Claims representative jobs in San Antonio, TX

Argo Group International Holdings, Inc. and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description A Brief Overview We are looking for a highly capable Senior Environmental Claims Adjuster to help us on a temporary assignment through 12 December 2025 (and possibly through May 2026) and work from anywhere in the United States. This individual will report to a manager who works in New York City and is focused on adjudicating first and third party commercial environmental claims (mostly complex storage tank claims) and contributing to providing superb results for our clients. The primary duties and responsibilities of the role are: * Working under limited technical direction and within broad limits and authority, adjudicate moderately complex commercial environmental claims, potentially with significant impact on departmental results. * Solving difficult problems that requires an understanding of a broader set of issues. * Reporting to claims management and underwriters on claims trends and developments. * Investigating claims promptly and thoroughly * Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage. * Investigating claims promptly and thoroughly, including interviewing all involved parties. * Managing claims in litigation * Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution. * Creates and reviews reserves in line with market and Argo's reserving policy * Identifying, assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution. * Preparing reports for file documentation * Applying creative solutions which result in the best financial outcome. * Settles straightforward claims in line with authority limits and adheres to organizational referral procedures * Negotiates in a timely and effective manner to provide cost effective solutions for the company and its customers within own limits using a range of negotiation styles. * Processing mail and prioritizing workload. * Completing telephone calls and written correspondence to/from various parties (insured, claimant, etc.). * Having an appreciation and passion for strong claim management. Core qualifications and requirements for this position include: * Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' ability to be profitable). * An advanced knowledge of commercial environmental claims typically acquired through: * A minimum of five years' experience adjudicating commercial environmental claims. A minimum of two of these years MUST including managing commercial environmental claims involving mold and gasoline storage tank leakage. * Bachelor's degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating general liability bodily injury beyond the minimum experience required above may be substituted in lieu of a degree. * Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days. * Ability to regularly exercise discretion and independent judgment with respect to matters of significance. This role primarily faces problems and issues that generalized and typically not complex, but require an understanding of a broader set of issues. * Must have excellent communication skills and the ability to build lasting relationships. * Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking. * Desire to work in a fast-paced environment. * Excellent evaluation and strategic skills required. * Strong claim negotiation skills a must. Ability to take proactive and pragmatic approach to negotiation. * Must possess a strong customer focus. * Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines. * Demonstrates an understanding of mechanisms available for resolving claims settlement disputes (e.g. arbitration and mediation) and when these are used. * Ability to articulate the financial value of your work at multiple responsibility levels inside our clients' business which may include CEO. * Must demonstrate the ability to exercise sound judgment working under technical direction. * Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis. * Proficient in MS Office Suite and other business-related software. * Uses listening and questioning techniques to effectively gather information from insureds and claimants * Polished and professional written and verbal communication skills. Presents information clearly, concisely, and accurately. * Ability to effectively network, build and maintain relationships, and establish appropriate visibility with business partner * The ability to read and write English fluently is required. * Must demonstrate a desire for continued professional development through continuing education and self-development opportunities. * Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. * Colorado outside of Denver metro, Maryland, Nevada, and Rhode Island Pay Ranges: $47.69 - $56.78 per hour * California outside of Los Angeles and San Francisco metro areas, Connecticut, Chicago metro area, Denver metro area, Washington State, and New York State (including Westchester County) Pay Ranges: $52.50 - $62.45 per hour * Los Angeles, New York City and San Francisco metro areas Pay Ranges: $57.26 - $68.17 per hour About Working in Claims at Argo Group Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful. Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is. We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses. Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas. We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply. PLEASE NOTE: Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas. If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at ************. Notice to Recruitment Agencies: Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions. We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. The collection of your personal information is subject to our HR Privacy Notice Benefits and Compensation We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.

Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Resolute PB Claims Analyst you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you'll do/Responsibilities As a Project Delivery Senior Analyst (PDSA) at Deloitte, you will work within an engagement team and be responsible for supporting the overall project goals and objectives. In this role, you will interact with stakeholders and cross-functional teams. It is expected that you will be able to perform independent tasks as well as provide technical guidance to team members, as needed. * Work with the implementation team to plan and complete build, implement end-to-end Epic. * Work command center shifts to investigate during go-live, document, and resolve break-fix tickets. * Conduct and document root cause analysis and complete any assigned system maintenance. * Assist in low level design, operational discussions, build, test, and migrate Epic build, provide go-live support following migration of new build. * Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management. The Team Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation. AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector. Qualifications Required * Current Epic Certification in Epic Professional Billing * 3+ years' experience in Epic Professional Billing * Experience in Epic implementation or enhancement processes * Experience in application design, workflows, build, troubleshooting, testing, and support. * Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience * Limited immigration sponsorship may be available. * Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve Preferred * Hospital or Clinic operations experience * Additional Epic Certifications * ITIL process knowledge * Analytical/ Decision Making Responsibilities * Analytical ability to manage multiple projects and prioritize tasks into manageable work products * Can operate independently or with minimum supervision * Excellent Written and Communication Skills * Ability to deliver technical demonstrations Additional Requirements Information for applicants with a need for accommodation: ************************************************************************************************************ Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte's purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more. Professional development From entry-level employees to senior leaders, we believe there's always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. As used in this posting, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see ********************************* for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law. Requisition code: 316852 Job ID 316852

Claims Specialist (Call Center CSR Experience Required) Duration : 12 Months Total Hours/week : 40.00 1 st shift Client: Medical Device Company Job Category: Customer Service Level Of Experience: Entry Level Employment Type: Contract on W2 (Need US Citizens, GC Holders Only) Training Schedule will be 7:30am - 4:30pm. Work days/hours: Work hours are between 7am - 6pm. 8-hour work schedule. Job Description: A Claims Specialist is responsible for entering and processing customer Claims. Duties will include: Completing the end-to-end Claims process. Communicating with customers over the phone or via email. Providing detailed Claim information. Reviewing customer orders and/or account information while resolving issues. Qualifications: Basic computer navigation skills required. Working knowledge of MS Excel, Word, Outlook required. Customer Service experience desired. Call Center experience desired. HS Diploma/GED required.

BCforward began as an IT business solutions and staffing firm. Founded in 1998, BCforward has grown with our customers' needs into a full service personnel solutions organization. BCforward's headquarters are in Indianapolis, Indiana and also operates delivery centers in 20 locations in North America as well as India and Puerto Rico. We are currently the largest consulting firm and largest MBE certified firm headquartered in Indiana. Title : Transaction Processing Representative Location : SAN ANTONIO TX 78249 Duration : 12 Months Job Description: Basic Qualifications: 1-2 experience with automotive warranty, policy and procedure 1-2 years experience with management systems used in automotive warranty and administration Overtime will be required Qualifications Preferred Qualifications: Technical and mechanical background Experience with management systems used in automotive warranty Administration Skills: Experience with coding warranty claims and warranty administration. Good verbal and written communication skills. Computer and excel skills Education: High school or equivalent work/military experience Additional Information Thanks & Regards, BCforward Recruitment Team

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.

Job DescriptionSalary: About Us Rockwall National Public Adjusters is one of the most established public adjusting firms in the region. For more than 15 years, we have successfully advocated for property owners, supported by leadership with over 20 years of experience in the insurance claims industry. We pride ourselves on our longevity, high retention, and reputation for excellence. Many of our adjusters and office staff have been with us for over 10 years, reflecting our supportive culture and commitment to long-term careers. At Rockwall, our mission is simple: level the playing field, fight for our clients rights, and secure the settlements they deserve. By joining our team, you will become part of a well-respected firm with proven processes, unmatched administrative support, and a collaborative environment that fosters professional growth. The Role We are seeking a motivated and Licensed Public Adjuster in San Antonio, Texas to join our team in a hybrid, commission-based role. As a Public Adjuster, you will represent policyholders throughout the insurance claims process, guiding them through stressful property damage losses and securing fair settlements. You will play a vital role in soliciting referral business, signing clients, evaluating damages, preparing and negotiating claims, and advocating for clients best interests. This position is designed to support all levels of experience: Newly licensed adjusters benefit from structured training, mentorship, and back-office support. Experienced adjusters gain access to qualified leads, advanced systems, and a trusted brand with a long-standing reputation. Key Responsibilities Collaboratively solicit residential and commercial new claims and referral partners Sign, inspect, evaluate, and document property damage for residential and commercial claims Prepare, submit, and negotiate insurance claims on behalf of policyholders Communicate with clients, insurance carriers, contractors, and stakeholders to advance claims efficiently Advocate for clients best interests and ensure fair settlements are achieved Maintain accurate records, reports, and claim documentation Deliver exceptional customer service while educating clients on the claims process Generate new business and efficiently close provided leads Required Qualifications Active Texas Public Adjuster license (or ability to obtain one) Prior experience in insurance adjusting, construction, restoration, or a related field preferred, but not required Strong negotiation and communication skills Organized, detail-oriented, and able to manage multiple claims simultaneously Professional demeanor with a client-focused mindset Valid drivers license and reliable transportation for field inspections Compensation & Benefits Commission-based structure with unlimited earning potential Training and ongoing professional development Career growth opportunities within a supportive and collaborative team Hybrid work flexibility (field + office) Full administrative and office support (contracts, compliance, claims, invoicing, mortgage company payments) The Rockwall Difference At Rockwall, we provide unmatched support at every stage of the claims process, allowing our adjusters to focus on serving clients and building careers. Key Advantages: Comprehensive adjuster onboarding and mentorship programs Professional ongoing sales training to close contracts faster and expand referral networks Proprietary lead generation sources and affiliate networks Automated client onboarding to reduce paperwork Access to advanced claims management software for streamlined workflows Hands-on field training for residential and commercial claims Xactimate training and estimate reviews to ensure complete assessments Seamless invoicing and fee collection support Regular updates on case law, legislation, and industry trends A collaborative team environment that promotes growth and shared knowledge Why Join Rockwall NPA 20+ years of insurance industry expertise 15+ years as a trusted, established firm Strong reputation and high staff retention Proprietary lead generation sources and long-standing affiliate networks Full support systems that empower adjusters to succeed A company culture built on professionalism, advocacy, and results

SWBC is seeking a talented individual to supervise the staff and activities involved in the accurate processing of mortgage claims to include resolving complex claims, training employees, and overseeing the department in management's absence. Why you'll love this role: This role allows one to learn, develop, or use a wide-set of skills in a face-paced environment. The person will be able to act as a business owner that makes key strategic, business, personnel, and development decisions. It is ideal for someone looking to manage and lead in multi-functional and complex environment. Essential duties include the following: Supervises the staff and activities involved in all aspects of processing CPI claims to ensure the highest degree of. quality, customer satisfaction, and compliance with company policies and procedures to include maintaining work schedules; interviewing for open positions; coaching, counseling and disciplining; and resolves personnel related issues. Resolves and provides assistance with complex calls, status questions, problems or client complaints to ensure customers satisfaction to include negotiating the settlement of claims and settling loss claims. Trains new employees and keeps staff members informed of new procedures to include ensuring that the claims procedure manual is current and up-to-date. Monitors, submits, and coordinates scheduling change requests with Workforce Management to ensure attendance and adherence standards. Oversees all aspects and functions of Claim's processing in the absence of the department manager. Provides coaching and feedback as necessary in support of performance goals and objectives. Performs assignment coordination of all work queues and roles related to ensuring the timely working of the claims inventory. Serious candidates will possess the minimum requirements: Some college course work in business, marketing, related field, or equivalent experience. Possess a Texas P&C Adjuster's License. Minimum of three to four (3-4) years high-level call center, telemarketing, customer service, quality auditing, or related experience, which includes one (1) year in a team lead, instructional, or training capacity, preferably in an insurance or banking environment. Property insurance claims adjusting experience, catastrophe, and/or field experience preferred. Working knowledge of mortgage insurance coverage and procedures. Excellent negotiation, analytical, and organizational skills. Excellent communication (both written and oral), customer service, and telephone etiquette skills. Working knowledge of personal computers to include MS Word, Excel, Internet, and AS400. Self-starter, be able to work independently and exercise sound judgment. Able to sit for long periods of time while executing computer applications and responding to customer phone inquiries. May be required to lift 10-20 lbs. of training materials or other documents. May be required to stand for long periods of time while conducting training and/or observation sessions. SWBC offers*: Competitive overall compensation package Work/Life balance Employee engagement activities and recognition awards Years of Service awards Career enhancement and growth opportunities Emerging Professionals and Mentor Program Continuing education and career certifications Variety of healthcare coverage options Traditional and Roth 401(k) retirement plans Lucrative Wellness Program *Based upon employee eligibility Additional Information: SWBC is a Substance-Free Workplace and requires pre-employment drug testing. Please note, SWBC does not hire tobacco users as allowed by law. To learn more about SWBC, visit our website at ************* If interested, please click the appropriate apply button.

Complex Bodily Injury Adjuster - Commercial Trucking/Transportation Seeking experienced and motivated Complex Bodily Injury Adjusters to join a growing team. This role involves managing complex bodily injury claims within the commercial trucking and transportation sector, including both litigated and non-litigated claims. The ideal candidate will have a strong background in claims adjusting, particularly in commercial trucking, and will thrive in a fast-paced, team-oriented environment. This is an excellent opportunity to contribute to a dynamic organization that values expertise, reliability, and self-motivation. Compensation Package Salary Range: $75,000 - $100,000 annually (DOE); up to $120,000 for exceptional candidates. 401(k): 3% employer contribution. Responsibilities Review and evaluate incoming claims for coverage. Manage a caseload of at least 100 pending claims, including claims up to $1M in losses. Handle all aspects of the claims process, including settling or denying coverage as necessary. Track claims and provide regular updates to the team throughout the litigation process. Collaborate with internal and external stakeholders to ensure timely and effective resolution of claims. Qualifications/Requirements Licenses: Active Claims Adjuster License (any state; assistance provided for additional licensing as needed). Experience: Minimum of 2 years in claims adjusting, with a focus on commercial trucking claims. Preference for bodily injury claims experience, but candidates with physical/property damage experience will also be considered. Technical Skills: Familiarity with web-based claims systems (training provided). Soft Skills: Thick skin and ability to handle challenging clients. Self-sufficient and self-motivated; capable of working independently without micromanagement. Team player with a collaborative mindset. Reliable and punctual, with a strong work ethic. #LI-DM2

Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress. As a claims adjuster trainee, you'll learn how to help customers get back on the road after an accident. This is not a field position, which means you'll be building relationships with customers over the phone. In a fast-paced environment, you'll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and insurance contracts so you can confidently and independently adjust claims. This is a hybrid role, which means you'll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that's at home or in the office, for a period of 12 months. After that period, the days you'll be expected to report to an office for important meetings, training, and collaboration will vary based on business needs. In this hybrid work environment, you'll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you're welcome to work in the office as often as you would like. Duties & responsibilities (upon completion of training) * Determine coverage * Determine liability (who's at fault for the damages) * Interview customers, claimants, and witnesses * Partner with appraisers/estimators to manage vehicle repairs * Negotiate with customers and other insurance carriers and resolve claims Must-have qualifications * Three years of work experience OR * Bachelor's degree OR * Two years work experience and an associate degree Schedule: During training: Monday - Friday, 8:30am - 5:30pm; after training, you'll work Monday - Friday, 8am -5pm, 8:30am - 5:30pm, or 9am - 6pm Location: 3800 Horizon Hill , Suite 105 San Antonio, TX 78229 Compensation * Once you complete training (which includes passing any necessary testing requirements), your salary will range from $54,000 - $57,500/year, however, during training, you will be paid an hourly rate based on your annual salary * Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance Benefits * 401(k) with dollar-for-dollar company match up to 6% * Medical, dental & vision, including free preventative care * Wellness & mental health programs * Health care flexible spending accounts, health savings accounts, & life insurance * Paid time off, including volunteer time off * Paid & unpaid sick leave where applicable, as well as short & long-term disability * Parental & family leave; military leave & pay * Diverse, inclusive & welcoming culture with Employee Resource Groups * Career development & tuition assistance Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership. Equal Opportunity Employer For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at **************************************************************** Share: Apply Now

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 Liability Claims Examiner - Auto & GL Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. + Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **OFFICE LOCATIONS** Hybrid (2 Days In-Office) **PRIMARY PURPOSE** : To analyze complex or technically difficult general liability and auto liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult general liability and auto liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Assesses liability and resolves claims within evaluation. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **TAKING CARE OF YOU** + Flexible work schedule. + Referral incentive program. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. _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 $75,000 - $90,000. 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._ \#Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 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.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Job Description CCMS & Associates is looking for 1099 Field Liability Adjusters. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team! We are seeking auto/homeowners/general liability field adjusters with at least 5 years of field experience. Requirements: Minimum 5 years auto and/or premise liability adjusting experience Working computer/laptop - internet access and Microsoft Word required Must demonstrate strong time management and customer service skills State adjusters license (where applicable) Must have a valid drivers license Responsibilities: Conduct in-depth investigations into liability claims to gather facts regarding the loss Investigate claims by obtaining recorded statements from insureds, claimants, or witnesses, and by interviewing fire, police, or other government officials as well as inspecting claimed damages Inspect damage to property and obtain personal injury information to assist in determining liability Maintain acceptable product quality through compliance with established best practices Knowledge and Skills: In-depth knowledge of property and liability insurance coverage and industry standards Ability to prepare full-captioned reports by collecting and summarizing required information Strong verbal and written communication skills Prompt, reliable, and friendly Detail-oriented individual to accurately gather and analyze information to avoid errors Preferred but Not Required: College degree Professional designations and certifications All candidates must pass a full background check (void in states where prohibited) Powered by JazzHR UjivJdTj2y

SafeRide Health is looking for a hands-on Claims Specialist to scale SafeRide. We are looking for a leader with deep experience managing Medicare and Medicaid programs as we scale past $100M in annual revenue. The Billing Specialist is responsible for elevating SafeRide's billing function and continuously enhancing the effectiveness of the organization. Strong business and financial orientation as well as a passion for growth and development are critical for this role. Responsibilities: Facilitates data processing and processes claims for NEMT and GMR rides. Performs reconciliation of billing data to encounter data. Works closely with the operations team to resolve issues. Work with internal operations and project teams to solve claims-related problems, benefit plans research and provider contract interpretation and configurations. Communicate and work with providers to get claims issues resolved and paid accurately and in accordance with healthcare/Medicare/Medicaid regulations, policies, and payment policies and guidelines. Receive incoming calls from providers, customers, vendors, and internal groups, to successfully analyze the caller's needs, research information, answer questions, and resolved issues and/or disputes in a timely and accurate manner. Identify issues negatively impacting the provider community including but not limited to system set up, required benefit modifications, EDI logic, provider education, claim examiner errors, and authorization rules. Develops and implements policies, processes and procedures that incorporate industry best practices, and reinforces high quality standards within the Billing team. Served as the Billing team's subject matter expert and primary contact for claims related projects and critical activities. Mentors junior team members and provides internal claims team training, coaching, guidance, and assistance with complex issues. Implement: Scalable and accurate billing operations systems leveraging best in class technology. This includes financial reporting for management, clients and designated state and federal agencies (e.g., HHSC in Texas). Champion and reinforce SafeRide's culture. Required Education/Experience: Minimum 1 years of experience in billing/claims management Must be bilingual Spanish Speaking Preferred NEMT/transportation background preferred Knowledge of CMS/HHSC regulations preferred Skills Strong data skills in Excel/Sheets, including pivot tables, v-lookups, etc. Self-starter, ability to work independently and in a team environment. Strength in problem solving, applying hard data and qualitative insight to frame problems and develop novel solutions Ability to adapt to unforeseen circumstances quickly Keen attention to detail Ability to work with a variety of stakeholders What we offer you An inclusive, encouraging and collaborative company culture Strong support for career growth, including access to our investor communities Competitive compensation with upside for growth (including stock options and performance grants) Competitive benefits including health/vision/dental insurance, 401k match and 18 day's PTO About SafeRide Health: SafeRide's mission is to restore access and dignity to care. SafeRide is transforming access to care for the nations sick, poor and underserved. We are a high growth, tech enabled services firm that's growing past 400 employees. SafeRide is backed by premier investors like NEA and clients like Fresenius. We operate nationally and now deliver over 5M rides per year. Learn more at ***********************

Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. **Essential Job Duties** - Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. - Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. - Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. - Assists with reducing rework by identifying and remediating claims processing issues. - Locates and interprets claims-related regulatory and contractual requirements. - Tailors existing reports and/or available data to meet the needs of claims projects. - Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. - Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. - Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. - Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. - Works collaboratively with internal/external stakeholders to define claims requirements. - Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. - Fields claims questions from the operations team. - Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. - Appropriately conveys claims-related information and tailors communication based on targeted audiences. - Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. - Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. - Supports claims department initiatives to improve overall claims function efficiency. **Required Qualifications** - At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. - Medical claims processing experience across multiple states, markets, and claim types. - Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. - Data research and analysis skills. - Organizational skills and attention to detail. - Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Ability to work cross-collaboratively in a highly matrixed organization. - Customer service skills. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software programs proficiency. **Preferred Qualifications** - Health care claims analysis experience. - Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Full Time 12238 Silicon Drive Professional Non-Nursing Day Shift $19.80 - $31.25 /RESPONSIBILITIES Analyze complex problems pertaining to claim payments, eligibility, other insurance, transplants and system issues that are beyond the scope of claim examiners and senior claim examiners that affect claims payment. Act as consultant to claims staff in complex claim issue resolution. Work cooperatively with Configuration in testing of contracts used in business operations and reporting to assure auto adjudication. Perform in accordance with company standards and policies. Promote harmonious relationships within own department, with other departments and within CFHP. Operate under limited supervision. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required. Five years HMO/PPO claims experience required. Amisys claims processing system experience preferred. Knowledgeable of all benefit programs offered by the CFHP, Medicaid, HMO, PPO, ASO.

Hi! I am a professional senior healthcare recruiting consultant placing healthcare professionals permanently in the United States. I am currently hiring for Claims & Denials Coordinators in the San Antonio area.This is for a Fortune 125 company. We have 5 Claims & Denials Coordinators positions available. I'm looking to hold my final batch of phone screenings tomorrow so apply now and please send your update resume directly. Position is Long Term Temp up to 6 months (after that position may end, get extended or go permanent based on business need), Schedule is Mon-Fri, 8:00am-5:00pm, some OT may be required. Will be working in office. Competitive pay and amazing benefits! Thanks, Ron Payos 321-332-6801 Job Description In charge of generating denial letters to explain to providers why services were not approved. Qualifications High school diploma or equivalent 2+ years of managed care experience (either working at a plan or interacting with a plan) Knowledge of medical terminology Knowledge of claims, appeals, & denials Computer skills Administrative experience Additional Information All your information will be kept confidential according to EEO guidelines.

Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259 Anticipated Training Class Start Dates: 1/5/2026 or 2/2/2026 What is your impact? As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties may be assigned. Day-to-day processing of claims for accounts: Responsible for processing of claims (medical, dental, vision, and mental health claims) Claims processing and adjudication. Claims research where applicable. Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. Utilize systems to track complaints and resolutions. Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. What You Must Have: 2+ years related work experience. Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry. High school diploma or GED Knowledge of CPT and ICD-9 coding required. Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. Must possess proven judgment, decision-making skills and the ability to analyze. Ability to learn quickly and multitask. Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. Concise written and verbal communication skills required, including the ability to handle conflict. Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. Review of multiple surgical procedures and establishment of reasonable and customary fees. What We Prefer: Some college courses in related fields are a plus. Other experience in processing all types of medical claims helpful. Data entry and 10-key by touch/sight What We Can Offer YOU! To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to: Medical, dental, vision, life and global travel health insurance Income protection benefits: life insurance, Short- and long-term disability programs Leave programs to support personal circumstances. Retirement Savings Plan includes employer contribution and employer match Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available and a comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ. General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

**Why USAA?** At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. **The Opportunity** As a dedicated Senior Property Adjuster, you will work within defined guidelines and framework, investigate, evaluate, negotiate and settle complex property insurance claims presented by or against our members. You will confirm/analyze coverage, recognize liability exposure and negotiate equitable settlement in compliance with all state regulatory requirements. You will recognize and empathize with members' life events, as appropriate. This hybrid role requires an individual to be **in the office 3 days per week** . Typical work schedules are 9:00 am - 5:30 pm (local time) Monday to Friday and may include some weekends. This position can be based in one of the following office locations: **San Antonio, TX, Phoenix, AZ, Chesapeake, VA, or Tampa, FL** . Relocation assistance is **not** available for this position. The Inside Sr. Property Adjuster role is a call center environment with a high volume of calls. This is an hourly, non-exempt position with paid overtime available. **Tasks:** + Proactively manage assigned claims caseload comprised of claims with moderate complexity damages that require commensurate knowledge and understanding of claims coverage. + Partner with vendors and internal business partners to facilitate moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance. + Investigate claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics. + Identify coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing investigation information involving moderate complexity policy terms and contingencies. + Determine and negotiates moderate complexity claims settlement. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes. + Maintain accurate, thorough, and current claim file documentation throughout the claims process. + Apply proficient knowledge of estimating technology platforms and virtual inspection tools; Utilizes platforms and tools to prepare claims estimates to manage moderate complexity property insurance claims. + Apply working knowledge of industry standards of inspection, damage mitigation and restoration techniques. + Serve as an informal resource for team members. + Recognize and addresses jurisdictional challenges such as applicable legislation and construction considerations. + Support workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours. + May be assigned CAT deployment travel with minimal notice during designated CATs. + Work various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. + Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. **What you have:** + High School Diploma or General Equivalency Diploma. + 2 years relevant property adjusting and/or claims adjusting experience handling moderately complex claims or construction related industry/insurance experience. + Developing knowledge of residential construction. + Working knowledge of estimating losses using Xactimate or similar tools and platforms. + Demonstrated negotiation, investigation, communication, and conflict resolution skills. + Working knowledge of property claims contracts and interpretation of case law and state laws and regulations. + Proficient in prioritizing and multi-tasking, including navigating through multiple business applications. + May need to travel up to 50% of the year (local & non-local) and/or work catastrophe duty when needed. + Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. **What sets you apart:** + Experience desk adjusting property claims involving Dwelling, Other Structures, Loss of Use, and Contents using virtual technologies (Hosta, Hover, Xactimate, ClaimsX) + Experience handling large loss complex claims (i.e., water, vandalism, malicious mischief, foreclosures, earth movement, appraisal, collapse, etc.) + Experience handling water loss claims including water mitigation, water loss estimating and reconciliation + Experience with full file ownership + Insurance industry designations such as AINS, CPCU, AIC, SCLA (or actively pursuing) + Xactimate Level 1 and/or Level 2 certification + Experience in a call center environment + Currently hold an active Adjuster License + Bachelor's degree + US military experience through military service or a military spouse/domestic partner **Compensation range:** The salary range for this position is: $63,590 - $117,990. **Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. **Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com _Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._ _USAA 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, disability, or status as a protected veteran._ **If you are an existing USAA employee, please use the internal career site in OneSource to apply.** **Please do not type your first and last name in all caps.** **_Find your purpose. Join our mission._** USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity. USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself - you just need to share our passion for serving our more than 13 million members. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law. California applicants, please review our HR CCPA - Notice at Collection (********************************************************************************************************** here. USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

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 Claims Examiner - General Liability | Hawaii License Required Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? * Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. * Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations. * Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. * Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights. * Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. * Enjoy flexibility and autonomy in your daily work, your location, and your career path. * Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. OFFICE LOCATIONS Hybrid 2 Days In-Office PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES * Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. * Assesses liability and resolves claims within evaluation. * Negotiates settlement of claims within designated authority. * Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. * Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. * Prepares necessary state fillings within statutory limits. * Manages the litigation process; ensures timely and cost effective claims resolution. * Coordinates vendor referrals for additional investigation and/or litigation management. * Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. * Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. * Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. * Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. * Ensures claim files are properly documented and claims coding is correct. * Refers cases as appropriate to supervisor and management. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge * Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. * Excellent oral and written communication, including presentation skills * PC literate, including Microsoft Office products * Analytical and interpretive skills * Strong organizational skills * Good interpersonal skills * Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed Service Expectations TAKING CARE OF YOU * Flexible work schedule. * Referral incentive program. * Career development and promotional growth opportunities. * A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 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 $80,000 - $90,000. 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. #Claims #ClaimsExaminer #Hybrid #LI-Hybrid #LI-Remote #LI-AM1 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.