Claims representative jobs in Pleasanton, CA

Workers' Compensation Claim Representative II Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $70,000-$80,000 annually (dependent on experience) 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 a Workers' Compensation Claim Representative II to manage California workers' compensation claims from intake through resolution for a PEO/Staffing account. This role may be remote or hybrid, reporting to our Irvine, CA branch. This position is designed for an experienced adjuster who can independently manage claims, apply sound judgment, and deliver consistent results within California's complex regulatory environment. You'll handle more complex claim scenarios, contribute to claim strategy, and partner closely with supervisors, clients, and vendors to drive quality outcomes. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care. Independently investigate, evaluate, and resolve California workers' compensation claims in compliance with CCMSI standards and client handling instructions Manage claims cradle-to-grave, including compensability, medical management, litigation coordination, and resolution strategy Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim-relatedness; negotiate disputed bills Establish, monitor, and adjust reserves in accordance with authority levels and best practices Authorize and issue claim payments within assigned settlement authority Negotiate settlements with injured workers and attorneys in accordance with client authorization Coordinate with and assist in the selection and oversight of defense counsel Identify and pursue subrogation opportunities Prepare and maintain accurate claim documentation, reports, payments, and reserve summaries Ensure compliance with service commitments, jurisdictional requirements, and excess reporting obligations Deliver consistent, high-quality claim service aligned with CCMSI's corporate standards Qualifications What You'll Bring Required 5-10 years of workers' compensation claims experience, with demonstrated success handling California claims Proven ability to manage claims independently from intake through resolution Strong working knowledge of the California workers' compensation claims process Excellent communication, organization, and time-management skills Ability to prioritize work, meet deadlines, and manage a full caseload with minimal supervision Reliable, predictable attendance within established client service hours Preferred SIP designation or ability to obtain within a defined timeframe Associate degree or higher Experience supporting PEO and/or staffing accounts Proficiency with Microsoft Word, Excel, Outlook, and claims systems Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. 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 #WorkersCompensation #WCClaims #WCClaimRepII #ClaimsAdjuster #CaliforniaWorkersComp #CAClaims #CAAdjusters #InsuranceCareers #ClaimsCareers #TPACareers #PEOClaims #StaffingClaims #HybridWork #RemoteJobs #CaliforniaJobs #EmployeeOwned #GreatPlaceToWorkCertified #CareerWithPurpose #CCMSICareers #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

**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** 2 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic + Verbal and written communication skills -Intermediate + Attention to detail ensuring accuracy - Basic + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic + Analytical Thinking - Basic + Judgment/ Decision Making - Basic + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. + Valid driver's license - 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 ******************************************************** .

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

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.

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.

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.

WestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an organization that is client-centered, trauma-informed, collaborative, and committed to justice and equity. Position Details Title: Medi-Cal Claims Billing Specialist Classification: Full time (1.0 FTE) Non-Exempt (Hourly), 40 hours per week Location: Oakland, CA / Hybrid (In-person for first 90 days) Regular Work Schedule: Monday - Friday Compensation: Hourly range: $26.00-$28.00 per hour The Medi-Cal Claims Billing Specialist will hold the crucial responsibility of inputting claims and corrections with precision and timeliness. Additionally, this role involves the monthly reconciliation of data between external and internal Electronic Health Record (EHR) systems. We are seeking an individual who is not only detail-oriented, but also embraces the opportunity to contribute to the seamless integration and accuracy of our healthcare data. Responsibilities: Generate billing reports from Welligent (WestCoast's internal EHR) and input claims data into Alameda County's EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC). Collaborate with providers, supervisors, and county staff to complete billing process to correct claims. Reconcile monthly claims generated from Smart Care and EPIC systems to internally generated reports. Prepare and submit Correction Claim Reports for Alameda and San Francisco with appropriate supporting documentation. Prepares monthly invoices for Alameda and San Francisco Medi-Cal. Monthly preparation of HCFA forms for OHC billings. Key Qualifications: BA/BS degree preferred Minimum one year of experience with Microsoft Office applications - Excel and Word At least one year of experience with Google Suite Professional experience in an office setting At least one year of experience with Medi-Cal billing procedures and processes is preferred. Competencies (Skills, Abilities, and Knowledge): Ability to work independently and collaboratively as part of a team Strong ability to prioritize projects with competing deadlines Knowledge of issues of race, class, and ethnicity and experience working with diverse communities Solid understanding of processing Medi-Cal services and claims Experienced and knowledgeable with EHR systems; preferred experience with Smart Care, EPIC and/or Welligent EHR systems Excellent interpersonal, communication, and writing skills Knowledge of MS Office Suite including Excel, PowerPoint, Google Calendar, and Google Mail on a Mac OS platform Benefits: Employer-paid Medical Benefits for Employees 100% employer-paid dental and vision Dependent medical, dental and vision (50% employer-paid) Medical and Dependent Care FSA and commuter plans 100% employer-paid life insurance long-term disability insurance Voluntary accident, term life and hospital indemnity insurance Annual incentive compensation (10% per year) 403(b) and ROTH retirement plan options, employer contribution targeted at 7.5% after first year of employment Three weeks PTO during the first year of employment, 4+ weeks PTO with additional years of service 12 paid holidays plus one paid floating holiday per year 4 paid self-care days per year Wellness stipend ($100.00 per month) Employee Assistance Program (EAP) Join us and make a difference in the lives of vulnerable children and families in the Bay Area. WCC is passionate about leading and encouraging open conversations around race, gender, power, and privilege and how these impact community mental health. We are an equal opportunity employer. We are committed to diminishing the influence of privilege and discrimination in our field and our workplace, whether due to differences concerning age, citizenship, color, disability, marital or parental status, race, religion, gender, or sexual orientation.

Job Description The Field Adjuster will investigate and evaluate daily property claims for clients pursuant to client and company direction. Provide timely, accurate, fair, and professional service to all clients and insured parties while maintaining a high level of production. Essential Functions: Handles all assigned claims promptly and effectively, with minimal need for direction and oversight. Inspect damaged property and determine claim related damage. Makes decisions within delegated authority as outlined in company policies and procedures. Understands insurance coverage and applies appropriate claims practices to resolve claims in alignment with company guidelines. Sets and relays adequate reserves according to carrier guidelines. Maintains current knowledge of insurance policies and carrier guidelines. Maintains current knowledge of local industry repair procedures and local market pricing. Submits severe incident reports, insured to value (ITV) reports and other information to claims management as needed. Delivers outstanding customer service experience to all internal, external, current, and prospective customers nationwide. Adheres to high standards of professional conduct while providing delivery of outstanding claim's service. Perform other duties as assigned. Job Requirements: Bachelors preferred; High School required. Must have a valid adjuster license for state residing/covering. Must have a valid driver's license to travel to insureds locations. 2-3 years of experience with property claims required. Experience preparing estimates with Symbility required. Xactimate preferred. Knowledge of insurance policies, theories, and practices. General understanding of construction concepts and principles strongly preferred. Must have the ability to climb ladders, get in attics/crawlspaces, get on roofs, kneel, bend, etc. Must complete continuing education credits where required to maintain licensing. Strong investigative, analytical, and problem-solving skills Capability to plan, organize and manage time efficiently. Ability to work within specific client guidelines concerning both service timelines and preparation of estimates.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

Introduction The San Joaquin County District Attorney's Office mission is clear: to serve and support victims of crime with unwavering dedication. The office has a staff of over 300 employees comprised of attorneys, investigators, and support personnel located in downtown Stockton, the Juvenile Justice Center in French Camp, and within branches of the Superior Court in Lodi and Manteca. This departmental promotional recruitment is being held to fill (1) vacancy in the District Attorney's Office and to establish a list that may be used to fill future vacancies. To qualify for this position, you must currently be employed with the San Joaquin District Attorney's Office. Resumes will not be accepted in lieu of an application. A completed application must be postmarked or received online by the final filing deadline. NOTE: All correspondences relating to this recruitment will be delivered via e-mail. The e-mail account used will be the one provided on your employment application during time of submittal. Please be sure to check your e-mail often for updates. If you do not have an e-mail account on file, Human Resources will send you correspondences via US Mail. Pre-employment Drug Screening and Background: Potential new hires into this classification are required to successfully pass a pre-employment drug screen and a background as a condition of employment. Final appointment cannot be made unless the eligible has passed the drug screen and background. The County pays for the initial drug screen. TYPICAL DUTIES * Reviews and evaluates victim-of-crime applications for adherence to California State statutory and eligibility requirements; obtains and analyzes crime reports and other documents from the appropriate law enforcement agency to verify factual case information; contacts law enforcement officers, court officials, attorneys, and others to obtain pertinent information in order to determine initial and on-going Program eligibility; establishes appropriate computer records for applicants based on approval or denial of victim application. * Reviews and processes a variety of claims submitted by victims including medical bills, mental health bills, funeral/burial bills, wage loss requests and other expenses; researches information as required to establish a link to the qualifying crime and to verify losses claimed by the victim; calculates losses to victims and determines reimbursements considering all other sources of compensation available; approves or denies claim reimbursement and level of services; notifies victims of claim determinations. * Acts as a lead worker as assigned; identifies staff training needs and learning opportunities; develops and oversees training plans; assesses and assigns work to staff as appropriate; may provide input to supervisory staff regarding staff assignments and performance; audits staff work for quality control and training purposes; may be assigned to complete special reports or projects. * Interacts effectively with victims, families, law enforcement personnel and others; obtains accurate information and identifies potential problem issues; acts as a liaison between victims, families and other organizations/individuals regarding Program benefits; interacts with other counties in order to fulfill contract obligations for claims processing. * Keeps accurate logs of all claims submitted; creates detailed computer files on all claims processed, whether approved or denied; processes approved bills for payment; creates pre-authorization statements as appropriate. * Monitors caseload data and develops comprehensive, periodic summary reports as required to receive State credit; prepares various memorandums and correspondence. * Coordinates victim claim services with the Victim Witness Advocates; refers victims to other agencies as appropriate. MINIMUM QUALIFICATIONS PLEASE NOTE: This is a departmental promotion. Qualified applicants must currently be employed with San Joaquin County District Attorney's Office and meet the promotional eligibility requirements as stated in Civil Service Rule 10, Section 3-Eligiblity for Promotional Examinations. Experience: One year performing claims review and/or program eligibility determination at a level comparable to or higher than Victim Claims Specialist II in San Joaquin County. Note: Individuals employed in the San Joaquin County classes of Victim Claims Technician II at the time of adoption of this class specification by the Civil Service Commission will be credited with their experience on a year-for-year basis. Special Requirement: Successful completion of the State of California Victims of Crime Introductory/Basic Training Course. License: Possession of a valid California driver's license. KNOWLEDGE Principles and practices of leadership and training; standard office procedures including the use of computers and other technological equipment; mathematics, reading and writing skills; technical research methods as they apply to evaluating and processing financial claims; principles of interviewing and gathering information; fundamental aspects of human behavior; basic medical and legal terminology. ABILITY Lead, train and audit the work of others; follow oral and written directions; read, understand, and apply regulations and other job related materials; maintain records and prepare reports; deal tactfully with the public; interview, gather, record and evaluate information; establish effective working relationships with a wide variety of people. PHYSICAL/MENTAL REQUIREMENTS Mobility-Frequent keyboard operation, sitting; occasional pushing, pulling, bending, squatting; Lifting-Frequent lifting up to 5 pounds; Vision-Constant reading and close-up work requiring good overall vision; frequent eye/hand coordination; occasional color/depth perception and peripheral vision; Dexterity-Frequent holding, gripping, writing and repetitive motion; occasional reaching; Hearing/Talking-Constant hearing normal speech, hearing/talking in person and on the telephone; occasional hearing faint sounds; Emotional/Special Conditions-Frequent public contact, decision making, and concentration; frequent exposure to trauma, grief and death; occasional working overtime. BENEFITS Employees hired into this classification are members of a bargaining unit which is represented by SEIU Local 1021. Health Insurance: San Joaquin County provides employees with a choice of three health plans: a Kaiser Plan, a Select Plan, and a Premier Plan. Employees pay a portion of the cost of the premium. Dependent coverage is also available. Dental Insurance: The County provides employees with a choice of two dental plans: Delta Dental and United Health Care-Select Managed Care Direct Compensation Plan. There is no cost for employee only coverage in either plan; dependent coverage is available at the employee's expense. Vision Insurance: The County provides vision coverage through Vision Service Plan (VSP). There is no cost for employee only coverage; dependent coverage is available at the employee's expense. For more detailed information on the County's benefits program, visit our website at ************* under Human Resources/Employee Benefits. Life Insurance: The County provides eligible employees with life insurance coverage as follows: 1 but less than 3 years of continuous service: $1,000 3 but less than 5 years of continuous service: $3,000 5 but less than 10 years of continuous service: $5,000 10 years of continuous service or more: $10,000 Employee may purchase additional term life insurance at the group rate. 125 Flexible Benefits Plan: This is a voluntary program that allows employees to use pre-tax dollars to pay for health-related expenses that are not paid by a medical, dental or vision plan (Health Flexible Spending Account $2550 annual limit with a $500 carry over); and dependent care costs (Dependent Care Assistance Plan $5000 annual limit). Retirement Plan: Employees of the County are covered by the County Retirement Law of 1937. Please visit the San Joaquin County Employees' Retirement Association (SJCERA) at ************** for more information. NOTE: If you are receiving a retirement allowance from another California county covered by the County Employees' Retirement Act of 1937 or from any governmental agency covered by the California Public Employees' Retirement System (PERS), you are advised to contact the Retirement Officer of the Retirement Plan from which you retired to determine what effect employment in San Joaquin County would have on your retirement allowance. Deferred Compensation: The County maintains a deferred compensation plan under Section 457 of the IRS code. You may annually contribute $18,000 or 100% of your includible compensation, whichever is less. Individuals age 50 or older may contribute to their plan, up to $24,000. The Roth IRA (after tax) is also now available. Vacation: Maximum earned vacation is 10 days each year up to 3 years; 15 days after 3 years; 20 days after 10 years; and 23 days after 20 years. Holidays: Effective July 1, 2017, all civil service status employees earn 14 paid holidays each year. Please see the appopriate MOU for details regarding holidays, accruals, use, and cashability of accrued time. Sick Leave: 12 working days of sick leave annually with unlimited accumulation. Sick leave incentive: An employee is eligible to receive eight hours administrative leave if the leave balance equals at least one- half of the cumulative amount that the employee is eligible to accrue. The employee must also be on payroll during the entire calendar year. Bereavement Leave: 3 days of paid leave for the death of an immediate family member, 2 additional days of accrued leave for death of employee's spouse, domestic partner, parent or child. Merit Salary Increase: New employees will receive the starting salary, which is the first step of the salary range. After employees serve 52 weeks (2080 hours) on each step of the range, they are eligible for a merit increase to the next step. Job Sharing: Employees may agree to job-share a position, subject to approval by a Department Head and the Director of Human Resources. Educational Reimbursement Program: Eligible employees may be reimbursed for career-related course work up to a maximum of $850 per fiscal year. Eligible employees enrolled in an approved four (4) year College or University academic program may be reimbursed up to $800 per semester for a maximum of $1600 per fiscal year. Parking Supplemental Downtown Stockton: The County contributes up to $17 per pay period for employees who pay for parking and are assigned to work in the Downtown Core Area. School Activities: Employees may take up to 40 hours per year, but not more than eight (8) hours per month, to participate in their children's school activities. Selection Procedures Civil Service Rule 10 - Section 3 - Eligibility for Promotional Examinations To compete in a promotional examination, an employee must: A. Meet the minimum qualifications of the class on or before the final filing date for filing applications. B. Meet one of the following qualifying service requirements: 1. Have permanent status in the Classified Service. 2. Probationary, part-time, or temporary employees who have worked a minimum of 1040 hours in the previous 12 months or previous calendar year. 3. Exempt employees who have worked a minimum of 2,080 continuous and consecutive hours. C. Have a rating of satisfactory or better on the last performance evaluation. D. If a person whose name is on a promotional list is separated (except for layoff) the name shall be removed from the promotional list of the action. Employees who meet the minimum qualifications will go through one of the following examination process: * Written Exam: The civil service written exam is a multiple choice format. If the written exam is administered alone, it will be 100% of the overall score. Candidates must achieve a minimum rating of 70% in order to be placed on the eligible list. * Oral Exam: The oral exam is a structured interview process that will assess the candidate's education, training, and experience and may include a practical exercise. The oral exam selection process is not a hiring interview. A panel of up to four people will determine the candidate's score and rank for placement on the eligible list. Top candidates from the eligible list are referred for hiring interviews. If the oral exam is administered alone, it will be 100% of the overall score. Candidates must achieve a minimum rating of 70% in order to be placed on the eligible list. * Written & Oral Exam: If both a written exam and an oral exam is administered, the written exam is weighted at 60% and the oral exam is weighted at 40% unless otherwise indicated on the announcement. Candidates must achieve a minimum rating of 70% on each examination in order to be placed on the eligible list. * Rate-out: A rate-out is an examination that involves a paper rating of the candidate's application using the following criteria: education, training, and experience. Candidates will not be scheduled for the rate-out process. Online Written Exams: Written exams may be administered in-person, online. Candidates will be notified of the examination date and will be responsible to complete the written exam per notice instructions. Candidates are required to read the Online Exam Guide for Test Takers prior to taking an online written exam. The link to the guide is here: Online Exam Guide For Test Takers Note: The rating of 70 referred to may be the same or other than an arithmetic 70% of the total possible points. Testing Accommodation: Candidates who require testing accommodation under the Americans with Disabilities Act (ADA) must call Human Resources Division at ************** prior to the examination date. Eligible Lists: Candidates who pass the examination will be placed on an eligible list for that classification. Eligible lists are effective for nine months, but may be extended by the Human Resources Director for a longer period which shall not exceed a total of three years for the date esblished. Certification/Referral: Names from the eligible list will be referred to the hiring department by the following methods. * Rule of Five: The top five names will be referred for hiring interviews. This applies only to department or countywide promotional examination. Physical Exam: Some classifications require physical examinations. Final appointment cannot be made until the eligible has passed the physical examination. The County pays for physical examinations administered in its medical facilities. Employment of Relatives: Applicants who are relatives of employees in a department within the 3rd degree of relationship, (parent, child, grand parent, grand child or sibling) either by blood or marriage, may not be appointed, promoted, transferred into or within the department when; * They are related to the Appointing Authority or * The employment would result in one of them supervising the work of the other. Department Head may establish additional limitations on the hiring of relatives by departmental rule. HOW TO APPLY Please be advised that Human Resources will only be accepting Online Application submittals for this recruitment. Paper application submittals will not be considered or accepted. Apply Online: *************/department/hr Office hours: Monday - Friday 8:00 am to 5:00 pm; excluding holidays. Phone: ************** Job Line: For current employment opportunities please call our 24-hour job line at **************. When a final filing date is indicated, applications must be submitted online to the Human Resources Division before the submission deadline. Resumes and paper applications will not be accepted in lieu of an online application. (The County assumes no responsibility for online applications which are not received by the Human Resources Division). San Joaquin County Substance Abuse Policy: San Joaquin County has adopted a Substance Abuse Policy in compliance with the Federal Drug Free Workplace Act of 1988. This policy is enforced by all San Joaquin County Departments and applies to all San Joaquin County employees. Equal Opportunity Employer: San Joaquin County is an Equal Employment Opportunity (EEO) Employer and is committed to providing equal employment to all without regard to age, ancestry, color, creed, marital status, medical condition, national origin, physical or mental disability, political affiliation or belief, pregnancy, race, religion, sex, or sexual orientation. For more information go to *************/department/hr/eeo. Click on a link below to apply for this position:

Workers' Compensation Claim Representative I Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $60,000 to $70,000 annually (dependent on experience) 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 a Workers' Compensation Claim Representative I to support a PEO/Staffing account handling California workers' compensation claims from intake through resolution. This role may be remote or hybrid, reporting to our Irvine, CA branch. This position is ideal for an early-career adjuster or claims professional with 1-3 years of claims experience-or a related insurance, medical, or legal background-who is ready to grow in a true adjusting role. You'll investigate claims, manage medical and legal activity, communicate with all parties, and deliver consistent, compliant outcomes under guidance and mentorship. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care. Investigate and adjust California workers' compensation claims in accordance with CCMSI standards and client handling instructions Manage claims cradle-to-grave, including compensability decisions, medical management, and resolution strategy Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim-relatedness Negotiate disputed medical bills and work toward timely resolution Authorize and issue claim payments within assigned settlement authority Communicate with injured workers, employers, attorneys, medical providers, and internal partners Assist with settlement negotiations in accordance with client authorization Support the selection and coordination of defense counsel as appropriate Evaluate and monitor subrogation opportunities Prepare claim reports, payment summaries, and reserve documentation Maintain compliance with service commitments, jurisdictional requirements, and excess reporting obligations Deliver consistent, high-quality claim service aligned with CCMSI's corporate standards Qualifications What You'll Bring Required 1-3 years of workers' compensation claims experience or related experience in insurance, medical claims, legal, or adjacent claim-support roles Working knowledge of the California workers' compensation claims process Strong organizational, communication, and time-management skills Ability to prioritize work, meet deadlines, and manage multiple tasks Reliable, predictable attendance within established client service hours Preferred SIP designation or ability to obtain within a defined timeframe Associate degree or higher Experience supporting PEO and/or staffing accounts Proficiency with Microsoft Word, Excel, Outlook, and claims systems Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. 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 #WorkersCompensation #WCClaims #WCClaimRep #ClaimsAdjuster #CaliforniaWorkersComp #CAClaims #CAAdjusters #InsuranceCareers #ClaimsCareers #TPACareers #HybridWork #RemoteJobs #CaliforniaJobs #CareerWithPurpose #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

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 2 What Is the Opportunity? This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. What Will You Do? * Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. * The on the job training includes practice and execution of the following core assignments: * Handles 1st party property claims of moderate severity and complexity as assigned. * Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. * Broad scale use of innovative technologies. * Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. * Establishes timely and accurate claim and expense reserves. * Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. * Negotiates and conveys claim settlements within authority limits. * Writes denial letters, Reservation of Rights and other complex correspondence. * Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. * Meets all quality standards and expectations in accordance with the Knowledge Guides. * Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. * Manages file inventory to ensure timely resolution of cases. * Handles files in compliance with state regulations, where applicable. * Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. * Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. * Identifies and refers claims with Major Case Unit exposure to the manager. * Performs administrative functions such as expense accounts, time off reporting, etc. as required. * Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * Must secure and maintain company credit card required. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. * This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. * Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic * Verbal and written communication skills -Intermediate * Attention to detail ensuring accuracy - Basic * Ability to work in a high volume, fast paced environment managing multiple priorities - Basic * Analytical Thinking - Basic * Judgment/ Decision Making - Basic * Valid passport preferred. What is a Must Have? * High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. * Valid driver's license - 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 *********************************************************

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

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.

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.

WestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an organization that is client-centered, trauma-informed, collaborative, and committed to justice and equity. Position Details Title: Medi-Cal Claims Billing Specialist Classification: Full time (1.0 FTE) Non-Exempt (Hourly), 40 hours per week Location: Oakland, CA / Hybrid (In-person for first 90 days) Regular Work Schedule: Monday - Friday Compensation: * Hourly range: $26.00-$28.00 per hour The Medi-Cal Claims Billing Specialist will hold the crucial responsibility of inputting claims and corrections with precision and timeliness. Additionally, this role involves the monthly reconciliation of data between external and internal Electronic Health Record (EHR) systems. We are seeking an individual who is not only detail-oriented, but also embraces the opportunity to contribute to the seamless integration and accuracy of our healthcare data. Responsibilities: * Generate billing reports from Welligent (WestCoast's internal EHR) and input claims data into Alameda County's EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC). * Collaborate with providers, supervisors, and county staff to complete billing process to correct claims. * Reconcile monthly claims generated from Smart Care and EPIC systems to internally generated reports. * Prepare and submit Correction Claim Reports for Alameda and San Francisco with appropriate supporting documentation. * Prepares monthly invoices for Alameda and San Francisco Medi-Cal. * Monthly preparation of HCFA forms for OHC billings. Key Qualifications: * BA/BS degree preferred * Minimum one year of experience with Microsoft Office applications - Excel and Word * At least one year of experience with Google Suite * Professional experience in an office setting * At least one year of experience with Medi-Cal billing procedures and processes is preferred. Competencies (Skills, Abilities, and Knowledge): * Ability to work independently and collaboratively as part of a team * Strong ability to prioritize projects with competing deadlines * Knowledge of issues of race, class, and ethnicity and experience working with diverse communities * Solid understanding of processing Medi-Cal services and claims * Experienced and knowledgeable with EHR systems; preferred experience with Smart Care, EPIC and/or Welligent EHR systems * Excellent interpersonal, communication, and writing skills * Knowledge of MS Office Suite including Excel, PowerPoint, Google Calendar, and Google Mail on a Mac OS platform Benefits: * Employer-paid Medical Benefits for Employees * 100% employer-paid dental and vision * Dependent medical, dental and vision (50% employer-paid) * Medical and Dependent Care FSA and commuter plans * 100% employer-paid life insurance long-term disability insurance * Voluntary accident, term life and hospital indemnity insurance * Annual incentive compensation (10% per year) * 403(b) and ROTH retirement plan options, employer contribution targeted at 7.5% after first year of employment * Three weeks PTO during the first year of employment, 4+ weeks PTO with additional years of service * 12 paid holidays plus one paid floating holiday per year * 4 paid self-care days per year * Wellness stipend ($100.00 per month) * Employee Assistance Program (EAP) Join us and make a difference in the lives of vulnerable children and families in the Bay Area. WCC is passionate about leading and encouraging open conversations around race, gender, power, and privilege and how these impact community mental health. We are an equal opportunity employer. We are committed to diminishing the influence of privilege and discrimination in our field and our workplace, whether due to differences concerning age, citizenship, color, disability, marital or parental status, race, religion, gender, or sexual orientation.

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Are you an experienced Claims Specialist looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Company Job Description/Essential Functions: Review and process provider dispute resolutions according to state and federally defined timeframes. Research issues; adjust claims, including computation of interest owed as appropriate. Send written responses to providers in a professional manner within required timelines. Forward cases to the IRE or the DMHC as needed. Answer provider inquiries regarding disputes that have been submitted. Maintain and track disputes through HPSM's grievance and appeals database. Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed. Qualifications 2+ years' experience working with medical claims (Example: Claims Examiner, Claims Provider Services Rep) Must have experience in a health services and/or managed care setting Medi-Cal & Medicare program knowledge Must be well-versed in medical claims and reimbursement process Experience with Microsoft Office software Additional Information Advantages of this Opportunity: • Hours for this Position: Monday- Friday 8:00am to 5:00pm • Pay up to $22 per hour, negotiable • Immediate opening, Temp-to-Perm position with excellent benefits offered. If you know of someone looking for a new opportunity, please pass along the information! We offer referral bonuses of up to $100.00 for each placement.

**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** 2 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic + Verbal and written communication skills -Intermediate + Attention to detail ensuring accuracy - Basic + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic + Analytical Thinking - Basic + Judgment/ Decision Making - Basic + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. + Valid driver's license - 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 ******************************************************** .

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.