Claims representative jobs in Pittsburgh, PA - 23 jobs
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Claims Representative
Claim Specialist
Liability Claims Representative
Claims Adjuster
Claim Investigator
Senior Claims Adjuster
Adjuster
Field Adjuster
Senior Claims Examiner
Senior Claims Analyst
Claim Processor
Pharmacy Claims Specialist
Blinkrx
Claims representative job in Pittsburgh, PA
This is a full-time, onsite position based in Robinson Township.
Responsibilities:
Process pharmacy claims accurately and timely to meet client expectations
Triage rejected pharmacy insurance claims to ascertain patient pharmacy benefits coverage
Maintain compliance with patient assistance program guidelines
Document all information and data discovery according to operating procedures
Research required information using available resources
Maintain confidentiality of patient and proprietary information
Perform all tasks in a safe and compliant manner that is consistent with corporate policies as well as State and Federal laws
Work collaboratively and cross-functionally between management, the Missouri-based pharmacy, compliance and engineering
Requirements:
High school diploma or GED required, Bachelor's degree strongly preferred
One year of Pharmacy Experience, having resolved third party claims
Healthcare industry experience with claims background
Strong verbal and written communication skills
Attention to detail and a strong operational focus
A passion for providing top-notch patient care
Ability to work with peers in a team effort and cross-functionally
Strong technical aptitude and ability to learn complex new software
Location/Hours
Full time position hourly, on-site role in Pittsburgh (Robinson)
Availability for Monday-Friday across various 8 hours shifts : 8am- 4pm EST , 9am- 5pm EST, 1pm- 9pm EST
Availability for rotating Saturday shifts 9am-5pm
Scheduling flexibility, as your schedule may change over time according to business needs
Benefits
Medical, dental, and vision insurance plans that fit your needs
401(k) retirement plan
Daily snack stipend for onsite marketplace
Pre-tax transit benefits and free onsite parking
$38k-66k yearly est. 5d ago
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Auto Claim Rep 1
The Travelers Companies 4.4
Claims representative job in Pittsburgh, PA
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
$55,200.00 - $91,100.00
Target Openings
5
What Is the Opportunity?
* There is also a potential for up to a $10,000 sign-on bonus! *
Be the Hero in Someone's Story
When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most.
As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner.
In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process.
Travelers offers a hybrid work location model that is designed to support flexibility.
What Will You Do?
Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations.
Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates.
Determine claim eligibility, coverage, liability, and settlement amounts.
Ensure accurate and complete documentation of claim files and transactions.
Identify and escalate potential fraud or complex claims for further investigation.
Coordinate with internal teams such as investigators, legal, and customer service, as needed.
What Will Our Ideal Candidate Have?
* Bachelor's Degree.
* Three years of experience in insurance claims, preferably Auto claims.
* Experience with claims management and software systems.
* Strong understanding of insurance principles, terminology with the ability to understand and articulate policies.
* Strong analytical and problem-solving skills.
* Proven ability to handle complex claims and negotiate settlements.
* Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants.
What is a Must Have?
* High School Diploma or GED.
* One year previous Auto claim handling experience or successful completion of Travelers Auto ClaimRepresentative training program.
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 *********************************************************
$55.2k-91.1k yearly 4d ago
Claims Specialist
Henderson Brothers 3.8
Claims representative job in Pittsburgh, PA
Details
Job Title: Claims Specialist
Department: Commercial Lines
Division: Risk Control/Claims
Reports To: Claims Supervisor
Contract: No
FLSA status: Exempt
Position Description
The Claims Specialist will provide heroic claims service by assisting with the management of all claims from the initial report of the claim to the closing to ensure the best outcome for all our customers.
Primary Responsibilities & Duties
Support and manage claim process for clients who are/and are not on a Client Service Plan. This includes initial claim reporting, carrier correspondence, data collection, and internal documentation.
Manage daily client correspondences in regard to claims and claim updates.
Manage data entry in agency management system.
Aid clients through property damage restoration process.
All other duties as assigned.
Position-specific Competencies
Effective Communication: Can clearly articulate oneself in a professional manner with the ability to read the audience and adapt. Possesses the intuition on what information to communicate, feedback to provide, and the right manner of delivery. Practices active listening with patience and can restate opinions accurately, as needed.
Attention to Detail: Ability to achieve thoroughness and accuracy when accomplishing a task. Strong ability to focus and provide thorough attention.
Relationship Management: Possesses the ability to create and maintain strong relationship with business owners and contacts.
Decision Quality: Consistently makes good decisions. Through analysis, wisdom, experience, and judgement can accurately act in the best interest of colleagues and clients.
HBI Competencies
Integrity: Conducts business with the utmost moral decency. A trusted advisor who displays the highest standard of ethics.
Heroic Service: White glove approach to client service and satisfaction. Can anticipate needs, and consistently exceeds expectations.
Teamwork: Works well with others towards a shared goal. Actively participates, shares responsibilities and rewards, and contributes to the effectiveness of the group.
Kindness: Shows concern and consideration for others. Is generous with time, talent, and overall possess a willingness to help.
Qualifications
Bachelor's degree or insurance designation preferred
1-3 years of claims experience required
CIA, ARM, CLA, etc. preferred but not required
*if you are not licensed, you will be required to obtain licensure within first 90 days of hire*
An insurance background or understanding of different types of insurance coverage is beneficial, but not required
Strong verbal communication and listening skills
Proficient in Microsoft Office products such as Word, PowerPoint, and Excel
Proficient virtual communication skills-preferably Zoom
Work Environment
This position requires travel capabilities. A valid driver's license is necessary to provide self-transportation to client meetings, events, and seminars. Local travel up to 50%.
While performing the responsibilities of the job, these work environment characteristics are representative of the environment the job holder will encounter. Reasonable accommodations may be made to enable people with disabilities to perform the essential functions of the job.
EEO Statement
Henderson Brothers supports workplace diversity and does not discriminate on the basis of race, color, religion, gender identity or expression, national origin, age, military service eligibility, veteran status, sexual orientation, marital status, physical or mental disability, or any other protected class.
$61k-98k yearly est. Auto-Apply 60d+ ago
Field Claims Representative - Cambria, Indiana & Westmoreland Counties
Auto-Owners Insurance 4.3
Claims representative job in Pittsburgh, PA
Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to:
Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
Become familiar with insurance coverage by studying insurance policies, endorsements and forms
Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
Ensure that claims payments are issued in a timely and accurate manner
Handle investigations by phone, mail and on-site investigations
Candidates should reside in Cambria, Indiana or Westmoreland County
Desired Skills & Experience
Bachelor's degree or direct equivalent experience handling property and casualty claims
A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
Field claims handling experience is preferred but not required
Knowledge of Xactimate software is preferred but not required
Above average communication skills (written and verbal)
Ability to resolve complex issues
Organize and interpret data
Ability to handle multiple assignments
Ability to effectively deal with a diverse group individuals
Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!
Equal Employment Opportunity
Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.
*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.
#LI-AT1 #LI-Hybrid
$35k-45k yearly est. Auto-Apply 50d ago
Liability Claims Specialist (Construction Defect)
CNA Financial Corp 4.6
Claims representative job in Pittsburgh, PA
You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.
This individual contributor position works under moderate direction, and within defined authority limits, to manage third party liability construction defect commercial claims with moderate to high complexity and exposure. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:
* Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
* Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
* Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.
* Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
* Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
* Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
* Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
* Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
* Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
* Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
* May serve as a mentor/coach to less experienced claim professionals
May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
* Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
* Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
* Demonstrated ability to develop collaborative business relationships with internal and external work partners.
* Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
* Demonstrated investigative experience with an analytical mindset and critical thinking skills.
* Strong work ethic, with demonstrated time management and organizational skills.
* Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
* Developing ability to negotiate low to moderately complex settlements.
* Adaptable to a changing environment.
* Knowledge of Microsoft Office Suite and ability to learn business-related software.
* Demonstrated ability to value diverse opinions and ideas
Education & Experience:
* Bachelor's Degree or equivalent experience.
* Typically a minimum four years of relevant experience, preferably in claim handling.
* Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
* Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
* Professional designations are a plus (e.g. CPCU)
#LI-KP1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
$54k-103k yearly Auto-Apply 29d ago
Independent Insurance Claims Adjuster in Pittsburgh, Pennsylvania
Milehigh Adjusters Houston
Claims representative job in Pittsburgh, PA
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-56k yearly est. Auto-Apply 60d+ ago
Senior Litigation Adjuster
CVS Health 4.6
Claims representative job in Homestead, PA
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health , you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
**Position Summary**
As a Senior Litigation Adjuster in Risk Management, you will be responsible for managing litigation against CVS and overseeing outside counsel defending CVS in premises lawsuits filed throughout the United States.
Responsibilities Include:
- Utilizing legal skills and knowledge to oversee and manage complex premises lawsuits against CVS from the initiation of suit through resolution.
- Analyzing case files and internal materials and utilizing resources across CVS to investigate and discern key issues in each case.
- Developing and implementing a litigation strategy in each case to most efficiently resolve or defend that case.
- Assessing the value of all cases through investigation of the pertinent allegations, evaluating the defenses and issues present in each case, and setting appropriate financial reserves.
- Reviewing discovery responses, pleadings, motions, etc. drafted by defense counsel.
- Providing reporting to key internal stake holders and leadership on case developments.
- Developing relationships with internal colleagues for fact-finding and key litigation activities.
- Participating in internal meetings and attending mediation and trial as necessary to oversee and assist in the defense or resolution of cases.
**Required Qualifications**
- 2+ years of litigation experience, ideally with a law firm or as a litigation adjuster with a large self-insured company or insurance carrier.
- Ability to travel and participate in legal proceedings, arbitrations, trials, etc.
**Preferred Qualifications**
- Experience overseeing or defending premises litigation.
- Litigation experience at a law firm, and/or significant experience overseeing litigated claims for an insurance carrier or corporation, including mediation experience and trial exposure.
- Experience overseeing and answering written discovery, reviewing pleadings and case filings.
- Ability to influence and work collaboratively with senior leaders, CVS's in-house legal counsel and outside defense counsel.
- Ability to positively and aggressively represent the company at mediation, arbitration and trial.
- Ability to work independently and in an environment requiring teamwork and collaboration.
- Ability to navigate difficult situations and communicate effectively with both internal and external groups.
- Excellent organizational and time management skills and ability to handle a full docket of litigated claims.
- Strong written and verbal communication skills, ability to summarize complex issues in a concise, cogent manner.
- Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook) with a proven ability to learn new claims software programs and systems.
**Education**
- Verifiable Bachelor's degree or equivalent work experience required.
- JD degree highly desired.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$46,988.00 - $122,400.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
**Great benefits for great people**
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .
+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit *****************************************
We anticipate the application window for this opening will close on: 02/28/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
$47k-122.4k yearly 6d ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims representative job in Pittsburgh, PA
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-55k yearly est. Auto-Apply 7d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark 4.5
Claims representative job in Homestead, PA
Company :Highmark Inc. :
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
ESSENTIAL RESPONSIBILITIES
Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
Maintains accurate claim records.
Other duties as assigned or requested.
EDUCATION
Required
High School Diploma/GED
Substitutions
None
Preferred
Bachelor's degree
EXPERIENCE
Required
5 years of relevant, progressive experience in health insurance claims
3 years of prior experience processing 1st dollar health insurance claims
3 years of experience with medical terminology
Preferred:
3 years of experience in a Stop Loss Claims Analyst role.
SKILLS
Ability to communicate concise accurate information effectively.
Organizational skills
Ability to manage time effectively.
Ability to work independently.
Problem Solving and analytical skills.
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$22.71
Pay Range Maximum:
$35.18
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
$22.7-35.2 hourly Auto-Apply 37d ago
Claims Investigator - Experienced
Command Investigations
Claims representative job in Pittsburgh, PA
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.
$41k-54k yearly est. Auto-Apply 60d+ ago
Senior Claim Examiner
Chubb 4.3
Claims representative job in Pittsburgh, PA
This is not your average Claims role.
When you think of a job handling insurance claims, you may think about storm damage or auto accidents. Or maybe a large stack of paper?
A career in Employment Practices Liability exposes you to emerging issues in the workplace that have been and remain at the center of national and global media. Issues such as the #MeToo movement, Racial Injustice and Covid.
In this paperless environment, you will use your analytical skills to resolve workplace claims.
We will teach you about Employment Law, contracts and claims. You will use your influence skills and knowledge to partner with defense counsel and our insureds in resolving discrimination, harassment and other workplace related claims.
The work is interesting. The environment is collaborative.
Our Claims Professionals in Employment Practices Liability enjoy the work they do and working with their peers that come from a variety of backgrounds (including Law Enforcement, Human Resources, other disciplines in Claims and Legal, to name a few) and bring different perspectives into the team.
Responsibilities after training include:
Contribute to a collaborative environment by raising new ideas, demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives.
Complete accurate and timely coverage assessments and letters, liability and damage investigations, and evaluations of complex Employment Practices Liability insurance policies.
Establish, document and execute appropriate strategies to bring early and cost-effective resolution to assigned claims.
Represent the company virtually or in person at mediations.
Effectively utilize technology systems and tools to track and manage caseload in most efficient and effective manner.
Build and maintain productive relationships with internal and external customers, including clients, underwriters and agents.
Consistently demonstrate sound claim handling practices by achieving compliance in areas including investigation, coverage, loss assessment, and case management BA/BS College required.
JD is helpful, but not required.
3 to 5 years experience in EPL or other specialty lines of business, or experience working in a legal position.
Excellent verbal and written communication skills.
A personal commitment to superior performance that adds value to our company.
Strong interpersonal skills with the ability to interact and build relationships with all levels of internal and external contacts.
An aptitude for evaluating, analyzing, and interpreting technical information.
Sound critical thinking and decision making skills.
Proven ability to work independently as well as part of a team.
Must demonstrate a high level of initiative and leadership skills
Excellent time management, problem solving, and supreme organizational skills are required in the fast paced environment.
An ability to adapt to new ideas and situations.
A willingness to use creative thinking to overcome obstacles and an ability to develop creative approaches to solving customer problems.
Additional Information:
Travel may be required for mediations and insured visits.
Training: Chubb managers, claim examiners and defense counsel provide a combination of classroom and on-the-job training to ensure our Claim Examiners are prepared to assume full claim handling responsibilities. The training will involve a wide range of knowledge and skill development, including:
Cultivating relationships with internal clients (e.g. underwriters)
Developing the ability to analyze initial claim reports
Developing an understanding of the legal system
Understanding how to effectively investigate and document findings
Understanding Chubb's products to appropriately determine coverage
Learning to interpret and apply insurance contracts
Learning how to negotiate settlements
If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
$67k-97k yearly est. Auto-Apply 13d ago
Lost Time Claims Specialist II
University of Pittsburgh Medical Center 4.6
Claims representative job in Pittsburgh, PA
UPMC WorkPartners is hiring a full-time Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The selected candidate for this role will need to have their West Virginia workers comp adjuster license.
The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers Compensation business unit. The Lost Time Claims Specialist II will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist II will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority within established best practices and performance standards. The Lost Time Claims Specialist II should possess strategic thought process skills to effectively and efficiently manage loss exposures.
Responsibilities:
* Assign medical or other experts to case and arrange for medical examinations when necessary.
* Develop lost time claim disposition skills under limited direction of supervisor.
* Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority.
* Ensure proper referrals and timely updates to appropriate Reinsurer(s).
* Actively participate in claim reviews with clients.
* Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
* Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor.
* Communicate claim status with the injured worker, clients, and broker as needed.
* Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases.
* Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level.
* Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information.
* Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases.
* Appropriate state licensing to be obtained for assigned jurisdictions.
* Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
* Effectively and efficiently manage vendors and expenses.
* Participate in monthly account renewal meetings as needed.
* Mentoring and training new employees as appropriately assigned by management.
Qualifications:
* Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience.
* Minimum of 2 years of Workers Compensation lost time claims handling experience.
* West Virginia insurance adjuster license is highly preferred.
* Experience with PA workers compensation is a bonus.
* Intermediate knowledge of law and insurance regulations in various jurisdictions.
* Demonstrated strong verbal and written communications skills.
* Demonstrated strong analytical and decision making skills.
* Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge.
* Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation) and compensability decisions.
Licensure, Certifications, and Clearances:
* Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
$39k-54k yearly est. 2d ago
Rec Marine Adjuster
Sedgwick 4.4
Claims representative job in Pittsburgh, PA
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 49d ago
Auto Liability Exp Claim Rep.
Travelers 4.8
Claims representative job in Pittsburgh, PA
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$67,000.00 - $110,600.00Target Openings3What Is the Opportunity?*There is also a potential for up to a $15,000 sign-on bonus! *
This position is responsible for handling Personal and Business Insurance Auto Bodily Injury claims from the first notice of loss through resolution/settlement and payment process. This may include interpreting and applying laws and statutes for multiple state jurisdictions. Claim types include moderate complexity Bodily Injury claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations.
Travelers offers a hybrid work location model that is designed to support flexibility.What Will You Do?
Customer Contacts/Experience:
Delivers consistent service quality throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, follow-through and meeting commitments to achieve optimal outcome on every file. Fulfills specific service commitments made to certain accounts, as outlined in Special Account Communication (SAC) instructions.
Coverage Analysis :
Reviews and analyzes coverage and applies policy conditions, provisions, exclusions and endorsements for moderate complexity Bodily Injury liability claims in assigned jurisdictions. Verifies the benefits available, the injured party's eligibility and the applicable limits. Addresses proper application of any deductibles, co-insurance, coverage limits, etc. Confirms priority of coverage (i.e. primary, secondary, concurrent) and takes into consideration issues such as Social Security, Workers Compensation or others relevant to the jurisdiction. Consults with Unit Manager on use of Claim Coverage Counsel.
Investigation/Evaluation:
Investigates each claim to obtain relevant facts necessary to determine coverage, the extent of liability, damages, and contribution potential with respect to the various coverages provided through prompt contact with appropriate parties (e.g. policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts). This may also include investigation of wage loss and essential services claims. Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation. Takes recorded statements as necessary. Utilizes evaluation documentation tools in accordance with department guidelines.
Identifies resources for specific activities required to properly investigate claims such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators and to other experts. Requests through Unit Manager and coordinate the results of their efforts and findings.
Recognizes cases based on severity protocols to be referred timely to next level claim professional or Major Case Unit.
Reserving:
Establishes timely and maintains appropriate claim and expense reserves. Manages file inventory and expense reserves by utilizing an effective diary system, documenting claim file activities in accordance with established procedures to resolve claim in a timely manner.
Negotiation/Resolution:
Determines settlement amounts, negotiates and conveys claim settlements within authority limits to claimants or their representatives. Recognizes and implements alternate means of resolution. As appropriate, writes denial letters, Reservation of Rights and other necessary correspondence to claimants.
Handles both unrepresented and attorney representedclaims. May manage litigated claims on appropriately assigned cases. Develops litigation plan with staff or panel counsel, track and control legal expenses. May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
Insurance License:
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.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Bachelor's Degree.
2 years bodily injury liability claim handling experience.
General knowledge and skill in claims handling and litigation.
Basic working level knowledge and skill in various business line products.
Demonstrated ownership attitude and customer centric response to all assigned tasks.
Demonstrated good organizational skills with the ability to prioritize and work independently.
Attention to detail ensuring accuracy.
Keyboard skills and Windows proficiency, including Excel and Word - Intermediate.
Verbal and written communication skills - Intermediate.
Analytical Thinking- Intermediate.
Judgment/Decision Making- Intermediate.
Negotiation- Intermediate.
Insurance Contract Knowledge- Intermediate.
Principles of Investigation- Intermediate.
Value Determination- Intermediate.
Settlement Techniques- Intermediate.
Medical Knowledge- Intermediate.
What is a Must Have?
One-year bodily injury liability claim handling experience or comparable liability claim handling experience, or successful completion of Travelers ClaimRepresentative training program is required.
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 *********************************************************
$34k-45k yearly est. Auto-Apply 6d ago
Daily Property Field Adjuster
Alacrity Solutions
Claims representative job in Pittsburgh, PA
Job Description
Alacrity Solutions
Independent Contractor
Daily Property Field Adjuster
Alacrity Solutions is a full end-to-end provider delivering streamlined insurance claims, repair, and recovery solutions. As one of the largest independent providers of insurance claims services in North America, we provide property, auto, heavy equipment, and casualty claims management services. Our staffing capabilities, temporary housing services, managed repair network, and subrogation services support a fully integrated solution for all your needs from first notice of loss through completion of repairs. By assembling the best service providers through strategic acquisitions and relying on the right talent, Alacrity Solutions provides consistent, professional, and scalable services throughout the entire claim handling and resolution process. To learn more, visit **************************
The objective of a Daily Property Field Adjuster is to provide excellent claim handling services for our clients regarding daily claim work within your area which can include multiple perils.
Contract Requirements Include:
A contract will be issued within 24 hours of accepting your first claim assignment with Alacrity. This IA contract will include pay details and other pertinent information regarding your work as an independent contract with Alacrity. A completed contract is required to issue pay.
Skills & Requirements/Licensure:
MUST live within 50-100 miles of posted location and willing to travel to location.
Minimum 2-3 years property field adjusting experience.
Independent adjusting license in your home state (area of work), or a designated home state license if residing in a non-licensing state.
Experienced in wind, hail, theft, fire, water losses and other perils preferred.
Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities.
Willing and able to climb roofs.
Computer and Phone System Requirements:
Smart Cell Phone able to access to internet.
Xactimate and/or Symbility proficient with current subscription
Working Laptop computer with reliable high-speed internet
Digital camera and other miscellaneous items necessary to perform adjuster responsibilities.
Working Conditions / Physical & Mental Demands:
The physical demands described here are representative and must be met by the independent contractor to successfully perform this job.
100% travel is required within designated working territory based on the location of assignments received.
Normal office or field claims environment. Ability to operate a motor vehicle for up to 8 hours daily, repeatedly entering and exiting the vehicle. Must be able to make physical inspections of auto loss sites. Must be able to work outdoors in all types of weather. Available to work catastrophic loss events. A willingness to work irregular hours and to travel with possible overnight requirements a plus.
Why Choose Alacrity?
Flexibility: Self-determined Scheduling
Diversity Statement
Alacrity is an equal opportunity employer and is committed to providing employees with a work environment free of discrimination and harassment. All decisions pertaining to an employee's employment are made without regard to race, color, religion, sex (including sexual orientation, pregnancy, childbirth), gender, gender identity or expression, age, national origin, ancestry, physical or mental disability, medical condition, reproductive health decisions, veteran's status, genetic information, creed, marital status, disability, citizenship status, or any other characteristic protected by applicable law.
How Long We Retain Personal Information:
We will keep your personal information for as long as necessary to fulfill legitimate business purposes and in accordance with applicable laws.
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$45k-63k yearly est. 15d ago
Lost Time Claims Specialist II
UPMC 4.3
Claims representative job in Pittsburgh, PA
UPMC WorkPartners is hiring a full-time Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The selected candidate for this role will need to have their West Virginia workers comp adjuster license.
The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers Compensation business unit. The Lost Time Claims Specialist II will apply litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist II will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority within established best practices and performance standards. The Lost Time Claims Specialist II should possess strategic thought process skills to effectively and efficiently manage loss exposures.
Responsibilities:
+ Assign medical or other experts to case and arrange for medical examinations when necessary.
+ Develop lost time claim disposition skills under limited direction of supervisor.
+ Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority.
+ Ensure proper referrals and timely updates to appropriate Reinsurer(s).
+ Actively participate in claim reviews with clients.
+ Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
+ Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor.
+ Communicate claim status with the injured worker, clients, and broker as needed.
+ Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases.
+ Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level.
+ Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information.
+ Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases.
+ Appropriate state licensing to be obtained for assigned jurisdictions.
+ Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
+ Effectively and efficiently manage vendors and expenses.
+ Participate in monthly account renewal meetings as needed.
+ Mentoring and training new employees as appropriately assigned by management.
+ Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience.
+ Minimum of 2 years of Workers Compensation lost time claims handling experience.
+ West Virginia insurance adjuster license is highly preferred.
+ Experience with PA workers compensation is a bonus.
+ Intermediate knowledge of law and insurance regulations in various jurisdictions.
+ Demonstrated strong verbal and written communications skills.
+ Demonstrated strong analytical and decision making skills.
+ Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge.
+ Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claims, Workers' compensation claim investigations (including subrogation) and compensability decisions. Licensure, Certifications, and Clearances:
+ Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
$43k-65k yearly est. 60d+ ago
Claims Examiner
Harris Computer Systems 4.4
Claims representative job in Oklahoma, PA
Responsibilities & Duties:Claims Processing and Assessment: * Evaluate incoming claims to determine eligibility, coverage, and validity. * Conduct thorough investigations, including reviewing medical records and other relevant documentation. * Analyze policy provisions and contractual agreements to assess claim validity.
* Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
* Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
* Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
* Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
* Ensure compliance with company policies, procedures, and regulatory requirements.
* Maintain accurate records and documentation related to claims activities.
* Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
* Identify opportunities for process improvement and efficiency within the claims department.
* Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
* Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
* Generate reports and provide data analysis on claims trends, processing times, and outcomes.
* Contribute to the development of management reports and presentations regarding claims operations.
$45k-63k yearly est. Auto-Apply 37d ago
Auto Claim Rep 1
Travelers Insurance Company 4.4
Claims representative job in Pittsburgh, PA
**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**
$55,200.00 - $91,100.00
**Target Openings**
5
**What Is the Opportunity?**
*There is also a potential for up to a $10,000 sign-on bonus! *
Be the Hero in Someone's Story
When life throws curveballs - storms, accidents, unexpected challenges - YOU become the beacon of hope that guides our customers back to stability. At Travelers, our Claims Organization isn't just a department; it's the beating heart of our promise to be there when our customers need us most.
As a Claim Rep, you will be responsible for managing, evaluating, and processing claims in a timely and accurate manner.
In this detail-oriented and customer focused role, you will work closely with insureds to ensure claims are resolved efficiently while maintaining a high level of professionalism, empathy, and service throughout the claims handling process.
Travelers offers a hybrid work location model that is designed to support flexibility.
**What Will You Do?**
Provide quality claim handling of Auto claims including customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution in accordance with company policies, compliance, and state specific regulations.
Communicate with policyholders, claimants, providers, and other stakeholders to gather information and provide updates.
Determine claim eligibility, coverage, liability, and settlement amounts.
Ensure accurate and complete documentation of claim files and transactions.
Identify and escalate potential fraud or complex claims for further investigation.
Coordinate with internal teams such as investigators, legal, and customer service, as needed.
**What Will Our Ideal Candidate Have?**
+ Bachelor's Degree.
+ Three years of experience in insurance claims, preferably Auto claims.
+ Experience with claims management and software systems.
+ Strong understanding of insurance principles, terminology with the ability to understand and articulate policies.
+ Strong analytical and problem-solving skills.
+ Proven ability to handle complex claims and negotiate settlements.
+ Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants.
**What is a Must Have?**
+ High School Diploma or GED.
+ One year previous Auto claim handling experience or successful completion of Travelers Auto ClaimRepresentative training program.
**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 ******************************************************** .
$55.2k-91.1k yearly 60d+ ago
Claims Specialist
Henderson Brothers Inc. 3.8
Claims representative job in Pittsburgh, PA
Job Description
Details
Job Title: Claims Specialist
Department: Commercial Lines
Division: Risk Control/Claims
Reports To: Claims Supervisor
Contract: No
FLSA status: Exempt
Position Description
The Claims Specialist will provide heroic claims service by assisting with the management of all claims from the initial report of the claim to the closing to ensure the best outcome for all our customers.
Primary Responsibilities & Duties
Support and manage claim process for clients who are/and are not on a Client Service Plan. This includes initial claim reporting, carrier correspondence, data collection, and internal documentation.
Manage daily client correspondences in regard to claims and claim updates.
Manage data entry in agency management system.
Aid clients through property damage restoration process.
All other duties as assigned.
Position-specific Competencies
Effective Communication: Can clearly articulate oneself in a professional manner with the ability to read the audience and adapt. Possesses the intuition on what information to communicate, feedback to provide, and the right manner of delivery. Practices active listening with patience and can restate opinions accurately, as needed.
Attention to Detail: Ability to achieve thoroughness and accuracy when accomplishing a task. Strong ability to focus and provide thorough attention.
Relationship Management: Possesses the ability to create and maintain strong relationship with business owners and contacts.
Decision Quality: Consistently makes good decisions. Through analysis, wisdom, experience, and judgement can accurately act in the best interest of colleagues and clients.
HBI Competencies
Integrity: Conducts business with the utmost moral decency. A trusted advisor who displays the highest standard of ethics.
Heroic Service: White glove approach to client service and satisfaction. Can anticipate needs, and consistently exceeds expectations.
Teamwork: Works well with others towards a shared goal. Actively participates, shares responsibilities and rewards, and contributes to the effectiveness of the group.
Kindness: Shows concern and consideration for others. Is generous with time, talent, and overall possess a willingness to help.
Qualifications
Bachelor's degree or insurance designation preferred
1-3 years of claims experience required
CIA, ARM, CLA, etc. preferred but not required
*if you are not licensed, you will be required to obtain licensure within first 90 days of hire*
An insurance background or understanding of different types of insurance coverage is beneficial, but not required
Strong verbal communication and listening skills
Proficient in Microsoft Office products such as Word, PowerPoint, and Excel
Proficient virtual communication skills-preferably Zoom
Work Environment
This position requires travel capabilities. A valid driver's license is necessary to provide self-transportation to client meetings, events, and seminars. Local travel up to 50%.
While performing the responsibilities of the job, these work environment characteristics are representative of the environment the job holder will encounter. Reasonable accommodations may be made to enable people with disabilities to perform the essential functions of the job.
EEO Statement
Henderson Brothers supports workplace diversity and does not discriminate on the basis of race, color, religion, gender identity or expression, national origin, age, military service eligibility, veteran status, sexual orientation, marital status, physical or mental disability, or any other protected class.
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$61k-98k yearly est. 5d ago
Claims Investigator - Experienced
Command Investigations
Claims representative job in Pittsburgh, PA
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.
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How much does a claims representative earn in Pittsburgh, PA?
The average claims representative in Pittsburgh, PA earns between $30,000 and $64,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Pittsburgh, PA
$43,000
What are the biggest employers of Claims Representatives in Pittsburgh, PA?
The biggest employers of Claims Representatives in Pittsburgh, PA are: