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Claims representative jobs in New Mexico - 64 jobs
Medical Claims Representative - Workers' Compensation (Albuquerque)
Cannon Cochran Management
Claims representative job in Albuquerque, NM
Workers' Compensation Medical Only Claim Representative Schedule: Monday-Friday, 8:00 a.m. - 4:30 p.m. (37.5 hours per week) Compensation: $20.00 per hour Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job SummaryThe Workers' Compensation Medical Only Claim Representative is responsible for managing medical-only workers' compensation claims for multiple client accounts across various industries. This position focuses on the timely and accurate adjudication of claims in compliance with New Mexico statutes, client expectations, and CCMSI standards. It offers structured training, mentorship, and the opportunity to develop foundational adjusting skills in a collaborative, in-office environment. Responsibilities Adjudicate medical-only workers' compensation claims timely and accurately in accordance with statutory, client, and CCMSI guidelines. Establish and maintain claim reserves within authority levels under direct supervision. Review, approve, and negotiate medical and miscellaneous invoices to ensure appropriate and related charges. Coordinate and monitor medical treatment in compliance with corporate claim standards. Document all claim activity, medical updates, and correspondence in the claim system. Close claim files when appropriate and assist with file maintenance as needed. Provide support to the broader claim team, including client service initiatives and administrative tasks. Maintain compliance with all Corporate Claim Standards and client-specific handling instructions. Qualifications Required: Associate degree or two (2) years of related business experience NM Adjuster's License or ability to obtain within 60 days of hire (must pass state licensing exam and background check) Proficiency in Microsoft Office (Word, Excel, Outlook) Preferred / Nice to Have: Previous workers' compensation or claim handling experience Knowledge of medical terminology is very helpful Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: Quality claim handling - thorough investigations, strong documentation, well-supported decisions Compliance & audit performance - adherence to jurisdictional and client standards Timeliness & accuracy - purposeful file movement and dependable execution Client partnership - proactive communication and strong follow-through Professional judgment - owning outcomes and solving problems with integrity Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us. Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #CareerDevelopment #ClaimsTraining #WorkersCompensation #InsuranceCareers #AlbuquerqueJobs #NowHiring #LearnAndGrow #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #AdjusterJobs #BilingualJobs #IND456 #LI-InOfficeWe can recommend jobs specifically for you! Click here to get started.$20 hourly Auto-Apply 7d agoProperty Claims Representative
Farm Bureau Financial Services
Claims representative job in New Mexico
Do you thrive in a work environment where you must multi-task and have strong organization skills? Are you a go-getter with high initiative, a positive attitude and strong customer service experience? Are you able to work with limited direction? If so, this Property Claims Representative opportunity could be a great fit for you! Who We Are: With Farm Bureau Financial Services, our client/members can feel confident knowing their family, home, cars and other property are protected. We value a culture where integrity, teamwork, passion, service, leadership and accountability are at the heart of every decision we make and every action we take. We're proud of our more than 80-year commitment to protecting the livelihoods and futures of our client/members and creating an atmosphere where our employees thrive. What You'll Do: As a Property Claims Representative, you will investigate, evaluate, negotiate and settle assigned claims involving property related insurance coverage. You must investigate the cause of the loss, interpret the policy, and determine whether the loss is covered. You will also determine the value of loss and assists in setting reasonable reserves. Other duties include: * Conduct outside work including on-site inspections of damaged properties * Climb ladders and access rooftops or elevated areas to conduct thorough inspections of property damage. What It Takes to Join Our Team: * College or equivalent required- claims experience a plus. * Insurance and basic building material knowledge is strongly preferred. * High attention to detail, strong organizational skills and a good work ethic. * Strong verbal and written communication skills. * Exceptional customer service skills. * Ag experience preferred * Must be able to work under all kinds of weather conditions and fully appraise all physical aspects of the property and buildings, which includes climbing on ladders. * A valid driver's license and satisfactory Motor Vehicle Records are required. * Some travel with overnight stays. * Must attend training schools as required. What We Offer You: When you're on our team, you get more than a great paycheck. You'll hear about career development and educational opportunities. We offer an enhanced 401K with a match, low cost health, dental, and vision benefits, and life and disability insurance options. We also offer paid time off, including holidays and volunteer time, as well as a company car and cell phone. Farm Bureau....where the grass really IS greener! If you're interested in joining a company that appreciates its employees, provides growth and professional development opportunities, and offers great benefits, we invite you to apply today! Work Authorization/Sponsorship Applicants must be currently authorized to work in the United States on a full-time basis. We are not able to sponsor now or in the future, or take over sponsorship of, an employment visa or work authorization for this role. For example, we are not able to sponsor OPT status.$35k-43k yearly est. 27d agoMedical Coding Analyst I or II - Must have a NM Residence
UNM Medical Group, Inc.
Claims representative job in Albuquerque, NM
Job Description UNM Medical Group, Inc. is hiring for a Medical Coding Analyst I or II to join our Coding Department. This opportunity is a REMOTE, full-time and day shift opening located in New Mexico. *This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico* *This position is remote, however the selected candidate would need to be available to come into the office in Albuquerque, New Mexico if they experience network or laptop issues* *Sign-On Bonus: $2,000* Medical Coding Analyst 1: Minimum $44,604 - Midpoint $55,766* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Medical Coding Analyst 2: Minimum $52,038 - Midpoint $65,043* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Responsible for coding Inpatient/Outpatient charges and specialty services using appropriate ICD and CPT classification systems for the purpose of reimbursement, research and compliance in accordance with federal regulation. Charges include all Inpatient/Outpatient visits, Day Surgeries, consultations and observation accounts. Specialty services include Interventional Radiology, GI Lab, Pathology, Cardiac Cath Lab, Vascular Lab, Orthopedics, Surgical and Anesthesia procedures. Responsible for review of documentation in medical records to assure that documentation by providers conforms to compliance and legal requirements. Provide feedback for practitioners on coding practices. Coder must meet department productivity and quality standards. Ensure adherence to policies and procedures and guidelines. Minimum Job Requirements or a Medical Coding Analyst I: High School diploma or GED and 6 months directly related experience or successful completion of UNMMG Medical Coding Internship Program. Certification in at least one of the following: RHIT, RHIA, RCC, CIRCC, CSS, CCA, CCS-P, COC, CIC, CPC, CPC-P or CPC-A. Verification of education and licensure (if applicable) will be required if selected for hire. Minimum Job Requirements or a Medical Coding Analyst II: High School diploma or GED and 2 years directly related experience. Certification in at least one of the following: RCC, CPC, CIRCC, CPC-P, CCS, CCS-P, COC, CIC, RHIA, or RHIT. Verification of education and licensure (if applicable) will be required if selected for hire. Duties and Responsibilities: Reviews and analyzes medical records in order to assign appropriate CPT and ICD-10 codes for inpatient and outpatient consultations, procedures, anesthesia, inpatient visits, and office visits for new or established patients. Analyzes as well as resolution of coding edits that occur. Identifies and reviews documentation in an EMR environment to ensure that all required signatures and addendums are present in the medical record(s). Interaction and feedback to providers, when necessary, regarding medical documentation deficiencies or to request clarification of documentation components. Ensures strict confidentiality of medical records and documentation. Follows established departmental policies, procedures and objectives. Why Join UNM Medical Group, Inc.? Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence. We are dedicated to embracing and promoting diversity while fostering well-being across New Mexico through cultural humility and respect for everyone. Benefits: Competitive Salary & Benefits: UNMMG provides a competitive salary along with a comprehensive benefits package. Insurance Coverage: Includes medical, dental, vision, and life insurance. Additional Perks: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.$36k-50k yearly est. 23d agoClaims Adjuster Professional Trainee
New Mexico Mutual Casualty Company
Claims representative job in Albuquerque, NM
Job Title: Claims Adjuster Professional Trainee Department: Claims Reports to: Claims Manager This position will be responsible, following the initial training phase, for the adjudication of all assigned claims in accordance with the Act, governing rules and regulations, related case law and company procedures. Case complexity assignment is determined by the responsible claims manager and is guided by the level of training and performance of the claims adjuster trainee candidate. The Claims Professional Trainee position is designed to introduce the individual to the workers' compensation claims function of New Mexico Mutual over a one-year (1) period of time. This candidate will have access to a comprehensive and formal training program under the direct guidance and supervision of our claims training manager, with active participation from other claims management personnel and claims specialists. Essential Functions: This claim training will cover claim investigation, compensability, policy coverage, statutory law, case law, benefits analysis and payment, litigation, medical and claims resolution. Responsibilities include effective and consistent partnership with the employer, injured worker and medical provider, administration of benefits, litigation management and claims resolution. Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, coordination of medical care. Document all activities in the claim management system. Responsible for outside legal counsel assignments, RTW strategies & all other expert assignments. Upon determination of compensability: Set and monitor reserves according to company policies and the worker's injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures. Make required filings and ensure benefit payments within the established time frames and guidelines. Prepare, attend, and present a majority of all mediations and hearings. Represent the company at trial. Maintain a diary on all open claims. Document all relevant information to provide a clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria. Perform other duties as assigned. Requirements Job Qualifications Education: Bachelor's Degree from an accredited college or university. Experience: No prior claims handling experience is necessary for this position. Specialized Knowledge, Licenses, etc.: MS Office (Word, Advanced Excel, PowerPoint, Outlook) Values and Mission: Adheres to New Mexico Mutual's values and mission by demonstrating Service Excellence, Trust, Ownership, One Team and Boldness in thought and action. Positive Attitude: Develops and maintains positive working relationships with team members, customers, co-workers, and management by demonstrating effective communication and collaborative skills. Working Conditions: NEW MEXICO MUTUAL maintains general office conditions with light physical demands. Employees of NEW MEXICO MUTUAL adhere to all safety rules and regulations including building security. Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities. NEW MEXICO MUTUAL maintains a drug free environment; drug testing prior to employment as well as upon a work-related accident. Exposure to VDT screens.$44k-52k yearly est. 13d agoRec Marine Adjuster
Sedgwick
Claims representative job in Santa Fe, NM
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Rec Marine Adjuster **PRIMARY PURPOSE** **:** To investigate and process marine claims adjustments for clients; to handle complex losses locally unassisted up to $50,000 and assist the department on larger losses. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Investigates the cause and extent of the damages, obtains appropriate documentation, and issues settlement. + Receives and reviews new claims and maintains data integrity in the claims system. + Reviews survey reports and insurance policies to determine insurance coverage. + Prepares settlement documents and requests payment for the claim and expenses. + Assists in preparing loss experience report to help determine profitability and calculates adequate future rates. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Appropriate state adjuster license is required. **Experience** 3 years or more of Marine Adjusting preferred. **Skills & Knowledge** + Strong oral and written communication skills + PC literate, including Microsoft Office products + Good customer service skills + Good organizational skills + Demonstrated commitment to timely reporting + Ability to work independently and in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** + Must be able to stand and/or walk for long periods of time. + Must be able to kneel, squat or bend. + Must be able to work outdoors in hot and/or cold weather conditions. + Have the ability to climb, crawl, stoop, kneel, reaching/working overhead + Be able to lift/carry up to 50 pounds + Be able to push/pull up to 100 pounds + Be able to drive up to 4 hours per day. + Must have continual use of manual dexterity **Auditory/Visual** **:** Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**$50k yearly 42d agoDaily Claims Adjuster - Albuquerque, NM Region
Cenco Claims
Claims representative job in Albuquerque, NM
CENCO is a trusted leader in claims solutions, proudly partnering with top insurance carriers to provide dependable and efficient claims handling. We are currently seeking experienced Daily Property Claims Adjusters to support residential and commercial claims throughout the Albuquerque and greater Southwest region. This opportunity is ideal for independent adjusters seeking steady work with flexible scheduling. Key Responsibilities: Conduct thorough inspections of property damage, including losses caused by wind, hail, and fire. Capture detailed documentation and high-quality photos of damage. Create accurate estimates using Xactimate or Symbility. Maintain clear and professional communication with policyholders, contractors, and carriers. Handle claims efficiently, meeting required timelines and expectations. Requirements: Licensing: Active adjuster license in New Mexico and other applicable Southwest states. Software: Experience with Xactimate or Symbility. Tools & Equipment: Reliable transportation, ladder, laptop, and standard inspection tools. Work Style: Self-motivated, organized, and capable of working independently. Responsiveness: Available to promptly accept assignments and complete reports on schedule. Why Join CENCO? Steady claim volume in a growing regional market Competitive, prompt pay Strong back-office support and simplified workflows If you're a dependable adjuster looking to build lasting relationships and take on consistent daily claims in Albuquerque, we'd love to connect with you!$44k-54k yearly est. Auto-Apply 60d+ agoIndependent Insurance Claims Adjuster in Farmington, New Mexico
Milehigh Adjusters Houston
Claims representative job in Farmington, NM
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.$44k-54k yearly est. Auto-Apply 60d+ agoField Claims Adjuster
EAC Claims Solutions
Claims representative job in Santa Fe, NM
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$44k-54k yearly est. Auto-Apply 38d agoClaims Specialist-Journal Center, (783)
Tricore Reference Laboratories
Claims representative job in Albuquerque, NM
Schedule: Monday-Friday 0800 - 1230 w/ 30 min lunch and other shifts as needed. Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: 1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration. 2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration. 3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days. 4. Researches adjustments and pull all necessary backup to support adjustments. 5. Utilizes on-line insurance resources to obtain and maintain current information. 6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives. 7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate. 8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting. The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified. MINIMUM EDUCATION: High school diploma or equivalent MINIMUM EXPERIENCE: Must have one of the following: Six (6) months as an Apprentice in the Business Office at TriCore Minimum of one (1) year of laboratory or medical claims follow-up/collections experience Minimum of three (3) years of medical billing or claims processing experience OTHER REQUIREMENTS: Must be able to type 30 words per minute (typing test required) Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted. GENERAL REQUIREMENTS: 1. Proficient in PC/data entry skills 2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills 3. Ability to resolve problems and follow up as needed or appropriate 4. Effective communication skills and telephone skills 5. Ability to deal with difficult clients and patients 6. Strong working knowledge of insurance and reimbursement$38k-62k yearly est. 60d+ agoClaims Investigator - Experienced
Command Investigations
Claims representative job in Albuquerque, NM
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.$36k-49k yearly est. Auto-Apply 60d+ agoClaims Review Support - Multiple Labor Categories
Novaces
Claims representative job in New Mexico
NOVACES is a leading provider of management consulting services specializing in process improvement and project management solutions for both government and commercial clients. We support disaster recovery efforts by delivering skilled professionals to assist FEMA and other agencies in rebuilding communities and enhancing resilience after major events. Our expertise spans across a wide range of labor categories crucial to recovery operations. We are seeking experienced professionals across multiple labor categories: ADMINISTRATIVE SUPPORT SPECIALIST SUBJECT MATTER EXPERTS SITE INSPECTORS SENIOR COMMERCIAL PROPERTY INSURANCE PROFESSIONAL COMMERCIAL PROPERTY INSURANCE PROFESSIONAL SENIOR ESTIMATOR ESTIMATOR SENIOR GENERAL PLANNER GENERAL PLANNER SENIOR PROJECT MANAGER PROJECT MANAGER Minimum Qualifications: Relevant undergraduate/graduate degree based on labor category (e.g., engineering, environmental science, architecture, accounting, etc.). At least 5 years of experience in the field of expertise. (Minimum 10 years experience for Senior positions) Must be a U.S. citizen. Must be able to pass a background check to obtain a FEMA Badge (Existing FEMA Badge preferred). Ability to deploy to a disaster area within 48 hours of notice. Superior written, verbal, and interpersonal skills. Proficient in Microsoft Office Suite. Strong administrative and organizational skills with attention to detail. Proven ability to support multiple projects and tasks simultaneously and effectively prioritize in a fast-paced work environment. Ability to work professionally, effectively, and efficiently in a team environment with various stakeholders. Job Types: Full-time, Temporary, Contract Location: Onsite Average Duration Per Task Order: Six (6) months to one (1) year Positions are contingent on contract award. NOVACES offers a full benefits package including medical, dental, vision, 401(k), profit sharing, and referral bonus incentives.$23k-30k yearly est. Auto-Apply 60d+ agoClaims Adjuster I
New Mexico Mutual Casualty Company
Claims representative job in Albuquerque, NM
Job Title: Claims Adjuster I Department: Claims Reports To: Claims Manager This position is responsible for the adjudication of all assigned claims in accordance with the Act, governing rules and regulations, related case law and company procedures. Case complexity assignment is determined by the experience and qualifications of the adjuster. This position will demand quality claim handling expertise, Service Excellence standards, and timely indemnity, medical and expense benefit management. Essential Functions: Evaluate, analyze and determine compensability, causation, offsets and exposures of basic workers compensation insurance claims in accordance with applicable law, corporate policy, best practice and prescribed authorities. Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, identify subrogation opportunities, coordination of medical care. Document all activities in the claim management system. Responsible for outside legal counsel assignments, RTW strategies with policyholders, implement medical case management strategies with nurse case managers and all other expert assignments. Upon determination of compensability: Set and monitor reserves according to company policies and the worker's injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures. Ensure the timely and accurate statutory/benefit payments within the established time frames and guidelines. Prepare and participate in mediation conferences and other authorized legal or regulatory proceedings before the regulatory agencies and courts of law. Maintain a diary on all open claims. Document all relevant information to provide a clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria. Detect and report reasonable suspicions of insurance fraud by claimants, medical or legal providers, policyholders or other individuals related to claims. Maintain claim records in compliance with applicable law, corporate policies and retention schedules. Requirements Job Qualifications: Education: Bachelor's Degree from an accredited college or university. Experience: A minimum of one year of workers' compensation claims experience is preferred. Additional relevant experience considered in lieu of education. Specialized Knowledge, Licenses, etc.: Demonstrated proficiency in: Related professional certifications preferred State required adjuster's license Values and Mission: Adhere to values and mission by demonstrating Service Excellence, Trust, Ownership, One team and Boldness in thought and action. Positive Attitude: Develops and maintains positive working relationships with team members, customers, co-workers and management by demonstrating effective communication and collaborative skills. Working Conditions: NEW MEXICO MUTUAL maintains general office conditions with light to moderate physical demands, with occasional lifting. Employees of NEW MEXICO MUTUAL adhere to all safety rules and regulations including building security. Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities. NEW MEXICO MUTUAL maintains a drug free environment; drug testing prior to employment as well as upon a work related accident. Exposure to VDT screens.$44k-52k yearly est. 13d agoField Claims Adjuster
EAC Claims Solutions
Claims representative job in Albuquerque, NM
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$44k-54k yearly est. Auto-Apply 38d agoIndependent Insurance Claims Adjuster in Santa Fe, New Mexico
Milehigh Adjusters Houston
Claims representative job in Santa Fe, NM
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.$43k-53k yearly est. Auto-Apply 60d+ agoProperty Claims Adjuster - Daily Albuquerque, NM
Cenco Claims
Claims representative job in Albuquerque, NM
CENCO Claims is seeking a driven Property Claims Adjuster to manage daily residential property inspections in the Albuquerque, NM area. This field position offers dependable claim volume, flexible scheduling, and direct support from an experienced in-house claims team. What You'll Be Responsible For: Conduct on-site residential property inspections to evaluate reported losses Prepare accurate and well-supported estimates using Xactimate Gather detailed photo documentation and complete clear written reports Communicate professionally with policyholders and carrier representatives Submit organized, timely claim files that meet carrier guidelines What We're Looking For: Working knowledge of Xactimate estimating software Strong understanding of residential construction and damage evaluation Excellent organization, communication, and time-management skills Reliable transportation and a valid driver's license Active New Mexico or designated home state adjuster license What We Offer: Competitive per-file compensation Consistent residential claim volume in the Albuquerque market Flexible scheduling with autonomy in the field Dedicated internal support to assist with file handling and questions Apply Today$44k-58k yearly est. Auto-Apply 60d+ agoClaims Specialist- Journal Center, (784)
Tricore Reference Laboratories
Claims representative job in Albuquerque, NM
Schedule: Monday-Friday 8:00 AM-5:00PM and other shifts as needed. Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: 1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration. 2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration. 3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days. 4. Researches adjustments and pull all necessary backup to support adjustments. 5. Utilizes on-line insurance resources to obtain and maintain current information. 6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives. 7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate. 8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting. The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified. MINIMUM EDUCATION: High school diploma or equivalent MINIMUM EXPERIENCE: Must have one of the following: Six (6) months as an Apprentice in the Business Office at TriCore Minimum of one (1) year of laboratory or medical claims follow-up/collections experience Minimum of three (3) years of medical billing or claims processing experience OTHER REQUIREMENTS: Must be able to type 30 words per minute (typing test required) Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted. GENERAL REQUIREMENTS: 1. Proficient in PC/data entry skills 2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills 3. Ability to resolve problems and follow up as needed or appropriate 4. Effective communication skills and telephone skills 5. Ability to deal with difficult clients and patients 6. Strong working knowledge of insurance and reimbursement$38k-62k yearly est. 60d+ agoClaims Investigator - Experienced
Command Investigations
Claims representative job in Albuquerque, NM
Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR RPlQMliA1V$36k-49k yearly est. 23d agoClaims Specialist
New Mexico Mutual Casualty Company
Claims representative job in Albuquerque, NM
Job Title: Claims Specialist Department: Claims Reports To: Claims Manager This position provides expert claim handling services in the areas of coverage, compensability, investigation, evaluation, negotiation, litigation management and resolution of serious and complex workers' compensation insurance claims under applicable law, corporate policy and best practice. Quality claim handling expertise, Service Excellence and indemnity and expense management will also be provided by the position. The claims specialist will also be an expert technical resource to other claims professionals, business partners, policyholders and stakeholders. Essential Functions: Evaluate, analyze and determine compensability, causation, offsets and exposures of serious and complex workers compensation insurance claims in accordance with applicable law, corporate policy, best practice and prescribed authorities Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, identify subrogation opportunities, coordination of medical care. Document all activities in the claim management system. Responsible for outside legal counsel assignments, RTW strategies with policyholders, implement medical case management strategies with nurse case managers and all other expert assignments. Upon determination of compensability: Set and monitor reserves according to company policies and the worker's injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures. Must have above-average knowledge, understanding and ability to apply case law to claim handling practices. Ensure the timely and accurate statutory/benefit payments within the established time frames and guidelines. Prepare and participate in mediation conferences and other authorized legal or regulatory proceedings before the regulatory agencies and courts of law. Maintain a diary on all open claims. Document all relevant information to provide a clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria. Assess and report claims litigation for significant financial exposure, case law precedent or reputation risk. Identify and recommend claims with potential for full and final settlement and negotiate and/or coordinate with authorized outside legal counsel in full and final settlements. Analyze assigned claims to identify trends and opportunities for improvement of policies, procedures and controls, and prepare related reports. Mentor junior adjusters and provide support to Claims Managers as directed. Detect and report reasonable suspicions of insurance fraud by claimants, medical or legal providers, policyholders or other individuals related to claims. Maintain claim records in compliance with applicable law, corporate policies and retention schedules. Requirements Job Qualifications: Education: Bachelor's Degree from an accredited college or university. Experience: 5+ years of serious workers' compensation claims experience. 10+ claims handling experience. Specialized Knowledge, Licenses, etc.: Demonstrated proficiency in: Related professional certifications preferred State required adjuster's license Values and Mission: Adhere to values and mission by demonstrating Service Excellence, Trust, Ownership, One team and Boldness in thought and action. Positive Attitude: Develops and maintains positive working relationships with team members, customers, co-workers and management by demonstrating effective communication and collaborative skills. Working Conditions: NEW MEXICO MUTUAL maintains general office conditions with light physical demands, with occasional lifting. Employees of NEW MEXICO MUTUAL adhere to all safety rules and regulations including building security. Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities. NEW MEXICO MUTUAL maintains a drug free environment; drug testing prior to employment as well as upon a work related accident. Exposure to VDT screens.$36k-52k yearly est. 12d agoIndependent Insurance Claims Adjuster in Albuquerque, New Mexico
Milehigh Adjusters Houston
Claims representative job in Albuquerque, NM
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.$43k-53k yearly est. Auto-Apply 60d+ agoField Claims Adjuster
EAC Claims Solutions
Claims representative job in Las Cruces, NM
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.$44k-54k yearly est. Auto-Apply 39d ago
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