Claims representative jobs in West Virginia - 50 jobs
Liability Adjuster
Erie Insurance 4.6
Claims representative job in Parkersburg, WV
Division or Field Office: West Virginia Branch Office Claims Department Work from: Remote Salary Range: $55,261.00 - $88,274.00 * salary range is for this level and may vary based on actual level of role hired for * This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.
At Erie Insurance, you're not just part of a Fortune 500 company; you're also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.
Benefits That Go Beyond The Basics
We strive to be Above all in Service to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including:
* Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
* Low contributions to medical and prescription premiums. We currently pay up to 97% of employees' monthly premium costs.
* Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
* 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
* Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave.
* Career development. Including a tuition reimbursement program for higher education and industry designations.
Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.
Position Summary
Exercises independent discretion and judgement in claims handling involving complex liability issues, to include coverage issues and minor injury claims.
* This is a remote, work from home position in West Virginia
* The ideal candidate can live in West Virginia or Southern, OH and is able to travel to the Parkersburg Branch Office on occasion when needed.
* The ideal candidate will have their West Virginia Adjusters license or must be willing to obtain a WV Adjusters license.
Duties and Responsibilities
* Conducts investigations, evaluate and make recommendations regarding coverage and liability.
* Sets and maintains reserves. Obtains documents to establish the value of claims and negotiates settlement or declines claim.
* Documents files and submits final report.
* Identifies subrogation opportunities and initiates appropriate action.
* Negotiates with all parties, or their representatives, within designated authority.
* Completes required training.
* Trains and mentors.
* Travel for training may be required.
The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.
This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.
Capabilities
* Values Diversity
* Nimble Learning
* Self-Development
* Collaborates
* Customer Focus
* Cultivates Innovation
* Information Management Skills
* Instills Trust
* Optimizes Work Processes (IC)
* Job-Specific Knowledge
* Ensures Accountability
* Decision Quality
Qualifications
Minimum Educational and Experience Requirements
* High school diploma or equivalent and two years of claims or customer service experience, preferably with casualty claims, required.
* Equivalent educational experience will be considered.
* Associate's or Bachelor's degree, preferred.
Designations and/or Licenses
* Appropriate license as required by state.
Physical Requirements
* Lifting/Moving 0-20 lbs; Occasional (
* Lifting/Moving 20-50 lbs; Occasional (
* Ability to move over 50 lbs using lifting aide equipment; Occasional (
* Pushing/Pulling/moving objects, equipment with wheels; Occasional (
* Climbing/accessing heights; Rarely
* Driving; Occasional (
* Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)
$55.3k-88.3k yearly 60d+ ago
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Claims Adjuster II, Field Property - National Catastrophe ($5000 Sign-on Bonus)
Nationwide Mutual Insurance 4.5
Claims representative job in West Virginia
If you're passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide's Property and Casualty team could be the place for you! At Nationwide , “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we're looking for associates who are passionate about delivering extraordinary care.
This is a field-based role on the National Catastrophe Response Team. This position is responsible for managing property claims in response to catastrophic events across the country. As a field-based adjuster, you will be deployed to areas impacted by large-scale disasters-such as hurricanes, tornadoes, floods, or other major events-to assess damages, support policyholders, and help communities begin the recovery process. The role requires extensive travel (up to 80%), often on short notice, and the ability to work in high-pressure, fast-paced environments for extended periods.
You will regularly engage in direct, and at times, emotionally charged conversations with customers-clearly explaining coverage decisions, setting expectations, and delivering difficult news with empathy and professionalism. The ability to remain composed and compassionate in the face of loss, frustration, or uncertainty is essential. Strong communication skills and emotional resilience are critical, as you'll be guiding customers through some of the most challenging moments of their lives.
In this role, you'll conduct on-site inspections, evaluate property damages, determine policy coverage, and make timely, accurate decisions using a variety of tools and resources, including vendor estimates, independent adjusters, and self-written assessments. You'll also be responsible for full file ownership, maintaining appropriate reserves, managing claim activity (including supplements and requests for depreciation), ensuring compliance with internal standards and regulatory requirements, and providing proactive communication with external customers throughout each stage of the claim. Collaboration with internal teams such as Special Investigations and Subrogation may be required to identify fraud or recovery opportunities. Staying current on industry repair practices, regional pricing trends, and legal developments is key to success. This is a demanding, customer-facing role that requires a unique blend of technical expertise, critical thinking, and emotional intelligence. Candidates should be comfortable working independently in disaster zones, managing a high volume of claims, working 12 hours a day, up to 21 days in a row, and adapting quickly to evolving priorities. If you're driven by purpose, thrive under pressure, and want to make a meaningful impact during times of crisis, this role offers a challenging and deeply rewarding opportunity.
Ideal candidates will have:
Prior insurance field/property claims handling or adjusting experience
Proficiency with Xactimate
Prior estimate writing experience
Ability to handle claims of varying complexity from start to finish
Prior experience working in on site in a catastrophe environment
Ability to carry a ladder and climb a roof
Strong customer service competency
Strong written and verbal communication skills.
A $5000 SIGN-ON BONUS will be given to all external candidates hired into this role. Half of the bonus will be paid after 3 months of employment and the remainder will be paid after 9 months of employment.
Summary
No two property claims are ever the same and each customer has unique needs. Our team thrives on providing the very best service and building lasting, successful relationships with our customers. If you are confident, curious, driven to learn and grow, and have a desire to help people when they most need it, we want to know more about you!
As a National Catastrophe (NATCAT) Field Claims Specialist primarily supporting our Personal Lines (PL) business, you'll investigate and resolve moderate to severe property damage claims by phone.
Job Description
Key Responsibilities:
Handles all assigned claims promptly and effectively, with little to no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures.
Determines proper policy coverages and applies appropriate claims practices to resolve cases in alignment with company guidelines.
Opens, closes, and adjusts reserves according to company practices to ensure reserve adequacy. Adheres to file conferencing notification and authority procedures.
Maintains current knowledge of insurance and applicable product/services; court decisions which may impact the claims function; current guidelines; and policy changes and modifications. This may require attending various seminars and training sessions.
Maintains current knowledge of local industry repair procedures and local market pricing.
Submits severe incident reports, reinsurance reports and other information to claims management as needed.
Partners with Special Investigations Unit and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for lawsuit, trial, or subrogation.
Initiates and conducts follow-ups through proficient use of claims and other related business systems.
Delivers outstanding customer service to all internal, external, current, and prospective Nationwide customers. Adheres to high standards of professional conduct while providing delivery of outstanding claim's service.
May perform other responsibilities as assigned.
Reporting Relationships: Reports to Claims Manager. Individual contributor role.
Typical Skills and Experiences:
Education: Undergraduate degree or equivalent experience.
License/Certification/Designation: State licensing where required. Successful completion of required/applicable claims certification training/classes.
Experience: Three to five years of related property claims experience or comparable job-related experience, or education preferred. Experience in a customer service environment, including flexible work schedules and extended work hours preferred. Commercial claims property experience preferred.
Knowledge, Abilities and Skills: General knowledge of insurance theory and practices, and contracts and their application. Property estimating and automated claims systems. Demonstrated knowledge of the investigation, consultation and settlement activities used to resolve extensive property damage claims. Proven ability to meet customer needs and provide exemplary meaningful service by guiding customers through the claims process and ensuring a positive customer experience. Analytical and problem-solving skills necessary to make decisions and resolve issues related to application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, and application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for property losses. Ability to evaluate and successfully advise on property claims. Organizational skills to prioritize work. Command of written and verbal communication skills to effectively communicate with policyholders, claimants, repairpersons, attorneys, agents and the general public. Ability to efficiently operate a personal computer and related claims and business software. Able to provide leadership to less experienced claims associates. Must be able to safely access and inspect rooftops using a ladder. Must be prepared and capable of conducting physical inspections on rooftops, including first and second story roofs with pitches up to 8/12.
Other criteria, including leadership skills, competencies and experiences may take precedence.
Staffing exceptions to the above must be approved by the business unit executive and HR Business Partner.
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Job Conditions:
Overtime Eligibility: Not Eligible (Exempt)
Working Conditions: Normal office or field claims environment. May require ability to sit and operate phone and personal computer for extended periods of time. Able to make physical inspections of property loss sites; including climb ladders, balance at various heights and rooftops up to 8/12 pitch stoop, bend and/or crawl to inspect vehicles and structures; work outside in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. May be on-call. Must be available to work catastrophes (CAT). Extended and/or non-standard hours as required. Must have a valid driver's license with satisfactory driving record in accordance with Nationwide standards.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
We currently anticipate accepting applications until 01/29/2026. However, we encourage early submissions, as the posting may close sooner if a strong candidate slate is identified before the deadline.
Benefits
We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.
Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.
#claims Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at ************.
For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) *************************************************************
NOTE TO EMPLOYMENT AGENCIES:
We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.
Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.The national salary range for Field Claims Specialist II, National Catastrophe Property - Personal Lines : $62,500.00-$115,500.00The expected starting salary range for Field Claims Specialist II, National Catastrophe Property - Personal Lines : $62,500.00 - $93,500.00
$62.5k-115.5k yearly Auto-Apply 6d ago
Benefit and Claims Analyst
Highmark Health 4.5
Claims representative job in Charleston, WV
This job is a non-clinical resource that coordinates, analyzes, and interprets the benefits and claims processes for clinical teams and serves as a liaison between various departments across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management, Customer Service, Claims, and Medical Policy. The person in this position must fully understand all product offerings available to Organization members and be versed in claims payment methodologies, benefits administration, and business process requirements.
**ESSENTIAL RESPONSIBILITIES**
+ Coordinate, analyze, and interpret the benefits and claims processes for the department.
+ Serve as the liaison between the department and the claims processing departments to facilitate care/case management activities and special handling claims. Communicate benefit explanations clearly and concisely to all pertinent parties.
+ Investigate benefit/claim information and provide technical guidance to clinical and claims staff regarding the final adjudication of complex claims. Research and investigate conflicting benefit structures in multi-payor situations.
+ Provide prompt, thorough and courteous replies to written, electronic and telephonic inquiries from internal/external customers (e.g., clinical, sales/marketing, providers, vendors, etc.) Follow-up on all inquiries in accordance with corporate and regulatory standards and timeframes.
+ Must have the ability to apply knowledge about the business operations of the area within the defined scope of the job. Assess benefit limitations in accordance with Medical Policy Guidelines.
+ Monitor and identify claim processing inaccuracies. Bring trends to the attention of management.
+ Assist with handling inbound calls and strive to resolve customer concerns received via telephone or written communication.
+ Work independently of support, frequently utilizing resources to resolve customer inquiries.
+ Collaborate with Clinical Strategy, Sales/Client Management and other areas across the enterprise to respond to client questions and concerns about care/case management and high-cost claimants.
+ Gather information and develop presentation/training materials for support and education.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School or GED
**Substitutions**
+ None
**Preferred**
+ Associate's degree in or equivalent training in Business or a related field
**EXPERIENCE**
**Required**
+ 3 years of customer service, health insurance benefits and claims experience.
+ Working knowledge of Highmark products, systems (e.g., customer service and clinical platforms, knowledge resources, etc.), operations and medical policies
+ PC Proficiency including Microsoft Office Products
+ Ability to communicate effectively in both verbal and written form with all levels of employees
**Preferred**
+ Working knowledge of medical procedures and terminology.
+ Complex claim workflow analysis and adjudication.
+ ICD9, CPT, HPCPS coding knowledge/experience.
+ Knowledge of Medicare and Medicaid policies
**LICENSES or CERTIFICATIONS**
**Required**
+ None
**Preferred**
+ None
**SKILLS**
+ Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services
+ Knowledge of administrative and clerical procedures and systems such as managing files and records, designing forms and other office procedures
+ The ability to take direction, to navigate through multiple systems simultaneously
+ The ability to interact well with peers, supervisors and customers
+ Understanding the implications of new information for both current and future problem-solving and decision-making
+ Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate and not interrupting at inappropriate times
+ Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
+ Ability to solve complex issues on multiple levels.
+ Ability to solve problems independently and creatively.
+ Ability to handle many tasks simultaneously and respond to customers and their issues promptly.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$21.53
**Pay Range Maximum:**
$32.30
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273827
$21.5-32.3 hourly 31d ago
Daily Claims Adjuster (Residential)
Renfroe
Claims representative job in West Virginia
SUMMARY DESCRIPTION: The Residential Field Adjuster is responsible for investigating, inspecting, negotiating, and bringing to final resolution property claims of all named-peril losses. For claims where the damage is less severe, the Property Field Adjuster may be assigned tasks, such as verification of damage. The role's primary duties include reviewing coverage, inspecting damaged property, and estimating repair/replacement costs in accordance with the client's and RENFROE's guidelines. The Property Field Adjuster is also responsible for documenting all activity, submitting proper claims paperwork, handling renters and personal property policies, meeting with contractors, effectively communicating with the client and all stakeholders, and ensuring compliance with legal and contractual obligations.
REPORTS TO: Assigned RENFROE Manager
ESSENTIAL JOB FUNCTIONS:
Follows RENFROE and clients' policies and procedures to handle all assigned property claims
Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills
Completes assigned property adjustments, such as property or contents inspections, verification of loss, and updates claims as new information becomes available using XactAnalysis, Xactimate, or other estimating platforms
Manages the progression of claims/tasks and claim inventories assigned to the them
Travels to the loss location to inspect the property, which could include climbing the roof, inspecting the attic, or other inspection points, to establish the cause and scope of the loss
Works with contractors or another representative to reach an agreement on the scope of loss
Reviews the insurance policy and endorsement details to confirm coverage
Contacts and interacts with the insured to obtain documents such as property deeds, purchase receipts, warranties, photographs, or other documents to establish the existence, ownership, and value of the items claimed lost
Assists the client and claims examiner in determining coverage and amounts for additional living expenses such as rental housing, travel, meals, etc.
Writes closing reports, including recommendations for repair and/or replacement, the pursuit of subrogation, and salvage potential
Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE
Does not handle claims for which they do not have client authorization or for which they are not licensed
Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes
Makes suggestions on ways to improve process efficiency
Participates in special projects and completes other duties as assigned
Non-Authorized Activities:
Field adjusters should not:
Communicate training requirements to client staff adjusters and non-affiliated firms
Communicate training requirements to any claim handler who is not deployed with RENFROE
Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE
Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind
EXPERIENCE/QUALIFICATIONS:
Minimum of 1 year of property claims experience is preferred
Participation in technical insurance coursework is preferred, such as CPCU
Experience using various claims processing systems is preferred
Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes
Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others
Strong analytical skills and consistent attention to detail
Knowledge of ISO forms, and client policy coverage, procedures, and systems
Communicates clearly and effectively, both verbally and in writing
Strong customer service orientation and good rapport with the insured
Well-organized and hard-working, with the ability to thrive in a fast-paced work environment
Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact
Computer skills, including but not limited to practical knowledge of Word and Excel
PHYSICAL DEMANDS:
Ability to operate an automobile and have a valid driver's license with a safe driving record
Ability to travel by automobile or airplane
Must be able to lift, carry, unfold/extend, and climb a ladder (which may exceed 50 lbs. in weight) that is approved by the appropriate regulatory agency or complies with legislative or regulatory occupational health and safety requirements
Must be able to complete measurements of roofs and inspect interior as necessary, including attics, basements, and crawl spaces for residential and commercial structures
Must be able to do the following while conducting an inspection: climb, bend, crawl, stoop, walk, reach, kneel, squat, and carry/lift objects (typically weighing less than 50 lbs.)
Must be able to work outdoors in all types of weather
Ability to operate a telephone and a computer for extended periods of time
Must be able to work extended and varying work schedules, including working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays
Ability to work in a fast-paced, changing, and multi-tasking environment
$41k-51k yearly est. 4d ago
Senior Professional Liability Claims Specialist
Sedgwick 4.4
Claims representative job in Charleston, WV
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
Senior Professional Liability Claims Specialist
**PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.
**ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**
+ Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
+ Negotiates claim settlement up to designated authority level.
+ Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
+ Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
+ Represents Company in depositions, mediations, and trial monitoring as needed.
+ Communicates claim activity and processing with the client; maintains professional client relationships.
+ Ensures claim files are properly documented and claims coding is correct.
+ Refers cases as appropriate to supervisor and management.
+ Delegates work and mentors assigned staff.
**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**
+ Performs other duties as assigned.
+ Supports the organization's quality program(s).
**QUALIFICATIONS**
**Education & Licensing**
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
**Experience**
Six (6) years of claims management experience or equivalent combination of education and experience required.
**Skills & Knowledge**
+ In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent negotiation skills
+ Good interpersonal skills
+ 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.
**TAKING CARE OF YOU BY**
+ We offer a diverse and comprehensive benefits package including:
+ Three Medical, and two dental plans to choose from.
+ Tuition reimbursement eligible.
+ 401K plan that matches 50% on every $ you put in up to the first 6% you save.
+ 4 weeks PTO your first full year.
**NEXT STEPS**
If your application is selected to advance to the next round, a recruiter will be in touch.
_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 $100,000 - $110,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
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.
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**
$100k-110k yearly 4d ago
Independent Insurance Claims Adjuster in Charles Town, West Virginia
Milehigh Adjusters Houston
Claims representative job in Charles Town, WV
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: (*********************************************************
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#AdjustersNeeded #CareerOpportunity #ClaimsAdjusterTraining #MileHighAdjustersHouston
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$41k-53k yearly est. Auto-Apply 60d+ ago
Field Claims Adjuster
EAC Claims Solutions 4.6
Claims representative job in Beckley, WV
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.
$41k-50k yearly est. Auto-Apply 37d ago
Claims Analyst
Health Plan 4.6
Claims representative job in Charleston, WV
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 school diploma 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.
$53k-68k yearly est. Auto-Apply 40d ago
Claims Examiner
Harris 4.4
Claims representative job in West Virginia
Responsibilities & Duties:Claims Processing and Assessment:
Evaluate incoming claims to determine eligibility, coverage, and validity.
Conduct thorough investigations, including reviewing medical records and other relevant documentation.
Analyze policy provisions and contractual agreements to assess claim validity.
Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
Ensure compliance with company policies, procedures, and regulatory requirements.
Maintain accurate records and documentation related to claims activities.
Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
Identify opportunities for process improvement and efficiency within the claims department.
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
Generate reports and provide data analysis on claims trends, processing times, and outcomes.
Contribute to the development of management reports and presentations regarding claims operations.
$53k-74k yearly est. Auto-Apply 32d ago
Daily Property Adjuster
Alacrity Solutions
Claims representative job in Princeton, WV
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
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$40k-55k yearly est. 10d ago
Claims Specialist, Unclaimed Property-WV State Treasurer's Office-Kanawha Co.
State of West Virginia 3.4
Claims representative job in Charleston, WV
Nature of Work * This job opportunity is not in the classified service and is not covered by the West Virginia Division of Personnel merit system. , you must apply directly to the hiring agency.* HOW TO APPLY: Email resumes or inquiries toresumes@wvsto.govby January 30, 2026
CLAIMS SPECIALIST, UNCLAIMED PROPERTY-WV STATE TREASURER'S OFFICE-KANAWHA CO.
Salary: $40,000 - $50,000; salary commensurate with training and experience. Full-time employees of the West Virginia State Treasurer's Office (WVSTO) are eligible for Public Employee Insurance Agency benefits and a number of other benefits available to state employees.
Location:Charleston, WV
Job Type:Full-Time Permanent; Not in the Classified Service; FSLA; non-exempt
Division:WVSTO Unclaimed Property
Reports To:Claims Manager, Unclaimed Property
Nature of Work:
Under direct supervision, this position is responsible for claims processing unclaimed property and returning the property back to the rightful owner. This position works with the general public, both by phone and in person, and must possess excellent communication and customer service skills. In addition, the position must have both analytical and good writing skills to effectively evaluate the evidence and communicate with the claimant. Returns unclaimed property to rightful owners and maintains records by performing the following duties. Work is performed according to detailed instructions and the methods of work are well established and outlined by the Claims Manager.
Job Duties:
* Provides customer service in the form of responding to telephone calls, walk-in assistance, and in follow up letters to the public on claims, as applicable.
* Process and review all claims in accordance with the Unclaimed Property Guidelines and in compliance with West Virginia Unclaimed Property Act. As well as any other applicable policies and procedures.
* Reviews claims to determine if all necessary information is provided. Provide necessary follow up.
* Processes claims, by the appropriate claim type, in the KAPS unclaimed property system when received from the state website.
* Creates claims as needed from paper claim forms and from claimants that call in and need assistance.
* Responsible for compiling all evidence required to approve the claim at first level in KAPS.
* Adds appropriate evidence to the workflow as needed.
* Acts as peer reviewer, which is second level review, to co-workers claims.
* Process agency requests for reimbursement and transferring of funds in wv OASIS.
* Process traveler's checks and money orders.
* Scan mail into OnBase to interface with KAPs
* Back up to the receptionist, as needed.
* Assists other staff as needed.
* Assist with unclaimed property outreach at events, as needed.
* Notifies supervisor when potential problems arise.
* Assists with related special projects, as required.
Minimum Qualifications
Associate degree (A. A.) or equivalent from two-year College or technical school required; Bachelor's degree from four-year college or university preferred; or equivalent combination of education and related experience.
Required Knowledge, Skills, and Abilities:
* Knowledge of Unclaimed Property procedures to ensure compliance with the West Virginia Unclaimed Property Act.
* Ability to process and review all claims in accordance with the Unclaimed Property Guidelines and in compliance with West Virginia Unclaimed Property Act.
* Skill in explaining complicated unclaimed property matters to claimants.
* Ability to converse in a professional manner with disgruntled claimants.
* Ability to establish and maintain effective working relationships.
* Ability to deal with highly sensitive issues in an orderly and controlled manner.
* Ability to learn and utilize Unclaimed Property database systems.
Other Information
The State Treasurer's Office provides equal opportunities to all employees and applicants for employment without regard to race, sex, color, religion, national origin, age, disability, veteran status, or any other factors made unlawful under applicable federal and state laws. Equal employment opportunity applies to all terms and conditions of employment, including hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training. Applicants have rights under the following Federal Employment Laws: Family Medical Leave Act and Equal Employment Opportunity.
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.
This job opportunity is not in the classified service and is not covered by the West Virginia Division of Personnel merit system. Therefore, interested persons must apply directly to the hiring agency as directed above.
$40k-50k yearly 4d ago
Claims Examiner
Harriscomputer
Claims representative job in West Virginia
Responsibilities & Duties:Claims Processing and Assessment:
Evaluate incoming claims to determine eligibility, coverage, and validity.
Conduct thorough investigations, including reviewing medical records and other relevant documentation.
Analyze policy provisions and contractual agreements to assess claim validity.
Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service:
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation:
Ensure compliance with company policies, procedures, and regulatory requirements.
Maintain accurate records and documentation related to claims activities.
Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement:
Identify opportunities for process improvement and efficiency within the claims department.
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis:
Generate reports and provide data analysis on claims trends, processing times, and outcomes.
Contribute to the development of management reports and presentations regarding claims operations.
$36k-60k yearly est. Auto-Apply 32d ago
Property Adjuster Insurance Claims
Elevate Claims Solutions
Claims representative job in Charleston, WV
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.
$40k-55k yearly est. 60d+ ago
Property Field Adjuster - Charleston, WV
RYZE Claim Solutions 4.1
Claims representative job in Charleston, WV
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
$39k-53k yearly est. 60d+ ago
Claims Support Specialist II
Kaeppel Consulting
Claims representative job in Parkersburg, WV
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 November 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
$27k-35k yearly est. Auto-Apply 60d ago
Customer Quality and Claims Specialist
Service Wire 4.1
Claims representative job in Culloden, WV
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
$32k-45k yearly est. 25d ago
Senior Stop Loss Claims Analyst - HNAS
Highmark Health 4.5
Claims representative job in Charleston, WV
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
HNAS (Health Now Administrative Services) offers flexible, cost-effective solutions for employee health benefits. HNAS is part of Highmark Health, a national blended health organization with a mission to create remarkable health experiences. Our culture is built on your growth and development, collaborating across our organization, and making a big impact for those we serve.
**ESSENTIAL RESPONSIBILITIES**
+ Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
+ Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
+ Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
+ Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
+ Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
+ Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
+ Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
+ Maintains accurate claim records.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's degree
**EXPERIENCE**
**Required**
+ 5 years of relevant, progressive experience in health insurance claims
+ 3 years of prior experience processing 1st dollar health insurance claims
+ 3 years of experience with medical terminology
**Preferred:**
+ 3 years of experience in a Stop Loss Claims Analyst role.
**SKILLS**
+ Ability to communicate concise accurate information effectively.
+ Organizational skills
+ Ability to manage time effectively.
+ Ability to work independently.
+ Problem Solving and analytical skills.
**Language (Other than English):**
None
**Travel Requirement:**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$22.71
**Pay Range Maximum:**
$35.18
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273755
$22.7-35.2 hourly 27d ago
Specialty Loss Adjuster
Sedgwick 4.4
Claims representative job in Charleston, WV
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**
$44k-60k yearly est. 60d+ ago
Independent Insurance Claims Adjuster in Beckley, West Virginia
Milehigh Adjusters Houston
Claims representative job in Beckley, WV
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.
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$41k-51k yearly est. Auto-Apply 60d+ ago
Daily Claims Adjuster (Residential)
Renfroe
Claims representative job in Charleston, WV
SUMMARY DESCRIPTION: The Residential Field Adjuster is responsible for investigating, inspecting, negotiating, and bringing to final resolution property claims of all named-peril losses. For claims where the damage is less severe, the Property Field Adjuster may be assigned tasks, such as verification of damage. The role's primary duties include reviewing coverage, inspecting damaged property, and estimating repair/replacement costs in accordance with the client's and RENFROE's guidelines. The Property Field Adjuster is also responsible for documenting all activity, submitting proper claims paperwork, handling renters and personal property policies, meeting with contractors, effectively communicating with the client and all stakeholders, and ensuring compliance with legal and contractual obligations.
REPORTS TO: Assigned RENFROE Manager
ESSENTIAL JOB FUNCTIONS:
Follows RENFROE and clients' policies and procedures to handle all assigned property claims
Works with the RENFROE Manager and other adjusters to share knowledge and experience and to gain new skills
Completes assigned property adjustments, such as property or contents inspections, verification of loss, and updates claims as new information becomes available using XactAnalysis, Xactimate, or other estimating platforms
Manages the progression of claims/tasks and claim inventories assigned to the them
Travels to the loss location to inspect the property, which could include climbing the roof, inspecting the attic, or other inspection points, to establish the cause and scope of the loss
Works with contractors or another representative to reach an agreement on the scope of loss
Reviews the insurance policy and endorsement details to confirm coverage
Contacts and interacts with the insured to obtain documents such as property deeds, purchase receipts, warranties, photographs, or other documents to establish the existence, ownership, and value of the items claimed lost
Assists the client and claims examiner in determining coverage and amounts for additional living expenses such as rental housing, travel, meals, etc.
Writes closing reports, including recommendations for repair and/or replacement, the pursuit of subrogation, and salvage potential
Maintains required jurisdictional adjusting licenses as required by the client and/or RENFROE
Does not handle claims for which they do not have client authorization or for which they are not licensed
Participates and communicates in client team meetings to discuss claim handling trends, team production, and any claim handling concerns or changes
Makes suggestions on ways to improve process efficiency
Participates in special projects and completes other duties as assigned
Non-Authorized Activities:
Field adjusters should not:
Communicate training requirements to client staff adjusters and non-affiliated firms
Communicate training requirements to any claim handler who is not deployed with RENFROE
Discuss Human Resource issues with any client staff adjusters in any segment or any claim handler that is not deployed with RENFROE
Discuss any of the following topics with a client staff adjuster or any claim handler that is not deployed with RENFROE: job openings, termination, prior work history, attendance, absence requests, daily work schedule, claim volume or workload, meal and rest break schedule, promotions, development, compensation, or mentoring of any kind
EXPERIENCE/QUALIFICATIONS:
Minimum of 1 year of property claims experience is preferred
Participation in technical insurance coursework is preferred, such as CPCU
Experience using various claims processing systems is preferred
Appropriate licenses, depending on state requirements, and successful completion of required/applicable claims certification training classes
Effective problem resolution and decision-making skills to include analyzing insurance policies and information, demonstrating sound judgment, and utilizing one's own experience and the experience of others
Strong analytical skills and consistent attention to detail
Knowledge of ISO forms, and client policy coverage, procedures, and systems
Communicates clearly and effectively, both verbally and in writing
Strong customer service orientation and good rapport with the insured
Well-organized and hard-working, with the ability to thrive in a fast-paced work environment
Strong interpersonal skills and proven ability to establish good relationships with clients, RENFROE management, employees, and others with whom they interact
Computer skills, including but not limited to practical knowledge of Word and Excel
PHYSICAL DEMANDS:
Ability to operate an automobile and have a valid driver's license with a safe driving record
Ability to travel by automobile or airplane
Must be able to lift, carry, unfold/extend, and climb a ladder (which may exceed 50 lbs. in weight) that is approved by the appropriate regulatory agency or complies with legislative or regulatory occupational health and safety requirements
Must be able to complete measurements of roofs and inspect interior as necessary, including attics, basements, and crawl spaces for residential and commercial structures
Must be able to do the following while conducting an inspection: climb, bend, crawl, stoop, walk, reach, kneel, squat, and carry/lift objects (typically weighing less than 50 lbs.)
Must be able to work outdoors in all types of weather
Ability to operate a telephone and a computer for extended periods of time
Must be able to work extended and varying work schedules, including working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays
Ability to work in a fast-paced, changing, and multi-tasking environment