Claims representative jobs in West Virginia

Job Description The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This is a remote role, Candidate must have their West Virginia License. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the appropriate parties. Manages subrogation and litigation of claim as it applies Manages potential claim recoveries of all types Reports claims to the excess carrier when applicable Communicates claim status with the customer and claimant Adheres to client and carrier guidelines and participates in claims review as needed Develops and maintains professional customer relationships Complies with rules and regulations of applicable state Additional projects and duties as assigned. KNOWLEDGE & SKILLS: West Virginia License is required Excellent written and verbal communication skills. Ability to assist team members to develop knowledge and understanding of claims practice. Ability to identify, analyze and solve problems. Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills. Ability to work both independently and within a team environment Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation. EDUCATION/EXPERIENCE: Bachelor's degree or a combination of education and related experience. Minimum of 3 years' industry experience and claim handling Self-Insured Certificate preferred State Certification as an experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $59,681 - $96,123 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

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.

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 Specialty Loss Adjuster **Embark on an Exciting Career Journey with Sedgwick Specialty** **Job Location** **: USA, Mexico, Brazil and strategic locations globally** **Job Type** **: Permanent** **Remuneration** **: Salaries can range from** **_$40,000.00USD to $250,000.00USD_** **taking into account skills, experience and qualifications.** **We have a number of fantastic opportunities for Specialty Loss Adjusters across the US, Mexico and Brazil and a number of key locations** We are looking for a variety of skill sets at all levels. Whether you have just started your career, you are a leader in the industry, or a claims management expert looking for a new challenge, this is your chance to showcase your skills and grow with a company that values innovation, excellence, and employee satisfaction. Are you ready to be a part of providing a differentiated and best of class proposition to clients whilst working with like-minded colleagues? Sedgwick Specialty is thrilled to announce that we are investing in growth across Natural Resources, Property, Casualty, Technical and Special Risks and Marine. As we expand our operations, we are seeking individuals who are passionate about making a difference to the Adjusting industry. **As a member of the Specialty platform, you will have the opportunity to:** + Work with a wide range of clients across the globe, handling complex cases and claims + Collaborate with a talented and supportive team of professionals who are dedicated to delivering exceptional results + Utilise state-of-the-art technology and resources to streamline processes and enhance efficiency + Receive ongoing training and development opportunities to further enhance your skills and knowledge in the marine industry + Enjoy a flexible work arrangement that allows you to maintain a healthy work-life balance while contributing to our global success **The skills you will have when you apply:** + **Qualified** : it is important to us that you are either accredited, on your way to be accredited or qualified by experience + **Insurance claims experience:** it is imperative that you have experience working on insurance claims within you respective field. Full claims life cycle experience is a must + **Great communicator:** you will be constantly working with policy holders, brokers, carriers and various third parties, so being able to communicate accurately important. Providing an excellent customer service with our clients in mind. Able to approach issues empathetically + **Commercially minded:** An understanding of how the industry operates and where the role of a Loss Adjuster fits in. Being able to negotiate. Understanding how to market your services is a big advantage **What we'll give you for this role:** 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 annual salaries can range from _$40,000.00 to $250,000.00USD._ Bonus eligible role. 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. Always Accepting Applications. **This isn't just a position, it's a pivotal role in shaping our industry** At Sedgwick, you won't just build your career; you'll cultivate a team of experts. Our Sedgwick University offering empowers you to excel as well as your team members, with the most comprehensive training program in the industry which includes more than 15,000 courses on demand, training specific to roles, and opportunities to continue formal education. Together, we're not only reshaping the insurance landscape, we're building a legacy of talent. Come and be a catalyst for change within our industry. **Next steps for you:** **Think we'd be a great match? Apply now -** ** we want to hear from you.** As part of our commitment to you, we are proud to have a zero tolerance policy towards discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation. After the closing date we will review all applications and may select some applicants for an interview (which may be virtual, or in-person). \#LI-HYBRID 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**

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** As a Product Liability Litigation Adjuster, Risk Management, you will be responsible for managing lawsuits and overseeing outside counsel defending CVS in high exposure, product liability mass tort litigations and general liability cases filed throughout the United States. Responsibilities include: + Developing relationships with internal colleagues for fact-finding and key litigation activities. + Utilizing legal skills to oversee and manage claims against CVS from the initiation of suit through resolution. + Managing all aspects of product liability mass tort litigations and complex general liability cases. + Working with outside national counsel and sr. management to develop consistent litigation strategies applicable to mass tort cases filed across the country. + Providing reporting to key internal stake holders on case developments and litigation trends for product liability mass torts and other cases. + Managing large scale discovery investigations by working with internal custodians, outside counsel and vendors to develop comprehensive procedures for identifying, locating, preserving and producing corporate records. + Analyzing case and internal materials and utilizing resources across CVS to discern key issues and identify the litigation strategy in every case assigned. + Creating a plan for claim evaluation to most efficiently resolve or defend cases against CVS while working with and overseeing outside counsel. + Participating in meetings and attending mediation and trial as necessary to oversee and assist in the defense or resolution of cases. **Required Qualifications** + 2+ years of legal experience, ideally with a law firm or as a litigation adjuster with a large self-insured company or insurance carrier. + Juris Doctor degree from an ABA accredited university. + Ability to travel and participate in legal proceedings, arbitrations, depositions, etc. **Preferred Qualifications** + Experience overseeing or defending product liability claims and litigation. + Familiarity or experience with insurance and coverage issues related to litigated claims. + Strong attention to detail and project management skills. + Experience overseeing and answering written discovery. + Ability to work independently and in an environment requiring teamwork and collaboration. + Strong written and verbal communication skills. + Demonstrated negotiation skills and ability. + Ability to articulate and summarize cases with management in a concise, cogent manner. + Litigation experience at a law firm, and/or significant experience overseeing litigated claims for an insurance carrier or corporation, including mediation experience and trial exposure. + 3-5 years of legal or claims experience. + Familiarity with the rules and procedures applicable to mass tort litigations, class actions, and/or multidistrict litigations. + Knowledge and experience navigating attorney-client privilege issues, corporate litigation holds, corporate witness depositions, and e-discovery. + Ability to influence and work collaboratively with senior leaders, CVS' in-house legal counsel and outside counsel. + Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook) with a proven ability to learn new software programs and systems. + Ability to positively and aggressively represent the company at mediation, arbitration and trial. + Ability to navigate difficult situations and communicate effectively with both internal and external groups. + Excellent organizational and time management skills and ability to handle a high volume of litigated claims. + Experience with and understanding of legal documents (pleadings, discovery, motions and briefs). **Education** + Verifiable Juris Doctor degree **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. **Great benefits for great people** We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** . + **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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.

Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures. Required: High dipolma or equivalent. Ability to follow written directions and work independently. Familiarity with medical terminology, CPT and ICD-10 coding is required. Computer and typing experience is required. Desired: Previous claims processing. Experience in billing or physician office experience is preferred. Responsibilities: Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines. Reports patterns of incorrect billing and utilization to manager or claims coordinator. Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines. Maintain a quality rating of 98%. Processes 15-20 claims per hour. Consistently displays a positive attitude and acceptable attendance. Participate in external and/or internal trainings as requested. Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Job Description Alacrity Solutions is seeking experienced property adjusters to join the Alacrity daily claims team! Skills & Qualifications: MUST live within 50-100 miles of posted location and willing to travel to location Minimum 2-3 years property experience Independent adjusting license in your home state, or a designated home state license if residing in a non-licensing state Xactimate proficient with current subscription Experienced in wind, hail, theft, fire, water loses and other perils preferred Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities Willing and able to climb roofs Powered by JazzHR Nme19F38tz

Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate? Elevate Claims Solutions is seeking an Independent Adjuster adjusters with commercial and residential property claims in Wisconsin: Greenbay Appleton and Fox Cities area. How will we Elevate you? We want to know and understand your unique skillset and goals. We are committed to receiving your feedback on how we can best support your progression and advancement towards those goals. Expand your career opportunities in a role where you can see that you are making a difference in people's lives. Meaningful work in a culture of continuous improvement. A diverse market of carriers Clear communication of service and quality expectations; internal and external. Guidelines that provide upfront understanding of each carrier's requirements. Continuous feedback, including real -time Quality Assurance and formalized quarterly coaching sessions to identify areas of strength and opportunity. Training and development opportunities tailored to individual growth objectives. A tenured foundation of industry experts with a wide knowledge base for you to consult. How will you Elevate? Prioritize policyholders during their time loss through demonstrated empathy and understanding. Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders. Outstanding work ethic. This is not a 9 -5 position, and you will be called upon to maintain a flexible schedule to help meet the needs of insureds and carriers. Clear, consistent, and timely communication. We, and our carriers, want and need strong lines of communication. You must be open to receiving and providing feedback. The ability to manage workload while exercising good judgment effectively and independently. Strong written and verbal communication skills. Strong technological skills with the ability to work within various claims management systems. Minimum of three years of residential and commercial property adjusting experience. Carrier experience is desired. Liability experience is a plus. Current, active Xactimate license and experience writing both residential and commercial damage estimates in Xactimate. Ability to pass a background screen. Current, active license where required. Equipment and ability to access roofs. If you are ready to Elevate claims with a firm that truly values and supports you, let us know - we may be a fit.

We are seeking experienced Independent Field Adjusters to investigate and evaluate daily property claims on behalf of our clients. This role involves delivering timely, accurate, fair, and professional service while managing a high volume of claims independently. Contractors are expected to uphold the highest standards of service and professionalism, representing both the client and company with integrity. Essential Responsibilities Promptly and effectively manage all assigned claims with minimal oversight. Make claim decisions within delegated authority per company and carrier policies. Accurately interpret policy coverages and apply appropriate claims practices. Establish and communicate reserves in alignment with carrier expectations. Maintain up -to -date knowledge of insurance policies, guidelines, and industry practices. Understand local construction methods, pricing, and repair standards. Submit supplemental reports as needed (e.g., severe incident reports, ITV reports). Provide exceptional customer service to all insureds, clients, and stakeholders. Maintain high standards of professional conduct throughout all assignments. Perform additional responsibilities as assigned. RequirementsQualifications High school diploma or equivalent required; associate's or bachelor's degree preferred Minimum 2 years of experience handling property claims Minimum 2 years of experience using Xactimate and Symbility estimating software Strong understanding of insurance policies, practices, and procedures General construction knowledge strongly preferred BenefitsImportant: This is a 1099 Independent Contractor Opportunity This opportunity is classified as an independent contractor role under the IRS and applicable state laws, including New York. By applying, you acknowledge and agree to the following: You will not be classified as an employee of Ryze Claim Solutions, and no employer -employee relationship exists. You are responsible for your own taxes, insurance, and business expenses. You control the manner, timing, and method of completing your work, consistent with client expectations. You may provide services to other clients or entities, subject to applicable confidentiality or non -compete terms. To qualify as a 1099 contractor under the ABC test: (A) You must be free from company control and direction in how work is performed. (B) The work must be performed outside the usual course of our business. (C) You must be customarily engaged in an independently established trade or business. If you do not meet all three criteria, you may not be eligible for this engagement

The salary range for this job posting is $55,132.00 - $110,642.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. While we may prefer candidates who can work a hybrid schedule in our Charleston, WV office, we will consider candidates who live in any of our listed payroll approved states. Lost Time Workers' Compensation claims handling experience in Virginia, West Virginia, Kentucky, or Pennsylvania is preferred. The position reports to the Director, Workers' Compensation Claims on the Energy team. We may hire a senior level depending on the candidate's background and experience and the salary range is inclusive of all levels. Are you a Referral? If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team. Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin. JOB OBJECTIVE: The Lost Time Claims Specialist, Workers' Compensation primarily manages indemnity claims. The Lost Time Claims Specialist is responsible for the investigation, evaluation, and determination of compensability for work-related injury and disease claims following established guidelines to determine benefit eligibility. The Lost Time Claims Specialist also serves as a resource to Medical Only Claims Specialists and Claims Specialist Trainees. The position's objective is to provide superior service in a cost-effective manner to achieve best possible outcomes as well as proactively collaborate across the enterprise to ensure alignment of objectives and foster continuous improvement. ESSENTIAL FUNCTIONS: 1. Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims to their most cost- effective conclusion. 2. Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines. 3. Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision. 4. Take recorded statements when necessary. 5. Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed within the designated authority levels. 6. Utilize proactive reserving behaviors to ensure adequate case reserves which reflect the probable ultimate outcome based on the current known circumstances throughout the life of the claim. 7. Actively identifies and develops the investigation of and pursuit of subrogation recoveries when possible. 8. Consults with assigned claim director, return to work specialists, nurse case managers, internal/external medical, and legal on current and/or recommended treatment, litigation or rehabilitation plans to ensure claims outcomes are achievable and appropriate. 9. Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs and promote quality medical care. 10. Works collaboratively with the injured worker, employer, assigned return to work specialist, and medical providers to facilitate the injured worker's safe and timely return to work. 11. Manages claims litigation, including expenses, by collaborating and providing direction to panel counsel throughout the life of the claim. 12. Analyzes reports from external resources such as physicians, attorneys, and/or vocational rehabilitation experts to evaluate and adjust claim strategies as needed. 13. Evaluates and negotiates claim settlements utilizing human relation skills and technical knowledge to achieve the best possible outcome. 14. Presents and summarizes claim details at internal team staffing, participates in discussions, and provides guidance as needed. 15. Consults with assigned claim director if the loss becomes significantly complex or presents significantly increasing financial exposure. 16. Follows established claims best practices related to medical management, litigation, fraud/abuse and recovery. 17. Effectively and independently uses available resources to prioritize, organize, and complete work in a timely manner to meet jurisdictional requirements, timeframes, and internal metrics. 18. Develops presentations for special projects such as internal/external meetings and conferences as needed. 19. Along with the claim director, regional vice president and other claims staff, participates in claim reviews, onboardings, etc. for our policyholders and agents. 20. Proactively collaborate with our policyholders to ensure alignment of objectives and foster continuous improvement. OTHER FUNCTIONS: 1. Nonessential function: other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES: • Bachelor's Degree from an accredited college or university is preferred. • Three years of experience in the field of workers' compensation insurance required. • Ability to manage claims through the litigation process. • Internal candidates must demonstrate knowledge of Encova Best Practices guidelines and meet quality standards. • One valid workers' compensation adjuster license is strongly preferred. Must be eligible to obtain additional licenses as required. • Must pass the claims adjuster license exam(s) as assigned within 90 days of being hired. • Preference may be shown to candidates with multiple state claims management experience. • Experience in workers' compensation claims practices and laws, court procedures, precedents and state statutes. • Ability to use logic and sound reasoning to identify alternative solutions for problem-solving. • Strong written and verbal communication skills. • Strong analytical skills. • Ability to multitasks and manage time effectively and productively. • Work effectively independently as well as in a team environment. • Develop and maintain strong, effective internal and external relationships. • Work effectively in a paperless environment. • Skilled in the use of laptops, claims management systems, and other typical business-related programs such as Microsoft Office suite. This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons. Ready to join our team? At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating and financially rewarding opportunities. Join us to discover a work experience where your diverse ideas will be met with enthusiasm - where you can learn and grow to your fullest potential. What you can expect from us Join our family of industry leaders, and let us reward you with a competitive salary, bonus and benefits package that includes but is not limited to: a 401(k), wellness programs, bonus incentive plans and flexible schedules, with an early close of the office every Friday. Additionally, Encova aspires to be an outstanding corporate citizen in all the markets we serve; we encourage and support associate participation in community initiatives through our foundations. Encova Insurance is an EOE/E-Verify employer. #LI-Hybrid#LI-MF1

Kaeppel Consulting is seeking an Claims Support Specialist to join our team at the West Virginia Branch, onsite in Parkersburg, WV. This role supports claims and zone operations through a variety of clerical and administrative tasks. The ideal candidate is customer-focused, detail-oriented, and thrives in a fast-paced environment. This position is expected to last 6 months, beginning in October 2025. Key Responsibilities: Provide general administrative support including answering phones, filing, imaging, faxing, and handling mail. Order office supplies and coordinate meetings as needed. Greet and direct visitors to the appropriate personnel. Deliver outstanding customer service through inbound and outbound calls to policyholders, claimants, and agents. Assist with weather-related claim support (CAT loss reports and other related duties). Support multiple claim disciplines: material damage, property, liability, subrogation, workers compensation, medical, and litigation. Process sensitive documents and maintain confidentiality of claim file data. Conduct follow-up calls and other claim file-related tasks as assigned. Education & Experience Requirements: High School Diploma or GED required Prior experience in an administrative or customer service role preferred Strong communication and organizational skills Proficiency with basic office equipment and software (e.g., Microsoft Office Suite) Ability to handle confidential information with professionalism Comfortable working in a fast-paced environment with minimal supervision Work Hours: Hours per Week: 37.5 Shift: 8:00 AM - 4:30 PM

Job DescriptionService Wire Company, a premier supplier of industrial and utility wire and cable, is currently seeking a Customer Quality and Claims Specialist in Culloden, WV. If you are looking to join a great organization and a chance to become a part of our growing team, this may be the opportunity for you! Position Summary:The Customer Quality and Claims Specialist supports internal and external customers by managing product claims, returns, and quality related inquiries. The role investigates issues, coordinates resolutions across departments, and ensures timely, accurate, and professional communication while recommending process improvements to prevent future claims.Tasks/Duties/Responsibilities: Monitor and manage customer cases, proactively addressing delays Investigate and resolve product claims, pricing adjustments, and deductions in coordination with Sales, Shipping and Quality Control Analyze customer complaints to determine root cause, corrective actions, and preventive measures Communicate findings, resolutions, and recommendations to customers and internal stakeholders Manage freight claim by providing raw material scrap values and re-claimed materials while tracking the funds received Check records, such as bills, computer printouts, and related documents and correspondence, and converse or correspond with customer and other company personnel, such as sales, shipping, engineering, and credit, to obtain facts regarding customer complaint Notify customer and designated personnel of findings, adjustments, and recommendations, such as exchange of merchandise Recommend improvements in product, packaging, shipping methods, service, or billing processes to minimize future claims. Perform additional duties as assigned Knowledge/Skills/Requirements: High school diploma or equivalent; 2-year degree preferred Strong research, documentation, and analytical skills Proficient with Microsoft Office Solid basic math skills Ability to multi-task, prioritize, and manage time effectively Strong written and oral communication skills Ability to effectively interact with internal and external customers Ability to travel from time to time (less than 10%) Familiarity with office equipment including printers, copiers, scanners etc. Reports To: Quality Assurance Manager

The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This is a remote role, Candidate must have their West Virginia License. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the appropriate parties. Manages subrogation and litigation of claim as it applies Manages potential claim recoveries of all types Reports claims to the excess carrier when applicable Communicates claim status with the customer and claimant Adheres to client and carrier guidelines and participates in claims review as needed Develops and maintains professional customer relationships Complies with rules and regulations of applicable state Additional projects and duties as assigned. KNOWLEDGE & SKILLS: West Virginia License is required Excellent written and verbal communication skills. Ability to assist team members to develop knowledge and understanding of claims practice. Ability to identify, analyze and solve problems. Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills. Ability to work both independently and within a team environment Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation. EDUCATION/EXPERIENCE: Bachelor's degree or a combination of education and related experience. Minimum of 3 years' industry experience and claim handling Self-Insured Certificate preferred State Certification as an experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $59,681 - $96,123 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

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.

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 Auto Claims Adjuster **PRIMARY PURPOSE** **:** To analyze mid- and higher-level general auto claims to determine scope of damages; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. + Assesses liability and resolves claims within evaluation. + Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. + Manages subrogation of claims and negotiates settlements. + Communicates claim action with claimant and client. + Ensures claim files are properly documented and claims coding is correct. + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Travels as required. **QUALIFICATIONS** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Four (4) 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 as applicable to line-of-business. + Excellent oral and written communication skills, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent interpersonal skills + Excellent negotiating skills + Ability to create and complete comprehensive, accurate and constructive written reports + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking 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 $25.00 to $35.00 USD/HR . This role is eligible for 401k. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Always accepting applications 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 Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures. Required: High dipolma or equivalent. Ability to follow written directions and work independently. Familiarity with medical terminology, CPT and ICD-10 coding is required. Computer and typing experience is required. Desired: Previous claims processing. Experience in billing or physician office experience is preferred. Responsibilities: Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan. Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines. Reports patterns of incorrect billing and utilization to manager or claims coordinator. Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines. Maintain a quality rating of 98%. Processes 15-20 claims per hour. Consistently displays a positive attitude and acceptable attendance. Participate in external and/or internal trainings as requested. Equal Opportunity Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment. 8:00am - 5:00pm 40

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.

Job Description Alacrity Solutions is seeking experienced property adjusters to join the Alacrity daily claims team! Skills & Qualifications: MUST live within 50-100 miles of posted location and willing to travel to location Minimum 2-3 years property experience Independent adjusting license in your home state, or a designated home state license if residing in a non-licensing state Xactimate proficient with current subscription Experienced in wind, hail, theft, fire, water loses and other perils preferred Have reliable transportation, computer, digital camera, ladder, and other miscellaneous items necessary to perform adjuster responsibilities Willing and able to climb roofs Powered by JazzHR wE7fE8mSVw

Elevate Claims Solutions is founded on the belief that human experience and claim quality are the essence of profitable growth and retention for our adjuster partners, our clients, and ourselves. Are you ready, willing, and able to Elevate? Elevate Claims Solutions is seeking an Independent Adjuster adjusters with commercial and residential property claims in Duluth, MN and surrounding area. How will we Elevate you? We want to know and understand your unique skillset and goals. We are committed to receiving your feedback on how we can best support your progression and advancement towards those goals. Expand your career opportunities in a role where you can see that you are making a difference in people's lives. Meaningful work in a culture of continuous improvement. A diverse market of carriers Clear communication of service and quality expectations; internal and external. Guidelines that provide upfront understanding of each carrier's requirements. Continuous feedback, including real -time Quality Assurance and formalized quarterly coaching sessions to identify areas of strength and opportunity. Training and development opportunities tailored to individual growth objectives. A tenured foundation of industry experts with a wide knowledge base for you to consult. How will you Elevate? Prioritize policyholders during their time loss through demonstrated empathy and understanding. Valuing our partnerships with our carrier clients; recognizing and maximizing the ways in which our Elevated Claims Handling can support them and their policyholders. Outstanding work ethic. This is not a 9 -5 position, and you will be called upon to maintain a flexible schedule to help meet the needs of insureds and carriers. Clear, consistent, and timely communication. We, and our carriers, want and need strong lines of communication. You must be open to receiving and providing feedback. The ability to manage workload while exercising good judgment effectively and independently. Strong written and verbal communication skills. Strong technological skills with the ability to work within various claims management systems. Minimum of three years of residential and commercial property adjusting experience. Carrier experience is desired. Liability experience is a plus. Current, active Xactimate license and experience writing both residential and commercial damage estimates in Xactimate. Ability to pass a background screen. Current, active license where required. Equipment and ability to access roofs. If you are ready to Elevate claims with a firm that truly values and supports you, let us know - we may be a fit.