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Senior Liability Adjuster - New York Labor Law (Major Case Unit)
Berkshire Hathaway 4.8
Claims representative job in Rancho Cordova, CA
Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.
Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!
Benefits:
We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer!
Competitive compensation
Healthcare benefits package that begins on first day of employment
401K retirement plan with company match
Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
Up to 6 weeks of parental and bonding leave
Hybrid work schedule (3 days in the office, 2 days from home)
Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
Tuition reimbursement after 6 months of employment
Numerous opportunities for continued training and career advancement
And much more!
Responsibilities Specializing in New York Labor Law & High-Exposure Losses Are you a veteran liability adjuster who thrives on complexity, strategy, and high‑stakes negotiations? Step into a role where your expertise in New York Labor Law and catastrophic loss management truly matters. Join our Major Case Unit as a Senior Liability Adjuster, and take ownership of some of the most challenging and impactful commercial general liability claims in our organization.
In this senior-level role, you'll lead the investigation, evaluation, and resolution of large‑loss and litigated CGL claims, with a strong emphasis on New York Labor Law matters. You will:
Manage large and catastrophic losses, ensuring deep‑dive investigations and strategic claim outcomes.
Lead the analysis of construction contracts and insurance policies to determine coverage, identify priority of coverage, and evaluate risk transfer opportunities.
Drive negotiation and settlement strategy, securing cost‑effective, defensible outcomes.
Investigate claims thoroughly, pinpointing covered vs. uncovered exposures.
Collaborate closely with panel counsel to build litigation strategy, prepare for hearings, and defend insureds effectively.
Review medical records, expert reports, and evidence to strengthen case positions.
Set accurate indemnity and expense reserves on complex, high‑exposure files.
Issue timely and precise payments, maintaining financial accuracy.
Interview insureds, claimants, and witnesses to gather critical claim intelligence.
Occasional travel for mediations, trials, hearings, and onsite conferences.
Qualifications
We're looking for a seasoned professional who is confident managing complex NY Labor Law matters with exposure over $500,000. The ideal candidate has:
10+ years of experience handling Commercial General Liability (CGL) and BOP liability claims
5+ years specializing in New York Labor Law with significant loss exposure
Bachelor's degree required, J.D. highly preferred
Strong coverage knowledge and the ability to interpret insurance policies and construction contracts
Demonstrated capability in risk transfer analysis and prioritizing coverage
Exceptional written and verbal communication skills
Strong organizational ability and comfort with claims technology
Excellent time‑management and multi‑tasking skills
Ability to collaborate effectively with counsel, experts, and internal partners
This role may be based out of any of our office locations, including:
New York, NY; Parsippany, NJ; Philadelphia, PA; Conshohocken, PA; Wilkes‑Barre, PA; Alpharetta, GA; Rosemont, IL; Plano, TX; Scottsdale, AZ; and Rancho Cordova, CA.
The salary ranges below reflect broad pay bands based on cost‑of‑labor groupings. Actual base pay will vary depending on factors such as experience, education, skills, performance, job responsibilities, and work location.
High‑Cost Markets
(e.g., New York City, Northern New Jersey, parts of California, Chicago)
Estimated Base Salary Range: $110,000 - $200,000
Standard‑Cost Markets
(e.g., Pennsylvania, Texas, Georgia, Arizona, Illinois, remaining markets)
Estimated Base Salary Range: $90,000 - $160,000
$110k-200k yearly Auto-Apply 6d ago
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Claims Representative - Rancho Cordova, CA
Federated Mutual Insurance Company 4.2
Claims representative job in Rancho Cordova, CA
Who is Federated Insurance? At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own.
Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values.
What Will You Do?
Customer-focused, source of knowledge and comfort, desire to help, professional, self-motivated - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss.
No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients.
This is an in-office position that will work out of our Rancho Cordova, CA office, located at 10850 Gold Center Drive. A work from home option is not available.
Responsibilities
* Work with policyholders, attorneys, and others to ensure claims are resolved in a prompt, fair and courteous way.
* Explain policy coverage to policyholders and third parties.
* Complete thorough investigations and document facts relating to claims.
* Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars.
Minimum Qualifications
* Current pursuing, or have obtained a four-year degree
* Experience in a customer service role in industries such as retail, hospitality, logistics, banking, equipment dealerships, equipment rental, sales or similar fields
* Ability to make confident decisions based on available information
* Strong analytical, computer, and time management skills
* Excellent written and verbal communication skills
* Leadership experience is a plus
Salary Range: $63,800 - $78,000
Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. In addition, this position is eligible for a Geographic Differential Payment. Details of this benefits will be discussed in the interview process.)
What We Offer
We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You.
Employment Practices
All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization.
If California Resident, please review Federated's enhanced Privacy Policy.
**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$52,600.00 - $86,800.00
**Target Openings**
3
**What Is the Opportunity?**
Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. The Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility.
As part of the hiring process, this position will require the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
**What Will You Do?**
+ Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training.
+ Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision.
+ Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud.
+ Participate in Telephonic and/or onsite File Reviews.
+ Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts.
+ Gather information from policyholders, claimants, witnesses, and third-party providers.
+ Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel.
+ Maintain accurate records of claim activity in claim management systems.
+ Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources.
+ Demonstrate openness to continuous learning, particularly in AI and digital transformation.
+ Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Previous internship or work experience in insurance, finance, or customer service.
+ Strong attention to detail and organizational skills.
+ Ability to manage multiple tasks and prioritize effectively.
+ Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants.
+ Ability to exercise sound judgement and make effective decisions.
+ Strong verbal and written communication skills with the ability to convey information clearly and professionally.
**What is a Must Have?**
+ High School Diploma or GED.
+ One year of customer service experience OR Bachelor's Degree.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit ******************************************************** .
$52.6k-86.8k yearly 21d ago
Claims Representative - Rancho Cordova, CA
Federated Insurance Companies 4.5
Claims representative job in Rancho Cordova, CA
Who is Federated Insurance?
At Federated Insurance, we do life-changing work, focused on our clients' success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we're looking for employees who want to make a difference in others' lives, all while enhancing their own.
Federated's culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect. We strive to create a work environment that embodies our values and commitment to diversity and inclusion. We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities. Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values.
What Will You Do?
Customer-focused, source of knowledge and comfort, desire to help, professional, self-motivated - Does that sound like you? We are seeking someone who possesses those skills to assist our clients through the claims process and to help them return to normalcy after a loss.
No previous insurance or claims experience needed! Federated provides an exceptional training program to teach you the fundamentals of claims and will prepare you to assist clients.
This is an in-office position that will work out of our Rancho Cordova, CA office, located at 10850 Gold Center Drive. A work from home option is not available.
Responsibilities
Work with policyholders, attorneys, and others to ensure claims are resolved in a prompt, fair and courteous way.
Explain policy coverage to policyholders and third parties.
Complete thorough investigations and document facts relating to claims.
Resolve claims, which may include paying, settling, or denying claims, defending policyholders in court, compromising or recovering outstanding dollars.
Minimum Qualifications
Current pursuing, or have obtained a four-year degree
Experience in a customer service role in industries such as retail, hospitality, logistics, banking, equipment dealerships, equipment rental, sales or similar fields
Ability to make confident decisions based on available information
Strong analytical, computer, and time management skills
Excellent written and verbal communication skills
Leadership experience is a plus
Salary Range: $63,800 - $78,000
Pay may vary depending on job-related factors and individual experience, skills, knowledge, etc. In addition, this position is eligible for a Geographic Differential Payment. Details of this benefits will be discussed in the interview process.)
What We Offer
We offer a wide variety of ways to support you as a whole, both professionally and personally. Our commitment to your growth includes opportunities for internal mobility and career development paths, inspiring excellence in performance and ensuring your professional journey thrives. Additionally, we offer exceptional benefits to nurture your personal life. We understand the importance of health and financial security, offering encompassing competitive compensation, enticing bonus programs, cost-effective health insurance, and robust pension and 401(k) offerings. To encourage community engagement, we provide paid volunteer time and offer opportunities for gift matching. Discover more about Federated and our comprehensive benefits package: Federated Benefits You.
Employment Practices
All candidates must be legally authorized to work in the United States for any employer. Federated will not sponsor candidates for employment visa status, such as an H1-B visa. Federated does not interview or hire students or recent graduates with J-1 or F-1 visas or similar temporary work authorization.
If California Resident, please review Federated's enhanced Privacy Policy.
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$63.8k-78k yearly Auto-Apply 37d ago
Senior Workers Compensation Claim Representative - Rancho Cordova, CA
Msccn
Claims representative job in Rancho Cordova, CA
ATTENTION MILITARY AFFILIATED JOB SEEKERS
- Our organization works with partner companies to source qualified talent for their open roles. The following position is available to
Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers
. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$70,400.00 - $116,200.00
What Is the Opportunity?
Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered.
What Will You Do?
Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.
Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions.
Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate.
Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation).
Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome
Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation.
Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment.
Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations.
Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals
Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status
Act as technical resource to others.
Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed.
Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers' Compensation claims.
Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims
Acts as an independent mentor to other Claim Professionals
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
Maintain Continuing Education requirements as required.
Perform other duties as assigned.
Additional Qualifications/Responsibilities
What Will Our Ideal Candidate Have?
Education/Course of Study: Work Experience:
Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology.
Ability to effectively present file resolution to internal and/or external stakeholders.
Negotiation: Advanced evaluation, negotiation and case resolution skills.
Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract.
Principles of Investigation: Intermediate investigative skills including the ability to take statements.
Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss.
Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Settlement Techniques: Advanced ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package.
Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
WC Technical:
Advanced ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims.
Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Customer Service:
Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
Teamwork:
Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
Planning & Organizing:
Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
What is a Must Have?
High school diploma or equivalent.
2 years Workers Compensation claim handling experience.
Who Are We?
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job CategoryClaimCompensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range$52,600.00 - $86,800.00Target Openings3What Is the Opportunity?Travelers' Claim Organization is at the heart of our business by providing assurance to our customers and their employees in their time of need. The Travelers Workers Compensation Claim team is committed to partnering with our business insurance customers to help their injured employees return to work as soon as medically appropriate. As an Associate Claim Rep, Workers Compensation, you will receive comprehensive training in claim handling, customer service, and policy interpretation while working alongside experienced claim professionals. This position focuses on developing your skills and knowledge to successfully manage workers compensation claims. This program can typically last up to 12 months and upon successful completion of this program you will have the skills needed to handle claims independently and progress toward full claims handling responsibility.
As part of the hiring process, this position will require the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.What Will You Do?
Actively participate in structured training classes covering insurance policies, specific claim processes, systems, and procedures, including virtual, classroom, and on-the-job training.
Assist in reviewing, investigating, and documenting Workers Compensation claims under close supervision.
Investigate, develop, and evaluate action plans for claim resolution. Assess coverage and determine if a claim is compensable under Workers Compensation including evaluating claims for potential fraud.
Participate in Telephonic and/or onsite File Reviews.
Learn how to determine coverage, compensability, and exposure based on policy terms and claim facts.
Gather information from policyholders, claimants, witnesses, and third-party providers.
Communicate and apprise all parties regarding claim status which may include our business customers, injured employees, medical providers, and legal counsel.
Maintain accurate records of claim activity in claim management systems.
Achieve a positive result by returning an injured party to work when appropriate. This may include coordinating medical treatment in collaboration with internal or external resources.
Demonstrate openness to continuous learning, particularly in AI and digital transformation.
Acquire and maintain relevant Insurance License(s) to comply with state and Travelers' requirements within three months of starting the job.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Previous internship or work experience in insurance, finance, or customer service.
Strong attention to detail and organizational skills.
Ability to manage multiple tasks and prioritize effectively.
Exceptional customer service skills and a commitment to providing a positive experience for insureds and claimants.
Ability to exercise sound judgement and make effective decisions.
Strong verbal and written communication skills with the ability to convey information clearly and professionally.
What is a Must Have?
High School Diploma or GED.
One year of customer service experience OR Bachelor's Degree.
What Is in It for You?
Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit *********************************************************
$52.6k-86.8k yearly Auto-Apply 21d ago
Senior Claims Examiner
Insurance Company of The West
Claims representative job in Sacramento, CA
Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here!
PURPOSE OF THE JOB
The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Manages all aspects of a California complex claims inventory.
Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service.
Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations.
Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results.
Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures.
Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.
Additional Responsibilities:
Consistently provides exceptional customer service.
Effectively collaborates with team members from various departments for project and process discussions.
Acts as a Subject Matter Expert for the department.
Makes recommendations for streamlining processes and adopting the industry's best practices.
Ensures accuracy of data in claims system for compliance with applicable regulatory reporting.
Provides knowledge transfer across the organization.
Continuously seeks to improve technical skills by attending job related training and tracking current case law.
Acts as a mentor and provides training for less experienced team members.
Additional Responsibilities in Workers' Compensation:
Prepares and presents claims status reports for internal and external stakeholders.
Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group's internal claims handling policies and procedures.
Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies.
Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law.
SUPERVISORY RESPONSIBILITIES
This position has no supervisory responsibility but will serve as a technical leader.
EDUCATION AND EXPERIENCE
Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience.
CERTIFICATES, LICENSES, REGISTRATIONS
Workers' Compensation:
Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches.
KNOWLEDGE AND SKILLS
Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change.
PHYSICAL REQUIREMENTS
Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
WORK ENVIRONMENT
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
#LI-ET1
#LI-Hybrid
The current range for this position is
$68,481.25 - $115,489.01
This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
WHY JOIN ICW GROUP?
Challenging work and the ability to make a difference
You will have a voice and feel a sense of belonging
We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
Bonus potential for all positions
Paid Time Off
Paid holidays throughout the calendar year
Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.
___________________
Job Category
Claims
$68.5k-115.5k yearly Auto-Apply 21d ago
General Liability Claims Adjuster III
The Jonus Group 4.3
Claims representative job in Rocklin, CA
General Liability Claims Adjuster
Seeking an experienced General Liability Claims Adjuster to investigate, evaluate, and resolve assigned claims of moderate to high complexity. This role is responsible for handling non-litigated and litigated general liability claims, including third-party automobile bodily injury and property damage matters, as well as claims involving more specialized lines of business. The position requires strong technical expertise, sound judgment, and the ability to manage complex claims through resolution in compliance with applicable regulations and best practices.
Responsibilities
Investigate, analyze, and determine liability related to personal injury, casualty, and property damage claims
Conduct interviews with claimants, witnesses, and other involved parties to gather relevant facts
Obtain, review, and analyze reports, records, and supporting documentation to evaluate losses and negotiate settlements
Assess and estimate property and vehicle damage as part of the claim evaluation process
Review policy language and coverage provisions to determine appropriate claim handling
Maintain accurate and thorough claim documentation in accordance with regulatory and internal standards
Support litigation activities, including coordination with defense counsel and participation in mediations, hearings, or related proceedings as required
Qualifications/Requirements
Four-year college degree preferred
Strong knowledge of public entity liability claims
Minimum of five years of experience handling insurance claims within insurance, self-insurance, pooled insurance, JPAs, or similar environments
Proficiency with Microsoft Word, Excel, and Outlook
Experience using video conferencing tools and claims management software
Excellent written and verbal communication skills, with the ability to manage complex and sensitive matters professionally
Compensation Package
Salary range: $95,000 - $101,000 (depending on experience)
Competitive benefits package, paid time off, professional development opportunities, etc.
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
#LI-JJ1
$95k-101k yearly 35d ago
Industry Advancement Program | Workers Compensaiton Claims Representative Trainee | Rancho Cordova, CA (In-Office)
Sedgwick 4.4
Claims representative job in Rancho Cordova, CA
By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work
Fortune Best Workplaces in Financial Services & Insurance
Industry Advancement Program | Workers Compensaiton ClaimsRepresentative Trainee | Rancho Cordova, CA (In-Office)
Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?
A stable and consistent work environment in an office setting.
A training program to learn how to investigate and resolve complex situations for employees and customers from some of the world's most reputable brands.
Career development and promotional growth opportunities through increasing responsibilities.
A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs including medical, dental, vision & 401k.
PRIMARY PURPOSE OF THE ROLE: To be oriented and trained as a new industry professional. This role begins with a comprehensive 4-week concept-based learning and professional training program, followed by a dedicated onboarding experience before entering the on-the-job phase. You will be assigned a mentor and manager that will support and guide you on your career journey and be equipped with the foundational skills needed for a successful career in claims adjusting. While in the program, you'll have the opportunity to grow and advance within the industry.
Next Class Date: March 30, 2026
ARE YOU AN IDEAL CANDIDATE? We are seeking enthusiastic and service-oriented individuals for an entry-level trainee position who are:
Strong Communicators
Empathetic
Multi-Taskers
Accountable
Structured Thinkers
Ambitious
Agile Learners
Team Collaborators
ESSENTIAL RESPONSIBLITIES INCLUDE
Attendance and completion of designated claims professional training program.
Adjusting various levels of workers' compensation claims under close supervision, which includes:
Processing and responding to incoming mail, emails and other claim related documents according to status of the claim.
Communicating effectively with injured workers, insureds/employers, medical providers, attorneys and carrier representatives, primarily through telephonic, video conference and email.
Thoroughly investigating new and existing claims by gathering relevant information including medical records, employer reports, and witness statements. Investigating employer/employee relationships, policy verification, coverage and any potential for subrogation issues or fraud indicators.
Determining coverage, compensability and appropriate benefits in accordance with jurisdictional guidelines and carrier program requirements.
Documenting claims files and properly coding claim activity. Preparing detailed reports documenting findings and recommendations.
Administering claim benefits i.e., indemnity and medical benefits, through maintenance of calendared claim-related action items, ensuring state compliance.
Participating in virtual and/or in-person meetings, claim reviews and business functions as needed for educational training, claim discussions and various meetings.
QUALIFICATIONS
Education Requirement - High School Diploma or GED.
EXPERIENCE
No experience required.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $27.69/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
$27.7 hourly Auto-Apply 1d ago
Claims Resolution Supervisor
Partnership Healthplan of California 4.3
Claims representative job in Auburn, CA
Supervision of the Medi-Cal customer service outreach functions. Ensures delivery of the highest level of provider claims training to medical providers and the community.
Responsibilities
Coordinates with Claims Resolution Coordinators (CRCs) to develop provider educational/training materials for all Partnership lines of
Prepares a quarterly and monthly plan of action for the Director, identifying key provider outreach targets and plan of
Prepares production statistics and related reports for the Director's revie
Collaborates with Claims Customer Service Manager to identify provider abrasion issues.
Leads group provider trainings or individual provider settings.
Reviews monthly reports and tracks claims trends for provider educational opportunit
Presents to Director with findings and recommendations for ongoing, long term resolutions
to Identifies items to address the “provider hassle factor.”
Prepares a post-visit report for Director to include visit results, expectations of provider and Partnership, with required follow-up pla
Reviews, strategies and tactics for more effective communication to provider billing staff with CRC Recommends changes for more efficient communication.
Reports system issues to Claims Configuration staff and/or IT
Assists Provider Relations Manager and Representatives in the review, research, and resolution of complex provider inquiries, appeals, and
Coordinates with CRCs, Claims, and Provider Relations, the development and maintenance of ongoing educational materials and tips for inclusion on the Partnership
Reviews and drafts PR newsletter articles related to claims issues identified during provider training and research.
Interviews and participates in the selection of qualified candidates for CRCs.
All other duties as as assigned.
SECONDARY DUTIES AND RESPONSIBILITIES
Leads or participates in special projects and assignments as needed.
Participates in provider meetings, both on and off site as required.
Qualifications
Education and Experience
High School diploma or equivalent, minimum two (2) years of supervisor experience in a claims environment; or equivalent combination of education and experience.
Special Skills, Licenses and Certifications
Thorough knowledge of CPT, HCPCs procedure coding, and ICD-9 diagnostic coding. Knowledge of medical terminology. Expertise in automated claims procedures and related problems resolution. Typing speed 30 wpm and proficient use of 10-key calculator preferred. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent interpersonal skills with ability to lead and manage staff to effectively complete assignments within established timeframes and standards. Ability to effectively exercise good judgment and handle sensitive issues with frequent interruptions. Good organization skills.
Work Environment And Physical Demands
Must be able to work in a fast-paced environment and maintain courtesy and composure when dealing with internal and external customers. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 10 lbs.
All HealthPlan employees are expected to:
Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.
HIRING RANGE:
$93,690.86 - $117,113.58
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
$93.7k-117.1k yearly Auto-Apply 60d+ ago
Copy of Claims Representative, Warranty
Cornerstone Building Brands
Claims representative job in West Sacramento, CA
ABOUT THE ROLE The ClaimsRepresentative is responsible for managing warranty claims from initial intake through final resolution while delivering a premier customer experience. This role requires strong analytical skills, clear communication, and the ability to balance accuracy, cost efficiency, and customer satisfaction. The ClaimsRepresentative serves as a key partner to customers, internal teams, and service providers, ensuring claims are processed effectively, documented thoroughly, and resolved in alignment with company standards.
You will need to be located within 35miles of either plant facility:
Vacaville, CA or West Sacramento, CA
Three days work from home and two days in office.
WHAT YOU'LL DO
Claim Intake & Validation
Receive, review, and validate incoming warranty claims to determine accuracy and required information.
Initiate clarification calls to customers as needed to complete claim details.
Maintain accurate claim documentation and communication updates within Dynamics 365 CRM.
Claim Management & Resolution
Create detailed work orders for Cornerstone Building Brands (CBB) Technicians and third-party vendors, optimizing cost, efficiency, and service quality.
Monitor claim progress and ensure timely, cost-effective resolutions that enhance customer satisfaction.
Host product standards and compliance discussions with customers, helping address concerns professionally and clearly.
Administer service reimbursements and prepare settlement letters when applicable.
Quality Review & Root Cause Analysis
Conduct research to identify root causes of product or service issues.
Collaborate with plant personnel, sales teams, and other departments to support long-term corrective actions and process improvements.
Participate in discussions and initiatives aimed at reducing recurring issues and improving overall product and service quality.
Communication & Reporting
Prepare clear communications and updates for management regarding claim trends, issues, and opportunities.
Ensure documentation and reporting for claims, resolutions, and settlement activities are accurate and complete.
Perform additional duties as assigned to support departmental needs.
SKILLS & QUALIFICATIONS
Strong ability to interpret customer claims and apply relevant warranty coverage.
Ability to read and interpret product specifications, drawings, and order confirmations.
Exceptional analytical and problem-solving skills with the ability to identify root causes and recommend solutions.
Strong verbal and written communication skills with a customer-centric approach.
Ability to manage difficult discussions and mitigate customer dissatisfaction effectively.
Proficiency in Microsoft Excel, Word, and PowerPoint, with the ability to learn new systems quickly.
Strong attention to detail and accuracy in a fast-paced environment.
Ability to work independently while supporting team and departmental goals.
High curiosity, initiative, and willingness to grow in an evolving environment.
WHAT YOU'LL NEED
Education:
High School Diploma or equivalent required; Bachelor's degree preferred. Professional experience in a claims or service role, preferably within the building materials industry will be considered in lieu of education.
Experience/Technical Skills:
Experience in Ordering/Quoting systems is desired (AccuQuote preferred).
Experience with CRM systems is desired.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Why work for Cornerstone Building Brands?
Our teams are at the heart of our purpose to positively contribute to the communities where we
live, work and play
. Full-time* team members receive** medical, dental and vision benefits starting day 1. Other benefits include PTO, paid holidays, FSA, life insurance, LTD, STD, 401k, EAP, discount programs, tuition reimbursement, training, and professional development.
*Full-time is defined as regularly working 30+ hours per week. **Union programs may vary depending on the collective bargaining agreement.
Cornerstone Building Brands is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, or status as a protected veteran. You can find the Equal Employment Opportunity Poster
here
. You can also view Your Right to Work Poster
here
along with This Organizations Participation in E-Verify Poster
here
. If you'd like to view a copy of the company's affirmative action plan for protected veterans or individuals with disabilities or policy statement, please contact Human Resources at ************ or
[email protected]
. If you have a disability and you believe that you need a reasonable accommodation in order to search for a job opening or to submit an online application, please contact Human Resources at ************ or
[email protected]
. This email is used exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only emails received for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.
All your information will be kept confidential according to EEO guidelines.
California Consumer Privacy Act (CCPA) of 2018
Must be at least 18 years of age to apply.
Notice of Recruitment Fraud
We have been made aware of multiple scams whereby unauthorized individuals are using Cornerstone Building Brand's name and logo to solicit potential job-seekers for employment. In some cases, job-seekers are being contacted directly, both by phone and e-mail. In other instances, these unauthorized individuals are placing advertisements for fake positions with both legitimate websites and fabricated ones. These individuals are typically promising high-paying jobs with the requirement that the job-seeker send money to pay for things such as visa applications or processing fees. Please be advised that Cornerstone Building Brands will never ask potential job-seekers for any sort of advance payment or bank account information as part of the recruiting or hiring process.
$36k-50k yearly est. 1d ago
Claim Representative III - Property
Capital Insurance Group 4.4
Claims representative job in Elk Grove, CA
Why CIG? At Capital Insurance Group we offer our employees more than just a job. We foster career growth, provide opportunities to give back to our communities, and help you take the next step in your career! CIG was founded in 1898 by a group of earnest farmers in need of protection and today, we are the leading West Coast Property & Casualty insurer. CIG is certified as a Great Place to Work and provides a collaborative, inclusive, and fun work culture for all employees.
Why choose CIGs Claims Team?
CIG claims department is here to support our insureds throughout their claims process. We work directly with our agency partners and policyholders to accomplish successful claim resolutions. Join the claims operation and you can be part of a team who provides excellent service, build relationships, and achieves successful outcomes for our clients.
Learn what it means to be a ClaimRepresentative III - Property at CIG
$39k-53k yearly est. 12d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Claims representative job in Sacramento, CA
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss Claims Analyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$22.71
**Pay Range Maximum:**
$35.18
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273755
$22.7-35.2 hourly 36d ago
Work Comp Claims Adjuster Temporary Assignment
Avonrisk
Claims representative job in Rocklin, CA
Job DescriptionWorkers Compensation Claims Adjuster - Temporary Assignment MUST Reside in California & MUST have California Workers Compensation Claims Experience. Workers' Compensation Claims Adjuster - Assist a Dynamic Team in Rocklin We're seeking an experienced and motivated Workers' Compensation Claims Adjuster to assist our team in Rocklin. As a Claims Adjuster , you'll work within a team of 7, including 5 Claims Adjusters and 2 Claims to ensure exceptional claim handling and adherence to company standards and regulations.
Our Offer:
Competitive salary and benefits package, including medical, dental, vision, and 401(k)
Opportunity for professional growth and advancement in a dynamic organization
Collaborative work environment with a team dedicated to workers' compensation excellence
Our Mission:
To be the leading third party administrator offering professional and technological resources through pro-active and aggressive claims and managed care solutions in support of our clients' objectives.
Innovative processes and state-of-the-art technology support our people. Competent and experienced individuals provide the human element needed to deliver good service and drives good outcomes.
Our Goal:
To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients.
Your Impact:
Provide ongoing coaching, counseling, and feedback to team members to enhance skills and performance
Ensure all claims are handled in accordance with relevant statutes and company guidelines
Address personnel issues promptly and decisively, keeping management informed of corrective action
Foster a collaborative and productive team environment focused on excellence in claim resolution
Our Offer:
Competitive salary and benefits package, including medical, dental, vision, and 401(k)
Opportunity for professional growth and advancement in a dynamic organization
Collaborative work environment with a team dedicated to workers' compensation excellence
Interested? Get in Touch:
To learn more about this exciting opportunity and what Intercare has to offer, please do one of the following:
Apply to this posting
Call me directly at ************
Email ************************
We look forward to hearing from you!
“Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.”
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$53k-66k yearly est. Easy Apply 6d ago
Senior Marine Claims Specialist-Hull
Zurich Na 4.8
Claims representative job in Sacramento, CA
130521 We are excited to share that Zurich North America is hiring a Marine Claims Senior Claims Specialist Role (With Hull and Liability experience preferred) to join our team! We are open to remote work for the right candidate located within the U.S..
In this role you will be responsible for:
+ Ability to handle dedicated accounts.
+ Frequent interaction with Assureds, Brokers and Underwriters.
+ Some travel may be required but this is not very frequent.
Basic Qualifications:
+ Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.OR
+ High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.AND
+ Must obtain and maintain required adjuster license(s)
+ Microsoft Office experience
+ Knowledge of insurance regulations, markets, and products as well as maritime and admiralty practices.
Preferred Qualifications:
+ Extensive Marine Hull claims experience preferred.
+ Emphasis on Marine Liability, Hull, Blue water and brown water claims, Jones Act, General Average and Ocean Cargo Claims experience preferred.
+ Licensed in all states as needed required.
+ Effective verbal and written communication skills
+ Strong analytical, critical thinking and problem-solving skills
+ Strong multi-tasking and prioritization skills
+ Experience collaborating in a team environment and building cross functional working relationships
+ Proactively shares and promotes sharing of insights
+ Ability to gather unique perspectives from other teams/functions to optimize outcomes.
+ Understands, analyzes, and applies the component parts of an insurance policy for complex claims
+ Ability to follow reserving process for indemnity and expense in analyzing the potential exposure of complex claims
+ Ability to determine the scope and exposure for complex claims
+ Ability to leverage trend and relationships to provide high-quality customer service
+ Well-versed in identifying, understanding and explaining complex financial and/or actuarial trends/concepts.
+ Ability to effectively communicate coverage determinations to customers/clients/brokers for complex claims
+ Ability to direct counsel on an ongoing basis to guide the course of complex litigation and settlement strategies
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply-your unique background matters to us.The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $75,800.00 - $124,100.00, with short-term incentive bonus eligibility set at 15%.
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here .]
**Why Zurich?**
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment-so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500 .
Join us for a brighter future-for yourself and our customers.
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets.
Zurich complies with 18 U.S. Code § 1033.
**Please note:** Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.
Location(s): AM - Texas Virtual Office, AM - Remote Work (US)
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-JJ1 #LI-ASSOCIATE #LI-REMOTE
EOE Disability / Veterans
$75.8k-124.1k yearly 4d ago
Daily Claims Adjuster - Sacramento, CA
Cenco Claims 3.8
Claims representative job in Sacramento, CA
CENCO is a trusted leader in property claims solutions, partnering with top insurance carriers to provide accurate, timely, and professional adjusting services. We're currently looking for experienced Daily Property Claims Adjusters to handle residential and commercial claims across Sacramento and the Northern California region. This opportunity is ideal for independent adjusters seeking consistent assignments and the flexibility of field-based work.
Key Responsibilities:
Conduct on-site inspections of property damage caused by wind, water, fire, and other covered perils.
Capture detailed documentation, including photos and written reports.
Prepare accurate repair estimates using Xactimate or Symbility.
Maintain professional communication with policyholders, contractors, and insurance carriers.
Manage each claim efficiently and submit all required documentation within deadlines.
What We're Looking For:
Licensing: Must hold an active California adjuster license.
Software: Proficiency in Xactimate or Symbility preferred.
Tools & Transportation: Reliable vehicle, ladder, laptop, and field inspection equipment.
Work Style: Organized, self-motivated, and able to work independently.
Responsiveness: Able to accept and complete assignments in a timely manner.
Why Join CENCO?
Steady claim volume in Sacramento and surrounding areas
Competitive pay and timely compensation
Strong internal support and efficient claim-handling processes
If you're an experienced adjuster looking for consistent work and the opportunity to grow with a trusted industry leader, we'd love to hear from you!
$55k-68k yearly est. Auto-Apply 60d+ ago
Claims Supervisor II - Commercial Auto - BI
Philadelphia Insurance Companies 4.8
Claims representative job in Roseville, CA
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a Claims Supervisor II - Commercial Auto - BI to join our team.
Summary:
Supervises claims adjusters and technical support staff to manage the day-to-day handling and settlement of claims, the processing and tracking of documents, making payments, tracking trends and communicating with underwriting.
A typical day will include the following:
Supervises the day-to-day activities of a claims handling unit; oversees the investigation of insurance claims.
Assures that corporate claims handling procedures and priorities are followed and that budget and productivity requirements are met.
Assures that department targets for customer service quality and priorities are met.
Participates in the hiring, training, evaluation and development of the claims staff.
Qualifications:
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
Associate in Claims, CPCU or other industry related studies.
Experience with Windows operating system.
Basic Word processing skills.
National Range : $112,165.00 - $125,360.00
Ultimate salary offered will be based on factors such as applicant experience and geographic location.
PHLY locations considered: Roseville, CA / Seattle, WA / West Linn, OR.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************
$112.2k-125.4k yearly Auto-Apply 60d+ ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims representative job in Sacramento, CA
At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at **********************
Overview:
Join EAC Claims Solutions as a Property Field Adjuster, where you will be managing insurance claims from inception to resolution.
Key Responsibilities:
- Planning and organizing daily workload to process claims and conduct inspections
- Investigating insurance claims, including interviewing claimants and witnesses
- Handling property claims involving damage to buildings, structures, contents and/or property damage
- Conducting thorough property damage assessments and verifying coverage
- Evaluating damages to determine appropriate settlement
- Negotiating settlements
- Uploading completed reports, photos, and documents using our specialized software systems
Requirements:
- Ability to perform physical tasks including standing for extended periods, climbing ladders, and navigating tight spaces
- Strong interpersonal communication, organizational, and analytical skills
- Proficiency in computer software programs such as Microsoft Office and claims management systems
- Self-motivated with the ability to work independently and prioritize tasks effectively
- High school diploma or equivalent required
- Previous experience in insurance claims or related field is a plus but not required
Next Steps:
If you're passionate about making a difference, thrive on challenges, and deeply value your work, we invite you to apply. Should your application progress, a recruiter will reach out to discuss the next steps.
Join us at EAC Claims Solutions, where your passion meets purpose, and where your contributions truly matter.
$54k-67k yearly est. Auto-Apply 6d ago
Independent Insurance Claims Adjuster in Sacramento, California
Milehigh Adjusters Houston
Claims representative job in Sacramento, CA
IS IT TIME FOR A CAREER CHANGE? INDEPENDENT INSURANCE CLAIMS ADJUSTERS NEEDED NOW! Are you ready to embark on a dynamic and in-demand career as an Independent Insurance Claims Adjuster? This is your chance to join a thriving industry with endless opportunities for growth and advancement.
Why This Opportunity Matters:
With the current surge in storm-related events sweeping across the nation, there's an urgent need for new adjusters to meet the escalating demand.
As a Licensed Claims Adjuster, you'll play a crucial role in helping individuals and businesses recover from unforeseen disasters and rebuild their lives.
This is not just a job-it's a rewarding career path where you can make a real difference in people's lives while enjoying flexibility, autonomy, and competitive compensation.
Join Our Team:
Are you actively working as a Licensed Claims Adjuster with 100 claims or more under your belt?
If so, that's great! If not, no problem! Let us help you on your career path as a Licensed Claims Adjuster.
You're welcome to sign up on our jobs roster if you meet our guidelines.
How We Can Help You Succeed:
At MileHigh Adjusters Houston, we offer comprehensive training programs tailored to equip you with the essential skills and knowledge needed to excel in the field of claims adjusting.
Our expert instructor, with years of industry experience, will provide you with hands-on training, insider tips, and practical insights to prepare you for real-world challenges.
Whether you're a seasoned professional or a newcomer to the field, our training programs are designed to meet you where you are and help you reach your full potential as a claims adjuster.
Don't miss out on this opportunity-let us assist you in advancing your career in claims adjusting and achieving your professional goals. With our guidance and support, you'll have the opportunity to thrive in a dynamic and rewarding industry, making a positive impact on the lives of others while achieving your professional goals.
Seize the Opportunity Today!
Contact us now at ************ or [email protected] to learn more about our training programs and take the first step towards a fulfilling career as a Licensed Claims Adjuster. Visit our website at ******************************** to explore our offerings and view our 375+ Five-Star Google Reviews.
You can also find us on YouTube at: (*********************************************************
and Facebook at: (************************************************** for additional resources and updates.
APPLY HERE
#AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston
By applying to this position, you consent to receive informational and promotional messages from MileHigh Adjusters Houston about training opportunities and related career programs. You may opt out at any time.
$53k-67k yearly est. Auto-Apply 60d+ ago
Sr. Claims Examiner (Onsite, Roseville)
Adventist Health 3.7
Claims representative job in Roseville, CA
We are hiring for two Sr. Claims Examiners to support our Corporate Office. Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Analyzes complex and/or technically challenging medical malpractice/general liability claims and resolves complex and/or severe injury claims. Coordinates case management within established standards and industry best practices. Manages total claim costs while providing high levels of customer service. Receives assignments in the form of objectives and determines tactical approach, resources, schedules and goals.
Job Requirements:
Education and Work Experience:
* Bachelor's degree or equivalent combination of education/related experience: Required
* Master's Degree or Juris Doctor: Preferred
* Seven years' liability claims management experience: Preferred
* One year's leadership experience: Preferred
* Experience with legal matters and complex litigation: Preferred
Essential Functions:
* Analyzes nature and extent of investigation necessary to evaluate liability and damages. Determines the need for and retains experts to evaluate the standard of care/damages. Develops, updates and executes case specific investigation plan and negotiates settlement of the claim. Applies advanced technical knowledge to solve complex problems for a department.
* Coordinates legal defense by assigning counsel, coordinates support for investigation. Reviews attorney invoices and monitors counsel for compliance with organization policies and guidelines.
* Calculates and assigns timely and appropriate reserves for claims. Monitors reserve adequacy throughout the life of the claim.
* Recommends and implements settlement strategies. Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery and other case management opportunities to mitigate total claim costs.
* Ensures claim file documentation is timely and accurate. Creates initial notice to reinsurers and provides timely updates on case status.
* Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit ******************************************** for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
How much does a claims representative earn in Rocklin, CA?
The average claims representative in Rocklin, CA earns between $31,000 and $58,000 annually. This compares to the national average claims representative range of $28,000 to $53,000.
Average claims representative salary in Rocklin, CA