pay Range: $24.52 to $39.16
Flexible hybrid work schedule (2 days per week in Seattle office required)
Medical, Dental, and Vision plans
401(k) plan with up to 5% match
Employer sponsored LTD, life insurance, and AD&D
Discretionary profit sharing and bonuses
Fully subsidized ORCA card and/or free parking for Seattle employees
Education Reimbursement
On-Site Fitness Center
Opportunities for career growth and advancement within the organization.
A supportive and collaborative work environment.
Ongoing training and professional development opportunities.
How to Apply:
If you are passionate about helping people, have a strong understanding of casualty claims , and are ready to join a dynamic team, we encourage you to apply.
Grange Insurance Association is an equal opportunity employer and welcomes all qualified candidates to apply.
Grange Insurance Association is committed to ensuring a diverse and inclusive workplace where all employees are treated with respect and dignity. We encourage applications from candidates of all backgrounds and experiences.
Auto-ApplyOutside Property Claim Representative Trainee - Seattle, WA
Claims representative job in Federal Way, WA
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$52,600.00 - $86,800.00Target Openings2What Is the Opportunity?This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services Insureds/Agents in and around Seattle, Washington. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory.What Will You Do?
Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Handles 1st party property claims of moderate severity and complexity as assigned.
Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves.
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
Negotiates and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with the Knowledge Guides.
Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations, where applicable.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
Identifies and refers claims with Major Case Unit exposure to the manager.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Must secure and maintain company credit card required.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred.
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic
Verbal and written communication skills -Intermediate
Attention to detail ensuring accuracy - Basic
Ability to work in a high volume, fast paced environment managing multiple priorities - Basic
Analytical Thinking - Basic
Judgment/ Decision Making - Basic
Valid passport preferred.
What is a Must Have?
High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required.
Valid driver's license - required.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
Auto-ApplySenior Claim Denial Prevention & Appeals Specialist
Claims representative job in Olympia, WA
Oracle Clinical AI Assistant (CAA) allows providers and their support staff to focus more on patient care by reducing administrative burden of clinical and reimbursement tasks such as charting, documentation, and coding by applying power of generative AI. Our diverse team of creators and inventors are building the future of conversational clinical interfaces, making real improvements in the lives of people across the world. We act with the speed and attitude of a start-up, but with the scale and customer focus of the world's leading enterprise software company. We have a big charter and a lot of creative freedom to get it done. Come join us and grow your career in this exciting arena.
We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the Claim Denial Prevention and Appeals features of Oracle Health Clinical AI Agent (CAA). This role leverages expert clinical judgment and regulatory knowledge (e.g., medical necessity, level of care, clinical validation) to lead the appeals initiative to review denied claims, create write-ups for appeals packets, identify trends/improvement opportunities to prevent future denials, and ensure maximum appropriate reimbursement. This role is critical for financial recovery and ultimate prevention of complex, high-dollar claim denials.
**Qualifications**
+ 3+ years hands on experience preparing appeals for claim denials in the hospital and ambulatory setting
+ 3+ years hands on experience in analyzing claim denials and formulating strategies for preventing future denials
+ Background knowledge of HIM field helpful, with focus on different reimbursement methodologies, AHA coding guidelines, and Clinical Documentation Improvement experience.
+ Knowledge of medical and insurance terminology, MS-DRG, APR-DRG, CPT, ICD coding structures, and billing forms (UB, 1500).
+ Experience with coding, clinical validation, and medical necessity for outpatient and inpatient stays.
+ Knowledge of third-party payor rules and regulations.
+ 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years of experience in hospital audits preferred
+ Associate or bachelor's degree in nursing from an accredited college and AHIMA Certified RHIT credentials preferred
+ Certification in Utilization Review, case management, and healthcare quality preferred
**Responsibilities**
+ **Act as subject matter expert (SME):** Provide expertise for Claim denial prevention and appeals submission workflows, different payer requirements, and clinical/administrative use cases to identify inefficiencies and opportunities for automation. Work closely with technical teams as the knowledge lead for denial prevention and appeals creation processes.
+ **Denied Claims Review and Appeal Drafting:** Conduct in-depth clinical reviews of denied claims, utilize medical records, medical necessity criteria, payer reimbursement guidelines/payment policies to determine appeal viability, prepare evidence-based appeal correspondence across all levels of appeals process.
+ **Denial Prevention:** Analyze denial data to accurately identify trends, patterns, and root causes of recurrence, identify documentation gaps and systemic process failures related to denials, identify concrete recommendations and articulate the necessary steps required to be implemented in the pre-claim submission workflows to prevent future denials
+ **Cross-functional Collaboration** : Work with product, engineering, and applied science teams to ensure alignment with medical necessity guidelines, payer policies, and clinical protocols. Provide input and expertise into the automation strategy across reimbursement (revenue cycle) workflows, ensuring alignment with organizational goals and industry standards and guidelines.
+ **Regulatory Compliance** : Stay current with regulatory requirements related to claims processing across payers and government entities such as CMS/state Medicaid, maintain current knowledge of payer policies and medical necessity criteria, CMS national and local coverage determinations affecting billing and ensuring that workflows meet all necessary compliance.
Leading contributor individually and as a team member. Work is very complex, involving the application of advanced technical/business skills in area of specialization. Ability to collect, organize, and display data in spreadsheet format. Follow-through skills necessary to get information implemented into incremental model development improvements. For this, relationship management skills strongly desired. Strong written and verbal communication skills.
Disclaimer:
**Certain US customer or client-facing roles may be required to comply with applicable requirements, such as immunization and occupational health mandates.**
**Range and benefit information provided in this posting are specific to the stated locations only**
US: Hiring Range in USD from: $75,000 to $178,100 per annum. May be eligible for bonus and equity.
Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle's differing products, industries and lines of business.
Candidates are typically placed into the range based on the preceding factors as well as internal peer equity.
Oracle US offers a comprehensive benefits package which includes the following:
1. Medical, dental, and vision insurance, including expert medical opinion
2. Short term disability and long term disability
3. Life insurance and AD&D
4. Supplemental life insurance (Employee/Spouse/Child)
5. Health care and dependent care Flexible Spending Accounts
6. Pre-tax commuter and parking benefits
7. 401(k) Savings and Investment Plan with company match
8. Paid time off: Flexible Vacation is provided to all eligible employees assigned to a salaried (non-overtime eligible) position. Accrued Vacation is provided to all other employees eligible for vacation benefits. For employees working at least 35 hours per week, the vacation accrual rate is 13 days annually for the first three years of employment and 18 days annually for subsequent years of employment. Vacation accrual is prorated for employees working between 20 and 34 hours per week. Employees working fewer than 20 hours per week are not eligible for vacation.
9. 11 paid holidays
10. Paid sick leave: 72 hours of paid sick leave upon date of hire. Refreshes each calendar year. Unused balance will carry over each year up to a maximum cap of 112 hours.
11. Paid parental leave
12. Adoption assistance
13. Employee Stock Purchase Plan
14. Financial planning and group legal
15. Voluntary benefits including auto, homeowner and pet insurance
The role will generally accept applications for at least three calendar days from the posting date or as long as the job remains posted.
Career Level - IC4
**About Us**
As a world leader in cloud solutions, Oracle uses tomorrow's technology to tackle today's challenges. We've partnered with industry-leaders in almost every sector-and continue to thrive after 40+ years of change by operating with integrity.
We know that true innovation starts when everyone is empowered to contribute. That's why we're committed to growing an inclusive workforce that promotes opportunities for all.
Oracle careers open the door to global opportunities where work-life balance flourishes. We offer competitive benefits based on parity and consistency and support our people with flexible medical, life insurance, and retirement options. We also encourage employees to give back to their communities through our volunteer programs.
We're committed to including people with disabilities at all stages of the employment process. If you require accessibility assistance or accommodation for a disability at any point, let us know by emailing accommodation-request_************* or by calling *************** in the United States.
Oracle is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability and protected veterans' status, or any other characteristic protected by law. Oracle will consider for employment qualified applicants with arrest and conviction records pursuant to applicable law.
Patient Claims Specialist - Bilingual Only
Claims representative job in Olympia, WA
We are united in our mission to make a positive impact on healthcare. Join Us!
South Florida Business Journal, Best Places to Work 2024
Inc. 5000 Fastest-Growing Private Companies in America 2024
2024 Black Book Awards, ranked #1 EHR in 11 Specialties
2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold)
2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)
Who we are:
We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.
ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine!
Your Role:
Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections
Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates
Input and update patient account information and document calls into the Practice Management system
Special Projects: Other duties as required to support and enhance our customer/patient-facing activities
Skills & Requirements:
High School Diploma or GED required
Availability to work 9:00 am - 6:00 pm PST
Minimum of 1-2 years of previous healthcare administration or related experience required
Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs)
Manage/ field 60+ inbound calls per day
Bilingual required (Spanish & English)
Proficient knowledge of business software applications such as Excel, Word, and PowerPoint
Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone
Ability and openness to learn new things
Ability to work effectively within a team in order to create a positive environment
Ability to remain calm in a demanding call center environment
Professional demeanor required
Ability to effectively manage time and competing priorities
#LI-SM2
ModMed Benefits Highlight:
At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:
India
Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
Allowances: Annual wellness allowance to support your well-being and productivity,
Earned, casual, and sick leaves to maintain a healthy work-life balance,
Bereavement leave for difficult times and extended medical leave options,
Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.
United States
Comprehensive medical, dental, and vision benefits
401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
Generous Paid Time Off and Paid Parental Leave programs,
Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,
Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,
Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,
Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,
Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.
PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.
Auto-ApplyClaims Representative (IAP) - Workers Compensation Training Program
Claims representative job in Olympia, WA
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
Claims Representative (IAP) - Workers Compensation Training Program
Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
+ A stable and consistent work environment in an office setting.
+ A training program to learn how to help employees and customers from some of the world's most reputable brands.
+ An assigned mentor and manager who will guide you on your career journey.
+ Career development and promotional growth opportunities through increasing responsibilities.
+ A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs.
**PRIMARY PURPOSE OF THE ROLE:** To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due.
**ARE YOU AN IDEAL CANDIDATE?** We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 6-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field.
**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**
+ Attendance and completion of designated classroom claims professional training program.
+ Performs on-the-job training activities including:
+ Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims.
+ Adjusting low and mid-level liability and/or physical damage claims under close supervision.
+ Processing disability claims of minimal disability duration under close supervision.
+ Documenting claims files and properly coding claim activity.
+ Communicating claim action/processing with claimant and client.
+ Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned.
+ Participates in rotational assignments to provide temporary support for office needs.
**QUALIFICATIONS**
Bachelor's or Associate's degree from an accredited college or university preferred.
**EXPERIENCE**
Prior education, experience, or knowledge of:
- Customer Service
- Data Entry
- Medical Terminology (preferred)
- Computer Recordkeeping programs (preferred)
- Prior claims experience (preferred)
Additional helpful experience:
- State license if required (SIP, Property and Liability, Disability, etc.)
- WCCA/WCCP or similar designations
- For internal colleagues, completion of the Sedgwick Claims Progression Program
**TAKING CARE OF YOU**
+ Entry-level colleagues are offered a world class training program with a comprehensive curriculum
+ An assigned mentor and manager that will support and guide you on your career journey
+ Career development and promotional growth opportunities
+ A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 25.65/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claims #claimsexaminer #entrylevel #remote #LI-Remote_
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**
Workers Compensation Claims Supervisor
Claims representative job in Seattle, WA
The Jonus Group is an insurance-only, full-service recruiting firm that offers both direct hire and contract hire services and we are seeking a Washington Workers Compensation Claims professional to join one of our valued client's dynamic and growing team. As a key member of their Claims department, you will not only be responsible for managing their Workers Comp Claims but you will also be a key member of the team in building strong customer relationships, providing strong customer service, and ensuring timely and fair resolution for all parties involved.
What's in it for you:
$95,000 - $115,000/year based on experience
Annual bonus potential based on individual performance and company profit sharing
Competitive PTO package
10 Company identified holidays
Full benefits available
Growth Opportunities
Key Responsibilities:
Supervise claims staff in daily operations
Assist management with recruiting, interviewing, and training new team members
Ensure compliance with Workers' Compensation laws and regulatory reporting requirements
Promote team performance through ongoing training, coaching, and performance evaluations; recommend merit adjustments for management review
Provide technical guidance on complex claims, investigations, litigation, and client-specific requirements
Serve as a liaison to resolve claim-related or procedural issues for clients and employees
Maintain compliance with HIPAA regulations, policies, and procedures
Maintain regular and reliable attendance
Follow all safety rules and regulations as part of the Injury and Illness Prevention Program (IIPP)
Follow all organizational policies, procedures, and best practices
Perform other duties and special projects as assigned
Qualifications:
5+ years of experience as a Workers' Compensation Claims Adjuster or Supervisor background within Washington, Oregon, and Alaska Indemnity claims
WA Adjuster's license
Knowledge of Washington state workers' compensation laws, regulations, and industry practices
Proficient in claims management software and Microsoft Office Suite
#LI-MW1
#LI-PR1
Claims Adjuster Trainee
Claims representative job in Federal Way, WA
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 heavy 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.
Candidates must reside within 30 miles of Progressive's Federal Way office.
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} Associate's degree and two years work experience
* {OR} Bachelor's degree
.
Schedule: Monday - Friday, 8am to 5pm with rotating shift 9am to 6pm
Compensation
* $28.61 - $30.53/hour
* 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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Senior Analyst, Claims Research
Claims representative job in Tacoma, WA
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively.
**Job Duties**
+ Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects
+ Assists with reducing re-work by identifying and remediating claims processing issues
+ Locate and interpret regulatory and contractual requirements
+ Expertly tailors existing reports or available data to meet the needs of the claims project
+ Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error
+ Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements.
+ Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits.
+ Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions.
+ Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes.
+ Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time.
+ Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format.
+ Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach.
+ Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency.
+ Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals.
+ QNXT
**Job Qualifications**
**REQUIRED QUALIFICATIONS:**
+ 5+ years of experience in medical claims processing, research, or a related field.
+ Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management.
+ Advanced knowledge of medical billing codes and claims adjudication processes.
+ Strong analytical, organizational, and problem-solving skills.
+ Proficiency in claims management systems and data analysis tools
+ Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers.
+ Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment.
+ Microsoft office suite/applicable software program(s) proficiency
**PREFERRED QUALIFICATIONS:**
+ Bachelor's Degree or equivalent combination of education and experience
+ Project management
+ Expert in Excel and PowerPoint
+ Familiarity with systems used to manage claims inquiries and adjustment requests
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $106,214 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Daily Claims Adjuster - Seattle, WA
Claims representative job in Seattle, WA
CENCO is a trusted provider of property claims services, working with top insurance carriers to deliver dependable, efficient, and accurate adjusting solutions. We are currently hiring Daily Property Claims Adjusters to handle residential and commercial claims in Seattle and the surrounding Puget Sound region. This is a great opportunity for adjusters seeking consistent work and the freedom of independent field assignments.
Key Responsibilities:
Perform on-site inspections for property damage caused by wind, water, fire, and other covered perils.
Capture detailed documentation, including photos and thorough written reports.
Create accurate repair estimates using Xactimate or Symbility.
Communicate clearly and professionally with policyholders, contractors, and carriers.
Manage each claim efficiently and meet all required deadlines.
What You'll Need:
Licensing: Must have or be able to obtain a Washington adjuster license.
Software: Experience with Xactimate or Symbility preferred.
Tools & Transportation: Reliable vehicle, ladder, laptop, and adjusting tools.
Work Style: Self-directed, detail-oriented, and dependable.
Availability: Ability to quickly accept and complete assignments on schedule.
Why Work with CENCO?
Reliable claim volume in Seattle and nearby markets
Competitive pay with prompt compensation
Supportive team and streamlined systems that help you succeed
If you're looking for steady daily claims work and a reliable partner in the field, CENCO would love to hear from you!
Property Adjuster Specialist - Field
Claims representative job in Olympia, WA
Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
As a dedicated Property Adjuster Specialist, you will work within established guidelines and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes coverage, recognize liability exposure and negotiate equitable settlements in compliance with all state regulatory requirements.
Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling. USAA also provides a company vehicle to physically inspect losses within your locally assigned territory. Field Adjusters may travel outside of their local territory to respond to claims in other regions when needed. This is an hourly, non-exempt position with paid overtime available.
This is a field-based role for the area of Tacoma, WA and Olympia, WA. Candidates currently living in does location or willing to self-relocate are encouraged to apply.
What you'll do:
* Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability.
* Partners with vendors and internal business partners to facilitate complex claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance.
* Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.
* Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing information involving complex policy terms and contingencies.
* Determines and negotiates complex claims settlement within authority limits. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes.
* Maintains accurate, thorough, and current claim file documentation throughout the claims process.
* Advance knowledge of estimating technology platforms and virtual inspection tools. Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims.
* Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
* May be assigned CAT deployment travel with minimal notice during designated CATs.
* Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
* Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience.
* Adjusts complex claims with attorney involvement.
* Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.
* May require travel to resolve claims, attend training, and conduct in-person inspections.
* Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
* High School Diploma or General Equivalency Diploma required.
* 2 years of relevant property claims adjusting experience of moderate complexity losses that includes writing estimates, involving dwelling and structural damages.
* Advanced knowledge of estimating losses using Xactimate or similar tools and platforms.
* Proficient knowledge of residential construction.
* Proficient knowledge of property claims contracts and interpretation of case law and state laws and regulations.
* Proficient negotiation, investigation, communication, and conflict resolution skills.
* Proven investigatory, analytical, prioritizing, multi-tasking, and problem-solving skills.
* Ability to travel 50-75% of the year (local & non-local) and/or work catastrophe duty when needed.
* Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
What sets you apart:
* US military experience through military service or a military spouse/domestic partner
* 5 years of prior field experience handling higher severity/complex losses (i.e. vandalism, malicious mischief, foreclosures, earth movement, collapse, liability, etc.)
* Prior experience adjusting property claims using virtual technologies
* Prior property field adjuster experience handling DWG, APS and ALE adjustments
* Industry designations such as AINS, CPCU, AIC, SCLA (or actively pursuing)
* Xactimate Level 1 and/or Level 2 certification
* Prior deployments in support of catastrophes
* Currently hold an active Adjuster License
* Currently reside within or have the ability to self-relocate to Tacoma, WA or Olympia, WA
Physical Demand Requirements:
* May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.
* May need to meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver's license.
* May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.
* May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics.
Compensation range: The salary range for this position is: $69,920.00 - $133,620.00.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on USAAjobs.com
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Field Claims Adjuster
Claims representative job in Tacoma, WA
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.
Independent Insurance Claims Adjuster in Tacoma, Washington
Claims representative job in Tacoma, WA
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-ApplyClaims Recovery Analyst I
Claims representative job in Seattle, WA
**This role is available remotely in Washington State Only.
Who we are
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:
Strive to apply an equity lens to all our work.
Reduce health disparities.
Become an anti-racist organization.
Create an equitable work environment.
About the Role
Responsible for conducting focused claim reviews and identifying and facilitating claim adjustments based on results found through Community Health Plan of Washington claim reviews or as identified by internal Community Health Plan of Washington departments. Responsible for sustaining processes and executing process improvement and quality monitoring. Responsible for contacting providers regarding negative balance collections.
Additionally, the role involves investigating and resolving escalated claims issues raised by internal Community Health Plan of Washington (CHPW) departments and committees. The incumbent monitors departmental compliance with state and CMS requirements, including managing the collection and submission of operational performance metrics and required data reporting. Finally, the position serves as a subject matter expert for Claims Recovery, contributing to companywide or specialized projects to improve processes and ensure accurate claims management.
To be successful in this role, you:
Have minimum two (2) years claims operations experience required, with proven broad knowledge and execution of quality improvement methods and tools or related experience. Experience in managed care preferred.
Have Medicaid Coordination of Benefits (COB) and Medicare Secondary Payor (MSP) experience preferred.
Have prior experience encouraging timely repayment from providers preferred.
Possess an understanding of the healthcare industry, specifically in the Operations area.
Have a GED or High School diploma or an equivalent combination of education and highly relevant experience in healthcare.
Essential functions and Roles and Responsibilities:
Identify and conduct focused and random claims audits.
Provide research for providers in a negative balance over 45 days.
Create demand letters and support collections effort.
Contacts providers to request refunds.
Regularly submit subrogation referrals.
Facilitate claim adjustments and system remediation as required.
Receive and research escalated claims issues identified by internal Community Health Plan of Washington departments and committees.
Regularly monitor departmental contractual compliance with state and CMS requirements including managing the collection and submission of required operational performance metrics and data reporting requirements.
Participate in companywide or specific projects as a subject matter expert for Claims Recovery.
Knowledge, Skills, and Abilities:
Analytical skills.
Project management skills and team facilitation skills.
Communication skills, both verbal and written.
Technical and process documentation skills.
Ability to work repetitive tasks.
Ability to work well with different people at all levels within the organization.
Ability to analyze, organize and prioritize work, while meeting multiple deadlines.
Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
As part of our hiring process, the following criteria must be met:
Complete and successfully pass a criminal background check.
Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
Vaccination requirement (CHPW offers a process for medical or religious exemptions)
Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits:
The position is FLSA Non-Exempt and is eligible for overtime and has a 5% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
Medical, Prescription, Dental, and Vision
Telehealth app
Flexible Spending Accounts, Health Savings Accounts
Basic Life AD&D, Short and Long-Term Disability
Voluntary Life, Critical Care, and Long-Term Care Insurance
401(k) Retirement and generous employer match
Employee Assistance Program and Mental Fitness app
Financial Coaching, Identity Theft Protection
Time off including PTO accrual starting at 17 days per year.
40 hours Community Service volunteer time
10 standard holidays, 2 floating holidays
Compassion time off, jury duty
Sensory/Physical/Mental Requirements:
Sensory*:
Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
Extended periods of sitting, computer use, talking and possibly standing.
Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
Frequent torso/back static position; occasional stooping, bending, and twisting.
Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.
Mental:
Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.
Work Environment:
Office environment. Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Field Auto Claims Adjuster
Claims representative job in Seattle, WA
National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers' evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.
Job Description
Responsible for creating a comprehensive estimate of damages for 1st and 3rd party material damage claims leading to the proper disposition. This role is utilized as a peer mentor having mastered our processes and obtained technical expertise.**This position will be located in the Seattle, WA area. Must have hands-on experience in auto estimation.Key Responsibilities
• Applies mastered content in interpretations of all policy types written by the company and assists leadership in formal and ad hoc training
• Negotiates settlements, makes settlement payments and documents all activities in the most complex of files
• Interprets regulatory compliance and fair claims practices
• Builds mastered relationships with both internal and external customers
• Exhibits mastery estimating fundamentals in order to create estimates of damages on 1st and 3rd party material damage losses of all severities
Experience
• 3 or more years of experience (Preferred)
Supervisory Responsibilities
• This job does not have supervisory duties.
#LI-SH1
Compensation
Base compensation offered for this role is $53,040-$88,462 [annually] and is based on experience and qualifications.
*** Total compensation for this role is comprised of several factors, including the base compensation outlined above, plus incentive pay (i.e. commission, bonus, etc.) as applicable for the role.
Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger - a winning team making a meaningful impact.
National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A- (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
Companies & Partners
Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.
Benefits
National General Holdings Corp. is an Equal Opportunity (EO) employer - Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at **************.
Auto-ApplyField Property Claims Adjuster
Claims representative job in Renton, WA
Join us as a Field Property Claims Adjuster where you'll be responsible for helping our customers navigate the claims process and get back on their feet following damage to the homeowner's property. This is a role where people who love every day to be new, different and exciting, can thrive - you'll be traveling on the road to meet customers in person, providing hands-on assessment of damage and empathetic support.
The Field Property Claims Adjuster will be traveling locally to insured homes within Renton, WA (98056) and surrounding areas. To be successful within the role, candidates should live within or near this area.
Sign-On Bonus Available! We're offering a sign-on bonus for experienced and actively licensed new hires.
What you'll do
Investigate and evaluate onsite to resolve complex coverage and damage issues to include preparing complete estimates of repair for the covered damages. This may include accessing roofs by ladder, inspecting attics, crawl spaces and basements in search of damage.
Handle moderate to complex claims independently while managing your workload, from first notice of loss to final closure.
Be expected to work in a vehicle in the field daily while occasionally handling assignments from the desk.
Explain coverage of loss, assist policyholders with itemization of damages, emergency repairs and additional living arrangements.
Work with and coordinate a few vendor services such as contractors, emergency repair, cleaning services and various replacement services.
May be called upon for catastrophe duty.
Position details
Territory-based work: Most workdays will be spent in the field within your assigned local territory, giving you the opportunity to work directly with customers and gain hands-on experience.
Training & support: To set you up for success, you'll participate in a comprehensive 5-month training program, which includes:
Primarily virtual and on-the-job learning.
Two short in-person training sessions (Weeks 4 and 7) at our Lewisville, TX office.
Limited overnight travel for training and team meetings (typically less than 10%).
Mileage Reimbursement: This role offers mileage reimbursement. You may qualify for a company-provided vehicle once mileage requirements are met. Additional details will be provided if you advance in the selection process.
Qualifications
Working knowledge of claims handling procedures and operations.
Proven ability to provide exceptional customer service.
Effective negotiation skills.
Ability to effectively and independently manage workload while exhibiting good judgment.
Strong written/oral communication and interpersonal skills.
Computer skills with the ability to work with multi-faceted systems.
The capabilities, skills and knowledge required through a bachelor's degree or equivalent experience and at least 1 year of directly related experience.
Ability to obtain proper licensing as required.
The ability to handle multiple competing priorities and organize your day.
Strong time management and organizational skills.
Demonstrated understanding of building construction principles.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
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.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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Auto-ApplyField Adjuster (Residential or Commercial) - Seattle, WA
Claims representative job in Seattle, WA
Job Description
CCMS & Associates is looking for a 1099 Field Adjuster in Washington, specifically the Seattle area. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team!
We are seeking a residential or commercial field adjuster with at least 1 year of field experience.
Requirements:
Minimum 1 year first-party commercial and/or residential property adjusting experience
Maintain own current estimating software - Xactimate preferred (Symbility experience a plus)
Working computer - internet access and Microsoft Word required
Must demonstrate strong time management and customer service skills
Experience in preparing Statement of Loss, Proof of Loss, and denial letters
Washington State adjusters license
Must have a valid drivers license
Responsibilities:
Complete residential and commercial field property inspections utilizing Xactimate software
Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses and by interviewing fire, police, or other governmental officials as well as inspecting claimed damages
Recommend claim reserves based on investigation, through well-supported reserve report
Obtain and interpret official reports
Review applicable coverage forms and endorsements, provide a thorough analysis of coverage and any coverage issues in a well-documented initial captioned report to the client
Maintain acceptable product quality through compliance with established best practices
Knowledge and Skills:
In-depth knowledge of property and liability insurance coverage and industry standards
Ability to prepare full-captioned reports by collecting and summarizing required information
Strong verbal and written communications skills
Prompt, reliable, and friendly
Preferred but Not Required:
College degree
AIC, IICRC, HAAG or other professional designations
All candidates must pass a full background check (void in states where prohibited)
CCMS & Associates offers multi-line claim adjusting and third-party administration services dedicated to solving the challenges of the complex claim in the property and casualty insurance industry. We create programs that drive a successful claim life cycle while strategically managing all aspects of the complicated issues carriers and policyholders are facing. Servicing excess and surplus/domestic carriers in the United States.
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Senior Claims Specialist - Swedish Physicians Billing
Claims representative job in Seattle, WA
Follow up on insurance denials and aged claims, submit claims to secondary payers, and ensure accurate billing information is submitted. Answer all information requests from those payers, and trace all claims to those payers making sure they have been paid or denied appropriately in a timely manner. Re-submit claims to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as necessary and resolve aged insurance balances. Act as resource for billing office staff.
Providence caregivers are not simply valued - they're invaluable. Join our team at Swedish Health Services DBA Swedish Medical Group and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
2 years related work experience in a health care environment.
Why Join Providence Swedish?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve.
Auto-ApplyClaims Analyst Credits Corrections - Auburn Univ Medical Cen
Claims representative job in Auburn, WA
EAMC MISSION
At East Alabama Medical Center, our mission is high quality, compassionate health care, and that statement guides everything we do. We set high standards for customer service, quality, and keeping costs under control.
POSITION SUMMARY
Performs billing functions for the department. The analyst must be familiar with medical terminology, sensitivity to confidential matters and exhibit the ability to problem-solve.
POSITION QUALIFICATIONS
Minimum Education
High school diploma or equivalent.
Familiarity with Medical terminology
Minimum Experience
6 months to 1 year of eligibility and benefits experience in a providers office or hospital department
Required Registration/License/Certification
n/a
Preferred Education
Billing and Insurance certification
Preferred Experience
4 years Billing, collection, customer service, aging patient and insurance accounts
Preferred Registration/License/Certification
N/A
Other Requirements
N/A