Claims service assistant jobs near me - 121 jobs

Pride Health is hiring for a Administration - Interviewer, Ins Risk to support our client's medical facility based in Lees Summit MO 64063 . This is a contract opportunity and a great way to start working with a top-tier healthcare organization! Job Title: Administration - Interviewer, Ins Risk Work Location: Lees Summit MO 64063 Pay : $16 to $17 /hr Shift: 7-4pm cst 8-5pm cst 9-6pm cst Contract: 3+ Months + possible Extension Contractors will have the ability to work from home after training is completed (after 3 weeks). Job Description: Summary: The primary purpose of this position is to complete life insurance medical and financial interviews via telephone outbound calls for multiple client companies. Duties and responsibilities: Place outbound calls to contact life insurance applicants. Complete interview with applicant or leave a message for a return call Gather medical, financial, occupational, and avocation histories during interview. Review and edit information collection during the interview for quality assurance purposes. Use the C4 call management system, Dialer, and Avaya Phone System to make telephone calls. log call attempts, document information with orders as necessary and record call results. Learn the specific requirements stipulated by each client company. Respond to the needs and request of clients, staff and management in a professional and expedited manner. Observe all compliance policies and safety policies and procedures as outlines in the Safety Manual or safety matters included in other special trainings. Perform other duties as assigned to meet the business needs or customer requirements. This is not an exhaustive list of all of the duties and responsibilities, but rather a general description of work performed by the position. Education: HS diploma or equivalent Additional Job Details: Please review shifts carefully and include your candidates' shift preferences (1. as in most preferable to 3. least preferable) Experience in Life Insurance, Medical Terminology, and Customer Service Experience are preferred. Attention to detail, ability to be on the phone and provide great customer service, as this is a concierge level of service. Production based and revenue generating call center Contractors will have the ability to work from home after training is completed (after 3 weeks). Interested? Apply now! About Pride Health Pride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010. As a minority-owned business that delivers exceptional service to its clients and candidates by capitalizing on diverse recruiting, account management, and staffing backgrounds, Pride Health's expert team provides tailored and swift sourcing solutions to help connect healthcare talent with their dream jobs. Our personalized approach within the industry shines through as we continue cultivating honest and open relationships with our network of healthcare professionals, creating an unparalleled environment of trust and loyalty. Equal Employment Opportunity Statement As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics. Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we've built deep relationships with approximately 30 thousand companies that are key to the home-buying transaction, such as home inspectors, mortgage companies, and title companies. In 2020, Porch Group rang the Nasdaq bell and began trading under the ticker symbol PRCH. We are looking to build a truly great company and are JUST GETTING STARTED. Job Title: Liability Claims Examiner Location: United States Workplace Type: Remote Homeowners of America is a provider of Personal Lines Insurance products. We're always looking to add talented and passionate people to our team. We value the knowledge that comes from experienced individuals with diverse backgrounds and strengths that can contribute to the various departments within our company. Our shared values are no jerks, no egos, be ambitious, solve each problem, care deeply and together we win. Summary The Liability Claims Examiner is responsible for managing complex and litigated 3rd party claims arising under homeowners' insurance policies. This role involves investigating losses, evaluating coverage, assessing liability exposures, and directing litigation strategies to achieve fair and timely resolution of claims. The examiner will work closely with insureds, claimants, field adjusters, defense counsel, experts, and internal stakeholders ensuring compliance with company guidelines and regulatory requirements while mitigating risk and controlling costs. Liability Claims Examiners are responsible for requesting payments, documenting files, and preparing and issuing claim payment letters or denial letters when appropriate. What you Will Do As A Liability Claims Examiner Responsibilities: May include any or all the following. Other duties may be assigned. Investigate and Evaluate Claims: Review policy language, coverage issues, and liability exposures. Analyze incident reports, statements, expert opinions, and other evidence to determine liability and damages. Handles claims from all types of policies, including homeowners, dwelling fire, tenant, condo, and renters. Confers with legal counsel on claims involving coverage, legal, or complex matters Effectively manage difficult or emotional customer situations Litigation Management: Direct and oversee defense counsel in litigated matters, including strategy development, budgeting, and case progression. Attend mediations, settlement conferences, and trials as needed. Evaluate litigation reports and provide recommendations for resolution. Negotiation and Settlement: Negotiate settlements within authority limits to achieve equitable outcomes. Collaborate with legal counsel to resolve complex coverage and liability disputes. Financial Oversight: Establish and adjust reserves based on claim developments and litigation exposure. Monitor litigation costs and ensure adherence to budget guidelines. Seeking out and utilizing top vendors that build quality, increase efficiency, and reduce cost Communication and Documentation: Maintain accurate and detailed claim files, including litigation plans and correspondence. Communicate effectively with insureds, claimants, attorneys, and internal teams. Enters claims payments when applicable and maintains clean, concise, and accurate file documentation Manages correspondence and communication with various parties involved in the claim Draft and prepare letters and other correspondence related to the claim Compliance and Best Practices: Ensure adherence to claims handling guidelines, regulatory requirements, and ethical standards. Identify opportunities for process improvement and cost containment. Take on assignments and duties as requested by the management team What you Will Bring As A Liability Claims Examiner Bachelor's degree or equivalent experience Minimum 5+ years of liability claims experience, with a strong focus on litigated 3rd party claims Appropriate state adjuster license and continuing education credits In-depth knowledge of homeowners liability and med pay coverage, policy language, and litigation processes Strong negotiation, analytical, and decision-making skills Excellent written and verbal communication skills Ability to manage multiple complex cases and meet deadlines in a fast-paced environment Proficiency in claims management systems and Microsoft Office suite (Outlook, Word, Excel, PowerPoint) Works with integrity and ethics Exceptional customer service skills Effectively manages difficult or emotional customer situations Ability to read, write, and interpret routine correspondence, policies, and reports Makes decisions and completes activities in a confident and timely manner Follows Claims Handling Guidelines, policies and procedures Maintains confidentiality Works independently, with the ability to assess workload and plan accordingly to meet competing deadlines Cultivates environment of teamwork and collaboration Comprehensive and up-to-date knowledge of General Liability and P&C insurance, contractual policy language requirements and the implications of that language as it pertains to denial of claims Demonstrated commitment to continuing education in the industry through licensing or designations applicable to property and liability insurance field is preferred. Certificates, Licenses, Registrations Appropriate state adjuster license and continuing education credits. The application window for this position is anticipated to close in 2 weeks (10 business days) from December 17th, 2025. Please know this may change based on business and interviewing needs. At this time, Porch Group does not consider applicants from the following states for remote positions: Alaska, Arkansas, Delaware, Hawaii, Iowa, Maine, Mississippi, Montana, New Hampshire, and West Virginia. What You Will Get As A Porch Group Team Member Pay Range*: Annually$67,500.00 - $94,500.00 *Please know your actual pay at Porch will reflect a number of factors among which are your work experience and skillsets, job-related knowledge, alignment with market and our Porch employees, as well as your geographic location. Our benefits package will provide you with comprehensive coverage for your health, life, and financial wellbeing. Our traditional healthcare benefits include three (3) Medical plan options, two (2) Dental plan options, and a Vision plan from which to choose. Critical Illness, Hospital Indemnity and Accident plans are offered on a voluntary basis. We offer pre-tax savings options including a partially employer funded Health Savings Account and employee Flexible Savings Accounts including healthcare, dependent care, and transportation savings options. We provide company paid Basic Life and AD&D, Short and Long-Term Disability benefits. We also offer Voluntary Life and AD&D plans. Both traditional and Roth 401(k) plans are available with a discretionary employer match. Headspace is part of our employer paid wellbeing program and provides employees and their families access to on demand guided meditation and mindfulness exercises, mental health coaching, clinical care and online access to confidential resources including will preparation. Brio Health is another employer paid wellbeing tool that offers quarterly wellness challenges and prizes. LifeBalance is a free resource to employees and their families for year-round discounts on things like gym memberships, travel, appliances, movies, pet insurance and more. Our wellness programs include flexible paid vacation, company-paid holidays of typically nine per year, paid sick time, paid parental leave, identity theft program, travel assistance, and fitness and other discounts programs. #LI-JS1 #LI-Remote What's next? Submit your application and our Porch Group Talent Acquisition team will be reviewing your application shortly! If your resume gets us intrigued, we will look to connect with you for a chat to learn more about your background, and then possibly invite you to have virtual interviews. What's important to call out is that we want to make sure not only that you're the right person for us, but also that we're the right next step for you, so come prepared with all the questions you have! Porch is committed to building an inclusive culture of belonging that not only embraces the diversity of our people but also reflects the diversity of the communities in which we work and the customers we serve. We know that the happiest and highest performing teams include people with diverse perspectives that encourage new ways of solving problems, so we strive to attract and develop talent from all backgrounds and create workplaces where everyone feels seen, heard and empowered to bring their full, authentic selves to work. Porch is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable laws, regulations, and ordinances. Porch Group is an E-Verify employer. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.

Job Description As a Commercial Casualty Claims Adjuster, you will serve as a real partner to our members by processing claims accurately and efficiently so they can resume their life's work without unnecessary delay. If you are optimistic, enjoy helping others in times of need, and are compassionate about making positive change in the world, this may be the role for you. Accountabilities: This position handles Commercial General Liability, Commercial Trucking, Director's & Officer Liability, Employment Practices Liability, Commercial Auto injuries, Contractor's Pollution Liability, Professional Liability and other Casualty exposures. Investigates coverage and cause of loss on routine to more complicated claims, which includes but is not limited to policy review, interviewing all parties associated with the loss and gathering and analyzing all necessary investigative documentation. Handles non-represented, represented and litigated injury and property damage claims including investigating and evaluating those exposures. Identifies exposures with significate severity to triage to the large loss team. Provides accurate assessments and negotiates fair and efficient claims resolutions while managing costs. Settles losses according to the documented damage, the language of the policy of insurance, pertinent regulatory and statutory considerations and within granted authority. Prepares written communication, including but not limited to settlement letters, disclaimers of coverage and reservation of rights letters. Maintains effective claim file documentation and diary system. Monitor diary to achieve timely development of file and timely disposition of the claim. Recognizes and pursues recovery opportunities and prepares submissions to SIU when indicated. Assigns and supervises field examiners and vendor resources, including but not limited to independent adjusters, engineers and other experts as needed. Assumes additional duties as defined. Required Qualifications: 5 or more years in the handling of Commercial Liability Claims. Understands concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims towards resolution using best practices. Ability to take responsibility and work independently in a home-based environment. Ability to negotiate skillfully in difficult situations. Willingness to travel periodically. Recommended Qualifications: Environmental claim experience is preferred. Propane Gas Distributors claim experience is preferred Bachelor's degree preferred New York, Florida or Texas claims handling license required If not licensed, willingness to obtain state licensing or certification where required within 30 days of employment Ability to formulate sound expense, indemnity, and business judgment while supporting loss evaluations and presenting them effectively. Basic computer skills including Microsoft applications Perform work related simple and advanced mathematical problems and calculations Compose written correspondence and factual reports which are well organized and concise, utilizing proper English, grammar, punctuation, and spelling Strong oral and written communication skills. Compensation: $59,400 - $99,000 commensurate with experience, plus bonus eligibility $65,400 - $109,000 commensurate with experience in CA, CT, MA, NJ, NY, and PA, plus bonus eligibility Benefits: We are proud to offer a robust benefits suite that includes: Competitive base salary plus incentive plans for eligible team members 401(K) retirement plan that includes a company match of up to 6% of your eligible salary Free basic life and AD&D, long-term disability and short-term disability insurance Medical, dental and vision plans to meet your unique healthcare needs Wellness incentives Generous time off program that includes personal, holiday and volunteer paid time off Flexible work schedules and hybrid/remote options for eligible positions Educational assistance #TMG

Alpha Automotive is looking for an Automotive Claims Representative to join our rapidly growing team! Here at Alpha Automotive, we pride ourselves on providing the best service possible for our customers by being an alternative to large, impersonal dealerships and providing them with an elevated level of personalized service each and every time. We are now hiring for ALL of our locations: Stealth Auto Recovery, Excite Towing, Wayne's Auto Powell, Wayne's Auto Schrock, Wayne's Auto Westerville, Mann's Expedite Service, H.I.N.T., Excite Collision Repair, and Ernie's Auto Repair! As an Automotive Claims Representative, a typical day may include the following: Acting as a liaison between insurance companies and customers, to assure claims are being paid in a timely manner so repairs can begin Working in harmony with the service writers in getting repair estimates sent to insurance companies, and following up to confirm they have been received and submitted correctly Keeping customers in the loop with any updates from the insurance company, and communicate when there are changes or any additional information is needed from them This career may be for you if: You enjoy helping people and problem solving You love the automotive industry and are ready to make the transition to an office environment You thrive in a fast paced environment Benefits include: Training & competitive pay Dental, vision, life & disability insurance Paid time off after a year of service View all jobs at this company

OverviewAt Advocate, our mission is to empower Americans to obtain the government support they've earned. Advocate aims to reduce long wait times and bureaucratic obstacles of the current government benefits application process by developing a unified intake system for the Social Security Administration, utilizing cutting-edge technologies such as artificial intelligence and machine learning, crossed with the knowledge and experience of our small team of EDPNA's and case managers. We are seeking a Claims Assistant to play a key role in ensuring smooth case management and operational support at Advocate. In this position, you will handle a variety of important administrative tasks, from managing incoming communication to scheduling appointments for case managers. You'll ensure that our administrative processes flow efficiently, contributing directly to the success of our mission. If you're organized, detail-oriented, and enjoy working in a fast-paced environment, this could be the perfect opportunity for you to make a meaningful impact.Job Responsibilities Ensure the Social Security Administration (SSA) has processed representative forms and provided access to Electronic Records Express (ERE). Manage a high volume of incoming mail as the company continues to grow. Handle calls and texts to the client care team's dedicated 888 line. Schedule appointments for case managers to keep operations on track. Request medical source statements and assist with other administrative tasks to ensure smooth process flow. Qualifications Strong administrative and clerical skills are essential. Prior experience with Social Security disability is preferred but not required. Highly organized and capable of managing multiple tasks efficiently. Strong attention to detail and task-oriented mindset. Ability to thrive in a fast-paced and growing work environment. This is a remote position and Advocate is currently a fully remote team. Advocate is an equal opportunity employer and values diversity in the workplace. We are assembling a well-rounded team of people passionate about helping others and building a great company for the long term.

Workers' Compensation Claims Adjuster II - California | 100% Remote Opportunity The Work comp Claims Adjuster II is responsible for timely and accurate management of workers' compensation claims with moderate medical and indemnity benefit exposure, including litigation. This opportunity will require working west coast hours (M-F 8am-5pm PDT) Essential Duties and Responsibilities Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability and develop of plan of action. Completes and maintains accurate claim system data as it pertains to work comp insurance claims. Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers. Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed. Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure. Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement and works within authority to resolve claims. Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Other duties as assigned. Requirements 2 - 5 years' work comp claims adjusting or insurance experience. Excellent communication and customer service skills and knowledge of an imaged environment. Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. Self-motivated with excellent analytical, problem solving and decision-making skills. Strong ability to multi-task and prioritize. High school diploma or equivalent required. Equivalent combinations of education and experience may be considered. Certification If state certification or license is required, must meet requirements and obtain certification within state mandated timeframe and maintain any required license through continuing education. WCCP, AIC, ARM, CPCU or other insurance certification preferred. Education Bachelor's degree or equivalent business experience preferred. Work Environment Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace. Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $50,000-$75,000 and a strong comprehensive benefits package, don't forget to follow the link to our benefits page for details, too many benefits to list! ********************************************************* About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

Fetch Pet Insurance, a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and health advice. Put simply, Fetch makes vet bills affordable. We offer a comprehensive product that does not have any restrictions based on breed, age, or size. We are believers in helping pets get through their bad days but also focus on extending the good days. How do we do that? - through a wide portfolio of products + offerings, which include Fetch Health Forecast, our pet health and lifestyle blog, The Dig, and our partnerships with Project Street Vet and animal no-kill shelters across North America. Our business is growing and we are looking for compassionate professionals that want to join a team that works hard and celebrates success! You will have an opportunity to hone your skills and develop new skills as you learn the ins-and-outs of Fetch pet insurance and support our pet parents. Your success is our success! RESPONSIBILITIES. Adjudicate assigned claims in accordance with the Terms & Conditions of the individual pet's policy Review medical records, lab results, invoices, and claims forms for complete and thorough assessment Process claims determinations to include assessment and payment for submitted claims Verify claims coverage through in-depth knowledge of policy Terms & Conditions Consult with treating veterinary practices regarding medical records evaluation and necessary documentation Maintain an average quality assurance score above department minimums Complete assigned tasks within compliance deadlines Maintain an average productivity rate above department minimums Provide feedback on process opportunities to further strengthen SOPs REQUIRED SKILLS. Comprehensive understanding of disease processes and veterinary medical terminology Ability to read and interpret veterinary medical records and invoices Ability to identify chronic and acute medical conditions Adapt quickly in a fast-paced, ever-changing environment and operate multiple computer systems simultaneously Work independently in a remote capacity, while also fostering teamwork and collaborating with others Superior communication skills for collaboration with team members and support from managers Demonstrated problem solving skills and ability to work through complex medical/vet-related scenarios affecting a pet's diagnosis and/or treatment plan QUALIFICATIONS. Minimum of five years experience as a veterinary technician Bachelor's degree in veterinary science OR CVT or equivalent preferred Property and Casualty Adjuster license in good standing preferred Complete and pass state adjuster licensing Be reliable with good attendance Able to work a minimum of 42 hours per week, with occasional weekends and extra hours as needed WORK-FROM-HOME SET-UP. Subscription to reliable high-speed internet connection (minimum of 100 Mbps download and 30 Mbps upload speed) A quiet, dedicated place to work in your home that is not easily disrupted by background noises or distractions Office workspace must be large enough to accommodate two 19” dual monitors, laptop, mouse, keyboard, and headset Ability to set up and connect (with instructions and remote IT team assistance) equipment that is shipped to your home -ABOUT FETCH- Fetch is a high-growth, Warburg-Pincus portfolio company. We are a passionate group of 200+ employees and partners across the U.S. and Canada dedicated to helping pets live their best lives. We have two offices (New York City, NY, and Winnipeg, Canada), and we currently provide security to over 360,000 pet parents. We don't just accept differences - we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. We are proud to be an equal opportunity employer. We recruit, hire, pay, grow and promote no matter of gender, race, color, sexual orientation, religion, age, protected veteran status, physical and mental abilities, or any other identities protected by law.

":"* This is a full-time, remote position working from 9:45am to 6:15pm CST American Guardian Warranty Services, Inc. (AGWS), an affiliate of Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In this role you will work remotely and be responsible for investigating, evaluating and negotiating minor to complex vehicle repair costs to accurately determine coverage and liability. You will take inbound calls to determine coverage based on contracts in order to appropriately resolve customer issues. Responsibilities will include, but are not limited to: -\tAnswering inbound calls -\tProvide information about claim processing and explain the different levels of contract coverage and terms -\tAccurately establish, review and authorize claims -\tEntering claim and contract information into the AGWS' system A home office package will be provided for this position. This includes two computer monitors, a laptop, keyboard and mouse. ","job_category":"Customer Service","job_state":"TX","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-12-18","zip":"75201","position_type":"Full-Time","salary_max":"55,000. 00","salary_min":"50,000. 00","requirements":"2+ years of experience as an automotive mechanic within a service department, dealership, or independent shop~^~2+ years of experience adjusting automobile mechanical claims~^~ASE certification is a plus~^~Must have a quiet designated work space to work from home~^~Must have reliable internet with at least a download speed of 50mbps~^~Must be able to work effectively under pressure in a fast paced environment~^~Strong communication skills~^~Strong organizational and multi-tasking skills~^~High school diploma","training":"On the job","benefits":"We strive to offer an environment that provides our associates with the right balance between work and family. We offer a comprehensive benefits package including: - Medical, dental, vision, life insurance, and a health savings account - 401(k) with up to 6% matching - Professional development and training - Promotion from within - Paid vacation and sick days - Eight paid holidays - Referral bonuses Reynolds and Reynolds promotes a healthy lifestyle by providing a non-smoking environment. Reynolds and Reynolds is an equal opportunity employer. ","

Job Description Are you a technician, service writer, or parts manager looking to get out of the shop and transfer your skills to a new career? Wise F&I is currently seeking full-time Claim Adjusters to support our VSC claims team and our continued business growth. This position is Monday through Friday with weekends off. We provide a competitive salary commensurate with experience, have 9 major holidays scheduled off annually - with pay, provide a robust health care and benefits package; in addition to, a bright, modern work space with optional stand-up desk capability. Remote position available if you reside outside the St. Louis metropolitan area. Primary Job Function: The Claims Adjuster is responsible for the set-up and processing of automotive VSC claims filed with our company that cover mechanical breakdown, appearance, tire & wheel and other benefits. This includes reviewing repair estimates, inspection reports, supporting documentation, communicating with repair facilities, and ultimately determining coverage. Company Description: Wise F&I delivers industry-leading administration services for automotive F&I-related, voluntary protection products such as VSC, Appearance, Tire & Wheel, Key Replacement, GAP and Theft-deterrent protection. We process and adjust claims for these contracts within programs that are underwritten by only Excellent (A- or better) rated Insurance Carriers. As a rapidly growing automotive F&I product provider with over 30 years of continuous operation in the Automotive F&I space, our operating partners include seasoned Insurance Agents, national Lenders and their client Automotive Dealers. Job Responsibilities / Tasks include: Working in a call center environment focused on handling calls daily within expected performance metrics, handle times, and volume. Reviewing claims using the adjudication process established by department and within company guidelines. Reviewing and verifying repair costs using standard "national labor and parts guides" (including labor rates and time) to ensure estimates are within approval guidelines. Verifying, analyzing, and investigating repair information to determine if coverage is within the guidelines of the service contract. Retrieving information from company systems and communicating information back to the customers, dealers, repair facilities, and vendors in a clear and concise manner. Determining the appropriate authorization amount based on contract guidelines via the use of good judgment combined with mechanical knowledge. Documenting all interactions, research, verifications and other claim-related information in the claim administration system. Ability to communicate effectively by telephone and email with retail and wholesale customers, repair facilities, and non-related parties using good customer service skills. Working pro-actively and cohesively as a member of the claims team. Attending training seminars and/or continuing education. Maintaining high customer service requirements and productivity standards. Working with management on specific issues as requested. Required Education and Skills include: High school diploma or GED preferred. Technical training or College Degree is a plus. Preferred 3 or more years of hands-on automotive repair or equivalent automotive technical experience. ASE or equivalent Manufacturer certification preferred. Outstanding verbal and written communication skills. Proficient use of current computer systems, Microsoft and web-based applications. Proficient use of communication tools for email, instant message and meeting platforms. Possess strong customer service skills including conflict avoidance/resolution, negotiation, and persuasive speaking. Possess problem solving, decisiveness and time management skills. Comprehensive Benefits: Competitive hourly wage (40 hrs/week) Annual Performance Evaluation w/ Compensation Review Bright, Modern Work Spaces 9 Paid Holidays (per year) Paid Vacation Days 401K Retirement Plan (100% company match up to 4% of income w/ immediate vesting) Insurance - paid benefits include Health, AD&D, Life and L/T Disability Voluntary benefits include Dental, Vision, Life and S/T Disability Convenient suburban location near intersection of I-270 and I-44 in southwest St. Louis County. We are an Equal Opportunity Employer.

Job Description Alternative Dispute Resolution (ADR) Claim Adjuster Remote At Frontline Insurance, we are on a mission to Make Things Better, and our Alternative Dispute Resolution (ADR) Claim Adjuster plays a pivotal role in achieving this vision. We strive to provide high quality service and proactive solutions to all our customers to ensure that we are making things better for each one. What makes us different? At Frontline Insurance, our core values - Integrity, Patriotism, Family, and Creativity - are at the heart of everything we do. We're committed to making a difference and achieving remarkable things together. If you're looking for a role, as an Alternative Dispute Resolution (ADR) Claim Adjuster, where you can make a meaningful impact and grow your career, your next adventure starts here! Our Alternative Dispute Resolution (ADR) Claim Adjusters enjoy robust benefits: Remote work schedule! Health & Wellness: Company-sponsored Medical, Dental, Vision, Life, and Disability Insurance (Short-Term and Long-Term). Financial Security: 401k Retirement Plan with a generous 9% match Work-Life Balance: Four weeks of PTO and Pet Insurance for your furry family members. What you can expect as an Alternative Dispute Resolution (ADR) Claim Adjuster: Review assigned claims promptly. Formulate and execute appropriate ADR strategy in compliance with statutory guidelines. Verify facts of loss and pertinent information to analyze and confirm coverage is appropriately applied. Handle the complete claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make coverage recommendation and issue payments within applicable authority level. Review and analyze all claim material to determine the facts of loss, the investigation completed and/or needed and position file for appropriate resolution. What we are looking for as an Alternative Dispute Resolution (ADR) Claim Adjuster: Bachelor's degree in Business Administration or an industry related field Minimum of 7 years of experience in claim adjusting and/or training in Property and Casualty or equivalent combination of education and experience Minimum of 3 years of experience in the appraisal process Maintain active Florida 5-20 License and obtain licenses in Alabama, North Carolina, South Carolina, Virginia, and Georgia within 30 days of hire Why work for Frontline Insurance? At Frontline Insurance, we're more than just a workplace - we're a community of innovators, problem solvers, and dedicated professionals committed to our core values: Integrity, Patriotism, Family, and Creativity. We provide a collaborative, inclusive, and growth-oriented work environment where every team member can thrive. Frontline Insurance is an equal-opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates residential and commercial contents inventories obtained by or submitted to VeriClaim on both a Replacement Cost and Actual Cash Value (ACV) basis. Applies limitations and/or exclusions on claims based on coverage afforded by the policy. Tracks time and log file notes for daily field activity. Assists with answering telephones. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). QUALIFICATIONS: Education & Licensing High school diploma or GED required. Resident Insurance Adjuster License (Fire and Other Hazards) preferred. Experience One (1) year customer service experience or equivalent combination of education and experience preferred. Accounting and insurance background preferred. Skills & Knowledge Oral and written communication skills PC literate, including Microsoft Office products Good comprehensive decision making skills Ability to read and comprehend policy language Ability to work in a team environment Ability to meet or exceed Performance Competencies

Lucrative Compensation Plan! Base of $15 per hour to start, PLUS monthly bonuses! Do you thrive in a competitive environment? Would you describe yourself as a go-getter? Determine how much you can make while investigating and resolving claims. Get your career started, no college degree required! Who We Are We are in the business of subrogation - companies trust us to recover payments on damage claims so that the party responsible is the one paying for the damage that was caused. We strive to provide excellent customer service to both our customers and the other parties involved in a claim. In short, we help our customers focus on theirs. Our business is driven by our Core Four principles : Process, Results, Culture, and Experience. Our dedication to practicing these has enabled our current and future success . We're passionate about throwing company events that bring us together and celebrate each other's achievements. We're also big on taking time out to give back to the community and host several volunteer events throughout the year. We believe in a healthy work-life balance. Join our team and thrive in an environment that values both efficiency and effective processes as well as a casual, comfortable atmosphere. Who We're Looking For We are looking for someone comfortable working from home who can positively interact with homeowners, business owners, contractors, insurance companies, and utility company field technicians over the phone. We need a “get it done”, high-energy, professional approach to recover claims effectively. The Insurance Claims Adjuster is responsible for recovering payments for damage claims involving motor vehicles in remote, work-from-home environment. The claims adjuster interacts with homeowners, business owners, contractors, insurance companies, and utility company field technicians. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and establishing liability so you can confidently and independently recover claims. Be The Captain of Your Own Destiny Determine how much money you want to make by earning bonuses based on the level of fees you recover. Earn between $1,000 and $5,500 in bonuses! Bonuses are paid out each month. Bonuses: $65,000 total fees = $1,000 $75,000 total fees = $1,200 $85,000 total fees = $1,400 $95,000 total fees = $1,800 $100,000 total fees = $2,000 $115,000 total fees = $2,500 $125,000 total fees = $3,500 $140,000 total fees = $4,000 $150,000 total fees = $5,000 Base Pay: First 30 days: $15.00/hour 30 - 60 days: $13.00/hour 60 days and beyond: $11.54/hour Stuff You Should Know Department hours are 7am - 4pm, Monday thru Friday This position is fully remote On a Typical Day, You'll Investigate claims issues and provide information to damagers and utility company field technicians Negotiate settlements with damagers and insurance companies as applicable Review claim information and request/research additional reference material to complete the claim record File subrogation packages with insurance companies Dispute resolution and response to damager objections Enter data into customized claims systems Tracks fees, closed and open claims, and other claims information Qualifications Teamwork Makes the Dream Work Your success is our success. We stress the group's success because we are all working towards a common goal - resolving as many claims as possible to benefit both ourselves and our customers. With lots of room for career advancement and growth, we are always looking to move our employees up to bigger roles within the company. Requirements Insurance Adjuster License (must obtain license within 4 months of moving into position) Excellent computer skills, must be familiar with using Outlook, Teams, Word and Excel Negotiating skills experience Excellent verbal and written communication skills Excellent attendance record High School Diploma or equivalent Must have a high-speed internet connection available in your home Bilingual in English and Spanish a plus! Okay, But What Are the Perks Obtain your adjuster's license on our dime, including: 3-day prep class Time off to take the test Career growth and learning opportunities Tiered bonus system based on team accomplishments Full menu of benefits including a matched 401k Consistent scheduling including nights and weekends off Paid time off as well as paid holidays CMR pays $50/month towards your internet service costs Christmas bonus CMR is a 2024 The Oklahoman Top Workplaces winner! Pre-employment drug screenings and criminal background checks are mandatory CMR is an Equal Opportunity Employer

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 401k plan. Additional employee paid coverage options available. Job Purpose The Claims Clerk plays a vital role in supporting the claims team by handling daily administrative tasks, including reviewing and responding to claims portal messages, processing incoming faxes, and organizing documentation. This position ensures efficient communication and smooth workflow within the department, helping to maintain timely and accurate claims processing. Duties and responsibilities Monitor and respond to claims portal messages daily. Assist Customer Service department with portal registrations. Process and categorize incoming claims-related faxes. Assist with Claims related inquiries from other departments. Requesting and reviewing medical records as needed for basic information to validate billing information. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Serve as a primary point of contact for providers, members, and internal staff regarding claims status, documentation requirements, and resolution steps. Respond to inbound claims phone calls, emails, and portal inquiries in a professional and timely manner. Provide clear explanations of claim outcomes, payment decisions, and next steps while maintaining a high level of customer service. Research and resolve claim-related issues by gathering information, reviewing documentation, and escalating as needed. Document all interactions in the system to ensure accurate records of customer communications and resolutions. Must maintain an error accuracy of under 5%. Support claims examiners and workflow projects. Attend weekly or monthly departmental meetings and provide feedback when requested. Complies with all Company and Department Policies and Procedures. When needed assist in claims audit activities. Support other departments as needed. All other duties as assigned. Qualifications Experience in administrative support, claims processing, or a related field preferred. Excellent communication skills including reports, correspondence, and verbal communications. Experience with EZ-Cap and Encoder preferred. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving. Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Must work well under pressure and deadlines.

Summary: This position is responsible for investigating, evaluating and negotiating settlement of assigned large loss Commercial Auto Body Injury Claims in accordance with best practices and to promote retention or purchase of insurance from Grange Enterprise. If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. What You'll Be Doing: Pursuant to line of business strategies and good faith claim settlement practices, investigates, evaluates, negotiates, and resolves (within authorized limits) assigned claims. Demonstrates technical proficiency, routinely handling the most complex claims with minimal manager oversight. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business relationships with agents, insureds and Commercial Lines partners through regular, effective and insightful communications. May include face-to-face as needed. Will be the “point person” (when required) for certain identified large customer accounts where specialized communication and handling are required. Regularly develops and mentors other associates. Assists leadership in advancing the technical acumen of the department through the development of formal and informal training and resources. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assists other departments (when required) with investigations. May be assigned general liability claims during high volume workload periods. Demonstrates effectiveness and efficiencies in managing diary system and handling workload with limited supervision or direction. What You'll Bring To The Company: High school diploma or equivalent education plus five (5) years claims experience with at least three (3) years of Commercial Casualty experience. Experience in General Liability preferred. Bachelor's degree preferred. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Requires excellent decision-making ability, a broad depth of experience and technical competence and capacity to manage work to meet time sensitive deadlines. Demonstrated ability to interact with internal and external customers in a professional manner. State specific adjusters' license may be required. About Us: Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent). Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave. Who We Are: We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength. We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow. Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals. Our Inclusive Culture Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth. Together, we use our individual experiences to learn from one another and grow as professionals and as people.  We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.

Are you an experienced claims professional ready to take on complex cases and make a meaningful impact? MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers' compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans. You'll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on complex claims and contributing to workflow improvements. Essential Duties and Responsibilities Manage complex workers' compensation claims involving high financial exposure, sensitive issues, or extended life cycles. Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes. Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors. Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel. Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit. Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances. Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance. Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines. Maintain accurate system data and prepare reports for management on high-profile claims. Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention. Provide mentorship and training to junior adjusters, supporting professional growth and team development. Qualifications High school diploma or equivalent required; bachelor's degree preferred. Associate in Claims (AIC) designation preferred. Valid driver's license required; Texas-All Lines license preferred. 3-5 years of claims handling experience, primarily in Workers' Compensation. Company Culture and Values At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other's growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered. Diversity Statement MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities. Total Rewards Overview Health Plans: Medical, Dental, and VisionIncludes fertility benefits, fully paid preventative care, and adult orthodontia. Employer-Paid Life and Disability Benefits:Life Insurance (3x base salary), AD&D, Short and Long-term Disability. Wellness and Recognition Program: Employer-paid incentives for employees and spouses. Flexible Spending Account and Dependent Care options Health Savings Account: Generous employer contribution. Time Away from Work:Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave. Employee Assistance Programs 401k Retirement Plan: Employer match and profit sharing. Adoption Assistance and Tuition Assistance Notice Regarding Use of Artificial IntelligenceMEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.

Job Description Ready for a change? Bring your mechanical background to Endurance and use your automotive knowledge in a professional remote environment. The Mechanical Claims Adjuster is responsible for investigating, evaluating and negotiating minor to complex vehicle repair claims and accurately determining coverage and liability (based on the reported fact scenario). You will be measured on your ability to provide accurate benefit and adjustment amounts on claims and reach fair, efficient claims resolutions while managing costs in accordance with policies and procedures. Key Responsibilities: Adjudicate and authorize claims within your dollar-limit authority. Ensure the accuracy of coverage information when responding to inquiries by providing customer clarity on coverage and financial commitment. Successfully handle an average of 50-70 inbound calls daily from repair centers and Endurance Customers/Contract Holders. Review and determine claims based on the reported fact scenario given by the repair facility submitted through the online portal. Collect and verify all diagnostic information provided by the repair facilities. Respond to inquiries while providing information and explanations regarding Endurance's various levels of coverage. Manage Workflow - Process and complete all requests and documents in accordance with established processes and procedures. Achieve and maintain agreed-upon metrics within the scheduled time. Establish, develop, and maintain positive business and customer relationships. Being interactive and communicative with management and co-workers in a visible manner is an essential function of the job; therefore, camera usage is required for training, team meetings, and meetings with management. Key to Success: High school Diploma or equivalent work experience. 1-2 years working at a dealership and/or independent auto repair shop. 1-2 years of automotive repair procedures, processes, parts, and repair costs 1-2 years of proven success negotiating and problem-solving Ability to efficiently understand contracts/policies/procedures and apply them accordingly. Must be able to communicate effectively with contract holders/customers, agents, dealers, internal staff, and upper management. Experienced in ProDemand, Alldata, and Carfax is a plus Call-center experience is a plus The candidate(s) offered this position will be required to submit to a background investigation. Compensation Ranges - $21.64-$23 Hourly Our Benefits Include: Paid training Work From Home Opportunity Computer Equipment Provided 401(k) with company match after 90 days of employment Medical, Dental, and Vision Insurance Voluntary Life Insurance Internet Stipend Paid Time Off Holiday Pay Learn more about life at Endurance-connect with us on LinkedIn, Facebook, Instagram, and Twitter. Equal Employment Opportunity Endurance Warranty Services is proud to be an equal-opportunity employer. We celebrate our employees' differences, including race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, and Veteran status. Our differences are what make us better together. Endurance Warranty is an E-Verify Company. About Endurance Endurance Warranty has been honored with multiple Stevie Awards for being a great place to work, and we're growing rapidly. We're a fast-paced company offering limitless opportunities to grow your career. Thanks to our dedicated employees, we provide best-in-class auto repair coverage to customers across the country, protecting people from unexpected and costly breakdowns for almost 15 years. At Endurance, we embrace the entrepreneurial spirit, and you'll play a role in shaping this dynamic industry. We offer great pay, amazing benefits, and the opportunity to learn and grow. When you work for Endurance, you're working for a company that cares about you and your future. We empower employees to lead, drive change and give back where they work and live. Our people are our greatest strength, and we're proud to work as a diverse team to serve our customers and our community. Therefore, we've been honored as a top place to work, including multiple StevieⓇ Awards for the best workplace and great employer. For the last several years, Endurance has also earned a spot-on Selling Power's "50 Best Companies to Sell For" and consistently makes industry lists from Crain's and Inc. magazine for our continuous and significant growth. Experts in the industry recognize that our employees care as well-Consumer Affairs highly recommends Endurance, and our customers highly rate us on Google, Trustpilot, and other major online review sites. Come accelerate your career with us. We'll give you the tools you need to succeed at work and the flexibility to enjoy life outside of your job.

Department: Claims Schedule: Monday to Friday; 4-6 hours daily Salary: Commensurate based on experience and qualifications About Responsive Founded in 2007 and headquartered in Plantation, Florida, Responsive is a leading provider of personal auto insurance in Florida. We collaborate with thousands of agents from the most respected insurance agencies to deliver world-class service and claims experiences. Responsive stands for making auto insurance simple, affordable, and hassle-free; a promise we deliver through innovation, feedback, and a commitment to excellence. What You'll Do As a Claims Adjuster, you'll guide customers through the claims process with empathy and expertise. From investigating coverage to resolving disputes, you'll handle claims from start to finish while maintaining strong relationships with customers and stakeholders. Responsibilities include: Investigating, evaluating, and resolving insurance claims. Reviewing policies to verify coverage and address coverage issues. Managing customer interactions with professionalism and accuracy. Responding to demands, requests, and questions with clear, well-documented communication. Collaborating with attorneys, medical providers, and other stakeholders. Maintaining detailed and timely records. Ensuring compliance with federal, state, and company regulations. Other duties as assigned Requirements What We're Looking For Education: Bachelor's degree. Licensing: Active Florida 6-20 All Lines Adjuster License. Language Skills: Fluent in Spanish and English (written and verbal proficiency required). Skills: Strong analytical, problem-solving, and communication skills. Proficiency in Microsoft Office. Experience: Customer-focused with experience in high-volume environments that require time management and attention to detail. Minimum of 2 years of experience as an auto property damage claims adjuster Mindset: Self-motivated, team-oriented, and adaptable. Our Culture Responsive is a dynamic, inclusive workplace where integrity, innovation, and collaboration thrive. We foster an environment where employees are encouraged to: Adapt: Embrace change and continuously improve. Collaborate: Work transparently and respectfully with others. Engage: Show curiosity and a commitment to serving customers and teammates. Be Data-Driven: Leverage insights to drive decisions and improvements. Responsive provides equal employment opportunities (EEO) to all employees and applicants, fostering a diverse and inclusive workplace. #claimsadjuster

Are you looking for an opportunity to join a claims team with a fast growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual Insurance has an excellent claims opportunity available for a Workers Compensation Claims Technician. Claims Technicians obtain essential information in order to process routine workers' compensation claims with on-going medical management for medical pension claims. Provides injured workers and customers with accurate, timely information and quality service. Claims Technicians also identify potential problems and make claim referral decisions. GRS North America Claims is excited to announce our go forward strategy to provide employees with the flexibility to include an option to work from home full-time. Candidates who are selected for this position will be trained remotely. You will be required to go into the office twice a month if you reside within 50 miles of one a specified office. Please note this policy is subject to change. Responsibilities: Conduct investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through telephone or written reports. Verifies information from claimants, physicians, and medical providers to assess compensability and/or causal relation of medical treatment, and make evaluations for cases with claim specific on-going medical management. Provides on-going medical case management for assigned claims. Initiates calls to injured worker and medical provider if projected disability exceeds maximum triage model projection or to resolve medical treatment issues as needed. Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and medical treatment. Continually assesses claim status to determine if problem cases or those exceeding protocols should be referred to Claims Service Team and/or would benefit from, MP RN review or other medical /claims resources. Arranges Independent Medical Exam and Peer Review as necessary. Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims. Records and updates status notes; documents results of contacts, relevant medical reports, and duration information per file posting standards including making appropriate medical information viewable to customers in Electronic Document Management (EDM). Generates form letters following set guidelines (i.e., letters to physicians projecting disability, letters confirming medical treatment and disability and letters outlining expected outcome to employers). Authorizes payment of medical payments and/or medical treatment. Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units. Qualifications High school diploma plus 1-3 years' of related customer service experience or applicable insurance knowledge. Licensing required in some states. Effective analytical skills required to learn and apply basic policy/contract coverage and recognize questionable coverage/contract situations (which necessitate supervisory involvement) along with effective interpersonal skills to explain the facts and logic used to arrive at decisions in a way that the customer understands. Effective written skills to compose clear, succinct descriptions when posting files and drafting correspondence. Good telephone and typing skills required. Ability to learn when to make proper use of medical management resources, know when to use them and follow through with medical management information received. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. 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The Claims Quality Review Technician is responsible for performing detailed quality reviews of processed claims to ensure accuracy and compliance with eligibility rules, benefits paid, client requirements and applicable legislative and regulatory guidelines. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by /Role." Key Duties and Responsibilities Reviews processed claims, including hospital, medical, dental, vision, prescription and time loss to confirm accuracy and appropriate adjudication of benefits. Identify and document quality trends, provide feedback, and assist management in monitoring processing performance against established standards. Reviews and interprets new benefit plans and/or benefit plan changes, develops resource materials and acts as a resource for staff. Conducts training for new and current employees on claims adjudication, contract language, benefit interpretation, claims QR process and departmental procedures. Collaborate with internal partners to resolve complex claim issues and support continuous improvement. Performs other duties as assigned. Minimum Qualifications High school diploma or GED required 5+ years of related experience, including claims processing, training and/or claims quality review. Strong understanding of claims processing guidelines and benefit plan structures, and regulatory requirements. Demonstrated analytical, research, and problem-solving abilities with strong attention to detail. Working knowledge of CPT, HCPC and ICD-10 coding Proficiency in Microsoft Word, Excel and Outlook. Preferred Qualifications Experience working in a Taft-Hartley environment Prior quality assurance or audit -focused experience Familiarity with automated claims platforms. *Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice. Working Conditions/Physical Effort Prolonged periods of sitting at a desk and working on a computer. Must be able to lift 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ******************************, and we would be happy to assist you. Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day. Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!