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Claims representative jobs in La Mesa, CA

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  • Senior Pharmacy Benefits Claims Analyst

    Milliman 4.6company rating

    Claims representative job in San Diego, CA

    We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Who We Are Independent for over 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world's most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation. Milliman invests in skills training and career development and gives all employees access to a variety of learning and mentoring opportunities. Our growing number of Milliman Employee Resource Groups (ERG's) are employee-led communities that influence policy decisions, develop future leaders, and amplify the voices of their constituents. We encourage our employees to give back to their varied professions, including leadership in professional organizations. Please visit our website (****************************************** to learn more about Milliman's commitments to our people, inclusion, and sustainability. Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance. This full-time position is for the pharmacy benefits consulting team within Milliman's San Diego Health Practice, which primarily serves plan sponsors that have contracted with PBMs to provide pharmacy benefits. The team helps plan sponsors navigate the evolving healthcare landscape by providing timely and thorough analysis, empowering our clients to make critical decisions impacting prescription drug affordability and access. What You Will Do We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Key responsibilities will include the following: Design and conduct data-driven analyses using pharmacy claims data and complex modeling. Participate actively as a member of a multi-disciplinary analytics team, fostering the sharing of relevant information to help identify creative solutions to complex problems. Explain results of analyses to internal teams and provide valuable insights, both orally and in clear, concise client reports. Stay current on industry trends, regulations, and best practices in pharmacy benefit management. Contribute to the development of innovative methodologies and tools for pharmacy claims analytics. What We Are Looking For Professional Qualifications Minimum of 10 years PBM or healthcare analytics experience, including at least 5 years of experience specific to PBM analytics. Working knowledge of Microsoft Office suite, including proficiency in Excel and SQL Server. Proficiency working with and explaining movements in key PBM performance indicators and pharmacy claims statistics. Knowledge of formularies, pharmacy claims data and their nomenclatures, including NDC, AWP, PBM, WAC, etc. Knowledge of claims data and how these manifest in claim adjudication and downstream analyses. Personal Qualifications Strong time management and people management skills. Experience working in a dynamic environment, demonstrating adaptability and integrity. Strong technical communication skills, written and oral. Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future. The Team The San Diego Health practice includes employees with diverse areas of experience and expertise in the pharmacy space. Current employees include those that have worked as actuaries, PBM analysts/consultants, pharmacists, and pharmacy technicians. Location This role is based out of the Milliman office in San Diego, California, but candidates hired into this role may work remotely anywhere in the US. The expected application deadline for this job is August 15, 2025. Compensation The overall salary range for this role is $85,100 - $168,600. For candidates residing in: Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, Pennsylvania, Virginia, Washington, or the District of Columbia the salary range is $93,610 - $154,550. New York City, Newark, San Jose, or San Francisco the salary range is $102,120 - $168,600. All other locations the salary range is $85,100 - $140,500. A combination of factors will be considered, including, but not limited to, education, relevant work experience, qualifications, skills, certifications, etc. Benefits We offer a comprehensive benefits package designed to support employees' health, financial security, and well-being. Benefits include: Medical, Dental and Vision - Coverage for employees, dependents, and domestic partners. Employee Assistance Program (EAP) - Confidential support for personal and work-related challenges. 401(k) Plan - Includes a company matching program and profit-sharing contributions. Discretionary Bonus Program - Recognizing employee contributions. Flexible Spending Accounts (FSA) - Pre-tax savings for dependent care, transportation, and eligible medical expenses. Paid Time Off (PTO) - Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis. Holidays - A minimum of 10 paid holidays per year. Family Building Benefits - Includes adoption and fertility assistance. Paid Parental Leave - Up to 12 weeks of paid leave for employees who meet eligibility criteria. Life Insurance & AD&D - 100% of premiums covered by Milliman. Short-Term and Long-Term Disability - Fully paid by Milliman. Equal Opportunity All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran.
    $102.1k-168.6k yearly 60d+ ago
  • Senior Claims Examiner

    Athens Administrators 4.0company rating

    Claims representative job in San Diego, CA

    DETAILS Senior Claims Examiner Department: Workers' Compensation California Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 12 Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers compensation offices and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday - Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Establish contact with employer to review issues Respond to inquiries from the employer, employee, doctors, and attorneys Establish and maintain appropriate reserves Review legal correspondence and medical reports Evaluate and approve medical procedures and treatment Administer benefits and ensure appropriateness of all payments Investigate coverage, liability, and monetary value of claim Review medical and legal bills for appropriateness Discuss appropriateness of medical treatment with medical case manager Determine compensability Monitor and assist litigation Negotiate settlement of claim, liens, rehabilitation plans, etc. Prepare and present reports to clients Appropriately close claims Help resolve client billing and payment inquiries Investigate complaints from injured workers Document and code the claim files and claims system with all relevant information Maintain and update action plans within specified time frames Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks Contact with employers, employees, attorneys, doctors, vendors, and other parties Provide customer service and support to clients and claimants Work collaboratively with attorneys to draft settlements and assist with litigation strategies Negotiate settlements Authorize and negotiate cost of medical treatment and supplies Internal communication with staff Prepare professional, well written correspondence and other communications ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f) 3+ years recent workers compensation claims handling experience required At least 5 years of workers compensation claims experience preferred Solid knowledge of workers compensation laws, policies, and procedures' Completion of IEA or equivalent courses Proficiency in determining case value and negotiating settlements Understanding of medical and legal terminology Mathematical calculating skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor. Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Ability to attend occasional in office meetings or file reviews APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************* This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here
    $71k-101k yearly est. 60d+ ago
  • Senior Claims Professional (Workers Compensation)

    Berkshire Hathaway 4.8company rating

    Claims representative job in San Diego, CA

    WHAT WE'RE LOOKING FORBerkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opportunity for experienced Claims Professionals (Adjusters). This position requires a self-starter who can work under minimum direction, can achieve defined results, and willing to accept ownership for their work product. The Senior Claims Professional is responsible for the management of a complex caseload of workers compensation indemnity claims from inception to resolution. This individual works under general supervision with elevated reserve and settlement parameters and encouraged to participate in special projects focused on process efficiency. ESSENTIAL RESPONSIBILITIES Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support. Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely three-point contacts on all new losses. Manages claims with an outcome-based and resolution focus. Demonstrates highly effective strategic plans for future handling that are well outlined in plans of action and followed through in a timely fashion. Demonstrates effective decision making in compensability determinations and benefit authorizations (within designated authority parameters). Proactively utilizes resources such as Medical Management, SIU, Subrogation, Recovery and Legal to ensure accurate determinations in compensability, causal relationship, appropriate medical treatment, and to achieve favorable outcomes. Prepares and maintains timely, accurate reserves on all claims for expected future costs of medical treatment, benefits and other elements in accordance with Claims Handling Guidelines. Ensures reserves are escalated and approved as appropriate. Ensures there is appropriate reserve documentation in the file. Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims. Reduces fraud through early identification and escalation. Effectively manages defense attorneys. Demonstrates excellence in litigation management by being prepared for hearings in a timely manner and appropriately considering exposures, settlement options, and other legal issues. Reviews and approves vocational rehabilitation plans. Effectively manages vendors and providers. Identifies need for assignment and removal of vendors and makes effective use of vendor expertise while maintaining ownership of the claim. Demonstrates expertise in technical aspects of claim management. Works with Medicare Set Asides, Structured Settlements and/or Part B issues. Maintains effective relationships with internal and external service partners, including participation in periodic telephonic claims reviews. Calculates and pays benefits in accordance with the law. Ensures that the claim as a whole is managed in accordance with all legal requirements including the issuance of appropriate notices and filings. WHAT YOU'D BRING TO THE ROLE EDUCATION: Minimum of a High School diploma required or equivalent certificate required; Bachelor's degree from four-year College or university preferred. EXPERIENCE: Minimum of five years of indemnity adjusting experience managing large and/or complex claims and accounts within a workers' compensation carrier required Maintains qualifying educational criteria to adjust workers' compensation claims for the State of California; Self-Insured certification preferred. Inquisitive, critical thinker; agile learner with adaptive, smart time management skills To perform this job successfully, an individual should have expert skills in the following: Microsoft Word, PowerPoint, Excel and be proficient on applicable databases, systems and vendor software programs. WHAT WE OFFER Reasonable caseload with in-house Medical Management support (UR, Med Bill Review, Resource Nurses); In-house Claims Assistant support Work-Life Balance Work From Home Program (up to 2 days per week) Modern Office Setting Free On-Site Fitness Facility Free On-Site Garage Parking BENEFITS Paid Time Off Paid Holidays Retirements Savings Match Group Health Insurance (Medical, Dental, and Vision) Life and AD&D Insurance Long Term Disability Insurance Accident and Critical Illness Insurance Flexible Savings Accounts Paid Community Volunteer Day Employee Assistance Program Tuition Reimbursement Program Employee Referral Program Diversity, Equity and Inclusion Program
    $89k-114k yearly est. Auto-Apply 60d+ ago
  • Complex Commercial Construction Defect Claim Representative

    The Travelers Companies 4.4company rating

    Claims representative job in San Diego, CA

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $94,400.00 - $155,800.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign-on bonus of up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. What Will You Do? * Directly handles assigned severity claims. * Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Consults with Manager on use of Claim Coverage Counsel as needed. * Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. * Maintains claim files and documents claim file activities in accordance with established procedures. * Utilizes evaluation documentation tools in accordance with department guidelines. * Proactively creates Claim File Analysis (CFA) by adhering to quality standards. * Utilizes diary management system to ensure that all claims are handled timely. * At required time intervals, evaluate liability & damages exposure. * Establishes and maintains proper indemnity and expense reserves. * Recommends appropriate cases for discussion at roundtable. * Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. * Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. * Develops and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiates disposition of claims with insureds and claimants or their legal representatives. * Recognizes and implements alternate means of resolution. * Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, * Tracks and controls legal expenses to assure cost-effective resolution. * Effectively and efficiently manage both allocated and unallocated loss adjustment expenses. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * 5 years equivalent business experience. * Advanced level knowledge and skill in claim and litigation. * Basic working level knowledge and skill in various business line products. * Strong negotiation and customer service skills. * Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices. * Demonstrated coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced. * Judgment/Decision Making - Advanced. * Communication - Advanced. * Negotiation - Advanced. * Insurance Contract. * Knowledge - Advanced. * Principles of Investigation - Advanced. * Value Determination - Advanced. * Settlement Techniques - Advanced. * Legal Knowledge - Advanced. * Medical Knowledge - Intermediate. What is a Must Have? * High School Degree or GED. * 3 years of liability claim handling experience and/or comparable litigation claim experience. * In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. * Generally, license(s) are required to be obtained within three months of starting the job. 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 *********************************************************
    $41k-54k yearly est. 2d ago
  • Senior Claims Examiner

    Berkley 4.3company rating

    Claims representative job in San Diego, CA

    Company Details Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company's distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company. Company URL: ********************* The company is an equal opportunity employer. Responsibilities The Senior Workers' Compensation Examiner is responsible for the analysis and management of complex workers' compensation claims. This position will review, investigate, and make decisions regarding coverage, compensability, and appropriateness of claims. The position will process and document claims to ensure compliance with company standards, industry best practices, and legislative provisions. The role acts in a fiduciary role on behalf of policyholders, negotiates claim settlements and manages subrogation. Senior Claims Examiner's conduct the handling of claims in the utmost of good faith in compliance with the rules, regulations and statutes of the WCAB and State of California. The Senior Workers' Compensation Examiner is expected to function with a degree of competency. The use of sound judgment coupled with consistent results is expected. Key functions include but are not limited to: Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Negotiates settlement of claims up to designated authority level and makes claims payments. Processes complex or technically difficult claims. Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level. Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. Prepares necessary state filings within statutory limits. Actively manages the litigation process; ensures timely and cost-effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims. Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets. Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner. Frequently communicates with all appropriate parties involved with the claim. Refers cases as appropriate to management. Maintains professional client relationships. Actively executes appropriate claims activities to ensure consistent delivery of quality claims service. Qualifications Bachelor's degree preferred 5+ years claims management experience. Professional certification as applicable to workers' compensation required WCCP Preferred In depth knowledge of appropriate insurance principles and laws for workers' compensation. Strong written and verbal communication skills. Strong organizational skills. Strong negotiation skills Strong analytical and interpretive skills. PC literate. Professional certification as applicable to workers' compensation required. Additional Company Details We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: • Base Salary Range: $100,000 - $120,000 • Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. 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. Sponsorship Details Sponsorship not Offered for this Role
    $100k-120k yearly Auto-Apply 60d+ ago
  • Outside Property Claim Representative Trainee

    Travelers 4.8company rating

    Claims representative job in San Diego, CA

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 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$48,700.00 - $80,400.00Target Openings1What Is the Opportunity?LOCATION REQUIREMENT: This position services Insureds/Agents in Southeast San Diego County. The selected candidate must reside in or be willing to relocate at their own expense to the assigned territory. Ideal locations include Santee, El Cajon, La Mesa, Lemon Grove, Poway, Spring Valley, Rancho San Diego, and surrounding areas. This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.What Will You Do? Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. The on the job training includes practice and execution of the following core assignments: Handles 1st party property claims of moderate severity and complexity as assigned. Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. Handles files in compliance with state regulations, where applicable. Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. Identifies and refers claims with Major Case Unit exposure to the manager. Performs administrative functions such as expense accounts, time off reporting, etc. as required. Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. Must secure and maintain company credit card required. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position Perform other duties as assigned. What Will Our Ideal Candidate Have? Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic Valid passport preferred. What is a Must Have? High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. Valid driver's license - required. What Is in It for You? Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************
    $48.7k-80.4k yearly Auto-Apply 55d ago
  • Workers Compensation | Claims Representative Trainee | In-Office (Roseville or San Diego, California)

    Sedgwick Claims Management Services, Inc. 4.4company rating

    Claims representative job in San Diego, CA

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Workers Compensation | Claims Representative Trainee | In-Office (Roseville or San Diego, California) 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 4-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. ESSENTIAL RESPONSIBLITIES MAY INCLUDE * Attendance and completion of designated classroom claims professional training program. * Performs on-the-job training activities including: * Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. * Adjusting low and mid-level liability and/or physical damage claims under close supervision. * Processing disability claims of minimal disability duration under close supervision. * Documenting claims files and properly coding claim activity. * Communicating claim action/processing with claimant and client. * Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. * Participates in rotational assignments to provide temporary support for office needs. QUALIFICATIONS Bachelor's or Associate's degree from an accredited college or university preferred. EXPERIENCE Prior education, experience, or knowledge of: * Customer Service * Data Entry * Medical Terminology (preferred) * Computer Recordkeeping programs (preferred) * Prior claims experience (preferred) Additional helpful experience: * State license if required (SIP, Property and Liability, Disability, etc.) * WCCA/WCCP or similar designations * For internal colleagues, completion of the Sedgwick Claims Progression Program TAKING CARE OF YOU * Entry-level colleagues are offered a world class training program with a comprehensive curriculum * An assigned mentor and manager that will support and guide you on your career journey * Career development and promotional growth opportunities * A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $27.69/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
    $27.7 hourly Auto-Apply 5d ago
  • Field Claims Adjuster

    EAC Claims Solutions 4.6company rating

    Claims representative job in Chula Vista, CA

    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.
    $53k-64k yearly est. 60d+ ago
  • Senior Claims Examiner

    ICW Group 4.8company rating

    Claims representative job in San Diego, CA

    Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a complex California claims inventory. Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: Consistently provides exceptional customer service. Effectively collaborates with team members from various departments for project and process discussions. Acts as a Subject Matter Expert for the department. Makes recommendations for streamlining processes and adopting the industry's best practices. Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. Provides knowledge transfer across the organization. Continuously seeks to improve technical skills by attending job related training and tracking current case law. Acts as a mentor and provides training for less experienced team members. Prepares and presents claims status reports for internal and external stakeholders. Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? • Challenging work and the ability to make a difference • You will have a voice and feel a sense of belonging • We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match • Bonus potential for all positions • Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year) • 11 paid holidays throughout the calendar year • Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims
    $68.5k-115.5k yearly Auto-Apply 1d ago
  • Independent Insurance Claims Adjuster in San Diego, California

    Milehigh Adjusters Houston

    Claims representative job in San Diego, CA

    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.
    $52k-65k yearly est. Auto-Apply 60d+ ago
  • Claims Investigator - Experienced

    Command Investigations

    Claims representative job in San Diego, CA

    CLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are highly needed. Must have reliable transportation, along with own digital recorder and camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: W/C and P&C investigations Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email)
    $43k-59k yearly est. Auto-Apply 60d+ ago
  • Daily Property Field Adjuster

    Alacrity Solutions

    Claims representative job in San Diego, CA

    Alacrity Solutions Independent Contractor Daily Property Field Adjuster Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy equipment, and casualty claims management services. Our staffing capabilities, temporary housing services, managed repair network, and subrogation services support a fully integrated solution for all your needs from first notice of loss through completion of repairs. By assembling the best service providers through strategic acquisitions and relying on the right talent, Alacrity Solutions provides consistent, professional, and scalable services throughout the entire claim handling and resolution process. To learn more, visit ************************** The objective of a Daily Property Field Adjuster is to provide excellent claim handling services for our clients regarding daily claim work within your area which can include multiple perils. Contract Requirements Include: A contract will be issued within 24 hours of accepting your first claim assignment with Alacrity. This IA contract will include pay details and other pertinent information regarding your work as an independent contract with Alacrity. A completed contract is required to issue pay. Skills & Requirements/Licensure: MUST live within 50-100 miles of posted location and willing to travel to location. Minimum 2-3 years property field adjusting experience. Independent adjusting license in your home state (area of work), or a designated home state license if residing in a non-licensing state. Experienced in wind, hail, theft, fire, water losses and other perils preferred. Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities. Willing and able to climb roofs. Computer and Phone System Requirements: Smart Cell Phone able to access to internet. Xactimate and/or Symbility proficient with current subscription Working Laptop computer with reliable high-speed internet Digital camera and other miscellaneous items necessary to perform adjuster responsibilities. Working Conditions / Physical & Mental Demands: The physical demands described here are representative and must be met by the independent contractor to successfully perform this job. 100% travel is required within designated working territory based on the location of assignments received. Normal office or field claims environment. Ability to operate a motor vehicle for up to 8 hours daily, repeatedly entering and exiting the vehicle. Must be able to make physical inspections of auto loss sites. Must be able to work outdoors in all types of weather. Available to work catastrophic loss events. A willingness to work irregular hours and to travel with possible overnight requirements a plus. Why Choose Alacrity? Flexibility: Self-determined Scheduling Diversity Statement Alacrity is an equal opportunity employer and is committed to providing employees with a work environment free of discrimination and harassment. All decisions pertaining to an employee's employment are made without regard to race, color, religion, sex (including sexual orientation, pregnancy, childbirth), gender, gender identity or expression, age, national origin, ancestry, physical or mental disability, medical condition, reproductive health decisions, veteran's status, genetic information, creed, marital status, disability, citizenship status, or any other characteristic protected by applicable law. How Long We Retain Personal Information: We will keep your personal information for as long as necessary to fulfill legitimate business purposes and in accordance with applicable laws.
    $53k-71k yearly est. Auto-Apply 60d+ ago
  • Field Adjuster

    Heritage Mga LLC

    Claims representative job in San Diego, CA

    Field Adjuster - Complex Field Specialist This is a remote role, must be based in Southern California, ideally San Diego area. Analyzes and reviews claims for accuracy, completeness and eligibility. Resolves claims by investigating losses, calculating and negotiating settlements. Prepares and maintains reports and records for processing. Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition. Essential Duties and Responsibilities: • Follow and maintain claims management guidelines to determine insurance coverage by examining claims forms, policies, and other records as appropriate. • Perform detailed investigations by coordinating field audits, and performing in-depth interviews both telephone and in person to research claims. Resolves claims by comparing claim information with evidence obtained to determine eligibility. • Settles claim by determining insurance carrier's liability and negotiating agreement with appropriate parties according to company policy provisions • Collects, updates and maintains all claim documentation including statements, pictures, reports, estimates, etc. and verifies the accuracy and completeness of claim forms. • Reports on pending claims and findings to the Claims Manager • Provide updates on customer problems and safety or policy violations. Responds to inquiries and requests for information from customers and staff. • Identifies exposures to the company and facilitates senior-level management's knowledge of pending claims and litigation that may have an adverse impact on the corporate goals. • Acts as the liaison to attorneys, insurance companies and individuals investigating any incidents that may result in asset loss. • Travels within an assigned region in the course of processing claims. • Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. • Communicates with co-workers, management, clients, vendors, and others as needed in a courteous and professional manner. • Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures. • May perform other duties and responsibilities as assigned. Job Qualifications: • A High School Diploma or equivalent is required; Associate's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree. • 620 Licensure required. • Three to five years of experience processing claims; in the property and casualty segment preferred. • Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions. • Proficiency with Microsoft Office products required; claims software and internet research tools preferred. • Experience with Xactware products preferred. • Demonstrate customer service focus / superior customer service skills. • Ability to work in a fast paced environment; ability to multitask. • Collaborative partner; ability to contribute to a positive work environment. • Excellent communication skills and ability to interact on a professional level with internal and external personnel • Results driven with strong problem solving and analytical skills. • Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively. • Detail-oriented and exceptionally organized • Collaborative partner; ability to contribute to a positive work environment. • Ability to climb, kneel, and crawl required; may worked in confined spaces. Ability to lift and move items up to 30 lbs. alone; more with assistance from a partner. This position is based within an assigned region; travel throughout the region is required with occasional travel to locations beyond the assigned region. Company paid pre-employment drug test and health screening required General Information: All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc. The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.
    $53k-71k yearly est. Auto-Apply 60d+ ago
  • Claims Specialist 1

    Public Consulting Group 4.3company rating

    Claims representative job in Chula Vista, CA

    Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.-all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit ****************************** Our Human Services team helps state and municipal human services and economic development agencies keep their promises-responsibly and sustainably-to the children, adults, and families they serve. Join us and use your professional skills to build stronger communities and better serve populations in need by making meaningful and lasting changes in government organizations. Services: Program Consulting Finance Consulting and Billing Services Applied Technology Outsourcing and Operations Strategy Project and Grants Management Assessments and Feasibility Studies PCG is seeking highly motivated and dependable Claims Specialist payment processing clerk with an interest in public service who can work in our San Diego, CA Stage 1 Child Care Payment Services operation. The clerks will be responsible for accurately distributing child care payments to child care providers and working with CalWORKs families to access child care. These staff will be responsible for managing, collecting, tracking, and reporting information for child care and additional supportive services in various software programs including KinderTrack and CalWIN. Specific Responsibilities: Identify proper forms; obtain signatures on all required forms and documentation. Establish and maintain good working relationships with partners including CalWORKs participants, County staff, child care providers and Stage 2 and 3 child care payment agencies. Provide monthly reporting statistics to supervisor for designated area of responsibility. Enter manual provider timesheets and invoice information accurately. Reconcile and troubleshoot timesheet and transaction reports. Create and maintain adequate budget files for clients for audit purposes. Monitor accuracy/timeliness of payment processing. Enter budget information and verify that invoices received are budget-authorized. Required Skills: Proper etiquette including customer relation techniques, superior verbal and communications skills. Excellent accuracy and attention to detail Ability to prioritize work and meet deadlines. Ability to recognize and maintain the confidentiality of all materials in the work setting. Understanding of modern office methods and practices; efficient with computers. Demonstrated ability to use various computer systems, preferably CalSAWS and KinderTrak, although not required. Ability to establish and maintain professional relationships with community partners and providers. Ability to partner with and motivate clients from a diverse range of backgrounds. Ability to maintain a record keeping and follow-up system. Ability to work independently, requiring minimal supervision and on multiple projects simultaneously. Required Education and Experience: Proficient with Microsoft Excel ad basic working knowledge of Access High School Diploma required; Bachelor's Degree preferred. Accounting experience or background a plus. Compensation: Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides a reasonable range of compensation for this role. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave. Range: $42,000-$59,300 EEO Statement: Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.
    $42k-59.3k yearly Auto-Apply 60d+ ago
  • Claims Coordinator/Collections

    Lemon Grove

    Claims representative job in Chula Vista, CA

    As the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required deadlines are met. The Coordinator will be responsible to follow up daily pack outs that occurred the day before all paperwork is completed, estimates and procedures are followed according to required program guidelines. Also this position needs to follow up that adjusters received estimates and where payment was sent and collect the payment. A successful Coordinator will possess tenacity and thrives in a fast-paced environment. The coordinator who is detail oriented and able to focus with many projects in varying degrees of completion will be most successful in this position. Job Responsibilities Understanding of the claims flow process -Contents, Fire Clean, Bio cleans, Structure Clean. Manages data entry for each claim from First Notice of Loss through to completion of job in the CRM system Daily review of compliance tasks and all job tasks are completed on time Monitor and update jobs in required operating system making sure the job flows efficiently through the claims process requirements and cycle times Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call Creates and or assists with job estimate, reviews final estimate to ensure estimate is complete per company standards Manages Customer Service issues and complaints, documenting actions and resolution Collect payments from homeowners. Client Care Calls - ensure constant, often daily, communication with the customer, may communicate with adjuster Ensure daily notes are entered in all jobs, contacting relevant participants and escalating to the department manager as required May be responsible for creating job estimate and or assisting the Estimator/Project Manager with final estimate Job Requirements High school diploma/GED required Bachelor's Degree or applicable experience preferred, work experience will be considered IICRC Certifications preferred but not required: WTR, ASD, OCT, STC Exceptional Customer Service skills 1 year of Xactimate experience required- proficient use Xactimate 28 Experience with Microsoft© Office application (Word, Outlook, PowerPoint, and Excel) required Personal time management and organizational skills Strong verbal and written communication skills Dependable and adaptable to operate within a fast-paced work environment Ability to manage highly confidential information Strong problem-solving skills Proficient at using Microsoft Office, Outlook, CRM software Experience do you have with customer interaction and conflict resolution Physical Demands and Working Conditions The physical demands are representative of those that must be met by an employee to perform the essential function to this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Incumbent must be prepared to: Sitting for long periods of time while using office equipment such as computers, phones etc. Fingering and Repetitive motions; such as movement of wrists, hands and fingers while picking, pinching and typing during your normal working environment. Express or exchange ideas with others quickly, accurately, and receive and act on detailed information. Close visual acuity to perform detail-oriented activities at distances close to the eyes, such as preparing and analyzing data, viewing computer screen and expansive reading. Be exposed to various inside working conditions: The change of building environment such as with or without air conditioning and heating. May be required to travel for short periods of time. Disclaimer The above statements are intended to describe the general nature and level of work being performed by associates assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. The Company reserves the right to modify this description in the future, with or without notice to the employee. This Job Description does not create an employment contract, implied or otherwise, and employment with the Company remains at will. These responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. Compensation: $30,000 - $40,000.00 Built on a foundation of great brands and employees with a passion for service, our vision is to be the leading provider of essential services through empowered people, world-class customer service and convenient access. By joining ServiceMaster, you'll be part of a talented network of employees with a shared vision. Our environment is a diverse community where successful people work together to achieve common goals. This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to The ServiceMaster Company, LLC.
    $30k-40k yearly Auto-Apply 60d+ ago
  • Claims Adjuster (Spanish Fluency Preferred)

    Berkshire Hathaway 4.8company rating

    Claims representative job in San Diego, CA

    WHAT WE'RE LOOKING FORAre you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Are you a Spanish speaker looking to apply those skills in a professional environment? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster. Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity. RESPONSIBILITIES Completes classroom training introducing workers' compensation claims handling strategies, medical terminology, and legal concepts. Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records. Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls. Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines. Develops and updates a plan of action for the successful resolution of each claim. Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently. Reduces fraud through early identification and escalation. Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers. Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims. Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim. WHAT YOU'D BRING TO THE ROLE Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred Exceptional interpersonal and customer service skills Ability to manage and prioritize multiple assignments in a fast-paced environment Strong organization skills to ensure tasks are completed within hard deadlines Basic mathematical skills to calculate monetary reserves Knowledge of Microsoft Word, Powerpoint, Excel, Outlook WHY YOU SHOULD APPLY Unparalleled financial strength and stability Fantastic growth and advancement opportunities WFH Hybrid schedule Free gym in building Generous Paid Time Off and Holidays Excellent Benefits (Medical, Dental, Vision, 401k, etc) Health and Wellness Reimbursement Tuition Assistance Reimbursement Discounts across companies such as GEICO, See's Candies, etc. In accordance with the California Equal Pay Act, the starting hourly wage for this job is $28.8462. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.
    $28.9 hourly Auto-Apply 60d+ ago
  • Workers Compensation Claims Representative Trainee | San Diego (Entry Level)

    Sedgwick 4.4company rating

    Claims representative job in San Diego, CA

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Representative Trainee | San Diego (Entry Level) Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? A stable and consistent work environment in an office setting. A training program to learn how to help employees and customers from some of the world's most reputable brands. An assigned mentor and manager who will guide you on your career journey. Career development and promotional growth opportunities through increasing responsibilities. A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs. PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as new industry professional with the ability to analyze workers compensation claims and determine benefits due. OFFICE LOCATIONS Onsite | San Diego (Onsite 5 days per week) ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic individuals for an entry-level trainee position. This role begins with a comprehensive 4-week classroom-based professional training program designed to equip you with the foundational skills needed for a successful career in claims adjusting. Over the course of a few years, you'll have the opportunity to grow and advance within the field. ESSENTIAL RESPONSIBLITIES MAY INCLUDE Attendance and completion of designated classroom claims professional training program. Performs on-the-job training activities including: Adjusting lost-time workers compensation claims under close supervision. May be assigned medical only claims. Adjusting low and mid-level liability and/or physical damage claims under close supervision. Processing disability claims of minimal disability duration under close supervision. Documenting claims files and properly coding claim activity. Communicating claim action/processing with claimant and client. Supporting other claims examiners and claims supervisors with larger or more complex claims as assigned. Participates in rotational assignments to provide temporary support for office needs. QUALIFICATIONS Bachelor's or Associate's degree from an accredited college or university preferred. EXPERIENCE Prior education, experience, or knowledge of: • Customer Service • Data Entry • Medical Terminology (preferred) • Computer Recordkeeping programs (preferred) • Prior claims experience (preferred) Additional helpful experience: • State license if required (SIP, Property and Liability, Disability, etc.) • WCCA/WCCP or similar designations • For internal colleagues, completion of the Sedgwick Claims Progression Program TAKING CARE OF YOU Entry-level colleagues are offered a world class training program with a comprehensive curriculum An assigned mentor and manager that will support and guide you on your career journey Career development and promotional growth opportunities A diverse and comprehensive benefits offering including medical, dental vision, 401K, PTO and more WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $27.69/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. #claimsrepresentative #claims #LI-DA1 Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
    $27.7 hourly Auto-Apply 4d ago
  • Field Claims Adjuster

    EAC Claims Solutions 4.6company rating

    Claims representative job in San Diego, CA

    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.
    $53k-64k yearly est. 60d+ ago
  • Claims Investigator - Experienced

    Command Investigations

    Claims representative job in San Diego, CA

    Job DescriptionCLAIMS INVESTIGATOR Seeking an experienced investigator with multi-lines investigations to include W/C and P&C experience. SIU experience is also highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are highly needed. Must have reliable transportation, along with own digital recorder and camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: W/C and P&C investigations Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Powered by JazzHR ae8MYMuvvL
    $43k-59k yearly est. 11d ago
  • Complex Commercial General Liability Claim Representative

    The Travelers Companies 4.4company rating

    Claims representative job in San Diego, CA

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $94,400.00 - $155,800.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign-on bonus of up to $20,000. Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned General Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. What Will You Do? * Directly handles assigned severity claims. * Provides quality customer service and ensures file quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Consults with Manager on use of Claim Coverage Counsel as needed. * Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Complete outside investigation as needed per case specifics. * Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. * Maintains claim files and documents claim file activities in accordance with established procedures. * Utilizes evaluation documentation tools in accordance with department guidelines. * Proactively reviews Claim File Analysis (CFA) for adherence to quality standards and trend analysis. * Utilizes diary management system to ensure that all claims are handled timely. * Establishes and maintains proper indemnity and expense reserves. * Recommends appropriate cases for discussion at roundtable. * Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. * Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. * Develops and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiates disposition of claims with insureds and claimants or their legal representatives. * Recognizes and implements alternate means of resolution. * Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, * Tracks and controls legal expenses to assure cost-effective resolution. * Effectively and efficiently manages both allocated and unallocated loss adjustment expenses. * Attends depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * Updates appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options. * Recognizes cases, based on severity/complexity protocols that should be transferred to another level of claim professional and refers on a timely basis. * Appropriately deals with information that is considered personal and confidential. * Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions and inquiries from agents and brokers. * Represents the company as a technical resource, attends legal proceedings as needed, acts within established professional guidelines as well as applicable state laws. * Actively provides mentoring and coaching to less experienced claim professionals to increase the technical expertise and improve bench strength. * Shares accountability with business partners to achieve and sustain quality results. * Evaluates all claims for recovery potential; directly handles recovery efforts and/or engages and directs Company resources for recovery efforts. * 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. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * 4 years bodily injury litigation claim handling experience. * Advanced level knowledge in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Thorough understanding of business line products, policy language, exclusions, ISO forms, and effective claims handling practices. * Openness to the ideas and expertise of others actively solicits input and shares ideas. * Strong customer service skills. - Intermediate. * Demonstrated coaching, influence and persuasion skills.- Intermediate. * Strong written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise.- Intermediate. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. - Intermediate. * Attention to detail ensuring accuracy -Intermediate. * Job Specific Technical Competencies: * Analytical Thinking - Intermediate. * Judgment/Decision Making - Intermediate. * Communication - Intermediate. * Negotiation -Advanced. * Insurance Contract. * Knowledge - Advanced. * Principles of Investigation - Advanced. * Value Determination - Advanced. * Settlement Techniques - Intermediate. * Legal Knowledge - Intermediate. * Medical Knowledge - Intermediate. What is a Must Have? * High School Degree or GED required with a minimum of 3 years bodily injury litigation claim handling or comparable claim litigation experience. 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 *********************************************************
    $48k-58k yearly est. 2d ago

Learn more about claims representative jobs

How much does a claims representative earn in La Mesa, CA?

The average claims representative in La Mesa, CA earns between $31,000 and $58,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.

Average claims representative salary in La Mesa, CA

$42,000

What are the biggest employers of Claims Representatives in La Mesa, CA?

The biggest employers of Claims Representatives in La Mesa, CA are:
  1. Sedgwick LLP
  2. The Travelers Companies
  3. The Independent Traveler
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