Claims representative jobs in Maryland - 199 jobs

We have an immediate opening in our home office located in Hanover, Maryland. This inside position is responsible for conducting liability and coverage investigations, bodily injury and property damage evaluations, as well as successfully negotiating the settlement of first and third party injury and property damage claims. Qualifications: Qualified applicants should have 2 to 5 years of experience adjusting automobile accident claims. Bachelor's Degree or equivalent industry experience. Attention to detail and ability to multi-task. Excellent communication, organizational, and customer service skills. A high degree of motivation and team orientation. Proficiency with property damage estimates. PC experience with knowledge of Word, Excel, and Outlook.

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.

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 1 **What Is the Opportunity?** LOCATION REQUIREMENT: This field position services Insureds/Agents in the Prince George County, MD area. The selected candidate must reside in the assigned territory. Ideal locations include Upper Marlboro, Bowie, Laurel, MD. *You will be issued a company vehicle for this position.* Travelers' Claim Organization is at the heart of our business by providing assurance to our customers during life's rainy days. As an Associate Claim Rep, Outside Property, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage 1st party property claims. This program is typically 9-12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. This position is based remotely with work at residential and commercial locations with a combination of mobile work, work from your primary residence, or the nearest Travelers office. As part of the hiring process, this position will require 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. **What Will You Do?** + Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. + Review, investigate, and document 1st party property claims under close supervision. + Gather information from policyholders, claimants, witnesses, and third-party providers. + Learn to investigate and evaluate all relevant facts and information (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact). Determine and apply coverage for building damages per policy terms. + Establish accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Provide timely and professional communication to customers, claimants, and internal stakeholders. + Maintain accurate records of claim activity in claim management systems. + Demonstrate openness to continuous learning, particularly in AI and digital transformation. + Adapt to new technology implementations, system upgrades, and digital tool rollouts while maintaining productivity and service quality. + Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job. + This position requires participation in our Catastrophe Response Program, which could include deployment to assist our customers in other states. + This position requires the individual to access and inspect all areas of a dwelling or structure, which is physically demanding requiring the ability to carry, set up and climb a ladder weighing approximately 38 to 49 pounds, walk on roofs, and enter tight spaces (such as attic staircases and entries, crawl spaces, etc.). 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?** + Previous internship or work experience in customer service or insurance. + Strong attention to detail and organizational skills. + Ability to manage multiple tasks and prioritize effectively. + Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. + Ability to exercise sound judgement and make effective decisions. + Strong verbal and written communication skills with the ability to convey information clearly and professionally. + Basic conflict resolution skills with willingness to learn advanced techniques for facilitating productive discussions and negotiations. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree. + Valid driver's license. **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 ******************************************************** .

As a Senior Claims Specialist, you will manage 3rd party claims, providing technical guidance, support analytics, and liaise with TPAs, legal, and clients in the claims review process. You will be specifically be responsible for managing and overseeing claims in captive insurance programs. Captive insurance refers to a form of self-insurance where a company creates its own insurance company to cover its risks. In this role, you will work closely with clients, insurance brokers, and underwriters to ensure timely and accurate claims handling. Your Impact: Review and assess claims submitted by clients within captive insurance programs. Investigate and gather necessary information to determine the validity of claims. Collaborate with internal teams, external vendors, and legal counsel to resolve complex claims issues. Negotiate settlements and manage claims payments in accordance with policy terms and conditions. Provide guidance and support to junior claims specialists in handling claims effectively. Monitor claims trends and provide recommendations for process improvements to enhance efficiency and customer satisfaction. Maintain accurate claims records and documentation in compliance with regulatory requirements. Successful Candidates Will Have: Bachelor's degree in Insurance, Risk Management, Business Administration, or related field. Minimum of 5 years of experience in claims management, preferably in captive insurance or a related industry. Strong knowledge of insurance policies, coverage terms, and claims handling procedures. Excellent analytical and problem-solving skills with attention to detail. Effective communication and negotiation skills to interact with various stakeholders. Ability to work independently and prioritize tasks in a fast-paced environment. Professional certifications such as CPCU, AIC, or ARM are a plus. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, the firm serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and 5,300 employees across the US and Canada. Industry recognition includes being named a Best Places to Work in Insurance for five consecutive years (2018-2022) and to the Inc. 5000 list as one of America's Fastest Growing Private Companies. Risk Strategies is committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: $64,800 - $110,000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

At Banner Life Insurance Company, we lead with heart and ambition. Every day, we transform purpose into progress, guided by our unwavering commitment to be better for our customers, clients, and communities, not just today but long-term as well. Our people are the driving force behind everything we achieve. Their passion, purpose, and pursuit of innovation empower us to deliver cutting-edge solutions that support those we serve, ensuring we are here for you, here for good and striving for better. We're a forward-thinking company energized by our work and how we show up for one another. Our culture is built on meaningful impact and genuine enjoyment, because we believe great work and great experiences should go hand in hand. By offering career development opportunities, comprehensive benefits, and programs that support your wellbeing, we help you thrive personally and professionally. We are here for you, here for good and here for better. The Claims Representative is responsible for the set up, research, review and processing of non-contestable claims and live rescissions within established productivity and quality standards. Complete all other claims related tasks to meet or exceed pre-defined productivity and quality standards. Complete other administrative duties and projects as directed by management. Responsibilities 1. Review and process live rescissions within established productivity and quality standards. 2. Prepare written communication to insureds regarding rescission of in force life insurance policies. 3. Set up, research, review and process non-contestable claims within established productivity and quality standards. 4. Review company records to confirm insurance coverage. 5. Review all beneficiary and title changes and collateral assignments for correctness and generate appropriate correspondence in accordance with state insurance regulations requesting appropriate claim requirements. 6. Open claims files according to departmental procedure. 7. Notify reinsurers of newly filed death claims. 8. Evaluate documentation submitted for processing of claim and confirm eligibility for payment utilizing knowledge of estates, trusts, minor beneficiary requirements, divorce statutes and other regulatory requirements. If documentation is insufficient, request correct or additional requirements needed in order to give the claim further consideration. 9. Correspond and communicate with claimants, attorneys, agents, reinsurers and other company departmental staff to discuss and/or resolve matters relevant to effective claims administration, including competing claim issues. 10. Review progress and status of pending claims with management and discuss problems and suggested solutions. 11. Follow up on all pending non-contestable claims within established regulatory requirements. 12. Follow established escheat procedures on pending claims review and run public records database searches as needed. 13. Process claim on administrative systems using the appropriate Post Mortem Interest statutes, dividend calculations, and contract provisions to reflect settlement or payment of claim to the appropriate party. 14. Send disbursement correspondence and document file reflecting interest and payment amount. 15. Document all activity to support claim file 16. Answer phones and respond to correspondence pertaining to the initial notification of death. 17. Keep abreast of “red flags” for fraud and identify potential issues to prevent payment of fraudulent claims including foreign death requirements. 18. Complete form 712's as needed. 19. As required, bill reinsurer for their share of the liability and update appropriate system. Communicate with reinsurers as needed on problem cases. 20. Keep abreast of claims related regulatory requirements. 21. Operate in a team environment and support other team members to enhance overall productivity. 22. Complete all other projects and tasks assigned by management. Qualifications Education High School diploma or equivalent Some college preferred Experience/Knowledge 1-2 years of experience in life or health claims or customer service/administrative position preferred. Skills Typing 35 WPM Proficiency in spreadsheet and word processing software Detail oriented Strong organization skills Outstanding verbal and written communication skills Superior customer service skills Good problem solving and negotiation skills Product knowledge and ability to understand basic contract language Good analytical skills Ability to work in a fast-paced environment Knowledge of Microsoft Office (Word and Excel) What's in it for you? The expected hiring compensation range for this position is $48,500 - $55,000 annually. This position is remote, operating on EST. The total compensation package for this position may include other elements, such as a sign-on bonus, long term incentives, and annual bonuses. This role is eligible to participate in the Annual Incentive Plan. The current target payment for the position is 3% of base salary, modified for corporate and individual performance. Bonuses are pro-rated based on start date. This role has 10 vacation days and 10 sick days that are accrued on a bi-weekly basis. Employees also have 9 paid holidays throughout the calendar year . We have a competitive compensation and benefits package focused on your overall wellbeing. Employee benefits include health, life, and dental insurance; 401K with company match up to 6% as well as a pension package; generous time off; and wellbeing initiatives throughout the year (we like doing fun stuff). We're big on professional development and we'll support and mentor you in your career progression and expect you to help us pay it forward by helping us develop tomorrow's leaders and growth-focused professionals. We value our teams and our communities and believe in giving back. Enjoy time off to volunteer for those causes that matter most to you! If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors. The Company reserves the right to change benefits plans at any time. We are an equal opportunity employer and value diversity at our company. We do not discriminate based on race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment. Please contact us to request accommodation.

As a Senior Claims Specialist, you will manage 3rd party claims, providing technical guidance, support analytics, and liaise with TPAs, legal, and clients in the claims review process. You will be specifically be responsible for managing and overseeing claims in captive insurance programs. Captive insurance refers to a form of self-insurance where a company creates its own insurance company to cover its risks. In this role, you will work closely with clients, insurance brokers, and underwriters to ensure timely and accurate claims handling. Your Impact: Review and assess claims submitted by clients within captive insurance programs. Investigate and gather necessary information to determine the validity of claims. Collaborate with internal teams, external vendors, and legal counsel to resolve complex claims issues. Negotiate settlements and manage claims payments in accordance with policy terms and conditions. Provide guidance and support to junior claims specialists in handling claims effectively. Monitor claims trends and provide recommendations for process improvements to enhance efficiency and customer satisfaction. Maintain accurate claims records and documentation in compliance with regulatory requirements. Successful Candidates Will Have: Bachelor's degree in Insurance, Risk Management, Business Administration, or related field. Minimum of 5 years of experience in claims management, preferably in captive insurance or a related industry. Strong knowledge of insurance policies, coverage terms, and claims handling procedures. Excellent analytical and problem-solving skills with attention to detail. Effective communication and negotiation skills to interact with various stakeholders. Ability to work independently and prioritize tasks in a fast-paced environment. Professional certifications such as CPCU, AIC, or ARM are a plus. Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, the firm serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and 5,300 employees across the US and Canada. Industry recognition includes being named a Best Places to Work in Insurance for five consecutive years (2018-2022) and to the Inc. 5000 list as one of America's Fastest Growing Private Companies. Risk Strategies is committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues. Pay Range: $64,800 - $110,000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role. Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: ******************************** Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.

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.

Since 1991, Collabera has been a leading provider of IT staffing solutions and services. We are known for providing the best staffing experience and taking great care of our clients and employees. Our client-centric model provides focus, commitment and a dedicated team to help our clients achieve their business objectives. For consultants and employees, we offer an enriching experience that promotes career growth and lifelong learning. Position Details: Industry: Financial Services Work Location: Hunt Valley, MD Job Title: Claims Analyst (Level II) Duration: 6+ months (Strong possibility of extension) Available Shift/s: • 11:00 am - 8:00 pm; Saturday, Monday, Tuesday, Thursday, Friday Job Description: • Receives incoming calls and assists customers with questions or issues regarding potential billing dispute and/or fraudulent related activity on their credit card account. • Takes appropriate action based on an evaluation of the customer's needs which may include, filing a new claim(s), updating and follow-up on existing claim(s), and/or reviewing appeals on denied claims. • Takes personal ownership to ensure that customer requests are processed quickly and efficiently, while maintaining compliance with industry regulations and bank procedures. • Responsibilities include but are not limited to: initiating claims using multiple systems and tools, providing first call resolution on inquiries, and may assist the customer in resolving disputes directly with the merchant. • May debit or credit customer's accounts, as appropriate. • May research and resolve other general customer account inquiries as appropriate and/or escalate issues on the customer's behalf while providing world class customer service. • Understand and adhere to established service level agreements and set appropriate expectation with the clients and customers regarding the claims process. Job Requirements: • Ideal candidate will have credit card knowledge in a customer service contact center. Qualifications MUST HAVE claims and/or customer service (call center environment) experience. Knowledge with credit card in a customer service contact center. Flexible with the work schedule.

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources. How you will contribute: * Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim * The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions * Maintain claim block and meet departmental production and quality metrics * An awareness of industry claim practices * Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records * Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. * Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process * Establish cooperative and productive relationships with professional resources What you will bring with you: * Bachelor's degree preferred * A minimum of three to five years' experience processing first dollar medical claims or stop loss claim processing * Demonstrated ability to work as part of a cohesive team * Strong written and verbal communication skills * Knowledge of Stop Loss Claims and Stop Loss industry preferred * Demonstrated success in negotiation, persuasion, and solutions-based underwriting * Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism * Overall knowledge of health care industry * Proficiency using the Microsoft Office suite of products * Ability to travel Salary Range: $54,900 - $82,400 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email ************************* to request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Job Category: Claims - Life & Disability Posting End Date: 30/01/2026

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 $18.22 - $27.36/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. 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! 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: 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.

The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. The Senior Claims Specialist may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads. This role is remote. Grade 13-14 blended role handling all claims segments. Workers compensation experience should be residing in Maryland. Responsibilities: Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages; determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. Refers to claim to subrogation group or Special Investigations Unit as appropriate. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company. Acts as senior technical professional on team, assisting team members with escalated issues. Mentors and trains new team members. Participates in Quality Review process. Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews. Performs other duties as assigned. Qualifications Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required. Demonstrated leadership ability and time management skills to delegate work appropriately and organize resources effectively. Demonstrates an expert level knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state`s tort laws as normally acquired through a bachelor`s degree or equivalent training plus 4 to 6 years directly related work experience (at least two of which should ordinarily be in a team leader capacity). Licensing required in some states. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco

CENCO is a trusted claims solutions provider, working with leading insurance carriers to deliver timely and accurate claims handling. We are currently seeking a Daily Claims Adjuster in the Baltimore, MD area to support residential property claims. This opportunity is ideal for adjusters looking for consistent daily assignments with the flexibility of independent field work. What You'll Do: Complete on-site inspections for residential property losses, including wind, hail, fire, and storm-related damage Document damages thoroughly with clear photos and detailed reports Write accurate estimates using Xactimate or Symbility Communicate effectively with policyholders, contractors, and carrier partners Manage claim files efficiently while meeting carrier timelines and expectations What We're Looking For: Licensing: Active Maryland adjuster license or designated home state license Software Experience: Working knowledge of Xactimate or Symbility Equipment: Reliable vehicle, ladder, laptop, and standard adjusting tools Work Style: Detail-oriented, self-motivated, and comfortable working independently Responsiveness: Ability to accept assignments promptly and meet reporting deadlines Why Work with CENCO? Consistent residential claim volume in the Baltimore market Competitive per-claim compensation with dependable payment Support from an experienced claims team and streamlined workflows Long-term opportunities for steady daily work If you're seeking reliable daily residential claims work in the Baltimore area and want to partner with a company known for professionalism and support, we'd love to connect.

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.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-AR1 #LI- Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best. We are looking for a Claims Specialist - Auto to join our team. JOB SUMMARY Investigate, evaluate and settle more complex first and third party commercial insurance auto claims. JOB RESPONSIBILITIES Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Communicates with all relevant parties and documents communication as well as results of investigation. Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts. Travel is required to attend customer service calls, mediations, and other legal proceedings. JOB REQUIREMENTS High School Diploma; Bachelor's degree from a four-year college or university preferred. 10 plus years related experience and/or training; or equivalent combination of education and experience. • National Range : $82,800.00 - $97,300.00 • Ultimate salary offered will be based on factors such as applicant experience and geographic location. 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. Benefits: We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online. Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************

Capstone ISG is one of the nation's fastest growing Independent Adjustment firms. As we continue to grow our business, we are looking for people who offer inspiration and innovation, as well as have an internal drive. Our team members are focused on customer service and are dedicated to making Capstone a fun and rewarding place to work. Our Field Property Adjuster specializes in investigating and adjusting residential and commercial property claims. Our focus is high quality claim investigation and resolution. We're seeking a conscientious individual with high attention to detail, excellent decision-making, ability to work well under pressure, solid organizational and time management skills to balance diverse tasks including on site investigations in a standard work day. 5+ Years Experience in and around the Baltimore Area.IA Experience is preferred Benefits Include: Competitive salary with annual raises Quarterly performance bonuses Profit Sharing Medical, Dental, Vision 401 (k) Short and Long Term Disability Life Insurance Sick, Vacation and Holiday Pay Fitness Membership Reimbursement Company paid training Primary Responsibilities: Conducts field investigations to resolve residential and commercial property claims. Examines and applies claims forms, policies and endorsements, client instructions and other records to determine coverage and client exposure. Adjusts all elements of Property Loss claims of varying levels of severity and complexity. Sets loss reserves. Prepares written reports by collecting and summarizing information required by client. Prepares settlement letters, denial letters, Reservations of Rights and other letters as needed. Maintains expected case load. Maintains company reputation and integrity of work product by complying with federal and state regulations and service standards. Maintains professional and technical knowledge through continuing education. May assist less-experienced adjusters with claims handling when requested Participates in special projects or performs duties in other areas if requested. Documents damage and prepares written estimates using Xactimate software. Handles content inventories to include moderate to complex pricing analysis and prepares claim inventory reports. Conducts subrogation investigations. Engages and manages consultants/independent contractors to assist in determining facts, causation, damage and exposure. Keeps the client and the insured informed about the claim status with clear, timely and accurate written/oral communication. Negotiates settlement of claims of varying complexity under the direction of the Claims Manager or Supervisor. Travels to loss locations in assigned territory Records time and expense charges to bill clients. Maintains adjuster license(s) when required. Requirements Requires a high school diploma; advanced education beyond high school preferred or an equivalent combination of education and experience. Previous experience as a claims adjuster or must complete Capstone specified adjuster training if no experience. If previous adjuster experience, working knowledge of Xactimate is preferred. Must be licensed, or have the ability to obtain license(s), as required by state and local jurisdictions to adjust insurance claims. Must have valid driver's license. Skills and Competencies: Ability to work in a high volume, fast paced environment managing multiple tasks. Ability to provide excellent service to policyholders and clients. Ability to efficiently operate a computer and related claims and business software. Effective analytical and problem-solving skills necessary to make decisions and resolve conflict Good verbal and written communication skills. Good attention to detail. Strong analytical and mathematical ability. Ability to work independently in a virtual environment when required. Good organizational and time management skills. Physical Demand Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this position, auto travel is required. Ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a vehicle. Ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics. Ability to work in a confined or restricted area. Kneeling, crouching, crawling, standing, sitting, walking, pushing, pulling, etc. as is required to inspect claims. Ability to work outdoors, exposed to all weather conditions.

The Claims Analyst will perform a variety of "changes and claims" related contract administration tasks. An ideal candidate requires experience in transit projects through design, construction and commissioning phases. The Claims Analyst will be responsible for coordinating and reviewing claims / changes and engaging, strategizing, and working with various Program / Project teams to undertake the merit assessment, mitigation, and resolution of claims. The role requires commercial claim knowledge, and preferably also technical understanding, of multiple subject areas related to implementation of a large transit infrastructure projects. Responsibilities Maintain claims and early warnings' register. Review alleged claims. Carry out initial triage and risk assessment of claims. Review project correspondence, and track and report on project claims. Interface with the contractor and other stakeholders, as required, to gather additional details etc. Attend various technical and commercial project working group meetings. Requirements Required Skills: Critical thinking skills sufficient to apply analytical techniques to assess claims. The ability to liaise effectively and to work closely with various multi-disciplinary technical and project controls teams Proficiency with Microsoft Office Suite, particularly Excel. Strong organization, time management, and prioritization skills with proven ability to balance competing tasks and meet deadlines. Self-directed, detail-oriented, excellent at meeting deadlines with well-developed time management skills. Excellent communication (both written and verbal), teamwork, and interpersonal skills. Required Qualifications: Bachelor's degree in engineering, business or other relevant degree. 1 - 4 years of relevant experience Position Location Field: Hybrid - 2 or 3 days in program office

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Covered California Claims (CCA) Manager, the CCA Claims Specialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The Claims Specialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * Telecommute schedule * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Life, short-term, and long-term disability options * Career advancement opportunities and professional development * Wellness programs that promote a healthy work-life balance * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims * Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred * High school diploma or GED required * Associate's degree from an accredited institution preferred Key Qualifications * ICD-9/ ICD-10 and CPT coding and general practices of claims processing * CMS/DMHC and Affordable Care Act regulations and guidelines * Commercial line of business specifically Covered California/Exchange * Excellent communication and interpersonal skills * Excellent analytical, critical thinking, customer service, and organizational skills * Ability to think critically with the capacity to work independently * All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $25.90 USD Hourly - $33.02 USD Hourly

**Aerotek has an immediate opening for a Claims Review Specialist (Workers Compensation) at the corporate office in Hanover, MD.** Reporting to the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and administering of Aerotek's workers compensation program to ensure the maximum cost containment. Seek to ensure that Third Party Administrator (TPA) is managing claims efficiently. **ESSENTIAL FUNCTIONS** + Conducts and properly document all incident /accident investigations into our RIMIS system. Ensures the TPA thoroughly and properly investigates all initial claims. Monitor to ensure that TPA follows appropriate state workers compensation laws and defenses + Within the scope of authority, reviews and authorizes worker's compensation settlement offers to be made by the TPA + Effectively monitors medical and disability claim authorizations and payments to ensure their appropriate and accurate + Reviews costs associated with all claims handling and develops strategies to improve performance + Works with TPA to move claims toward closure + Partners with Safety, Human Resources and Corporate Legal to drive claims management + Makes appropriate referrals to outside vendors such as defense attorneys, nurse case managers and investigator + Collect OSHA data and update OSHA field in GRA + Coordinates the colleague's release to transitional duty with the Return to Work Specialist and the Field Office; + Obtains evidence in contested and/or litigated claims to assist outside attorneys to defend claim and to prepare for trial + Initiates subrogation where appropriate with management's authorization + Prepares for and attends Claim Review Conference with TPA to evaluate individual cases; reviews, and adjusts financial reserves of claims; negotiates with TPA the settlement of claims within established authority and work together to develop detailed and doable Plans of Actions + Review reserves and provide authorization to TPA, where appropriate within authority + Reviews performance of external vendors in the areas of claims administration, manages litigation and make recommendation to Workers Compensation Compliance Supervisor for adjustments + Monitors and reviews workers compensation claims and the claims processing; identifies claims management trends and inefficiencies and make recommendation as needed + Participates in developing strategies to reduce claims frequency and severity + Establishes and maintains a file and diary on all open claims + Participates in communicating claims trends to Regional Safety Manager + Working with Compliance Supervisor to develop and conduct training to field offices regarding workers compensation issues and process + Attends training sessions, conferences and workshops to keep abreast of current practices, programs and legal issues for the purpose of conveying and/or gathering information required to perform functions + Authority level for settlements up to $70,000 + Authority level for reserves up to $80,000 **QUALIFICATIONS** + High School Diploma required + 3 years work experience in insurance, workers compensation claim management or risk management or + Ability to learn TPA system & generate requested reports Per Pay Transparency Acts: The range for this position is $60,000 - $80,000 + annual bonus potential of $4,000 Benefits are subject to change and may be subject to specific elections, plan, or program terms. This role is eligible for the following: Medical, dental & vision 401(k)/Roth Insurance (Basic/Supplemental Life & AD&D) Short and long-term disability Health & Dependent Care Spending Accounts (HSA & DCFSA) Transportation benefits Employee Assistance Program Tuition Assistance Time Off/Leave (PTO, Primary Caregiver/Parental Leave) Connect With Us! (********************************************************************************************************************************************************** Cookie Notice (***************************************** Cookie Settings Privacy Notices (******************************************* CA Notice at Collection CA Notice at Collection (for Employees and Job Applicants) (************************************************************************************ Your Privacy Choices Our People Are Everything. Aerotek Inc. provides staffing and services solutions in manufacturing, logistics, construction, aviation, facilities and maintenance. We provide the expertise, solutions and people required to rise to the challenges of North American industry. Headquartered in Hanover, Md., Aerotek operates a unified network of over 200 offices across North America, supporting more than 14,000 clients each year. Aerotek is an operating company within Allegis Group, a global leader in talent solutions. To learn more, visit: Aerotek.com . The company is an equal opportunity employer and will consider all applications without regards 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 process due to a disability, please call ************ or email accommodation@aerotek.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position. **Job ID** _2026-13045_ **Category** _Risk & Compliance_ **Location : Location** _US-MD-Hanover_