Claims representative jobs in Lynwood, CA - 239 jobs
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Claims Investigator
Apex Investigation
Claims representative job in Los Angeles, CA
About the Company
For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss.
About the Role
The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports.
This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role.
Key Responsibilities
Case Management & Communication
Receive, review, and manage assigned cases from start to completion.
Communicate professionally with clients, claimants, witnesses, and other involved parties.
Provide timely case updates and correspondence in accordance with company guidelines via CaseLink.
Maintain objectivity and professionalism in all interactions.
Investigative Field Work
Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings.
Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires.
Perform scene and neighborhood canvasses, including walking on varied terrain.
Meet with treating physicians and medical offices as required.
Travel to designated locations, including overnight stays when necessary.
Respond to rush cases within business hours when required.
Documentation & Reporting
Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis.
Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired.
Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements.
Prepare and submit comprehensive investigative reports within 72 hours of final update submission.
Evidence & Records Handling
Retrieve records from agencies and entities both in-person and remotely.
Take clear photographs and video when necessary and label all electronic files accurately.
Securely collect, store, and maintain custody of evidence when required.
Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure.
Additional Responsibilities
Identify and recommend additional investigative services outside the scope of the original assignment when appropriate.
Work overtime as needed to meet case demands and deadlines.
Maintain an efficient, safe, and organized telecommuter workspace.
Physical & Work Environment Requirements
Ability to sit for extended periods performing computer-based work and report writing.
Ability to stand for extended periods while conducting interviews and canvasses.
Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment).
Ability to operate digital audio recording equipment.
Qualifications
Experience with workers' compensation claims and investigative processes.
Strong written and verbal communication skills.
Ability to work independently, manage time effectively, and meet strict deadlines.
Willingness and ability to travel up to (but not limited to) 150 miles per assignment.
Possession of a personal credit card with available balance for reimbursable business expenses.
Proficiency with case management systems; CaseLink experience preferred.
Access to a personal scanner for document upload and record handling.
Preferred Qualifications
Prior experience conducting recorded statements and field investigations.
Experience with process service assignments.
Familiarity with evidence handling and documentation standards.
Background in insurance investigations or a related field.
$44k-61k yearly est. 3d ago
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Claims Technician
Insight Global
Claims representative job in Los Angeles, CA
About the Role
We're partnering with a leading insurance company to find a Claims Technician. In this role, you'll be responsible for initiating, directing, and supporting case management and claims processes. You'll work closely with the claims team to ensure accuracy and professionalism in every step.
Key Responsibilities
Process insurance claims with attention to detail and accuracy
Support case management activities under moderate guidance
Assist the Claims organization with additional responsibilities as needed
Maintain professionalism and adhere to company standards
Qualifications
Experience: 6 months to 1 year of office experience
Skills: Proficiency in Microsoft Office Suite
Education: Bachelor's degree preferred (not required)
Claims experience: Is a plus, but training provided on internal systems
Strong professionalism and cultural fit
Additional Details
Interview: One round, on-site
Background Check: Full employment and education verification.
Work Environment: Desk-based, 8-hour shifts
$36k-47k yearly est. 3d ago
Claims Processor
Pacer Staffing
Claims representative job in Whittier, CA
Job Title - Claims Processor
Hourly Pay - $30/hr
Shift - Day 5x8-Hour (07:00 - 15:30)
Job Description -
SPECIFIC SKILLS NEEDED
Knowledge of HMO/or IPA operations; medical terminology; ICD-10, RVS, and CPT coding knowledge; knowledge of Medicare and Medi-Cal guidelines; 10-key skills by touch; excellent communication skills; knowledge of system applications; ability to function effectively under time deadlines; strong organizational skills.
Required:
Formal training will be indicated by a high school diploma or equivalent;
Four years medical claims processing.
DUTIES AND RESPONSIBILITIES
1. Safeguards and preserves the confidentiality of patient's protected health information in accordance with State and Federal (HIPAA) regulatory requirements, hospital and departmental policies.
2. Ensures a safe patient environment and adherence to safety practices per policy.
3. With consideration to age, employee utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant other when administering care.
4. Assist the Claims Director in the training and education of the Claims department staff
5. Coordinate the generation and review of claims audit, status and pending claims reports ensuring authorized claims are paid in accordance with company guidelines
6. Investigate, process and track payment adjustments including refunds, overpayments and underpayments
7. Act as a confidential and professional resource for group providers and other staff.
8. Act as a resource for providers, members, insurance carriers, attorneys and co-workers, researching and responding to questions in a timely manner
9. Create, maintain and generate system reports
10.Review and audit member liability denials and Provider Dispute Resolution claims to ensure compliance with regulatory requirements and passing audit scores from health plans
$30 hourly 2d ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claims representative job in Irvine, CA
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$35k-44k yearly est. 4d ago
Bottler Claims Representative (Temp to Hire)
Monster 4.7
Claims representative job in Corona, CA
Energy:
Forget about blending in. That's not our style. We're the risk-takers, the trailblazers, the game-changers. We're not perfect, and we don't pretend to be. We're raw, unfiltered, and a bit unconventional. But our drive is unrivaled, just like our athletes. The power is in your hands to define what success looks like and where you want to take your career. It's not just about what we do, but about who we become along the way. We are much more than a brand here. We are a way of life, a mindset. Join us.
A day in the life:
As a Bottler ClaimsRepresentative at Monster Energy, you'll be at the heart of the action, processing, validating, and coding promotional invoices with the precision of a high-speed racer! Get ready to rev up your data-entry skills and keep the promotions engine running smoothly. Your role is all about ensuring everything flows seamlessly, just like the thrilling rush of a Monster Energy drink!
The impact you'll make:
Review, validate, and process distributor invoices in accordance with company policies and procedures. Requires frequent communication with distributors and the Sales Team to obtain necessary supporting documentation and approvals.
Verify invoice program details, ensure accuracy, compliance, and adherence to promotional execution or contractual agreements. -->> Collect, organize, and maintain supporting documents required for invoice validation and/or support in SAP, Vistex, Sales Force and or other source locations.
Accurately code and enter invoice details into SAP, Vistex, Sales Force, and or other source locations, to ensure proper GL coding and reporting.
Identify discrepancies or errors in claims and work with relevant teams to resolve issues efficiently.
Ensure all claims adhere to company policies, industry regulations, and audit requirements.
Maintain accurate and up-to-date records of processed claims for tracking and audit purposes.
Identify opportunities to enhance efficiency and accuracy in claims processing workflows.
Work closely with internal teams, including Finance and Sales and Chain Claims, to support business objectives and streamline operations alongside any additional ad hoc duties.
Who you are:
Prefer a Bachelor's Degree in the field of --Accounting, Math, Business Administration, or other related field of study
Additional Experience Desired: Minimum 1 year of experience in Accounts Payable position
Additional Experience Desired: Minimum 1 year of experience in processing vendor invoices, data entry, account reconciliation
Computer Skills Desired: Proficiency with Microsoft's office desktop solutions (Intermediate Excel a must - Test Scores required), Teams, Outlook, SharePoint, SAP or other accounting technology a plus.
Preferred Certifications: N/A
Additional Knowledge or Skills to be Successful in this role: Typing, 10 Key desired
Monster Energy provides a competitive total compensation. This position has an estimated hourly rate of $17.00 - $23.00 per hour. The actual pay may vary depending on your skills, qualifications, experience, and work location.
$17-23 hourly 60d+ ago
Adjuster II - LA
Tokio Marine Group 4.5
Claims representative job in Los Angeles, CA
Marketing Statement:
TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
Process and adjust ocean and inland marine claims.
Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
Review survey reports or supporting documentation for determining loss.
Determine whether coverage exists for loss.
Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
Handle tasks that require a high level of organization and attention to detail.
Conclude all settlement agreements.
Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
Such responsibility may include direct recovery handling.
Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
Participate in training seminars and additional technical training courses.
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
College degree preferred
Strong PC skills, including Word and Excel
Strong written and oral communication skills
Auto industry experience preferred
Minimum 3 years claims handling experience.
Ability to work as part of a team
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
$34-47 hourly Auto-Apply 38d ago
Workers' Compensation Claim Rep I (CA Expertise Required)
Ccmsi 4.0
Claims representative job in Irvine, CA
Workers' Compensation ClaimRepresentative I
Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $60,000 to $70,000 annually (dependent on experience)
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified
Great Place to Work
, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking a Workers' Compensation ClaimRepresentative I to support a PEO/Staffing account handling California workers' compensation claims from intake through resolution. This role may be remote or hybrid, reporting to our Irvine, CA branch.
This position is ideal for an early-career adjuster or claims professional with 1-3 years of claims experience-or a related insurance, medical, or legal background-who is ready to grow in a true adjusting role. You'll investigate claims, manage medical and legal activity, communicate with all parties, and deliver consistent, compliant outcomes under guidance and mentorship.
Responsibilities
When we hire adjusters at CCMSI, we look for professionals who understand that every claimrepresents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care.
Investigate and adjust California workers' compensation claims in accordance with CCMSI standards and client handling instructions
Manage claims cradle-to-grave, including compensability decisions, medical management, and resolution strategy
Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim-relatedness
Negotiate disputed medical bills and work toward timely resolution
Authorize and issue claim payments within assigned settlement authority
Communicate with injured workers, employers, attorneys, medical providers, and internal partners
Assist with settlement negotiations in accordance with client authorization
Support the selection and coordination of defense counsel as appropriate
Evaluate and monitor subrogation opportunities
Prepare claim reports, payment summaries, and reserve documentation
Maintain compliance with service commitments, jurisdictional requirements, and excess reporting obligations
Deliver consistent, high-quality claim service aligned with CCMSI's corporate standards
Qualifications
What You'll Bring
1-3 years of workers' compensation claims experience
or
related experience in insurance, medical claims, legal, or adjacent claim-support roles
Working knowledge of the California workers' compensation claims process
Strong organizational, communication, and time-management skills
Ability to prioritize work, meet deadlines, and manage multiple tasks
Reliable, predictable attendance within established client service hours
Preferred
SIP designation or ability to obtain within a defined timeframe
Associate degree or higher
Experience supporting PEO and/or staffing accounts
Proficiency with Microsoft Word, Excel, Outlook, and claims systems
Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
• Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claimrepresents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#NowHiring #WorkersCompensation #WCClaims #WCClaimRep #ClaimsAdjuster
#CaliforniaWorkersComp #CAClaims #CAAdjusters #InsuranceCareers #ClaimsCareers #TPACareers #HybridWork #RemoteJobs #CaliforniaJobs #CareerWithPurpose #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Hybrid #LI-Remote
$60k-70k yearly Auto-Apply 28d ago
Publishing - Content Claiming Specialist
Create Music Group 3.7
Claims representative job in Los Angeles, CA
Create Music Group is currently looking for a Youtube Publishing Administrator to join our Publishing Department. This role is responsible for ensuring complete delivery of our publishing content, as well as maintaining internal systems and metadata to company standards. This is a full-time position located in our Hollywood office.
YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for artists and labels.
REQUIREMENTS:
1-3 years work experience
Excellent communication skills, both written and verbal
Internet culture and social media platforms, especially YouTube
Conducting basic level research
Organizing large amounts of data efficiently
Proficiency with Mac OSX, Microsoft Office, and Google Apps
PLUSES:
Strong understanding of the online video market (YouTube, Instagram, TikTok)
Bilingual - any language, although Spanish, Mandarin, and Russian is preferred
RESPONSIBILITIES:
Watching YouTube videos for several hours daily
Content claiming
Uploading and defining intellectual assets
Administrative metadata tasks
Researching potential clients
Staying on top of accounts for current client roster
You are required to bring your own laptop for this position.
BENEFITS:
Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included.
TO APPLY:
Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste
Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.
$44k-75k yearly est. Auto-Apply 60d+ ago
Public Adjuster I
Allied Public Adjusters Inc.
Claims representative job in Glendale, CA
Job DescriptionOur Company: At Allied Public Adjusters (APA), our North Star is clear: we envision a world where every property loss is settled truthfully and equitably. Since 1997, weve worked on behalf of policyholders to demand whats right using technical expertise, field investigations, and uncompromising quality. We empower policyholders with the most skillful representation, while ensuring that carriers have the information they need to do whats right.
Our team is a dedicated group of professionals committed to ensuring individuals receive fair insurance settlements. We combine licensed expertise with an in-house assortment of legal professionals, construction estimators, accountants, and adjusters. At Allied, were not just about claims; were about people. Join us as we advocate for transparency, equity, and the rightful interests of our community.
Core Values:
We Show Up with G.R.I.T.:
Go-Getters, Relationship Builders, Intelligent Experts, Truth Champions
Every day. In every role. Through every decision and every moment of every engagement. This is the ethos that defines us. So, lets define it for one another.
Role:
APA is currently expanding and is looking for motivated individuals to come onboard as public adjusters. The Public Adjuster I is a professional claims handler who advocates for the policyholder in appraising and negotiating a claimant's insurance claim throughout the claim process. The PA works well in a rapid paced environment, model behaviors that reflect APAs core values and reports to a Managing Public Adjuster. The purpose of a PA I is to develop foundational skills in claims handling, client communication, and documentation while supporting more senior adjusters. The PA I will learn to manage claims with structured guidance.
Responsibilities:
Assist in managing assigned claims with support and guidance
Learn and apply policy interpretation and coverage fundamentals
Promptly handle claims that are assigned, creating a positive client experience
Conduct onsite inspections (with direction or supervision as necessary)
Capture photos and measurements to accurately measure losses
Prepare detailed scope and cost estimates (including using experts when needed)
Investigate claims thoroughly and present strong cases to negotiate settlements for clients.
Follow internal processes, documentation standards, and timelines
Maintain timely client communication and expectations
Draft reports and claim documentation
Properly document claim files pursuant to company standards
Effectively and efficiently utilize support teams such as legal, engineering, and leadership where needed to resolve claims and maximize value for our clients
Be a good team player and assist others where needed. This may include mentoring junior staff members in various situations.
Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
Qualifications:
02 years claims, construction, property, insurance, legal, or related experience
State Public Adjuster License (or ability to obtain)
Strong writing, organization, follow-through, and professionalism
Understanding of the insurance Industry standards, policies applicable laws and regulations
Construction knowledge and experience
Within your first year, you will have:
Built and manage a full and dynamic case load with timely movement on each claim
Achieve strong claim outcomes for clients
Demonstrate relentless advocacy while maintaining professionalism
Maintain excellent communication standards : proactive client updates, clear expectations, well documented outreach
Build trust and strong relationships with clients to produce high client satisfaction and referral feedback
Meet or exceed claim cycle time standards while balancing quality and urgency
Produce audit-ready files with complete documentation
Collaborate effectively with company departments to drive results
Demonstrate strategic, clear intentioned claim critical thinking
Show ownership mentality by treating every claim like it matters in a proactive manner
Demonstrate resilience and persistence, and embrace objections and denials
Contribute positively to the company culture and results
Key Performance Indicators:
Client satisfaction scores
Response & follow-up timeliness
Documentation accuracy
Claim cycle time
Learning progression benchmarks
Financial goals
Benefits:
Salary: $80,000 - 105,000 plus up to 10% bonus
401(k) with 3% non-elective contribution.
Health, dental and vision insurance. Along with voluntary selections as well.
Generous paid holidays and paid time-off.
Opportunities for career advancement and professional growth.
Car and phone allowance, if needed.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
$80k-105k yearly 9d ago
Public Adjuster
The Misch Group
Claims representative job in Los Angeles, CA
Job DescriptionDescriptionPosition: Production Public Adjuster (Licensed) Compensation: $75,000 - $100,000 compensation + Performance-based bonuses QUICK FACTS:
Must have Public Adjuster License
Must have experience with Xactimate
Must have network of Condo, Apartment, Property Management partners
Must be able to physically examine all buildings top to bottom (roofs as well)
About the Company:A well-established, industry-leading public adjusting firm is seeking motivated and driven Outside Sales Representatives to join our growing team. We specialize in advocating for policyholders, ensuring they receive fair settlements for property damage claims. Our sales team plays a critical role in developing strong client relationships and driving company growth.
Position Overview:We are looking for a results-oriented Outside Sales Representative with a strong background in direct-to-consumer (D2C) or business-to-business (B2B) sales. This role requires a motivated self-starter who thrives in building and maintaining client relationships while working in a fast-paced, competitive environment.
Key ResponsibilitiesKey Responsibilities:
Identify and pursue new business opportunities with homeowners, contractors, and referral partners.
Educate prospective clients on our services and guide them through the insurance claims process.
Develop and maintain a pipeline of leads through prospecting and networking efforts.
Conduct presentations and training sessions to build brand awareness and establish partnerships.
Provide exceptional customer service to existing clients, ensuring their satisfaction and retention.
Work closely with internal teams to optimize the sales process and improve closing rates.
Maintain accurate records of sales activities and client interactions.
Skills, Knowledge and ExpertiseQualifications & Experience:
3+ years of proven sales experience as a licensed Public Adjuster
Strong ability to generate leads, manage relationships, and close deals.
Bachelor's degree in Business, Marketing, Communications, or equivalent experience.
Familiarity with CRM tools, Microsoft Office Suite, and digital communication platforms.
Highly organized with strong follow-through skills in a fast-paced environment.
Public Adjuster license
BenefitsWhat We Offer:
Extensive training and support to help you succeed.
Flexible work environment with opportunities for growth and career advancement.
A team-oriented culture with strong leadership and professional development opportunities.
If you're a highly motivated sales professional looking for a rewarding career with a company that makes a difference, apply today!
$75k-100k yearly 14d ago
Adjuster II - LA
Tokio Marine North America, Inc. (TMNA
Claims representative job in Los Angeles, CA
Marketing Statement: TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
* Process and adjust ocean and inland marine claims.
* Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
* Review survey reports or supporting documentation for determining loss.
* Determine whether coverage exists for loss.
* Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
* Handle tasks that require a high level of organization and attention to detail.
* Conclude all settlement agreements.
* Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
* Such responsibility may include direct recovery handling.
* Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
* Participate in training seminars and additional technical training courses.
* Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
* College degree preferred
* Strong PC skills, including Word and Excel
* Strong written and oral communication skills
* Auto industry experience preferred
* Minimum 3 years claims handling experience.
* Ability to work as part of a team
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
$34-47 hourly Auto-Apply 39d ago
Auto Claims Specialist I (Manheim)
Cox Enterprises 4.4
Claims representative job in Riverside, CA
Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $19.90 - $29.81/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program.
Job Description
At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto.
That's where you come in.
We're looking for an Auto Claims Specialist I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details!
Benefits
* We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies.
* We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans.
* How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program.
* 10 days of free child or senior care through your complimentary Care.com membership.
* Generous 401(k) retirement plans with up to 6% company match.
* Employee discounts on hundreds of items, from cars to computers to continuing education.
* Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance.
* Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so.
* We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well.
At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits.
What You'll Do
From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include:
* Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines.
* Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making.
* Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases.
* Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution.
* Uses appropriate levels/limits of financial approval authority to resolve cases.
* Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information.
* Prepares and facilitates communication for resolution via telephone, email, and in-person discussion.
* Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold.
* Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements.
* Engages with supervisor/manager to determine if escalation is required.
* Performs other duties as assigned.
Who You Are
You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications:
Minimum
* A high school diploma or GED and less than 2 years of related experience.
* Accuracy and attention to detail.
* Organizational and time management skills.
* The ability to adapt in a fluid and changing environment.
Preferred
* 1+ years of automotive or body shop experience.
* Claims adjuster experience.
Cox is a great place to be, wouldn't you agree? Apply today!
Drug Testing
To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited.
Benefits
Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave.
About Us
Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.
Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.
$19.9-29.8 hourly Auto-Apply 11d ago
Claims Specialist
TCI Transportation 3.6
Claims representative job in Commerce, CA
Schedule: Full-time | Monday-Friday, 8:00 a.m. - 5:00 p.m. Compensation: Starting $25.00/hour plus quarterly incentives
About Us At TCI, we're committed to delivering outstanding logistics solutions with integrity, teamwork, and innovation. We're seeking a detail-oriented and motivated Claims Specialist to join our team. This is a great opportunity to work in a fast-paced environment where your organizational skills and problem-solving abilities will make a real impact.
Position Overview:
The Claims Specialist is responsible for investigating, evaluating, and resolving claims involving auto, bodily injury, property damage, freight, and subrogation. This role requires direct interaction with claimants, insurance carriers, attorneys, vendors, and internal stakeholders to ensure claims are handled efficiently, fairly, and in compliance with company policies. The claims specialist plays a key role in controlling costs while delivering responsive, customer-focused claims service.
What You'll Do
Investigate and evaluate claims by reviewing incident reports, inspecting damages, interviewing involved parties, and gathering supporting documentation.
Determine liability and damages by assessing coverage, establishing responsibility, and calculating fair settlements for auto, property, bodily injury, and freight claims.
Negotiate and resolve claims with claimants, attorneys, and carriers to reach fair and timely settlements.
Communicate with stakeholders, including insurance carriers, internal departments, and external partners, throughout the claims process.
Manage claim files by documenting all activities, maintaining detailed notes, and ensuring compliance with company requirements.
Work with the team to approve repairs, determine fair market value, and manage asset salvage, disposal, or sale decisions.
Respond to inquiries from claimants, vendors, and internal teams, providing updates and follow-up information.
Prepare reports on claim activity, outcomes, and trends for management review.
Support continuous improvement by identifying opportunities to improve claims handling processes and outcomes.
What We're Looking For
Strong administrative, organizational, and customer service skills.
Excellent written and verbal communication.
Ability to thrive in a fast-paced environment with accuracy and attention to detail.
A team-oriented, flexible, and solution-driven mindset.
High level of confidentiality and professional ethics.
Preferred Skills & Experience
Proficiency in Microsoft Excel, Word, Teams, Adobe, DocuSign, and Outlook
Prior experience in transportation, logistics, or insurance claims adjusting
Familiarity with freight and subrogation claim processes
Why Join Us?
Be part of a dedicated, supportive team in a growing company.
Contribute directly to resolving claims and improving processes.
Work in a culture that values innovation, accountability, and teamwork.
Compensation:
Starting at $25/Hourly plus quarterly incentives
About Us:
We are a family-owned company doing business since 1978.
We are dedicated and committed to safety, each other, and our customers.
Our team is positive and passionate and come to work each day with a "Can Do" attitude. We strive to be creative problem solvers who bring innovative thinking in all our work.
Being ethical, transparent, and accountable has helped shape our team and how we do business. We are looking for more people that match our core values to join our team.
$25 hourly 11d ago
Complex Claims Specialist - Cyber, Technology, Media & Crime
Hiscox
Claims representative job in Los Angeles, CA
Job Type: Permanent Build a brilliant future with Hiscox Put your claims skills to the test and join one of the top Professional Liability Insurers in the Industry as a Complex Claims Specialist! Please note that this position is hybrid and requires working in office two (2) days per week. Position can be based near the following office locations:
* West Hartford, CT (preferred)
* Atlanta, GA
* Boston, MA
* Chicago, IL
* Los Angeles, CA
* Manhattan, NY
About the Hiscox Claims team:
The US Claims team at Hiscox is a growing group of professionals with experience across private practice and in-house roles, working together to provide the ultimate product we offer to the market. Complex Claims Specialists are empowered to manage their claims with high levels of authority to provide fair and fast resolution of claims for our insured and broker partners.
The Role:
The primary role of a Complex Claims Specialist is to analyze liability claim submissions for potential coverage, set adequate case reserves, promptly and professionally respond to inquiries from our customers and their brokers, and to proactively drive early resolution of claims arising from our commercial lines of insurance. This particular role is open to Atlanta and will be focused on servicing claims and potential claims arising from our book of Cyber, Tech PL, Media and/or Crime professional liability lines of business. This is a fantastic opportunity to join Hiscox USA, a growing business where you will be able to make a real impact. Together, we aim to be the best people producing the best insurance solutions and delivering the best service possible.
What you'll be doing as the Complex Claims Specialist:
Key Responsibilities: To perform all core aspects of in-house claims management, including but not limited to:
* Reviewing and analyzing claim documentation and legal filings
* Drafting coverage analyses for tech E&O, first and third party cyber claims
* Strategizing and maximizing early resolution opportunities
* Monitoring litigation and managing local defense and breach counsel
* Attending mediations and/or settlement conferences, either in person or by phone as appropriate
* Smartly managing and tracking third-party vendor and service provider spend
* Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
* Liaising directly on daily basis with insureds and brokers
* Maintaining timely and accurate file documentation/information in our claims management system
Our Must-Haves:
* 5+ years of professional lines claims handling experience
* A JD from an ABA-accredited law school and bar admission in good standing may be considered as a supplement to claims handing experience
* A minimum of 2-3 years professional experience in the area of Cyber and Technology coverage experience required
* Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
* Advanced knowledge of coverage within the team's specialty or focus
* Advanced knowledge of litigation process and negotiation skills
* Excellent verbal and written communication skills
* Advanced analytical skills
* B.A./B.S degree from an accredited College or University, JD degree from an ABA accredited law school is preferred
What Hiscox USA Offers:
* Competitive salary and bonus (based on personal & company performance)
* Comprehensive health insurance, Vision, Dental and FSA (medical, limited purpose, and dependent care)
* Company paid group term life, short-term disability and long-term disability coverage
* 401(k) with competitive company matching
* 24 Paid time off days with 2 Hiscox Days
* 10 Paid Holidays plus 1 paid floating holiday
* Ability to purchase 5 additional PTO days
* Paid parental leave
* 4 week paid sabbatical after every 5 years of service
* Financial Adoption Assistance and Medical Travel Reimbursement Programs
* Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
* Company paid subscription to Headspace to support employees' mental health and wellbeing
* Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program
* Dynamic, creative and values-driven culture
* Modern and open office spaces, complimentary drinks
* Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
About Hiscox USA:
Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.
Today, Hiscox USA has a talent force of about 420 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism.
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)
Salary Range: $125,000- $160,000
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
#LI-RM1
Work with amazing people and be part of a unique culture
$39k-66k yearly est. Auto-Apply 10d ago
Insurance Claims Specialist
Actalent
Claims representative job in Long Beach, CA
We are seeking an Insurance Claim Specialist to support the vehicle fleet for our Field Services Group, for an engineering firm. This role is pivotal in maintaining operational efficiency and asset management within the organization. This role will focus in filing insurance claims for vehicles that have been damaged. Also will setup fuel cards with pin numbers, selling vehicles and purchasing vehicles. Prior experience with a vehicle insurance claim company or submitting vehicle insurance claims is required.
Responsibilities
+ Manage the assignment of equipment such as vehicles, ATVs/UTVs, and PIN numbers.
+ Maintain and update the asset schedule.
+ Assist in asset purchasing when necessary.
+ Submit insurance claims for vehicles.
+ Order transponders, fuel cards, and vehicle registrations as required.
+ Process vendor invoices efficiently.
+ Oversee the sales of company-owned assets.
+ Maintain documentation for vehicles, trailers, and ATVs/UTVs.
+ Manage vehicle registrations and renewals, ensuring communication with relevant staff about requirements.
+ Assist in preparing asset inventory for tracking installations.
+ Update and maintain various databases.
+ Process fuel cards and insurance documentation for new vehicle purchases.
+ Handle incoming mail distribution related to the fleet.
+ Process the cancellation of Telematics devices.
+ Dispatch necessary fleet-related items via FedEx to dealerships or upon driver requests.
Essential Skills
+ Ability to work effectively in with employees who work in the field.
+ Experience submitting insurance claims for vehicles.
+ Skilled in Excel, experience with pivot tables is ideal.
+ Proficiency in Adobe PDF editor or Adobe Acrobat Pro is a plus.
+ Competency in Microsoft Office Suite.
Additional Skills & Qualifications
+ Ability to complete tasks within 24 hours, particularly for urgent matters such as fuel cards and registrations.
+ Maintain a 24-hour response rate for emails to ensure timely communication.
Work Environment
This is a full-time, 40-hour in-office position, operating Monday through Friday from 7:30 am to 4:30 pm. You will work in the office supporting field staff nationally. A company laptop and phone will be provided. The dress code is business casual, allowing jeans without holes.
Job Type & Location
This is a Contract to Hire position based out of Long Beach, CA.
Pay and Benefits
The pay range for this position is $27.00 - $27.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully onsite position in Long Beach,CA.
Application Deadline
This position is anticipated to close on Jan 29, 2026.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
$27-27 hourly 3d ago
Claims Investigator
Apex Investigation
Claims representative job in Riverside, CA
About the Company
For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss.
About the Role
The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports.
This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role.
Key Responsibilities
Case Management & Communication
Receive, review, and manage assigned cases from start to completion.
Communicate professionally with clients, claimants, witnesses, and other involved parties.
Provide timely case updates and correspondence in accordance with company guidelines via CaseLink.
Maintain objectivity and professionalism in all interactions.
Investigative Field Work
Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings.
Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires.
Perform scene and neighborhood canvasses, including walking on varied terrain.
Meet with treating physicians and medical offices as required.
Travel to designated locations, including overnight stays when necessary.
Respond to rush cases within business hours when required.
Documentation & Reporting
Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis.
Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired.
Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements.
Prepare and submit comprehensive investigative reports within 72 hours of final update submission.
Evidence & Records Handling
Retrieve records from agencies and entities both in-person and remotely.
Take clear photographs and video when necessary and label all electronic files accurately.
Securely collect, store, and maintain custody of evidence when required.
Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure.
Additional Responsibilities
Identify and recommend additional investigative services outside the scope of the original assignment when appropriate.
Work overtime as needed to meet case demands and deadlines.
Maintain an efficient, safe, and organized telecommuter workspace.
Physical & Work Environment Requirements
Ability to sit for extended periods performing computer-based work and report writing.
Ability to stand for extended periods while conducting interviews and canvasses.
Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment).
Ability to operate digital audio recording equipment.
Qualifications
Experience with workers' compensation claims and investigative processes.
Strong written and verbal communication skills.
Ability to work independently, manage time effectively, and meet strict deadlines.
Willingness and ability to travel up to (but not limited to) 150 miles per assignment.
Possession of a personal credit card with available balance for reimbursable business expenses.
Proficiency with case management systems; CaseLink experience preferred.
Access to a personal scanner for document upload and record handling.
Preferred Qualifications
Prior experience conducting recorded statements and field investigations.
Experience with process service assignments.
Familiarity with evidence handling and documentation standards.
Background in insurance investigations or a related field.
$44k-60k yearly est. 3d ago
Claims Technician
Insight Global
Claims representative job in Calabasas, CA
Insight Global is currently hiring a Claims Technician for a client located in the Woodland Hills, CA area. This role will start as a 6-month contract, but will have the opportunity for extension or conversion based on performance! The ideal candidate will have at least 6 months to a year of experience in an office environment and strong administrative and computer skills. This position will require working fully onsite M-F during standard work hours! The Claims Assistant is the foundation of the claims process and as such is responsible for performing support activities that meet expected standard process and productivity guidelines. They are part of a team, and as such, is responsible for maintaining professional and positive rapport with all team members to provide quality support to the Claims Department.
Responsibilities
• Complete assigned daily claims support activities timely and accurately (whether as primary or backup role) according to Markel Service Standards. Including but not limited to; setting up first notices of loss according to established guidelines and routing documents and new losses accurately either via email or through document management system.
• Maintain understanding of departmental service standards, guidelines, processes and procedures.
• Strong phone skills necessary - ability to effectively communicate with customers over the phone, ensuring a clear and positive interaction
• Work effectively in a team environment to include participation on projects and testing initiatives.
• Strong PC skills, especially in Word, Excel, Outlook and paperless working environment
• Comfortable with high volume workloads, multiple priorities and productivity standards
$36k-47k yearly est. 18h ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claims representative job in Los Angeles, CA
At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.
About Stout's Forensics and Compliance GroupStout's Forensics and Compliance group supports organizations in addressing complex compliance, investigative, and regulatory challenges. Our professionals bring strong technical capabilities and healthcare industry experience to identify fraud, waste, abuse, and operational inefficiencies, while promoting a culture of integrity and accountability. We work closely with clients, legal counsel, and internal stakeholders to support investigations, regulatory inquiries, litigation, and the implementation of sustainable compliance and revenue cycle improvements.What You'll DoAs an Analyst, you will play a hands-on role in client engagements, contributing independently while collaborating closely with senior team members. Responsibilities include:
Support and execute client engagements related to healthcare billing, coding, reimbursement, and revenue cycle operations.
Perform detailed forensic analyses and compliance reviews to identify potential fraud, waste, abuse, and process inefficiencies.
Analyze and document EMR/EHR hospital billing workflows (e.g., Epic Resolute), including charge capture, claims processing, and reimbursement logic.
Assist in audits, investigations, and litigation support engagements, including evidence gathering, issue identification, and corrective action planning.
Collaborate with Stout engagement teams, client compliance functions, legal counsel, and leadership to support project objectives.
Support EMR/EHR implementations and optimization initiatives, including system testing, data validation, workflow review, and post-go-live support.
Prepare clear, well-structured analyses, reports, and client-ready presentations summarizing findings, risks, and recommendations.
Communicate proactively with managers and project teams to ensure alignment, quality, and timely delivery.
Continue developing technical, analytical, and consulting skills while building credibility with clients.
Stay current on healthcare regulations, payer rules, EMR/EHR enhancements, and industry trends impacting compliance and reimbursement.
Contribute to internal knowledge sharing, thought leadership, and practice development initiatives within Stout's Healthcare Consulting team.
What You Bring
Bachelor's degree in Healthcare Administration, Information Technology, Computer Science, Accounting, or a related field required; Master's degree preferred.
Two (2)+ years of experience in healthcare revenue cycle operations, EMR/EHR implementations, compliance, or related healthcare consulting roles.
Experience supporting consulting engagements, audits, or investigations related to billing, coding, reimbursement, or compliance.
Epic Resolute or other hospital billing system experience preferred; Epic certification a plus.
Nationally recognized coding credential (e.g., CCS, CPC, RHIA, RHIT) required.
Additional certifications such as CHC, CFE, or AHFI preferred.
Working knowledge of EMR/EHR system configuration, workflows, issue resolution, and optimization.
Proficiency in Microsoft Office (Excel, PowerPoint, Word); experience with Visio, SharePoint, Tableau, or Power BI preferred.
Understanding of key healthcare regulatory and compliance frameworks, including CMS regulations, HIPAA, and the False Claims Act.
Willingness to travel up to 25%, based on client and project needs.
How You'll Thrive
Analytical and Detail-Oriented: You are comfortable working with complex data and systems, identifying risks, and drawing well-supported conclusions.
Collaborative and Client-Focused: You communicate clearly, work well in team-based environments, and contribute to positive client relationships.
Accountable and Proactive: You take ownership of your work, manage priorities effectively, and deliver high-quality results on time.
Adaptable and Curious: You are eager to learn new systems, regulations, and methodologies in a fast-paced consulting environment.
Growth-Oriented: You seek feedback, develop your technical and professional skills, and build toward increased responsibility.
Aligned with Stout Values: You demonstrate integrity, professionalism, and a commitment to excellence in all client and team interactions.
Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.
en/careers/benefits
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.
Stout is an Equal Employment Opportunity.
All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.
Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.
A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - en/careers/benefits.
$35k-44k yearly est. 4d ago
Public Adjuster I
Allied Public Adjusters Inc.
Claims representative job in Newport Beach, CA
Job DescriptionOur Company: At Allied Public Adjusters (APA), our North Star is clear: we envision a world where every property loss is settled truthfully and equitably. Since 1997, weve worked on behalf of policyholders to demand whats right using technical expertise, field investigations, and uncompromising quality. We empower policyholders with the most skillful representation, while ensuring that carriers have the information they need to do whats right.
Our team is a dedicated group of professionals committed to ensuring individuals receive fair insurance settlements. We combine licensed expertise with an in-house assortment of legal professionals, construction estimators, accountants, and adjusters. At Allied, were not just about claims; were about people. Join us as we advocate for transparency, equity, and the rightful interests of our community.
Core Values:
We Show Up with G.R.I.T.:
Go-Getters, Relationship Builders, Intelligent Experts, Truth Champions
Every day. In every role. Through every decision and every moment of every engagement. This is the ethos that defines us. So, lets define it for one another.
Role:
APA is currently expanding and is looking for motivated individuals to come onboard as public adjusters. The Public Adjuster I is a professional claims handler who advocates for the policyholder in appraising and negotiating a claimant's insurance claim throughout the claim process. The PA works well in a rapid paced environment, model behaviors that reflect APAs core values and reports to a Managing Public Adjuster. The purpose of a PA I is to develop foundational skills in claims handling, client communication, and documentation while supporting more senior adjusters. The PA I will learn to manage claims with structured guidance.
Responsibilities:
Assist in managing assigned claims with support and guidance
Learn and apply policy interpretation and coverage fundamentals
Promptly handle claims that are assigned, creating a positive client experience
Conduct onsite inspections (with direction or supervision as necessary)
Capture photos and measurements to accurately measure losses
Prepare detailed scope and cost estimates (including using experts when needed)
Investigate claims thoroughly and present strong cases to negotiate settlements for clients.
Follow internal processes, documentation standards, and timelines
Maintain timely client communication and expectations
Draft reports and claim documentation
Properly document claim files pursuant to company standards
Effectively and efficiently utilize support teams such as legal, engineering, and leadership where needed to resolve claims and maximize value for our clients
Be a good team player and assist others where needed. This may include mentoring junior staff members in various situations.
Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
Qualifications:
02 years claims, construction, property, insurance, legal, or related experience
State Public Adjuster License (or ability to obtain)
Strong writing, organization, follow-through, and professionalism
Understanding of the insurance Industry standards, policies applicable laws and regulations
Construction knowledge and experience
Within your first year, you will have:
Built and manage a full and dynamic case load with timely movement on each claim
Achieve strong claim outcomes for clients
Demonstrate relentless advocacy while maintaining professionalism
Maintain excellent communication standards : proactive client updates, clear expectations, well documented outreach
Build trust and strong relationships with clients to produce high client satisfaction and referral feedback
Meet or exceed claim cycle time standards while balancing quality and urgency
Produce audit-ready files with complete documentation
Collaborate effectively with company departments to drive results
Demonstrate strategic, clear intentioned claim critical thinking
Show ownership mentality by treating every claim like it matters in a proactive manner
Demonstrate resilience and persistence, and embrace objections and denials
Contribute positively to the company culture and results
Key Performance Indicators:
Client satisfaction scores
Response & follow-up timeliness
Documentation accuracy
Claim cycle time
Learning progression benchmarks
Financial goals
Benefits:
Salary: Salary: $80,000- 105,000 annually plus up to 10% bonus
401(k) with 3% non-elective contribution.
Health, dental and vision insurance. Along with voluntary selections as well.
Generous paid holidays and paid time-off.
Opportunities for career advancement and professional growth.
Car and phone allowance, if needed.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
$80k-105k yearly 9d ago
Auto Claims Specialist I (Manheim)
Cox Enterprises 4.4
Claims representative job in Anaheim, CA
Company Cox Automotive - USA Job Family Group Vehicle Operations Job Profile Arbitrator I Management Level Individual Contributor Flexible Work Option No remote option; must work at a specified Cox location Travel % No Work Shift Day Compensation Hourly base pay rate is $19.90 - $29.81/hour. The hourly base rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's knowledge, skills, and abilities. Position may be eligible for additional compensation that may include commission (annual, monthly, etc.) and/or an incentive program.
Job Description
At Manheim (a Cox Automotive company), we strive to make sure every customer is completely satisfied when they do business with us. On the off-chance we fall short, we do our best to make things right, pronto.
That's where you come in.
We're looking for an Arbitrator I to learn the ropes of resolving customer complaints and ensuring we don't make the same mistake again. Do you have the skills we're looking for? Keep reading for more details!
Benefits
* We all have lives and responsibilities outside of work. We have an exceptional work/life balance at Cox, with accommodating work schedules and flexible time-off policies.
* We show our appreciation for our talent with a competitive salary package and top-notch bonus & incentive plans.
* How does a great healthcare benefits package from day one sound? Multiple options are available for individuals and families. One employee-only plan could be FREE, if you participate in our health screening program.
* 10 days of free child or senior care through your complimentary Care.com membership.
* Generous 401(k) retirement plans with up to 6% company match.
* Employee discounts on hundreds of items, from cars to computers to continuing education.
* Looking to grow your family? You'll have access to our inclusive parental leave policies, plus comprehensive fertility coverage and adoption assistance.
* Want to volunteer in your community? We encourage that, and even offer paid hours for you to do so.
* We all love our pets-whether they walk, crawl, fly, swim or slither-and we're happy to supply insurance for them as well.
At Cox, we believe in being transparent - please click on this link (Cox Benefits Overview) to learn more about our amazing benefits.
What You'll Do
From your very first day on the job, you'll receive guidance and coaching so you can learn the ropes. You'll work with everyone from buyers to sellers to dealers in coordinating and validating customer returns and claims. With Guidance, responsibilities include:
* Reviews customer claims to verify that they meet Manheim's National Arbitration policies and any account-specific guidelines.
* Investigates basic, less complex cases (e.g., late title claims, basic condition report claims, vehicle availability, post-sale inspection fails, mechanical/structural/undisclosed vehicle damage, etc.) or those requiring more prescriptive decision-making.
* Interfaces with all departments involved in the complaint (i.e., reconditioning, front office, dealer services, vehicle entry, etc.), including during the fact finding and investigative phases.
* Uses appropriate resources to investigate and facilitate relevant inspection, documentation, and communication to ensure appropriate actions are completed to move cases forward or to resolution.
* Uses appropriate levels/limits of financial approval authority to resolve cases.
* Evaluate claims by obtaining, comparing, evaluating, and validating various forms of information.
* Prepares and facilitates communication for resolution via telephone, email, and in-person discussion.
* Mediates disputes and negotiates repair and/or pricing of disputed vehicles to arrive at a mutually acceptable solution and to keep vehicles sold.
* Monitors and maintains accurate files for each arbitration case, verifying the accuracy of all required documentation, including invoices and settlement agreements.
* Engages with supervisor/manager to determine if escalation is required.
* Performs other duties as assigned.
Who You Are
You've got a knack for negotiation. You're ethical, dependable, and trustworthy. You're eager to learn. You also have the following qualifications:
Minimum
* A high school diploma or GED and less than 2 years of related experience.
* Accuracy and attention to detail.
* Organizational and time management skills.
* The ability to adapt in a fluid and changing environment.
Preferred
* 1+ years of automotive or body shop experience.
* Claims adjuster experience.
Cox is a great place to be, wouldn't you agree? Apply today!
Drug Testing
To be employed in this role, you'll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited.
Benefits
Employees are eligible to receive a minimum of sixteen hours of paid time off every month and seven paid holidays throughout the calendar year. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave.
About Us
Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells - or simply uses - cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer - All qualified applicants/employees will receive consideration for employment without regard to that individual's age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.
Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. No OPT, CPT, STEM/OPT or visa sponsorship now or in future.
How much does a claims representative earn in Lynwood, CA?
The average claims representative in Lynwood, CA earns between $31,000 and $59,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Lynwood, CA
$43,000
What are the biggest employers of Claims Representatives in Lynwood, CA?
The biggest employers of Claims Representatives in Lynwood, CA are: