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Claims representative jobs in Pittsburg, CA - 184 jobs

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  • Senior Auto Claims & Risk Analyst

    Futureshaper.com

    Claims representative job in San Francisco, CA

    A leading autonomous driving technology company is seeking a Claims Analyst to support their Risk & Insurance Team. This hybrid role involves developing strategies and processes for handling unique claims related to autonomous vehicles while coordinating with various stakeholders. The ideal candidate will have over 7 years of experience in insurance claims, advanced communication skills, and a proven ability to investigate and triage complex claims. Competitive salary and benefits package provided. #J-18808-Ljbffr
    $75k-131k yearly est. 3d ago
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  • Senior PMM - Insurtech & Claim Automation

    Hover 4.2company rating

    Claims representative job in San Francisco, CA

    A leading technology firm in San Francisco is looking for a Senior Product Marketing Manager to lead the marketing of insurance products. The ideal candidate will have 5-7 years of B2B SaaS experience, strong storytelling abilities, and be able to translate complex product functionalities into compelling narratives. The role entails collaboration across various teams and requires a deep understanding of customer challenges. Competitive salary and equity are offered along with comprehensive benefits. #J-18808-Ljbffr
    $80k-129k yearly est. 5d ago
  • Claims Investigator

    Apex Investigation

    Claims representative job in Antioch, CA

    About the Company For over 40 years, APEX Investigation has been dedicated to reducing insurance risk and combating fraud through trusted, high-quality investigations. We build lasting client relationships through integrity, clear communication, and timely, actionable results. Specializing in suspicious claims across multiple coverage areas-including workers' compensation, property, casualty, and auto liability-we provide critical information that supports efficient claims resolution, cost control, and reduced financial loss. About the Role The Claims Investigator plays a critical role in the investigation of insurance claims-primarily workers' compensation-by conducting recorded statements, field investigations, scene and medical canvasses, and producing clear, well-documented reports. This position requires adaptability, strong communication skills, sound judgment, and the ability to manage both fieldwork and detailed administrative responsibilities. Travel and variable schedules are a regular part of this role. Key Responsibilities Case Management & Communication Receive, review, and manage assigned cases from start to completion. Communicate professionally with clients, claimants, witnesses, and other involved parties. Provide timely case updates and correspondence in accordance with company guidelines via CaseLink. Maintain objectivity and professionalism in all interactions. Investigative Field Work Conduct recorded statements at various locations, including claimants' homes, workplaces, medical offices, and public settings. Ask open-ended questions, interpret responses, and conduct appropriate follow-up without reliance on scripted questionnaires. Perform scene and neighborhood canvasses, including walking on varied terrain. Meet with treating physicians and medical offices as required. Travel to designated locations, including overnight stays when necessary. Respond to rush cases within business hours when required. Documentation & Reporting Enter case updates, notes, hours worked, mileage, and expenses into CaseLink on a daily basis. Upload all obtained statements, documents, recordings, photographs, and evidence to CaseLink the same day they are acquired. Compose clear, concise, and grammatically correct case updates within 24 hours of obtaining statements. Prepare and submit comprehensive investigative reports within 72 hours of final update submission. Evidence & Records Handling Retrieve records from agencies and entities both in-person and remotely. Take clear photographs and video when necessary and label all electronic files accurately. Securely collect, store, and maintain custody of evidence when required. Maintain organized and protected case files and establish backup procedures to safeguard data in the event of technical failure. Additional Responsibilities Identify and recommend additional investigative services outside the scope of the original assignment when appropriate. Work overtime as needed to meet case demands and deadlines. Maintain an efficient, safe, and organized telecommuter workspace. Physical & Work Environment Requirements Ability to sit for extended periods performing computer-based work and report writing. Ability to stand for extended periods while conducting interviews and canvasses. Ability to lift and carry items weighing between 5-30 lbs (e.g., laptop, briefcase, equipment). Ability to operate digital audio recording equipment. Qualifications Experience with workers' compensation claims and investigative processes. Strong written and verbal communication skills. Ability to work independently, manage time effectively, and meet strict deadlines. Willingness and ability to travel up to (but not limited to) 150 miles per assignment. Possession of a personal credit card with available balance for reimbursable business expenses. Proficiency with case management systems; CaseLink experience preferred. Access to a personal scanner for document upload and record handling. Preferred Qualifications Prior experience conducting recorded statements and field investigations. Experience with process service assignments. Familiarity with evidence handling and documentation standards. Background in insurance investigations or a related field.
    $48k-67k yearly est. 2d ago
  • Claims Examiner

    JT2 Integrated Resources

    Claims representative job in Oakland, CA

    JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions. We are searching for highly motivated Claims Examiners to join our team! Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims. This position is available for either remote or in office work. Minimum Requirements Three (3) years of claims management experience Bachelor's degree from an accredited college or university preferred. Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM. Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims. Duties and Responsibilities Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards. Prepare accurate and timely issuance of benefits notices and required reports within statutory limits. Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits. Ensure timely payment of benefits, bills and appropriate caseload and performance goals. Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data. Monitor, report, and assign claims for fraud potential and subrogation possibilities. Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws. Prepare and present claims summaries to clients during file reviews. Train and direct Claims Assistants to meet goals and deadlines. Review and approve priority payments and other documents from Claims Assistants. Performs other duties as assigned Knowledge, Skills, and Abilities Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions. Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits. Strong skills with use of general office administration technology, including Microsoft Office Suite and related software Excellent verbal and written communication skills Excellent interpersonal and conflict resolution skills Excellent organizational skills and attention to detail Excellent interpersonal, negotiation, and conflict resolution skills Strong analytical and problem-solving skills Ability to act with integrity, professionalism, and confidentiality, at all times The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed. JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
    $34k-57k yearly est. 2d ago
  • Claims Supervisor, Workers' Compensation (CA Expertise Required)

    Cannon Cochran Management 4.0company rating

    Claims representative job in Concord, CA

    Workers' Compensation Claim Supervisor Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $98,000-$110,000 annually Direct Reports: 2-6 Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking an experienced Workers' Compensation Claim Supervisor with deep California jurisdiction expertise to lead a team of 3-6 adjusters supporting a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch. This is a hands-on leadership role for a supervisor who understands the full California workers' compensation lifecycle-from intake through resolution-and can coach adjusters through complex, fast-paced claims while ensuring strict compliance with regulatory and client-specific requirements. You'll guide claim strategy, mentor your team, and partner closely with clients to deliver consistent, high-quality outcomes. Responsibilities When we hire claim supervisors at CCMSI, we look for leaders who believe strong teams create strong outcomes-leaders who own results, develop people, and treat every claim with purpose and care. Supervise and guide a team of 3-6 California Workers' Compensation adjusters handling cradle-to-grave claims Ensure claims are investigated, evaluated, and resolved accurately, timely, and in compliance with California WC laws Review claim files regularly, providing direction on complex, litigated, or high-exposure matters Oversee reserve accuracy and compliance with client handling instructions Participate in claim reviews, audits, and quality initiatives Partner with internal teams, clients, and vendors to resolve issues and maintain service standards Recruit, onboard, train, and mentor staff; conduct performance evaluations and manage development plans Address personnel and administrative matters with professionalism and consistency Ensure compliance with carrier/state reporting requirements Qualifications What You'll Bring Required: • 10+ years of WC claims experience (California jurisdiction) • Proven experience adjusting CA WC claims from intake through resolution • CA SIP designation or CA Claims Certificate (or ability to obtain within 60 days) • Demonstrated leadership, coaching, and communication skills Preferred: • 3+ years of supervisory experience • Bilingual (English/Spanish) communications skills ) - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required. • Experience supporting PEO and/or staffing accounts • Proficiency in Microsoft Office and claims systems Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every 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. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #ClaimsLeadership #WorkersCompensationJobs #InsuranceCareers #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWork #CareerWithPurpose #JoinOurTeam #TPACareers #CCMSICareers #WorkersCompensation #WCSupervisor #ClaimsSupervisor #ClaimsLeadership #ClaimsManagement #RemoteJobs #RemoteLeadership #CaliforniaWorkersComp #CAClaims #CAAdjusters #WorkersCompSupervisor #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.
    $98k-110k yearly Auto-Apply 5d ago
  • Workers Compensation Claim Representative Associate

    Travelers Insurance Company 4.4company rating

    Claims representative job in Walnut Creek, CA

    **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 3 **What Is the Opportunity?** Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. The Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. As part of the hiring process, this position will require the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. **What Will You Do?** + Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. + Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision. + Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. + Participate in Telephonic and/or onsite File Reviews. + Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts. + Gather information from policyholders, claimants, witnesses, and third-party providers. + Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. + Maintain accurate records of claim activity in claim management systems. + Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources. + Demonstrate openness to continuous learning, particularly in AI and digital transformation. + Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Previous internship or work experience in insurance, finance, or customer service. + Strong attention to detail and organizational skills. + Ability to manage multiple tasks and prioritize effectively. + Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. + Ability to exercise sound judgement and make effective decisions. + Strong verbal and written communication skills with the ability to convey information clearly and professionally. **What is a Must Have?** + High School Diploma or GED. + One year of customer service experience OR Bachelor's Degree. **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 ******************************************************** .
    $52.6k-86.8k yearly 21d ago
  • Claims Analyst or Claims & Patient Safety Specialist

    MIEC 3.9company rating

    Claims representative job in Oakland, CA

    Full-time Description Are you ready to make a real difference in healthcare? MIEC is searching for a dynamic Claims professional to join our passionate team and play a pivotal role in protecting medical professionals and advancing patient safety! Whether you step into the role of Claims Analyst or take on the expanded responsibilities of Claims & Patient Safety Specialist, you'll be at the heart of our mission-opening, investigating, managing, and resolving incident and claim files for our valued policyholders. But that's just the beginning! As an Analyst or Specialist in our Claims Department, you'll go beyond claims management, partnering directly with groups and individual policyholders to deliver innovative Patient Safety & Risk Management services. You'll help shape safer healthcare environments, drive impactful change, and become a trusted advisor to those who count on us most. Join MIEC and be part of a team that's redefining excellence in claims and patient safety-where your expertise, initiative, and commitment truly matter. Get a sneak peek into MIEC's mission-driven, collaborative culture by following this link. LOCATION: This position is remote, with a preference for candidates located in Southern California, with limited travel to our main office in Oakland, CA. This position requires some travel from time to time, including overnight stays. COMPENSATION: The hiring salary range of $73,050 to $149,484 will be based on role, experience, and location. Priority will be given to candidates in Southern California, but see hiring ranges below for all locations: Hiring range for Claims Analyst role: San Francisco Bay Area and Hawaii: $84,519 to $112,691 All other locations: $73,050 to $97,400 Hiring range for Claims & Patient Safety Specialist role: San Francisco Bay Area and Hawaii: $112,113 to $149,484 All other locations: $96,900 to $129,200 MIEC offers competitive compensation, commensurate with experience and a comprehensive benefits package. MIEC is an EEO employer; we enjoy diversity in our staff, policyholders and business partners. BENEFITS: 401(K) + Pension Plan Health Insurance Vision and Dental Insurance Generous Paid Time Off Plans WHAT YOU'LL DO: Whether hired as a Claims Analyst or a Claims & Patient Safety Specialist, your primary duties will be in Claims, where you will: Respond to first notice of potential claims from policyholders and handle advice calls, gathering preliminary information and providing appropriate advice for action. Collaborate with the Claims team to identify and evaluate insurance coverage issues, and to develop, prepare and implement appropriate negotiation/case resolution strategies. Obtain and review records, interrogatories, depositions, consultant reports, and attorney reports; coordinate discovery with defense counsel; monitor file status, reserves, legal landmarks and billings. Prepare documentation, reports, and correspondence with policyholders, claimants and attorneys. Submit incident, claim and suit files for opening; manage and close files in a timely manner. Exercise strong judgment in settling cases within authority and develop indemnity and expense reserve recommendations above defined authority level. Study trends and current developments within the medical malpractice industry in the states in which MIEC operates, and nationally. Proactively share information within the department about the trends and current developments, including relevant court cases. Participate in seminars, trainings, meetings, and Board meetings, when requested. If hired as a Claims & Patient Safety Specialist, you will also: Collaborate with MIEC's Patient Safety & Risk Management (PSRM) staff to provide specialized internal and external services addressing existing member groups and new business, including large medical groups and hospitals. Apply principles of healthcare risk management, such as incident reporting and investigation, risk analyses, and policies/procedures, to further develop PSRM services which can be applied in all healthcare settings. Collect, analyze, and compare MIEC data to present evidence-based information to members, utilizing data from various healthcare and medical malpractice claims sources including Candello - Solutions by CRICO, the MPL Association Data Sharing Project, and Preverity. Coordinate and conduct Claims Prevention Surveys for policyholders. Manage active matters involving unanticipated patient harm through MIEC's RESTORE communication and resolution program; work with MIEC policyholders to support effective patient communication, disclosure, and/or apology discussions. Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials. Participate in the conception and completion of special projects. Requirements WHO YOU ARE: An experienced team member with a demonstrated expertise in the handling of medical malpractice claims and a solid understanding of Patient Safety Risk Management (PSRM) services and products, and the ability to address general PSRM questions or refer to the appropriate discipline. A flexible collaborator who has a demonstrated customer service focus with all levels of internal and external stakeholders. An enthusiastic and self-directed contributor who is skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines. An inquisitive analytical thinker with good judgement, professional initiative, and strong research skills. An excellent communicator, with strong written, verbal, and interpersonal communication skills and ideally with proficiency in medical terminology. Additionally, a candidate hired for the Claims & Patient Safety Specialist role would need: An understanding of clinical systems. Knowledge of hospital policies and procedures, and governmental healthcare regulations. Ability to analyze medical records and quality issues. WHAT YOU'LL BRING: Education: A Bachelor's degree (BA/BS) is required. Licenses/Certification: A valid driver's license is required. A Certified Professional in Healthcare Risk Management (CPHRM) designation is preferred. Experience: The ideal Claims & Patient Safety Specialist candidate will join us with a minimum of seven (7) years of experience as a medical professional liability claims representative, risk manager or similar experience in defense of medical professional liability or risk management/patient safety field required. The ideal Claims Analyst candidate will join us with a minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry. Digital Skillsets: Our ideal candidate will be a digitally fluent contributor, comfortable in a range of virtual environments and proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs. About MIEC: MIEC was founded in 1975 in the depths of the malpractice crisis by physicians and their medical societies when insurance was largely unavailable to the healthcare community. As the West's first truly physician-owned medical professional liability insurer, MIEC has always been guided by the desire to protect physicians and other healthcare professionals from malpractice risks and committed to a long-term philosophy of business conduct that ensures such a crisis never happens again. We exist to foster enduring partnerships within the healthcare community by serving members through a philosophy of vigorous protection and high value, delivered by people who care. As a member-owned exchange Headquartered in Oakland, CA, MIEC now insures more than 7,400 physicians and other healthcare professionals in 4 states, with regional claims offices in Idaho, Alaska, and Hawaii. MIEC has consistently adapted to meet the changing needs of healthcare delivery and continually seeks to reinvent medical professional liability through effective partnership, innovative insights, and dynamic risk solutions. Salary Description Salary based on role, experience, & location.
    $112.1k-149.5k yearly 48d ago
  • General Liability Claims Adjuster II

    Ahold Delhaize

    Claims representative job in Pleasant Hill, CA

    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 Adjuster

    The Greenspan Co./Adjusters International 3.9company rating

    Claims representative job in South San Francisco, CA

    About Us: The Greenspan Co./Adjusters International is the leading Public Insurance Adjusting firm with locations in California, Nevada, and Arizona. We advocate for the insured during times of crisis, navigating them through the complex and tedious insurance claims process. We aim to be the gold standard in customer service, and we've helped thousands of residential and commercial clients with their claims for over 70 years. Job Summary: We are seeking a Senior Claims Adjuster for our San Jose office. This role is a full time position with base salary plus commission. The Senior Claims Adjuster role will have the following responsibilities but not limited to: will investigate commercial and residential property claims, evaluate damages, determine coverage, set accurate cost estimates, control the insured's exposures and losses, manage consultants, and achieve a prompt, fair and equitable settlement according to fair claims handling requirements. Additionally, negotiate settlement of claims with varying complexity and perils. If you're an independent adjuster or a staff adjuster who wants to do the right thing for the policy holder and work to help homeowners and business owners rebuild after a catastrophe, we are the right team to join! The Senior Claims Adjuster will have the following duties & responsibilities but not limited to: Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin, and extent of loss losses. Reviews & utilizes financial statements to adjust complex residential and/or business interruption losses. Conduct on-site appraisal or direct independent adjuster to determine facts relevant causation, damages and exposures Engages and manages team members as required to assist in determining facts, causation, damages and exposure; monitors the costs to ensure they are reasonable and necessary. Establishes and maintains accurate loss cost estimates and reserves for each claim for reporting, financial records, and other purposes. Keeps the clients and others informed about the claim's status with clear, timely and accurate written/oral communications. Effectively communicates in writing on moderately complex coverage issues with minimal review and coaching. Determines depreciate of claim. Meet time requirements of the policy and fair claims handling practices. Effectively negotiate settlement of claims of varying complexity and perils. Achieves a prompt, fair, and equitable settlement of a claim, where there is policy liability. Keeps the electronic claim file properly documented with accurate, clear and timely information and reports that reflects the adjustment activities and substantiates any payments made. Provide guidance to inexperienced team members and may act as a mentor to other entry level adjusters. Qualifications: 10 years plus experience in an insurance company handling residential & commercial property and casualty claims required 2 years' experience handling losses in excess of $ 200,000.00 required Bachelor's degree required Must have a valid CA Driver License Ability and willingness to travel to the site of catastrophe for assignments. Capability to build and maintain positive relationships Ability to train and mentor less experienced team members Ability to write business correspondence, produce accurate work, manage projects and vendors; and use core applications/spreadsheets Empathetic and Compassionate advocate for policy holder Someone invested in protecting and defending the best interests of the claimant The ability to be an avid listener and a conscientious member of our team Compensation: Competitive salary (Base plus commission package worth $150k to $175k per year) Company Offered Benefits: Health, Dental, Vision Coverage 401K ESOP LTD Coverage Find out how you can become a dynamic part of our growing team and employee owned company.
    $150k-175k yearly 60d+ ago
  • Senior Workers Compensation Claim Representative - Walnut Creek, CA

    Msccn

    Claims representative job in Walnut Creek, CA

    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. 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. 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 $70,400.00 - $116,200.00 What Is the Opportunity? Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered. What Will You Do? Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability. Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions. Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation. Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment. Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations. Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status Act as technical resource to others. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed. Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers' Compensation claims. Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims Acts as an independent mentor to other Claim Professionals 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. Maintain Continuing Education requirements as required. Perform other duties as assigned. Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Education/Course of Study: Work Experience: Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. Negotiation: Advanced evaluation, negotiation and case resolution skills. Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract. Principles of Investigation: Intermediate investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss. Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. Settlement Techniques: Advanced ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package. Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed. WC Technical: Advanced ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. What is a Must Have? High school diploma or equivalent. 2 years Workers Compensation claim handling experience.
    $70.4k-116.2k yearly 17d ago
  • Claims Adjuster

    Berkshire Hathaway 4.8company rating

    Claims representative job in Sacramento, CA

    WHAT WE'RE LOOKING FORAre you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Are you a Spanish speaker looking to apply those skills in a professional environment? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster. Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity. ESSENTIAL RESPONSIBILITIES Successfully completes classroom training introducing workers compensation claims handling strategies, medical terminology, statutory requirements, and investigative skills. Conducts initial investigation of reported claims to determine coverage, compensability, severity, and gather all other relevant information via three-point contact telephone calls. Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines. Develops and updates a Plan of Action for the successful resolution of each claim. Makes prompt, sound decisions on issues that arise based on the best information available, ensuring that work is performed in accordance with Company guidelines and applicable statutory requirements. Timely escalates issues/red flags to Supervisor. Ensures benefits due injured worker are calculated and issued appropriately in accordance with legal requirements including the issuance of appropriate notices and filings. Fosters a positive and close working relationship with internal and external partners, including Call Center, Medical Management, Special Investigations, and Indemnity Adjusting Staff. REQUIRED QUALIFICATIONS Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred. Ability to communicate effectively verbally and in writing; Spanish Fluency ability a plus. Solid interpersonal and customer service skills. Ability to manage and prioritize multiple assignments in a fast-paced environment. Strong organization skills to ensure tasks are completed within hard deadlines. To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications and be proficient, or able to become proficient, on applicable databases, systems, and vendor software programs. WHAT WE OFFER Full Training Program Growth and advancement opportunities Work - Life Balance Manageable Caseloads Modernized Historical Setting in East Sacramento Free Lot Parking BENEFITS Paid Time Off Paid Holidays Retirements Savings Match Group Health Insurance (Medical, Dental, and Vision) Life and AD&D Insurance Long Term Disability Insurance Accident and Critical Illness Insurance Flexible Savings Accounts Paid Community Volunteer Day Employee Assistance Program Tuition Reimbursement Program Employee Referral Program Diversity, Equity and Inclusion Program In accordance with the California Equal Pay Act, the starting hourly wage for this job is $30.2885. This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations. ABOUT USWith more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts. At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace-something we truly value. We've created an approachable and collaborative atmosphere. Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.
    $30.3 hourly Auto-Apply 60d+ ago
  • Workers Compensation Claim Representative Associate

    Travelers 4.8company rating

    Claims representative job in Sacramento, CA

    Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job CategoryClaimCompensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range$52,600.00 - $86,800.00Target Openings3What Is the Opportunity?Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. The Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility. As part of the hiring process, this position will require the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.What Will You Do? Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training. Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision. Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud. Participate in Telephonic and/or onsite File Reviews. Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts. Gather information from policyholders, claimants, witnesses, and third-party providers. Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel. Maintain accurate records of claim activity in claim management systems. Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources. Demonstrate openness to continuous learning, particularly in AI and digital transformation. Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job. Perform other duties as assigned. What Will Our Ideal Candidate Have? Previous internship or work experience in insurance, finance, or customer service. Strong attention to detail and organizational skills. Ability to manage multiple tasks and prioritize effectively. Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants. Ability to exercise sound judgement and make effective decisions. Strong verbal and written communication skills with the ability to convey information clearly and professionally. What is a Must Have? High School Diploma or GED. One year of customer service experience OR Bachelor's Degree. 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 *********************************************************
    $52.6k-86.8k yearly Auto-Apply 21d ago
  • Senior Claims Examiner

    Insurance Company of The West

    Claims representative job in Sacramento, CA

    Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ESSENTIAL DUTIES AND RESPONSIBILITIES Manages all aspects of a California complex claims inventory. Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service. Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations. Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results. Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs. Additional Responsibilities: Consistently provides exceptional customer service. Effectively collaborates with team members from various departments for project and process discussions. Acts as a Subject Matter Expert for the department. Makes recommendations for streamlining processes and adopting the industry's best practices. Ensures accuracy of data in claims system for compliance with applicable regulatory reporting. Provides knowledge transfer across the organization. Continuously seeks to improve technical skills by attending job related training and tracking current case law. Acts as a mentor and provides training for less experienced team members. Additional Responsibilities in Workers' Compensation: Prepares and presents claims status reports for internal and external stakeholders. Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures. Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies. Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. SUPERVISORY RESPONSIBILITIES This position has no supervisory responsibility but will serve as a technical leader. EDUCATION AND EXPERIENCE Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience. CERTIFICATES, LICENSES, REGISTRATIONS Workers' Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches. KNOWLEDGE AND SKILLS Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change. PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. #LI-ET1 #LI-Hybrid The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? Challenging work and the ability to make a difference You will have a voice and feel a sense of belonging We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match Bonus potential for all positions Paid Time Off Paid holidays throughout the calendar year Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims
    $68.5k-115.5k yearly Auto-Apply 21d ago
  • Claims Representative, Warranty

    Cornerstone Building Brands

    Claims representative job in Vacaville, CA

    Job Description ABOUT THE ROLE The Claims Representative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The Claims Representative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards. You will need to be located within 35miles of either plant facility: Vacaville, CA or West Sacramento, CA Three days work from home and two days in office. WHAT YOU'LL DO Claim Intake & Validation Receive, review, and validate incoming warranty claims to determine accuracy and required information. Initiate clarification calls to customers as needed to complete claim details. Maintain accurate claim documentation and communication updates within Dynamics 365 CRM. Claim Management & Resolution Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality. Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction. Host product standards and compliance discussions with customers, helping address concerns professionally and clearly. Administer service reimbursements and prepare settlement letters when applicable. Quality Review & Root Cause Analysis Conduct research to identify root causes of product or service issues. Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements. Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality. Communication & Reporting Prepare clear communications and updates for management regarding claim trends, issues, and opportunities. Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete. Perform additional duties as assigned to support departmental needs. SKILLS & QUALIFICATIONS Strong ability to interpret customer claims and apply relevant warranty coverage. Ability to read and interpret product specifications, drawings, and order confirmations. Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions. Strong verbal and written communication skills with a customer-centric approach. Ability to manage difficult discussions and mitigate customer dissatisfaction effectively. Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly. Strong attention to detail and accuracy in a fast-paced environment. Ability to work independently while supporting team and departmental goals. High curiosity, initiative, and willingness to grow in an evolving environment. WHAT YOU'LL NEED Education: High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education. Experience/Technical Skills: Experience in Ordering/Quoting systems is desired (AccuQuote preferred). Experience with CRM systems is desired. Additional Information All your information will be kept confidential according to EEO guidelines. Why work for Cornerstone Building Brands? Our teams are at the heart of our purpose to positively contribute to the communities where we live, work and play. Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development. *Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement. Cornerstone Building Brands is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster here. You can also view Your Right to Work Poster here along with This Organizations Participation in E-Verify Poster here. If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or *******************************. If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or *******************************. This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response. All your information will be kept confidential according to EEO guidelines. California Consumer Privacy Act (CCPA) of 2018 Must be at least 18 years of age to apply. Notice of Recruitment Fraud We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.
    $36k-51k yearly est. 13d ago
  • Claim Representative III - Property

    Capital Insurance Group 4.4company rating

    Claims representative job in Elk Grove, CA

    Why CIG? At Capital Insurance Group we offer our employees more than just a job. We foster career growth, provide opportunities to give back to our communities, and help you take the next step in your career! CIG was founded in 1898 by a group of earnest farmers in need of protection and today, we are the leading West Coast Property & Casualty insurer. CIG is certified as a Great Place to Work and provides a collaborative, inclusive, and fun work culture for all employees. Why choose CIGs Claims Team? CIG claims department is here to support our insureds throughout their claims process. We work directly with our agency partners and policyholders to accomplish successful claim resolutions. Join the claims operation and you can be part of a team who provides excellent service, build relationships, and achieves successful outcomes for our clients. Learn what it means to be a Claim Representative III - Property at CIG
    $39k-53k yearly est. 12d ago
  • Independent Insurance Claims Adjuster in Vallejo, California

    Milehigh Adjusters Houston

    Claims representative job in Vallejo, CA

    IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement. Why This Opportunity Matters: With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand. As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives. This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation. Join Our Team: Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt? If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster. You're welcome to sign up on our jobs roster if you meet our guidelines. How We Can Help You Succeed: At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting. Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges. Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster. Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals. Seize the Opportunity Today! Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews. You can also find us on YouTube at: (********************************************************* and Facebook at: (************************************************** for additional resources and updates. APPLY HERE #AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.
    $53k-67k yearly est. Auto-Apply 60d+ ago
  • Medical Claims Benefits Analyst - 25-186

    Hill Physicians Group

    Claims representative job in San Ramon, CA

    We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you're making a great choice for your professional career and your personal satisfaction. DE&I Statement: At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right! Job Description: We are seeking a Benefit Analyst to join our Business Operations team. This role is responsible for interpreting Evidence of Coverage (EOC) documents and translating them into accurate benefit configuration within the Epic Tapestry system, which includes member cost shares, maximum out of pockets and benefit limits. The Benefit Analyst will work hand in hand with IT Application Analysts to ensure new or changed benefits, and necessary corrections are implemented timely and accurately. The ideal candidate will have strong critical thinking and analytical skills, experience with benefit interpretation, medical coding and claims adjudication. Key Responsibilities Benefit interpretation and analysis of EOCs across multiple health plans Mapping and/or configuration of new benefit plans and plan elements to support various health plan designs including HMO, POS, Medi-Cal, Medicare, and Exchange plans Analysis and alignment of CPT, HCPCS, REV, ICD-10 codes to benefit categories Analysis of authorization rules and Division of Financial Responsibility (DOFR) Conduct detailed analysis/quality assurance of benefit plan documentation and validate coverage and cost shares configured in Epic Tapestry system, including benefit limits and accumulators Assist with testing new benefits and complex benefit configuration changes within the claims processing system as part of analysis and validation Perform review and analysis of pending claims resulting from benefit configuration issues and assist with resolution Identify potential errors in configuration and notify IT working to troubleshoot and make corrections in a timely manner, submitting and tracking necessary corrections to completion, documenting outcomes, and making recommendations as necessary Adjudicate/finalize pending claims while resolution of issue is in progress and assist with necessary adjustments of claims that were unintentionally denied because of benefit configuration issue(s) Assist with maintenance of benefit requirements and configuration decisions and policies and procedures Continuous improvement of strategies to drive efficiencies and ensure process viability in the future and across systems Perform workflow analysis and consult on workflow/process improvement changes related to new functionality, applications, or systems Collaborate with IT, Enrollment, Claims, and Contracting teams to ensure benefit accuracy and compliance Other duties as assigned Requirements 5+ years of experience in benefits and claims in Managed Care, delegated model setting Experience with benefit analysis and/or quality assurance College degree in healthcare (preferred) or equivalent experience/knowledge Certified Medical Coder (preferred), or equivalent experience/knowledge of medical coding Proficiency in CPT, HCPCS, REV Coding & Billing, and ICD-10. Experience with Epic Tapestry (preferred) Understanding of various health plan types and regulations including HMO, POS, Medicare, Medi-Cal, CMS mandates, NCDs, and LCDs Strong analytical, communication, and documentation skills. Knowledge/Skills/Abilities Knowledge of how benefit configuration relates to claims adjudication and payment processes. Knowledge of member responsibility, cost shares, accumulators and out-of-pocket maximums. Experience with testing, reviewing, and validating benefit plans Critical thinking skills, decisive judgement, and the ability to work with minimal supervision. Must be able to work in a fast-paced environment with frequently shifting priorities and take appropriate action. Ability to build and maintain interpersonal relationships with management, core Benefits staff, and interdepartmental colleagues. Strong excel and Microsoft office 360 skills. Additional Information No of positions available: 2 Salary: $75,000 - $97,000 Annual Hill Physicians is an Equal Opportunity Employer
    $75k-97k yearly Auto-Apply 6d ago
  • Daily Claims Adjuster - Sacramento, CA

    Cenco Claims 3.8company rating

    Claims representative job in Sacramento, CA

    CENCO is a trusted leader in property claims solutions, partnering with top insurance carriers to provide accurate, timely, and professional adjusting services. We're currently looking for experienced Daily Property Claims Adjusters to handle residential and commercial claims across Sacramento and the Northern California region. This opportunity is ideal for independent adjusters seeking consistent assignments and the flexibility of field-based work. Key Responsibilities: Conduct on-site inspections of property damage caused by wind, water, fire, and other covered perils. Capture detailed documentation, including photos and written reports. Prepare accurate repair estimates using Xactimate or Symbility. Maintain professional communication with policyholders, contractors, and insurance carriers. Manage each claim efficiently and submit all required documentation within deadlines. What We're Looking For: Licensing: Must hold an active California adjuster license. Software: Proficiency in Xactimate or Symbility preferred. Tools & Transportation: Reliable vehicle, ladder, laptop, and field inspection equipment. Work Style: Organized, self-motivated, and able to work independently. Responsiveness: Able to accept and complete assignments in a timely manner. Why Join CENCO? Steady claim volume in Sacramento and surrounding areas Competitive pay and timely compensation Strong internal support and efficient claim-handling processes If you're an experienced adjuster looking for consistent work and the opportunity to grow with a trusted industry leader, we'd love to hear from you!
    $55k-68k yearly est. Auto-Apply 60d+ ago
  • Contracts and Legal Claims Specialist

    Washington County Hospital 4.0company rating

    Claims representative job in Fremont, CA

    Salary Range: $50.42 - $68.08 The Contracts and Legal Claims Specialist oversees contracts management the organization's system. and contract lifecycle, from drafting and preparation to execution; ensuring contractual accountability and duties are met by all parties involved. The role ensures effective administration of the full contract lifecycle, from drafting and review. to execution and compliance monitoring. The Contracts and Legal Claims Specialist is also responsible for coordinating claims and legal matter in collaboration with Vice President, outside legal counsel, insurance carriers and internal stakeholders. The Contracts and Legal Claims Specialist is also responsible for the following duties: Oversite and daily management Management System of the health system's Contract administrative function. Oversite and management of health system policies and numbered memorandums lifecycle with the collaboration stakeholders. on internal Subpoena intake and management for the healthcare system, ensuring timely and accurate response to subpoenas and related data requests and coordinating with legal counsel and internal departments and external vendor to manage the subpoena lifecycle Daily management of the health system's Public Record Request website and coordinate with the appropriate stake holders and legal counsel to ensure compliance with regulatory requirements for responding to requests. Supporting the Vice President and Chief Compliance & Risk Officer with management of litigation claims and other legal matter logistics. Facilitates the claims filing and adjudication process with malpractice carriers and collaborates malpractice carriers with legal counsel and to ensure timely coordination of the discovery process for litigation. Works with legal counsel to coordinate meetings, interviews depositions with and support. staff and medical staff and provides logistical In addition to performing the essential functions listed below, may also be assigned other duties as required. Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.
    $50.4-68.1 hourly Auto-Apply 1d ago
  • Field Claims Adjuster

    EAC Claims Solutions 4.6company rating

    Claims representative job in Fairfield, CA

    At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at ********************** Overview: Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution. Key Responsibilities: - Planning and organizing daily workload to process claims and conduct inspections - Investigating insurance claims, including interviewing claimants and witnesses - Handling property claims involving damage to buildings, structures, contents and/or property damage - Conducting thorough property damage assessments and verifying coverage - Evaluating damages to determine appropriate settlement - Negotiating settlements - Uploading completed reports, photos, and documents using our specialized software systems Requirements: - Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces - Strong interpersonal communication, organizational, and analytical skills - Proficiency in computer software programs such as Microsoft Office and claims management systems - Self-motivated with the ability to work independently and prioritize tasks effectively - High school diploma or equivalent required - Previous experience in insurance claims or related field is a plus but not required Next Steps: If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps. Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.
    $55k-67k yearly est. Auto-Apply 6d ago

Learn more about claims representative jobs

How much does a claims representative earn in Pittsburg, CA?

The average claims representative in Pittsburg, CA earns between $31,000 and $59,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.

Average claims representative salary in Pittsburg, CA

$43,000

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

The biggest employers of Claims Representatives in Pittsburg, CA are:
  1. Sedgwick LLP
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