Claims representative jobs in Massachusetts - 217 jobs
Casualty Claims Adjuster
The Jacobson Group 4.9
Claims representative job in Hingham, MA
Responsibilities:
Conduct in-depth investigations into complex bodily injury claims, determining coverage, establishing liability, and evaluating damages by analyzing medical records, police reports, and witness statements.
Develop and execute effective negotiation strategies to achieve fair and timely settlements with claimants, attorneys, and other parties.
Manage litigated files, including developing defense strategies, communicating with legal counsel, and attending mediations, arbitrations, and trials as necessary.
Maintain meticulous and accurate claim file documentation in compliance with company standards and regulatory requirements.
Provide exceptional customer service, guiding insureds and claimants through complex claim processes with professionalism and empathy.
Candidate & SkillsTop 3-5 Skills:
5 + years of direct experience handling casualty claims, with a strong focus on bodily injury (BI) claims across various lines (Auto, Homeowners, Commercial).
Proven ability to investigate, analyze, and evaluate complex BI claims, including understanding medical terminology and injury causation.
Solid understanding of insurance policies, relevant state laws, and the litigation process.
Strong negotiation and conflict resolution skills, with a track record of successful settlements.
Takes ownership of files, even when litigation is involved.
Soft Skills:
Exceptional communication (verbal and written), interpersonal, and customer service skills.
Ability to work independently, manage a challenging caseload, and make sound judgments.
Strong analytical, problem-solving, and decision-making abilities.
Meticulous attention to detail and excellent organizational skills.
An eagerness to learn, adapt, and embrace new technologies
Ability to work effectively both independently and as part of a supportive team.
Certifications/Licenses/Education:
Active Adjuster License in CT, MA, RI - willing to get additional licenses as needed (company to assist)
A bachelor's degree is preferred, or equivalent work experience.
Pay Range:
$80,000-$100,000
We understand salary is an important factor in your job search and encourage you to apply even if your desired compensation falls outside this range. The final rate is determined based on several factors including relevant experience, education, certifications, and market conditions.
Benefits:
Our comprehensive benefits package includes:
o Medical insurance
o Dental insurance
o Vision insurance
o 401(k) retirement savings plan
Contact:
Justine Haley
************************
Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!
Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at ********************* or ***************** to make a request.
$80k-100k yearly 3d ago
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Auto Claims Representative
Beacon Hill 3.9
Claims representative job in Boston, MA
Auto ClaimsRepresentative to $47K - Lauch Your Career!
Our client, a leading insurance organization, is seeking an Auto ClaimsRepresentative to manage automobile property damage claims while delivering exceptional customer service. As part of a growth-oriented training program, you'll investigate claims, assess liability, and ensure timely resolution.
Position Details:
Location: Boston, MA
Work Model: Hybrid
Degree: Preferred
Responsibilities include analyzing policy provisions to determine coverage; investigating auto accidents and gathering documentation; negotiating and settling claims within authority limits; maintaining accurate records and follow-up systems; coordinating with vendors and internal teams to resolve disputes; initiating subrogation processes when applicable; and managing phone and email communications to ensure timely updates.
The ideal candidate possesses strong organizational and multitasking skills; excellent verbal and written communication abilities; proficiency in Microsoft Office Suite; ability to handle sensitive situations with professionalism; and a customer-focused mindset with adaptability to manage multiple priorities.
Enjoy a role that offers comprehensive benefits, long-term career growth, and a supportive team environment committed to your success!
Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply.
California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
If you would like to complete our voluntary self-identification form, please click here or copy and paste the following link into an open window in your browser: *****************************************
Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for reporting purposes only and will be kept separate from all other records.
Company Profile:
Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement.
Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.
Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting *************
Benefits Information:
Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.
We look forward to working with you.
Beacon Hill. Employing the Future (TM)
$47k yearly 4d ago
Analyst, Healthcare Medical Coding - Disputes, Claims & Investigations
Stout 4.2
Claims representative job in Boston, MA
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.
$36k-43k yearly est. 5d ago
Medicare Advantage and DSNP Claims Analyst
Massachusetts Eye and Ear Infirmary 4.4
Claims representative job in Somerville, MA
Site: Mass General Brigham Health Plan Holding Company, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Responsible for extracting knowledge and insights from data in order to investigate business/operational problems through a range of data preparation, modeling, analysis, and/or visualization techniques.
Essential Functions
-Collects, monitors and analyzes Medicare Advantage and D-SNP Claims reporting to ensure timeliness, accuracy and compliance internally to support decisions on day-to-day operations, strategic planning, and/or specific business performance issues.
-Reviews, tracks, and communicates key performance indicators (KPIs) related to regulatory compliance, timeliness, and accuracy.
-Performs data validation of source-to-target data for data visuals and dashboards.
-Creates and updates claim reports.
-Collates, models, interprets, and analyzes data.
- Identifies trends and explains variances and trends in data, recommends actions, and escalates to leaders as appropriate.
-Identifies and documents enhancements to modeling techniques.
-Completes thorough quality assurance procedures, ensuring accuracy, reliability, trustworthiness, and validity of work.
-Provides audit support, both internal and external, which includes supporting the monthly Claims Compliance Monitoring and Organization Determination, Appeals, and Grievances (ODAG/ODR) reporting processes for all Medicare Advantage and D-SNP contracts.
-Works closely with internal departments, including but not limited to Enrollment, Customer Service, Reimbursement Strategy, Benefits, Product, Configuration, IT, and Digital Services to ensure seamless coordination and integration for claims data analysis.
-Collaborate with vendor partners to monitor and analyze claims reporting.
-Identifies operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member and provider satisfaction.
-Assist with the implementation and management of new medical health plan products or changes to existing plans.
-Support the creation and maintenance of medical health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
-Performs other duties as assigned
-Complies with all policies and standards
Qualifications
Education
Bachelor's Degree required; experience can be substituted for degree
Experience
At least 2-3years of medical claims processing and/or data analysis within the health insurance or healthcare industry experience required
Medicare experience required.
Massachusetts Medicaid experience required.
Knowledge, Skills, and Abilities
Healthcare knowledge, particularly as it pertains to medical claims processing data, is preferred but not required.
Working knowledge of relational databases, SQL, Power BI, data visualization, and business intelligence tools such as Tableau.
Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred.
Project management skills and/or experience are a plus.
Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint.
Additional Job Details (if applicable)
Working Conditions
This is a remote role that can be done from most US states
This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 5:00 pm
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$62,400.00 - $90,750.40/Annual
Grade
6
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement:
8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
$62.4k-90.8k yearly Auto-Apply 15d ago
Senior Casualty Claims Representative
Berkley 4.3
Claims representative job in Massachusetts
Company Details
Acadia Insurance is a regional property casualty insurer with offices throughout the Northeast. As a member of W.R. Berkley Corporation (NYSE: WRB), one of the largest property casualty insurance holding companies in the United States, our financial strength and integrity are two of the main reasons why Independent Agents place business with us. Acadia is rated A+ (Superior) by A.M. Best, with an A+ claim paying ability rating by Standard & Poor's.
At Acadia, we value our employees, our customers and our communities. Employees at Acadia are part of a progressive company where everyone can make a difference. We promote an inclusive environment which encourages continuous learning and the chance to grow and develop.
Company URL: ********************************
Responsibilities
Ideal candidates will have 5 or more years of experience in adjusting commercial liability claims, with a proven record of increasing responsibility, appropriate claim outcomes and excellent customer service, along with demonstrated ability to:
Investigate, evaluate and resolve commercial casualty claims in accordance with company standards, procedures, and state regulatory requirements. Claims handled may include General Liability bodily injury and property damage, Commercial Automobile bodily injury including Uninsured/Underinsured Motorist claims, pollution and environmental exposures, construction defect, product liability bodily injury and property damage, employment-related practices claims and other types of commercial exposures.
Analyze and interpret commercial policy language in conjunction with specific facts of loss to reach appropriate coverage decisions, and effectively communicate the company's coverage position verbally and in writing.
Compose a variety of other written communications to insureds, claimants, attorneys and agents in a professional and error-free manner.
Conduct detailed, comprehensive claim investigations including on-site scene examinations and in-person witness interviews; attend mediations, depositions and trials, both virtually and in-person.
Evaluate and document damages to ensure accurate and timely reserves; immediately escalate to management cases with significant exposure.
Negotiate effectively and in good faith to achieve fair and accurate claim settlements.
Proactively manage litigated claim files from inception to closure, including collaboration with defense counsel to determine and execute an appropriate plan of action; bring litigated cases to resolution either by negotiated settlement or trial, as appropriate.
Retain experts and vendors to achieve appropriate claim outcomes while remaining mindful of loss adjustment expenses.
Manage assigned workloads effectively to achieve quality and quantity production goals while providing superior customer service.
Effectively present cases in roundtable discussions with peers and members of management at all levels.
Appropriately and clearly document all notes and file activity in a paperless claim system; compose detailed periodic reports including claim summary reports and large loss notifications.
Communicate with other departments regarding developments on specific claim files as well as overall claim trends relevant to Acadia's business.
Maintain a strong relationship and frequent communication with Acadia's agency partners.
Serve as a mentor and technical resource for trainees and less-experienced claim professionals.
Work proficiently with various computer programs including MS Word, Excel, and other applications used in the claim handling process.
Attend internal and external seminars and other training events and provide feedback to peers and/or members of management.
Obtain all required state adjuster licenses and maintain them as needed by complying with continuing education requirements.
Pursuit of industry-related professional designations is encouraged.
Perform other duties as assigned.
Qualifications
Education
Bachelor's degree (B. A.) and minimum of 5-7 years of related experience and/or training; or equivalent combination of education and experience.
Qualifications
5-7 years of commercial liability claims.
Excellent organizational skills, ability to handle multiple tasks and effectively prioritize workload.
Demonstrated depth in negotiation and claims resolution skills.
Strong computer skills and ability to work with multi-faceted systems.
Ability to effectively and independently manage complex workload while exhibiting very sound judgment.
Excellent written and verbal communication skills.
Demonstrated ability to develop and maintain relationships with agents and other departments while exemplifying superior teamwork.
Advanced professional insurance coursework (i.e., AIC, CPCU) or completion of other insurance-related classes is preferred.
Valid driver's license required.
The Company is an equal employment opportunity employer.
Additional Company Details We do not accept unsolicited resumes from third party recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees including:
• Base Salary Range: 80k-$110k
• Eligible to participate in annual discretionary bonus
• Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Sponsorship Details Sponsorship not Offered for this Role Not ready to apply? Connect with us for general consideration.
$110k yearly Auto-Apply 4d ago
Outside Property Claim Representative
The Travelers Companies 4.4
Claims representative job in Falmouth, MA
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
$67,000.00 - $110,600.00
Target Openings
1
What Is the Opportunity?
Under moderate supervision, this position is responsible for the handling of first party property claims including: investigating, evaluating, estimating and negotiating to ensure optimal claim resolution for personal or business claims of moderate severity and complexity. Handles claims and other functional work involving one or more lines of business other than property (i.e. auto, workers compensation, premium audit, underwriting) may be required. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
This position services a territory in Southeastern, South Shore and Cape Cod areas of Massachusetts . The selected candidate must either reside in or be willing to relocate at his or her own expense to the assigned territory.
What Will You Do?
* Handles 1st party property claims of moderate severity and complexity as assigned.
* Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates.
* Broad scale use of innovative technologies.
* Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies. Secures recorded or written statements as appropriate.
* Establishes timely and accurate claim and expense reserves.
* Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
* Negotiates with multiple constituents, i.e.; contractors or insured's representatives and conveys claim settlements within authority limits.
* Writes denial letters, Reservation of Rights and other complex correspondence.
* Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
* Meets all quality standards and expectations in accordance with the Knowledge Guides.
* Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
* Manages file inventory to ensure timely resolution of cases.
* Handles files in compliance with state regulations, where applicable.
* Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
* Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
* Identifies and refers claims with Major Case Unit exposure to the manager.
* Performs administrative functions such as expense accounts, time off reporting, etc. as required.
* Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
* May provides mentoring and coaching to less experienced claim professionals.
* May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
* CAT Duty ~ This position will require participation in our Catastrophe Response Program, which could include deployment away for a minimum of 16 days (includes 2 travel days) to assist our customers in other states.
* Must secure and maintain company credit card required.
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* On a rotational basis, engage in resolution desk technical work and resolution desk follow up call work.
* 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?
* Bachelor's Degree.
* General knowledge of estimating system Xactimate.
* Two or more years of previous outside property claim handling experience.
* Interpersonal and customer service skills - Advanced.
* Organizational and time management skills- Advanced.
* Ability to work independently - Intermediate.
* Judgment, analytical and decision making skills - Intermediate.
* Negotiation skills - Intermediate.
* Written, verbal and interpersonal communication skills including the ability to convey and receive information effectively -Intermediate.
* Investigative skills - Intermediate.
* Ability to analyze and determine coverage - Intermediate.
* Analyze, and evaluate damages -Intermediate.
* Resolve claims within settlement authority - Intermediate.
* Valid passport.
What is a Must Have?
* High School Diploma or GED.
* One year previous outside property claim handling experience or successful completion of Travelers Outside ClaimRepresentative training program.
* 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 *********************************************************
$67k-110.6k yearly 6d ago
Outside Property Claim Representative - West Bridgewater, MA
Msccn
Claims representative job in West Bridgewater, MA
ATTENTION MILITARY AFFILIATED JOB SEEKERS
- Our organization works with partner companies to source qualified talent for their open roles. The following position is available to
Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers
. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
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.
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
What Is the Opportunity?
This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence.
What Will You Do?
Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel.
The on the job training includes practice and execution of the following core assignments:
Handles 1st party property claims of moderate severity and complexity as assigned.
Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates.
Broad scale use of innovative technologies.
Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate.
Establishes timely and accurate claim and expense reserves.
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
Negotiates and conveys claim settlements within authority limits.
Writes denial letters, Reservation of Rights and other complex correspondence.
Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools.
Meets all quality standards and expectations in accordance with the Knowledge Guides.
Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures.
Manages file inventory to ensure timely resolution of cases.
Handles files in compliance with state regulations, where applicable.
Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners.
Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit.
Identifies and refers claims with Major Case Unit exposure to the manager.
Performs administrative functions such as expense accounts, time off reporting, etc. as required.
Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed.
May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Must secure and maintain company credit card required.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
In order to progress to ClaimRepresentative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards.
This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position
Perform other duties as assigned.
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience.
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic.
Verbal and written communication skills -Intermediate.
Attention to detail ensuring accuracy - Basic.
Ability to work in a high volume, fast paced environment managing multiple priorities - Basic.
Analytical Thinking - Basic.
Judgment/ Decision Making - Basic.
Valid passport.
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.
$52.6k-86.8k yearly 26d ago
Claim Representative
A.I.M. Mutual Insurance Companies 4.1
Claims representative job in Burlington, MA
Ask Yourself This... Are you someone who thrives working in a fast-paced environment? Do you enjoy providing support to others?
Then join us as a ClaimRepresentative
in Burlington, MA!
What You'll Do
This fast-paced, highly rewarding entry-level position is all about helping people with a focus on customer service, and is the first point of contact when a worker is injured at work. The ClaimRepresentative handles the claim process from beginning to end; working closely with injured workers, employers, doctors, insurance companies, as well as co-workers in other departments within the company. The ClaimRepresentative manages the claim process and treatment plans, with the goal of getting an injured worker back on the job as soon as possible.
This position offers a hybrid working schedule after an initial training period.
We're looking for someone that:
has a college degree,
has experience in a call center or customer service environment,
can organize and prioritize workflows and meet company/industry deadlines,
is self-motivated and once trained, able to work with little direction, and
has or is willing to pursue a professional insurance designation.
At A.I.M. Mutual Insurance Companies, we are committed to building a diverse and inclusive workplace, and we believe that all people are capable of great things. So, if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway!
Who We Are
At A.I.M. Mutual Insurance Companies, we are committed to setting the standard in service excellence. We are guided by our founding principles to help employers effectively manage their workers' compensation program, providing quality services to injured workers and creating safe workplaces. We are one of the largest regional workers' compensation specialists, and we credit our staff for putting their service-oriented work ethic and workers' compensation insurance knowledge into practice, every day, in all they do.
What we do
...
We provide a workers' compensation experience that ensures peace of mind for all.
Why we do it
...
To protect and support the well-being of all New England workers and their families.
How we do it
...
Listening with empathy
Acting with compassion
Doing the right thing
Succeeding through collaboration
We proudly offer robust compensation and benefits packages, including:
35-hour work week
Summer hours June through September
Competitive pay, with opportunities to advance
Medical, dental, vision plans and pet insurance
Employer-sponsored retirement plan with matching employer contribution
Tuition reimbursement
Company-paid life and disability insurance
Paid time off and generous holiday time
A.I.M. Mutual has also earned the 2024 Best Place for Working Parents business designation.
At. A.I.M. Mutual, we recognize the importance of having a highly experienced staff to meet day-to-day customer needs. Come be a part of a great team of people that strives to surpass customer expectations every day. Working for A.I.M. Mutual is not just a job, it's a career.
Thank you for your interest in joining the A.I.M. Mutual Insurance team!
$39k-52k yearly est. 3d ago
Associate Claims Representative, Desk
Plymouth Rock 4.7
Claims representative job in Boston, MA
Responsibilities: * Timely investigation of lower exposure First Party Property claim losses for Homeowners Property Claim Department * Proactive communication and setting of accurate claims length expectations * Conducting accurate coverage analysis and damage assessments to ensure prompt payment of claims in accordance with quality standards
* Writing estimates for related damage, provide customers scope of loss and cost of repairs
* Assign, direct and oversee vendors conducting mitigation and/or inspection during the adjustment of homeowners' property claim
* Identify subrogation potential and liability exposures
* Establish timely and appropriate claim reserves in accordance with claim standards
* Ability to Adjust homeowner's property claims in all states in which Plymouth Rock writes business.
* Appropriately represent the company by executing a high level of service and maintaining professionalism at all times
* Requires Consistent Oversight by Direct Supervisor
* Low Authority Levels
Qualifications:
* Ability to obtain licensed in applicable states in which Plymouth Rock does business
* Bachelor's Degree from an accredited four-year college or university is preferred
* Excellent oral and written communications skills
* Ability to multitask and adapt to changes quickly
* Capability to identify and address customer's needs to ensure an outstanding experience on every interaction
* Capacity to work in a fast-pace supporting the rapid growth of our customer base
* Be a self-motivated individual to meet & exceed goals
* Proficient in the use of Microsoft Office
* No prior claims experience necessary
Salary Range:
The pay range for this position is $47,000 to $66,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
Benefits & Perks:
* Paid time off
* Free onsite gym at our Boston location
* Tuition reimbursement
* Low cost and excellent health insurance coverage options that start on Day 1 (medical, dental, vision)
* Robust health and wellness programs
* Auto and home insurance discounts
* Matching donation opportunities
* Annual 401(k) employer contribution
* Various Paid Family leave options including Paid Parental Leave
* Resources to promote professional development
* Convenient locations and pre-tax commuter benefits
About the Company
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of "A-/Excellent".
#LI-SM1
$47k-66k yearly Auto-Apply 60d+ ago
Field Claims Representative - Massachusetts
Concord General Mutual Insurance Company 4.5
Claims representative job in Westborough, MA
Our role as a Senior Field ClaimsRepresentative will be responsible for the investigation, evaluation and settlement of assigned claims involving 1st Party Homeowner and Commercial Property claims. This role is a field-based position and will require travel to loss sites to evaluate the damages. This also includes special investigation activities with an emphasis on investigating possible fraudulent activity.
This is a field based position, travel will be required within Central/Eastern Massachusetts, with occasional travel to other areas as required.
Responsibilities
Field appraise losses of all types for both personal lines and commercial lines claims
Take loss reports directly from insureds and/or claimants and/or their representatives.
Appropriately handle incoming correspondence on assigned claim files.
Investigate assigned claims - confirm coverage - verify damages.
Effectively handle portions of claim investigations principally through on-site investigations, as warranted.
Evaluate and settle assigned claims based upon the results of the investigation.
A strong ability to work independently.
Other related duties as assigned by supervisor including but not limited to aiding during CATs or other unusual spikes in claim volume.
Requirements
Bachelor's degree preferred or several years of direct experience
5-7 years of experience handling Property Claims; Commercial Lines experience a plus.
Strong understanding of personal and commercial lines policy forms and coverage analysis.
Multi-line adjuster's license as required in our operating territories.
Demonstrated proficiency in writing detailed structural cost of repair/replacement estimates in Xactimate estimating system and proficient in PC Windows environment.
Demonstrated proficiency in investigating, evaluating and settling contents claims.
Excellent understanding and skill level of claim handling and customer service.
Possess or has ability to timely secure and maintain required multiline adjuster licenses. Knowledge of policy contracts, insurance laws, regulations, and the legal environment in which we operate.
Outside/Field Adjusters - ability to view damages and prepare estimates based on their inspection of the damaged property.
Benefits
At The Concord Group, we're proud to offer a comprehensive benefits package designed to support the wellbeing of our associates. This includes medical, vision, dental, life insurance, disability insurance, and a generous paid time off program for vacation, personal, sick time, and holiday pay. Additional benefits include parental leave, adoption assistance, fertility treatment assistance, a competitive 401(k) plan with company match, gym member/fitness class reimbursement, and additional resources and programs that encourage professional growth and overall wellness.
Why Concord Group Insurance
Since 1928, The Concord Group has been protecting families and small businesses across New England with trusted, personal insurance solutions. The Concord Group is a member of The Auto Owners Group of Companies and is recognized as a leading insurance provider through the independent agency system. Rated A+ (Superior) by AM Best, the company is represented by more than 550 of the best local independent agents throughout Maine, Massachusetts, New Hampshire, and Vermont.
At Concord Group, we believe in more than just insurance, we believe in our people. Our associates thrive in a supportive, collaborative workplace where community involvement, professional growth, and shared values drives everything we do.
Starting your career with The Concord Group means joining a team that values people first and gives you the opportunity to grow, give back, and make a lasting difference in the lives of those we serve.
Compensation
We are dedicated to fair and competitive total compensation package that supports the wellbeing and success of our associates. In addition to this, we offer other components like bonus opportunities. For this position, the anticipated annualized starting base pay range is: $60,000 - $80,000.
Equal Employment Opportunity
The Concord Group is an equal opportunity employer and hires, transfers, and promotes based on ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state, or local law.
The Concord Group participates in E-Verify
$60k-80k yearly Auto-Apply 39d ago
General Liability Claims Adjuster II
Delhaize America 4.6
Claims representative job in Quincy, MA
Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.
Position Summary
Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.
Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.
Applicants must be currently authorized to work in the United States on a full-time basis.
Principle Duties and Responsibilities:
Claims Management
* Manage caseload within established targets and appropriate level. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
* Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
* Analyze facts of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines.
* Identify fraud indicators and actively pursue subrogation opportunities.
* Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
* Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.
Financial Impact Administration
* Manage book of claims business (up to $ 2million) with authority to settle/negotiate a single claim within their authority of up to $25,000.
* Communicate ongoing causes of incidents to Safety and Brands.
* Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.
Basic Qualifications:
* Licensed adjuster (as appropriate by jurisdiction)
* Bachelor's degree or experience handling General Liability claims or equivalent expertise.
* Thorough knowledge of rules, regulations, statutes, and procedures pertaining to general liability claims.
* Knowledge of medical terminology involved in complex claims
* Negotiates resolution of claims of various exposure and complexity
Skills and Abilities:
* Demonstrates relationship building and communication skills, both written and verbal.
* Highly self-motivated, goal oriented, and works well under pressure.
* Customer focused solid understanding of legal procedures, processes, practices and standards in the handling of general liability claims
* Ability to identify problems and effectuate solutions
* Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail
* Able to apply critical thinking when solving problems and making decisions.
ME/NC/PA/SC Salary Range: $63,440-$95,160
IL/MA/MD/NY Salary Range: $72,880 - $109,320
Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.
#LI-SM1 #LI-Hybrid
At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent.
Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies.
Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work.
We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.
$72.9k-109.3k yearly 60d+ ago
Senior Claims Compliance Analyst
Hiscox
Claims representative job in Boston, MA
Job Type: Permanent Build a brilliant future with Hiscox Please note that this position is hybrid and requires work in office a minimum of two (2) days per week. Position can be based at our following hub office locations: * Atlanta, GA * Boston, MA * Chicago, IL
* Manhattan, NY
* Scottsdale, AZ
* West Hartford, CT
The US Claims Compliance and Quality Assurance team at Hiscox is a growing group of professionals with operational and technical experience. The team serves as a claims technical resource, as well as provides assistance and expertise across Hiscox by identifying and promoting claims best practices and facilitating required improvements. We foster consistency, calibration, and continuous improvement in the handling of Hiscox claims. Our team is quite diverse, and you will be able to demonstrate that you can flex your work and delivery style to accommodate different stakeholders.
You'll play a critical role in safeguarding our organization from regulatory risk. This is a high-impact role suited for an experienced insurance claims compliance professional or attorney, with deep knowledge of insurance claims regulations, processes, and technology. This role is ideal for someone who can translate risk into actionable strategy and build sustainable compliance practices as Hiscox USA grows.
Key Responsibilities
* Manage and maintain 50-state claims database
* Monitor legislation, DOI bulletins, court reporters/decisions, and statutory changes; manage backlog and implement targeted compliance training
* Develop and own controls related to Medicare, OFAC, Child Support Lien Network, and other federal protocols
* Partner with Claims Technical, US Legal, and IT to design controls and workflows aligned with regulatory requirements
* Lead US Claims response to regulatory inquiries and complaints
* Deliver training and legal support to internal teams and vendors
* Develop audit programs and dashboards to monitor compliance effectiveness
* Oversee/support technology-related compliance integrations
* Provide executive reporting, trends analysis, and regulatory insights
Qualifications
* 10+ years of experience in claims compliance, insurance regulation, or legal operations
* J.D. highly desired
* Degree in law, risk management, or a related field; required
* Advanced insurance compliance certifications a plus (CPCU, CIPP, CAMS, CRCM, or similar) Scrum/PMP a plus but not required
* Deep understanding of claims handling regulations, Medicare protocols, and market conduct standards
* Experience with multiple lines of business in a 50-state claims environment
* Knowledge of Medicare Secondary Payer requirements and Section 111 reporting
* Strong research and policy writing skills
* Excellent collaboration, project management, and problem-solving skills
* Experience with regulatory audit preparation and response
Compensation: $90,000-$140,000 based on experience
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.
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 several major cities - New York, Atlanta, Chicago, West Hartford, and Scottsdale. 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.
What We Offer:
* 401(k) with competitive company matching
* Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
* Company paid group term life, short- term disability and long-term disability coverage
* 24 Paid time off days plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 5 PTO days
* Paid parental leave
* 4-week paid sabbatical after every 5 years of service
* Financial Adoption Assistance and Medical Travel Reimbursement Programs
* Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
* Company paid subscription to Headspace to support employees' mental health and wellbeing
* 2024 Gold level recipient of Cigna's Healthy Workforce Designation for having a best-in-class health and wellness program
* Dynamic, creative and values-driven culture
* Modern and open office spaces, complimentary drinks
* Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance).
#LI-AJ1
Work with amazing people and be part of a unique culture
$90k-140k yearly Auto-Apply 11d ago
Experienced Multi-Line Adjuster
Geico 4.1
Claims representative job in Boston, MA
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Multi-Line Property Damage Adjuster -In Massachusetts and surrounding area
Salary: Starting pay rate varies based upon position and location. Ask your Recruiter for details!
We are looking for a highly motivated and service-oriented individual to join our Multi-line Damage team as a Multi-line Property Damage Adjuster! As an ambassador for GEICO's renowned customer service, you will work in a dynamic environment that may include repair shops, salvage yards, a customer's home or in a virtual estimating environment. You will be responsible for inspecting damage, estimating cost of repairs, negotiating settlements, issuing payments, and providing excellent customer service. This position primarily will include servicing boat, motorcycle, RV and other specialty claims.
Qualifications & Skills:
Valid driver's license (must meet company underwriting guidelines for at least the past 3 consecutive years) and the ability to maintain applicable state and federal certifications and permits
Willingness to be flexible with primary work location - position may require either remote or in-office work
Solid computer, mechanical aptitude, and multi-tasking skills
Effective attention to detail and decision-making skills
Ability to effectively communicate, verbally and in writing, and willingness to expand on these abilities
Minimum of high school diploma or equivalent, college degree or currently pursuing preferred
Annual Salary
$36.63 - $57.49
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$36.6-57.5 hourly Auto-Apply 60d+ ago
Senior Claims Representative
Liberty Mutual 4.5
Claims representative job in Westborough, MA
Are you looking for an opportunity to join a claims team with a fast growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As a Commercial Insurance ClaimsRepresentative, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual.
The preference is for the candidates to be located close to a hub and be in the office a minimum of 2 days/week (Hubs: Plano, TX, Suwanee, GA, Westborough, MA, Hoffman Estates, IL, Indianapolis, IN) although candidates from any location will be considered. Please note this policy is subject to change.
Responsibilities:
Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
Determines and negotiates settlement amount for damages claimed within assigned authority limits.
Writes simple to moderately complex property damage estimates or review auto damage estimates.
Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed.
Qualifications
Bachelor's Degree preferred. High school diploma or equivalent required.
1-2 years of experience. Claims handling skills preferred.
Strong customer service and technology skills.
Able to navigate multiple systems, strong organizational and communication skills.
License may be required in multiple states by state law.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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$94k-150k yearly est. Auto-Apply 6d ago
Senior Commercial Bodily Injury Claims Examiner
King's Insurance Staffing 3.4
Claims representative job in Massachusetts
Our client, a leading insurance carrier, is looking to hire a Commercial Bodily Injury Claims Examiner to their New England team. This crucial role involves managing complex claims in both bodily injury and casualty, ensuring accurate, fair, and legally compliant resolutions. The ideal candidate will bring a strong background in insurance carrier operations, with extensive experience in claims evaluation and settlement negotiations. Key Responsibilities:
Investigate and evaluate Commercial Liability and Bodily Injury claims to determine liability and estimate damages.
Negotiate settlements and manage litigation efficiently, ensuring timely and equitable outcomes.
Analyze detailed information, including medical records, accident reports, and legal statements to assess claims accurately.
Advise on coverage issues and contribute to the development of claims handling policies.
Mentor junior adjusters and provide expert guidance on complex claims scenarios.
Maintain comprehensive records of all claim activities, ensuring all documentation is accurate and up-to-date in the claims management system.
Ensure compliance with all regulatory and internal guidelines during the claims process.
Requirements:
5 - 10+ years of experience handling Commercial or Personal Lines Bodily Injury claims.
Experience working for an insurance carrier is preferred.
Active adjuster license is a plus.
Strong negotiation skills with a proven track record of resolving claims effectively.
Exceptional analytical and problem-solving abilities.
Proficiency in claims management software and Microsoft Office.
Bachelor's degree highly preferred.
Salary & Benefits:
$80,000 to $110,000+ annual base salary plus Bonus
Generous PTO
Opportunity to work remotely.
Competitive 401k Employer Matching Contributions
Comprehensive benefits package including health, dental, and vision coverage.
Opportunities for advancement and professional growth.
Supportive and inclusive team environment.
$80k-110k yearly 58d ago
Medicare Advantage and DSNP Claims Analyst
Brigham and Women's Hospital 4.6
Claims representative job in Somerville, MA
Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Responsible for extracting knowledge and insights from data in order to investigate business/operational problems through a range of data preparation, modeling, analysis, and/or visualization techniques.
Essential Functions
* Collects, monitors and analyzes Medicare Advantage and D-SNP Claims reporting to ensure timeliness, accuracy and compliance internally to support decisions on day-to-day operations, strategic planning, and/or specific business performance issues.
* Reviews, tracks, and communicates key performance indicators (KPIs) related to regulatory compliance, timeliness, and accuracy.
* Performs data validation of source-to-target data for data visuals and dashboards.
* Creates and updates claim reports.
* Collates, models, interprets, and analyzes data.
* Identifies trends and explains variances and trends in data, recommends actions, and escalates to leaders as appropriate.
* Identifies and documents enhancements to modeling techniques.
* Completes thorough quality assurance procedures, ensuring accuracy, reliability, trustworthiness, and validity of work.
* Provides audit support, both internal and external, which includes supporting the monthly Claims Compliance Monitoring and Organization Determination, Appeals, and Grievances (ODAG/ODR) reporting processes for all Medicare Advantage and D-SNP contracts.
* Works closely with internal departments, including but not limited to Enrollment, Customer Service, Reimbursement Strategy, Benefits, Product, Configuration, IT, and Digital Services to ensure seamless coordination and integration for claims data analysis.
* Collaborate with vendor partners to monitor and analyze claims reporting.
* Identifies operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member and provider satisfaction.
* Assist with the implementation and management of new medical health plan products or changes to existing plans.
* Support the creation and maintenance of medical health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
* Performs other duties as assigned
* Complies with all policies and standards
Qualifications
Education
* Bachelor's Degree required; experience can be substituted for degree
Experience
* At least 2-3years of medical claims processing and/or data analysis within the health insurance or healthcare industry experience required
* Medicare experience required.
* Massachusetts Medicaid experience required.
Knowledge, Skills, and Abilities
* Healthcare knowledge, particularly as it pertains to medical claims processing data, is preferred but not required.
* Working knowledge of relational databases, SQL, Power BI, data visualization, and business intelligence tools such as Tableau.
* Knowledge and application of statistical analyses, including variance analysis and statistical significance, are preferred.
* Project management skills and/or experience are a plus.
* Proficiency with Microsoft Office Suite, including Word, Excel and PowerPoint.
Additional Job Details (if applicable)
Working Conditions
* This is a remote role that can be done from most US states
* This role is 40 hours/week with five 8-hour days, with a typical schedule of 8:30 am to 5:00 pm
Remote Type
Remote
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$62,400.00 - $90,750.40/Annual
Grade
6
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement:
8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
$62.4k-90.8k yearly Auto-Apply 14d ago
Analyst (Graduate Hire 2026) - Medical (Boston)
Prescient Healthcare Group
Claims representative job in Boston, MA
Analyst (Graduate Hire 2026) - Medical Important Dates: * Application Deadline: February 13, 2026 * Start Date Range: August - September 2026 Application & Recruitment Process As part of your application, please submit a cover letter addressing the questions below.
Candidates who do not submit a cover letter with responses to these questions will not be considered.
Cover Letter Questions:
* Why are you interested in Prescient Healthcare Group? What attracted you to this role?
* What are your top three attributes that will make you a successful consultant?
* How many times have you practiced a case with a peer?
* What interests you most about working in the life sciences and pharmaceutical industry, and how have your academic experiences, internships, or other relevant exposure prepared you for this role?
Recruitment Timeline:
* February 16- February 27: Selected candidates will complete an introductory interview with a member of our Talent Acquisition team
* February 27: All candidates will be notified of next steps.
* March 4th: Final in-person assessment day (behavioral + case interviews)
To ensure availability, candidates are encouraged to tentatively block March 4th for the in-person interview day.
About You
Do you have a passion for:
* Understanding tomorrows emerging therapeutic areas?
* Unlocking the full potential of new therapies and shaping successful future therapies?
* Understanding why healthcare professionals and patients behave the way they do, and applying this to medical, clinical, and commercial strategies?
* Are you a highly motivated professional interested in being part of a new and exciting team, working with global healthcare and pharmaceutical clients across the full product life cycle?
About Prescient Healthcare Group (PHG)
Our goal is a simple one: we solve exciting, real-world pharma challenges that ultimately make a meaningful difference in patients' lives.
PHG is a unique global biopharma, insight-led strategy consultancy. Our core focus is helping biopharmaceutical clients create clinical and commercial strategies that deliver groundbreaking new treatments for patients.
With offices in ten major cities across the world, we are a truly global enterprise and are still growing fast, offering our people endless opportunities, supporting rapid personal and professional development.
We work with industry leading companies across the full product life cycle, to help them unlock the full potential of their brands.
About the Opportunity
The role will be varied, giving you the opportunity to develop and hone new skills whilst improving your knowledge of the healthcare industry. You will receive exposure to a broad mix of projects - varied therapeutic areas, a range of client sizes, and domestic vs. global reach. This will enable you to get the experience to decide if you want to take a more specialized route as your career progresses. Our onboarding and training program will provide the support and development you need to hit the ground running; a mix of formal classroom training, shadowing colleagues on projects and 'on the job' coaching will equip you with the capabilities you need to succeed at Prescient.
Key Responsibilities:
* Exhibit high degrees of professionalism across each aspect of working life, demonstrating respect, integrity and support for colleagues and in our interactions with clients
* Take pride in and full responsibility for meeting high levels of performance in work process and output; take charge of own professional development and proactively seek opportunities for growth
* Demonstrate a strong willingness to learn and a 'can-do' attitude; showcase ability to gain expert status on a new topic and create an impact within the team and with clients
* Demonstrate an ability to thrive in an environment through efficient planning
* Demonstrate an ability and willingness to take risks, work in a non-hierarchical environment and take step-up/step-down roles to support strong outcomes
* Act as a role model in line with company and client codes of ethics and processes; represent the company and promote its reputation to a high standard
Desired Experience and Skills
* Bachelors in a relevant field (e.g., Life Sciences, Biotechnology, Neuroscience, Pharmacology, Business, Economics, Marketing, or Psychology).
* Demonstrated passion for the life sciences and pharmaceutical industry, supported by academic research, industry exposure, or relevant coursework.
* Ability to rapidly synthesize, analyse, and apply new information, demonstrating intellectual agility and a proactive approach to problem-solving.
* Exceptional verbal and written communication abilities, with a track record of delivering clear, concise, and impactful presentations and reports.
* A drive for self-improvement - the best consultants are those that seek out and action on feedback to improve themselves.
* Entrepreneurship - The ability to lead and drive outcomes, particularly in situations that have some ambiguity.
* Consulting is a team sport so a demonstrated willingness and enthusiasm to collaborate with others is required.
What We Offer
* Highly competitive base salary plus performance-related bonus, 401K matching and Health & Dental benefits.
* A strong values-based culture that promotes respect, inclusion and teamwork, encouragement to contribute and influence on the business - where everybody has a voice.
* Leaders who are accessible, truly listen, are ambitious for our teams, and committed to coaching & sharing their expertise.
* A high-growth, entrepreneurial environment where our thinking and our work are innovative, imaginative and bright.
* Endless and tailored career development that stretches you and is based on your ambition, abilities and interests - not just box-ticking.
* Flexible working, recognition for going the extra mile, and a flat hierarchy.
More about Prescient Healthcare Group
Prescient is a pharma services firm specializing in dynamic decision support and product and portfolio strategy. We partner with our clients to turn science into value by helping them understand the potential of their molecules, shaping their strategic plans and allowing their decision-making to be the biggest differentiating factor in the success of their products. When companies partner with Prescient, the molecules in their hands have a greater potential for success than the same science in the hands of their competitors.
Founded in 2007, Prescient is a global firm with a footprint in ten cities across three continents. Our team of nearly 475 experts partners with 27 of the top 30 biopharmaceutical companies, the fastest-growing mid-caps and cutting-edge emerging biotechs, including some of the biggest and most innovative brands. More than 70% of our employees hold advanced life sciences degrees, and our teams deliver an impressive depth of therapeutic, clinical and commercial expertise.
The annual full time base salary range for this role is ($75,000 - $85,000). Specific compensation is determined through interviews and a review of relevant education, experience, training, skills, geographic location and alignment with market data. Additionally, positions may be eligible to receive a discretionary bonus as determined by bonus program guidelines. Prescient offers PTO and paid holidays, the terms of which are set forth in the program policies. All full-time employees also are eligible to participate in various benefit plans, including medical, dental, vision, life, disability insurance and 401K; in each case in accordance with the terms of the applicable plans.
Prescient has been a portfolio company of Bridgepoint Development Capital since 2021 and Baird Capital since 2017. For more information, please visit: ********************
We are an equal opportunity employer and fully comply with applicable legislation in all the geographies in which we operate. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable national, federal, state or local laws.
$75k-85k yearly 4d ago
Public Adjuster
The Misch Group
Claims representative job in Boston, MA
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
Stop Loss & Health Claim Analyst
Sun Life Financial 4.6
Claims representative job in Wellesley, MA
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
$54.9k-82.4k yearly Auto-Apply 9d ago
Independent Insurance Claims Adjuster in Boston, Massachusetts
Milehigh Adjusters Houston
Claims representative job in Boston, MA
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.