Claims representative jobs in San Mateo, CA

Who Are We? Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $52,600.00 - $86,800.00 Target Openings 2 What Is the Opportunity? This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. What Will You Do? * Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. * The on the job training includes practice and execution of the following core assignments: * Handles 1st party property claims of moderate severity and complexity as assigned. * Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. * Broad scale use of innovative technologies. * Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. * Establishes timely and accurate claim and expense reserves. * Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. * Negotiates and conveys claim settlements within authority limits. * Writes denial letters, Reservation of Rights and other complex correspondence. * Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. * Meets all quality standards and expectations in accordance with the Knowledge Guides. * Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. * Manages file inventory to ensure timely resolution of cases. * Handles files in compliance with state regulations, where applicable. * Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. * Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. * Identifies and refers claims with Major Case Unit exposure to the manager. * Performs administrative functions such as expense accounts, time off reporting, etc. as required. * Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. * May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. * Must secure and maintain company credit card required. * In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. * In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. * This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. * Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic * Verbal and written communication skills -Intermediate * Attention to detail ensuring accuracy - Basic * Ability to work in a high volume, fast paced environment managing multiple priorities - Basic * Analytical Thinking - Basic * Judgment/ Decision Making - Basic * Valid passport preferred. What is a Must Have? * High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. * Valid driver's license - required. What Is in It for You? * Health Insurance: Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. * Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. * Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. * Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. * Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. Employment Practices Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit *********************************************************

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Our associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more. Position Summary Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Primary responsibilities include investigation of General Liability claims to determine liability exposure. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners. Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days. Applicants must be currently authorized to work in the United States on a full-time basis. Principle Duties and Responsibilities: Claims Management Manage caseload within established targets and appropriate level. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations. Monitor and ensure timely execution of all statutory deadlines or legal filings as needed. Analyze facts of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines. Identify fraud indicators and actively pursue subrogation opportunities. Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks. Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers. Financial Impact Administration Manage book of claims business (up to $ 2million) with authority to settle/negotiate a single claim within their authority of up to $25,000. Communicate ongoing causes of incidents to Safety and Brands. Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications. Basic Qualifications: Licensed adjuster (as appropriate by jurisdiction) Bachelor's degree or experience handling General Liability claims or equivalent expertise. Thorough knowledge of rules, regulations, statutes, and procedures pertaining to general liability claims. Knowledge of medical terminology involved in complex claims Negotiates resolution of claims of various exposure and complexity Skills and Abilities: Demonstrates relationship building and communication skills, both written and verbal. Highly self-motivated, goal oriented, and works well under pressure. Customer focused solid understanding of legal procedures, processes, practices and standards in the handling of general liability claims Ability to identify problems and effectuate solutions Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail Able to apply critical thinking when solving problems and making decisions. ME/NC/PA/SC Salary Range: $63,440-$95,160 IL/MA/MD/NY Salary Range: $72,880 - $109,320 Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws. #LI-SM1 #LI-Hybrid At Ahold Delhaize USA, we provide services to one of the largest portfolios of grocery companies in the nation, and we're actively seeking top talent. Our team shares a common motivation to drive change, take ownership and enable our brands to better care for their customers. We thrive on supporting great local grocery brands and their strategies. Our associates are the heartbeat of our organization. We are committed to offering a welcoming work environment where all associates can succeed and thrive. Guided by our values of courage, care, teamwork, integrity (and even a little humor), we are dedicated to being a great place to work. We believe in collaboration, curiosity, and continuous learning in all that we think, create and do. While building a culture where personal and professional growth are just as important as business growth, we invest in our people, empowering them to learn, grow and deliver at all levels of the business.

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

We're looking for a Claims Adjuster to own and drive the end-to-end claims process. This role will be responsible for managing the end-to-end claims process with a strong focus on accuracy, communication, and timely resolution. You will collaborate closely with Drivers, Operations teams, Insurance Adjusters, Claims Administrators, Legal partners, and CloudTrucks leadership. In addition, you will maintain comprehensive claim files, track key metrics, and provide reporting that helps the business understand claim trends and exposure. Who you are * Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. * Empathetic and patient. You approach every interaction with understanding and care. * Strong sense of urgency. You act quickly and decisively, maintaining momentum at all times. * Creative. You can find the right exit ramp for the resolution of the claim that is in the insured's best interest. * Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. * Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. * Anti-status quo. You don't just wish things were done differently, you act on it. What you'll do * Oversee the claims processing function, ensuring efficient and accurate handling of claims with a robust documentation process. * Lead the evaluation of claims and negotiate settlements, setting an example for the team in terms of prompt and fair resolution. * Analyze claims data to identify trends and develop proactive strategies to reduce future incidents. * Provide input on annual insurance renewals. * Remain current on state and federal laws relating to trucking litigation and trends within the claims industry and remain compliant * Be available to handle after-hours emergencies. * Prepare and present regular reports on claims data, providing insights and recommendations for improvement. * Analyzing and reviewing insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim to assist TPA and underwriters in evaluating a claim. Experience * Bachelor's degree or equivalent experience * 5+ years of claim handling experience (commercial claims a plus) * Understand transportation coverages, contractual risk transfer and additional insured forms * Strong communication and collaboration with multiple stakeholders with a sense of urgency * Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines About CloudTrucks CloudTrucks is a virtual trucking carrier in the multi-billion dollar trucking space. Core to this industry are over 3.5M truck drivers. They move more than 70% of all goods transported around the U.S., yet operate in a highly fragmented industry with huge opportunities for products, services and automation. We strive to deliver solutions that help truck drivers operate with much greater efficiency, increase their revenue, and offload business complexity. We are looking for uniquely exceptional people to join us on our journey as we massively scale into an industry-defining business. We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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.

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.

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

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

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

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

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

Workers' Compensation Claim Representative I Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Salary Range: $60,000 to $70,000 annually (dependent on experience) Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We are seeking a Workers' Compensation Claim Representative I to support a PEO/Staffing account handling California workers' compensation claims from intake through resolution. This role may be remote or hybrid, reporting to our Irvine, CA branch. This position is ideal for an early-career adjuster or claims professional with 1-3 years of claims experience-or a related insurance, medical, or legal background-who is ready to grow in a true adjusting role. You'll investigate claims, manage medical and legal activity, communicate with all parties, and deliver consistent, compliant outcomes under guidance and mentorship. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems with purpose and care. Investigate and adjust California workers' compensation claims in accordance with CCMSI standards and client handling instructions Manage claims cradle-to-grave, including compensability decisions, medical management, and resolution strategy Review medical, legal, and miscellaneous invoices for accuracy, reasonableness, and claim-relatedness Negotiate disputed medical bills and work toward timely resolution Authorize and issue claim payments within assigned settlement authority Communicate with injured workers, employers, attorneys, medical providers, and internal partners Assist with settlement negotiations in accordance with client authorization Support the selection and coordination of defense counsel as appropriate Evaluate and monitor subrogation opportunities Prepare claim reports, payment summaries, and reserve documentation Maintain compliance with service commitments, jurisdictional requirements, and excess reporting obligations Deliver consistent, high-quality claim service aligned with CCMSI's corporate standards Qualifications What You'll Bring Required 1-3 years of workers' compensation claims experience or related experience in insurance, medical claims, legal, or adjacent claim-support roles Working knowledge of the California workers' compensation claims process Strong organizational, communication, and time-management skills Ability to prioritize work, meet deadlines, and manage multiple tasks Reliable, predictable attendance within established client service hours Preferred SIP designation or ability to obtain within a defined timeframe Associate degree or higher Experience supporting PEO and/or staffing accounts Proficiency with Microsoft Word, Excel, Outlook, and claims systems Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: • Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #NowHiring #WorkersCompensation #WCClaims #WCClaimRep #ClaimsAdjuster #CaliforniaWorkersComp #CAClaims #CAAdjusters #InsuranceCareers #ClaimsCareers #TPACareers #HybridWork #RemoteJobs #CaliforniaJobs #CareerWithPurpose #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Hybrid #LI-Remote We can recommend jobs specifically for you! Click here to get started.

**Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $52,600.00 - $86,800.00 **Target Openings** 2 **What Is the Opportunity?** This is an entry level position that requires satisfactory completion of required training to advance to Claim Professional, Outside Property. This position is intended to develop skills for investigating, evaluating, negotiating and resolving claims on losses of lesser value and complexity. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration. This position is based 100% remotely and may include a combination of mobile work and/or work from your primary residence. **What Will You Do?** + Completes required training which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The training may require travel. + The on the job training includes practice and execution of the following core assignments: + Handles 1st party property claims of moderate severity and complexity as assigned. + Establishes accurate scope of damages for building and contents losses and utilizes as a basis for written estimates and/or computer assisted estimates. + Broad scale use of innovative technologies. + Investigates and evaluates all relevant facts to determine coverage (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. + Establishes timely and accurate claim and expense reserves. + Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. + Negotiates and conveys claim settlements within authority limits. + Writes denial letters, Reservation of Rights and other complex correspondence. + Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. + Meets all quality standards and expectations in accordance with the Knowledge Guides. + Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. + Manages file inventory to ensure timely resolution of cases. + Handles files in compliance with state regulations, where applicable. + Provides excellent customer service to meet the needs of the insured, agent and all other internal and external customers/business partners. + Recognizes when to refer claims to Travelers Special Investigations Unit and/or Subrogation Unit. + Identifies and refers claims with Major Case Unit exposure to the manager. + Performs administrative functions such as expense accounts, time off reporting, etc. as required. + Provides multi-line assistance in response to workforce management needs; including but not limited to claim handling for Auto, Workers Compensation, General Liability and other areas of the business as needed. + May attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed. + Must secure and maintain company credit card required. + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + In order to progress to Claim Representative, a Trainee must demonstrate proficiency in the skills outlined above. Proficiency will be verified by appropriate management, according to established standards. + This position requires the individual to access and inspect all areas of a dwelling or structure which is physically demanding including walk on roofs, and enter tight spaces (such as attic staircases, entries, crawl spaces, etc.) The individual must be able to carry, set up and safely climb a ladder with a Type IA rating Extra Heavy Capacity with a working load of 300 LB/136KG, weighing approximately 38 to 49 pounds. While specific territory or day-to-day responsibilities may not require an individual to climb a ladder, the incumbent must be capable of safely climbing a ladder when deploying to a catastrophe which is a requirement of the position + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Bachelor's Degree preferred or a minimum of two years of work OR customer service related experience preferred. + Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic + Verbal and written communication skills -Intermediate + Attention to detail ensuring accuracy - Basic + Ability to work in a high volume, fast paced environment managing multiple priorities - Basic + Analytical Thinking - Basic + Judgment/ Decision Making - Basic + Valid passport preferred. **What is a Must Have?** + High School Diploma or GED and one year of customer service experience OR Bachelor's Degree required. + Valid driver's license - required. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .

We're looking for a Claims Adjuster to own and drive the end-to-end claims process. This role will be responsible for managing the end-to-end claims process with a strong focus on accuracy, communication, and timely resolution. You will collaborate closely with Drivers, Operations teams, Insurance Adjusters, Claims Administrators, Legal partners, and CloudTrucks leadership. In addition, you will maintain comprehensive claim files, track key metrics, and provide reporting that helps the business understand claim trends and exposure. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Empathetic and patient. You approach every interaction with understanding and care. Strong sense of urgency. You act quickly and decisively, maintaining momentum at all times. Creative. You can find the right exit ramp for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you act on it. What you'll do Oversee the claims processing function, ensuring efficient and accurate handling of claims with a robust documentation process. Lead the evaluation of claims and negotiate settlements, setting an example for the team in terms of prompt and fair resolution. Analyze claims data to identify trends and develop proactive strategies to reduce future incidents. Provide input on annual insurance renewals. Remain current on state and federal laws relating to trucking litigation and trends within the claims industry and remain compliant Be available to handle after-hours emergencies. Prepare and present regular reports on claims data, providing insights and recommendations for improvement. Analyzing and reviewing insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim to assist TPA and underwriters in evaluating a claim. Experience Bachelor's degree or equivalent experience 5+ years of claim handling experience (commercial claims a plus) Understand transportation coverages, contractual risk transfer and additional insured forms Strong communication and collaboration with multiple stakeholders with a sense of urgency Knowledge of multiple state statutes, including good faith claim handling practices, regulations, and guidelines About CloudTrucks CloudTrucks is a virtual trucking carrier in the multi-billion dollar trucking space. Core to this industry are over 3.5M truck drivers. They move more than 70% of all goods transported around the U.S., yet operate in a highly fragmented industry with huge opportunities for products, services and automation. We strive to deliver solutions that help truck drivers operate with much greater efficiency, increase their revenue, and offload business complexity. We are looking for uniquely exceptional people to join us on our journey as we massively scale into an industry-defining business. We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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.

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

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

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

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 $94,400.00 - $155,800.00 Target Openings 1 What Is the Opportunity? This role is eligible for a sign-on bonus of up to $20,000. This position is hybrid (3 days in office, 2 days remote). Under general supervision, this position is responsible for investigating, evaluating, reserving, negotiating and resolving assigned Specialty Liability Bodily Injury and Property Damage claims. Provides quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, litigation management, negotiation and resolution) including maintaining full compliance with internal and external quality standards and state specific regulations. Provides consulting and training resources, and serves as a contact and technical resource to the field and our business partners. This job does not manage staff. What Will You Do? * Directly handles assigned severity claims. * Provides quality customer service and ensures quality and timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case. * Consults with Manager on use of Claim Coverage Counsel as needed. * Directly investigates each claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. * Actively engages in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims, such as Subrogation, Risk Control, nurse consultants, and fire or fraud investigators, and other experts. * Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damage documentation. * Maintains claim files and documents claim file activities in accordance with established procedures. * Utilizes evaluation documentation tools in accordance with department guidelines. * Proactively creates Claim File Analysis (CFA) by adhering to quality standards. * Utilizes diary management system to ensure that all claims are handled timely. * At required time intervals, evaluate liability & damages exposure. * Establishes and maintains proper indemnity and expense reserves. * Recommends appropriate cases for discussion at roundtable. * Attends and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense. * Actively and enthusiastically shares experience and knowledge of creative resolution techniques to improve the claim results of others. * Applies the Company's claim quality management protocols and Best Practices to all claims; documents the rationale for any departure from applicable protocols with or without assistance. * Develops and employ creative resolution strategies. * Responsible for prompt and proper disposition of all claims within delegated authority. * Negotiates disposition of claims with insureds and claimants or their legal representatives. * Recognizes and implements alternate means of resolution. * Manages litigated claims. Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers. * Applies litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy, * Tracks and controls legal expenses to assure cost-effective resolution. * Effectively and efficiently manage both allocated and unallocated loss adjustment expenses. * Perform other duties as assigned. What Will Our Ideal Candidate Have? * Bachelor's Degree. * 5 years equivalent business experience. * Advanced level knowledge and skill in claim and litigation. * Basic working level knowledge and skill in various business line products. * Strong negotiation and customer service skills. * Skilled in coverage, liability and damages analysis and has a thorough understanding of the litigation process, relevant case and statutory law and expert litigation management skills. * Extensive claim and/or legal experience and technical expertise to evaluate severe and complex claims. * Able to make independent decisions on most assigned cases without involvement of supervisor. * Openness to the ideas and expertise of others actively solicits input and shares ideas. * Thorough understanding of commercial lines products, policy language, exclusions, ISO forms, and effective claims handling practices. * Demonstrated coaching, influence and persuasion skills. * Advanced written and verbal communication skills are required so as to understand, synthesize, interpret and convey, in a simplified manner, complex data and information to audiences with varying levels of expertise. * Can adapt to and support cultural change. * Strong technology aptitude; ability to use business technology tools to effectively research, track, and communicate information. * Analytical Thinking - Advanced. * Judgment/Decision Making - Advanced. * Communication - Advanced. * Negotiation - Advanced. * Insurance Contract. * Knowledge - Advanced. * Principles of Investigation - Advanced. * Value Determination - Advanced. * Settlement Techniques - Advanced. * Legal Knowledge - Advanced. * Medical Knowledge - Intermediate. What is a Must Have? * High School Degree or GED. * 3 years of liability claim handling experience and/or comparable litigation claim experience. * In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. * Generally, license(s) are required to be obtained within three months of starting the job. 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 *********************************************************