Claims Representative jobs at Clearcover - 17 jobs

At Lendbuzz, we believe financial opportunity should be more personalized and fair. We develop innovative technologies that provide underserved and overlooked borrowers with better access to credit. From our employees to our dealers, partners, and borrowers, we've built a company and a culture around a resolute belief in the promise and power of diversity. We value independent and critical thinking. As an Insurance Claims Associate, you will play a pivotal role in working towards maximizing the financial recoveries for Lendbuzz. You will ensure that our clients receive the support and assistance they need to navigate auto insurance claims effectively. You will also ensure that Insurance companies pay us and our customers promptly and accurately. This role will require cross functional collaboration with various internal and external stakeholders. Your attention to detail, strong communication skills, and commitment to customer satisfaction will contribute to our continued success.Key Responsibilities: Assist clients in the initiation of auto insurance claims, providing guidance and support through the initial reporting process Follow up with insurance companies to check on status of claims and troubleshoot any hold ups / blockers in their processing Gather and review all necessary documentation related to insurance claims, including accident reports, policy details, and other relevant information Verify the accuracy and completeness of claims, ensuring they meet company and industry standards Serve as a primary point of contact for clients, insurance providers, and third parties involved in the claims process. Maintain clear and timely communication to keep all stakeholders informed Work with insurance providers to process claims efficiently and accurately, following up on any outstanding issues or discrepancies Provide exceptional customer support to clients, addressing their questions and concerns while ensuring a seamless claims experience Maintain detailed and organized records of claims, correspondence, and associated documentation Assist in the resolution of claims issues, including coverage disputes, repair estimates, and settlements Identify opportunities to enhance our claims process and provide feedback for process improvement Key Requirements: Bachelor's degree or equivalent experience in a relevant field preferred 1+ years of experience in the insurance industry preferred Previous experience in auto insurance claims or a related field is preferred Proficiency in both English is required, ability to also speak Spanish and/or Portuguese is preferred Strong interpersonal and communication skills Detail-oriented with excellent organizational abilities Customer service focussed with a commitment to delivering a positive experience Ability to work independently and as part of a team Adept at problem-solving and conflict resolution Adherence to ethical and professional standards in the insurance industry We believe: Diversity is a competitive advantage. We celebrate our differences, and are better when we have a variety of experiences, viewpoints, and backgrounds. Compassion is a strength. We care about our customers and look to build long-term relationships with them. Simplicity is a key feature. We work hard to make our forms and processes as painless and intuitive as possible. Honesty and transparency are non negotiable. We incorporate these traits in all of our interactions. Financial opportunity belongs to everyone. We work every day to improve lives by extending this opportunity. If you believe these things too then we would love to hear from you! A Note on Recruiting Outreach We've been made aware of individuals falsely claiming to represent Lendbuzz using lookalike email addresses (eg @ lendbuzzcareers.com ). Please note that all legitimate emails from our team come from @ lendbuzz.com . We will never ask for sensitive information or conduct interviews via messaging apps.

Sana's vision is simple yet bold: make healthcare easy. We all know navigating healthcare in the U.S. is confusing, costly, and frustrating -- and our members are used to feeling that pain. That's why we're building something different: affordable health plans designed around Sana Care, our integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. Whether it's a quick prescription refill or guidance through a complex medical journey, Sana Care makes it feel effortless to get the right care at the right time. And for employers and brokers, we've built intuitive tools to make managing health benefits just as seamless. If you love solving hard problems that make people's lives easier, come build with us. We're currently seeking a Claims Operations Manager who will lead our claims processing team and drive operational excellence in claims adjudication, appeals, compliance and reporting, dispute resolution, and member support. This role is critical to ensuring accurate, timely claims processing while building scalable processes and developing team members. We are building a distributed team and encourage all applicants to apply, regardless of location. What you will do: Manage and develop a team of Claims and Appeals Processors, providing training, feedback, and performance management to ensure SLA and quality targets are consistently met Own end-to-end claims operations, including adjudication, appeals, QA, IDR negotiations, and compliance with plan policies and regulatory requirements Develop and strengthen scalable processes by documenting SOPs, identifying workflow improvements, and leading automation or tooling initiatives that reduce friction and improve accuracy Manage customer support and provider escalations, partnering closely with CX, Network Operations, Sales, and Broker teams to resolve issues efficiently and represent Claims Operations with professionalism and clarity Oversee rule-based payment logic, collaborating with Product and Engineering to maintain and enhance our claims rules engine and operational systems (Jira, internal platforms, reporting tools, etc.) Build and maintain plan document infrastructure ensuring operational accuracy,alignment with claims logic and network rules, and regulatory compliance Serve as claims subject-matter expert for internal teams, manage vendor relationships, and ensure timely support for Stop Loss reporting and required documentation. Develop KPIs and reporting dashboards to monitor performance, uncover trends, and drive continuous operational improvement Partner on payment integrity and cost containment programs, leveraging data and vendor partnerships to reduce waste, ensure appropriate reimbursement, and protect plan assets Drive cross-functional projects, coordinating requirements, timelines, and stakeholders for system changes, rule updates, plan documents, and process improvements About you: 4+ years of experience in health insurance claims processing, with strong familiarity across institutional and professional claims, coding standards (ICD, CPT/HCPCS, revenue codes), and regulatory requirements 2+ years managing and developing teams in fast-paced, metrics-driven environments, with a track record of building high-performing, accountable teams Exceptionally organized with strong time-management skills, able to prioritize competing deadlines, manage escalations, and keep multiple workflows moving in parallel Process-builder with a startup mindset and who is comfortable creating structure from ambiguity, documenting SOPs, and improving systems while adapting quickly to change Gritty problem-solver who's willing to dive into the details, ask foundational questions, and work through complex or ambiguous scenarios to get to clarity Excellent verbal and written communication skills, with the ability to synthesize data from disparate sources, tell a clear story, and communicate effectively to both technical and non-technical audiences Analytical and data-driven, with experience in spreadsheets and (ideally) SQL to support operational reporting, trend analysis, and KPI development Stop Loss and Independent Dispute Resolution (IDR) experience is a plus, but not required. Benefits: Remote company with a fully distributed team - no return-to-office mandates Flexible vacation policy (and a culture of using it) Medical, dental, and vision insurance with 100% company-paid employee coverage 401k w/ company match FSA, and HSA plans Paid parental leave Short and long-term disability, as well as life insurance Competitive stock options are offered to all employees Transparent compensation & formal career development programs Paid one-month sabbatical after 5 years Stipends for setting up your home office and an ongoing learning budget Direct positive impact on members' lives - wait until you see the positive feedback members share every day About Sana Founded in 2017, Sana is a health plan solution built for small and midsize businesses - designed around our integrated primary care service, Sana Care. It's the foundation of everything we build: ensuring members can easily access high-quality, affordable care while employers and brokers have the tools they need to manage company benefits with confidence. We've been remote-first since day one, with a fully distributed team across the U.S. We value curiosity, ownership, and speed - and we build in the open, together. If you're energized by solving complex, meaningful problems and want to help reshape how healthcare works from the inside out, we'd love to meet you.

Job Title: Total Loss Settlement Adjuster Company: Snapsheet Job Type: Full-time About Snapsheet: Snapsheet is claims technology the way it should be: purposeful, precise, and designed to deliver outcomes. Where others bolt things on, we engineer them in to our core systems and processes across cloud-based claims management, virtual vehicle appraisals, and elite loss and recovery services. Trusted by over 170+ P&C Carriers, MGAs, MGUs, TPAs, and logistics companies, our open architecture is built to fit how our companies work, not the other way around. What you'll get: Remote working environment - your new commute is however long it takes to walk to your desk! Flexibility - empathy is ingrained in who we are and we are happy to offer a flexible PTO policy, casual dress code, and more! Development - Mentorship programs, 1-on-1 management, promote when ready culture, quarterly internal promotion opportunities, and goal setting sessions. Fun - Celebrations just because, yearly in-person and remote events, Snapsheet Swag, Employee Resource Groups, and more! Job Overview: As a Total Loss Settlement Adjuster at Snapsheet, you are highly competitive and motivated by constant improvement. You are an effective communicator, whether you are emailing a request to your peer, talking with a body shop, lienholder or a carrier customer. You love working in an ever-evolving environment where openness to feedback and the ability to adapt is highly valued. You are a strong problem solver, identifying and resolving the day-to-day challenges involved in auto claims handling, specifically understanding total loss evaluations, settlements with carrier customers, salvage regulations and state compliance, as well as solving more complex problems. You want to work for a company where you can make a real impact and do it all from the comfort of your home office! Not licensed? We will license you prior to starting. Responsibilities: Settle Total Loss claims with owners and lienholders Secure vehicle releases, negotiate release fees, and relocate salvage Mitigate expenses for storage, rental, etc, within state compliance Process associated paperwork to transfer title and secure salvage returns Issue settlement payments to owners and lienholders Maintain working understanding of estimatics, policy and carrier guidelines, state and regional regulatory compliance and laws. Maintain working understanding of Actual Cash Value. Candidates should be able to confidently speak to options, condition ratings, unrelated prior damage, refurbishments, comparable vehicles and market availability to negotiate settlement agreement Utilize internal training tools and external resources to clearly document every claim with high attention to detail Maintain documentation of all interactions with internal and external customers or sources Work effectively with repair facilities, rental agencies and salvage yards while maintaining a positive and professional demeanor Manage and maintain virtual relationships with teammates, managers, and directors while working remotely from home Qualifications: Must be currently completing total loss settlements with an insurance carrier Must have a working understanding or background in estimating and evaluating total losses Thorough understanding of UPD estimates, parts costs, total loss classification, and fraud detection 2-5 years of Auto Total Loss Settlement experience in the Insurance Industry Extensive knowledge of Automobile Total Loss Conditioning and Optioning processes Thorough understanding of automobile terminology and vehicle construction. Working experience of estimating platforms: Mitchell UltraMate, CCC One and/or Audatex Excellent verbal and written communication skills Detail-oriented and organized, with a commitment to delivering accurate and timely results Excellent negotiation and communication skills to interact with customers, shops and vendors remotely Team player with positive attitude and ability to work well with others Ability to work independently and manage time efficiently in a virtual work environment We're Built to Grow With You - And That Starts With How We Support You At Snapsheet, we know that growth doesn't happen in a vacuum-it's fueled by the right support at the right time. That's why we've built a benefits experience designed to grow with you, wherever life takes you. Choose from 2 robust medical plans through Blue Cross Blue Shield-plus, we contribute to your HSA when you enroll in our high-deductible health plan. Offer two dental plans and one vision plan to keep you and your family healthy. Peace of mind with company-paid Short Term Disability, Long Term Disability, and Life Insurance. Additional protection through voluntary benefits like Accident Insurance, Hospital Indemnity, Critical Illness, and Legal Assistance. 401(k) with a 4% company match-because your future is worth investing in. Employee Assistance Program (EAP) with 6 sessions per life incident to support your mental well-being. Perks That Make Growing Here Even Better: Flexible PTO and 7.5 company-observed holidays to recharge on your terms. In-person connection points throughout the year including our annual Summit and Roadshows. Snapsheet SWAG and surprise mailers to keep the spirit alive. Endless opportunity to shape your path-career growth, learning, and real impact are all within reach. Health and wellness campaigns that evolve with you year over year. Compensation that Grows with You For this position, the base salary range is $50,000-$60,000. While this range serves as a guideline, your actual compensation will reflect your experience and skillset. At Snapsheet, we believe growth should be rewarded-our compensation and benefits are built to evolve with you as your career does. *Please note that we are unable to sponsor applicants for work visas for this position at this time. Don't meet every single requirement? Studies have shown that women and people of color are less likely to apply for jobs unless they meet every single qualification. At Snapsheet, we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. Snapsheet is committed to providing reasonable accommodations for candidates with disabilities in our recruiting process. If you need assistance or accommodations, please let us know by emailing [email protected]. Snapsheet is proud to be an Equal Opportunity employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender, gender identity, gender expression, transgender status, sexual stereotypes, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. #BI-Remote #LI-Remote Snapsheet is an equal opportunity employer.

OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types. About the Role The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions). Primary Responsibilities * Flexible to work rotational shifts inside our office hours from 8:00 a.m. - 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday - Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs) * Fax intake and labeling * Prior authorization creation * Quality Performance Program Outreach when assigned * Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues * Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues * Triage request/claims processing issues to health plans as needed Prior authorization creation * Quality Performance Program Outreach when assigned About You * College degree or relevant experience preferred * Fully Bilingual (English and Spanish) * Remote/hybrid work experience preferred * A minimum of 2 years of administrative experience and/or customer service or relevant educational attainment required * Must possess the ability to lead and develop a department and staff to achieve organizational goals * Skills for implementation of systems for program effectiveness and productivity required * Systems/Tools: MS Office Suite proficient About the Location OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted. Our Culture Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation - all with a focused mission of putting patients first! We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together! OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need. The Opportunity The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done - now is the perfect time to talk to us! Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment. OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape. OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff. OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

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

General information Career area Insurance Country United States 1450 American Lane, IL State Illinois City Schaumbarg Remote? No Ref # 21235 Posted Date 12-05-25 Working time Full time Ally and Your Career Ally Financial only succeeds when its people do - and that's more than some cliché people put on job postings. We live this stuff! We see our people as, well, people - with interests, families, friends, dreams, and causes that are all important to them. Our focus is on the health and safety of our teammates as well as work-life balance and diversity and inclusion. From generous benefits to a variety of employee resource groups, we strive to build paths that encourage employees to stretch themselves professionally. We want to help you grow, develop, and learn new things. You're constantly evolving, so shouldn't your opportunities be, too? Work Schedule: Ally designates roles as (1) fully on-site, (2) hybrid, or (3) fully remote. Hybrid roles are generally expected to be in the office a certain number of days per week as indicated by your manager. Your hiring manager will discuss this role's specific work requirements with you during the hiring process. All work requirements are subject to change at any time based on leader discretion and/or business need. The Opportunity We're looking for people interested in claim subrogation and who are focused on helping our customers while maintaining Ally's interest. You will be responsible for the investigation, valuation, establishment of exposure, negotiation and settlement property and casualty subrogation registers within a predetermined settlement authority. Ensures that all assigned registers are concluded promptly, equitably and economically within the provisions of the policy contract and in accordance with the policy. If you'd like to learn more about what we believe makes this role - and this place - so phenomenal, get in touch. The Work Itself * Handles intake of subrogation referrals. * Conducts investigations independently and at the direction of management utilizing sound investigative procedures to establish liability as quickly as possible. * Negotiates settlement of subrogation claims with at fault party while following established, authorized settlement authority. * Handles questions as needed. * Maintain a complete and thoroughly documented subrogation file ensuring registers are properly documented and all supporting documents are attached. * Uses compassionate communication and persuasive negotiation to ensure a positive customer experience. * Work with and refer subrogation registers to 3rd party vendors as directed. * Work closely with the claim adjusters to ensure accurate and timely claim referral. * Issue deductible reimbursement payments to the appropriate parties. * Identify subrogation situations in a timely manner to protect the interests of the Corporation and request documents needed to process files. * Handles all registers within the guidelines of the state's Fair Claims Practices Acts and other Regulations while also ensuring timeliness and KPIs are being met. * Maintain an up-to-date dairy. * Maintain necessary licensing and continuing education The Skills You Bring * 1+ years in customer service or insurance industry is required. * HS diploma or equivalent required. * Prior subrogation experience preferred. * The ability to take detail statements and demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan * Ability to resolve conflicts and treat customers in a courteous, friendly and professional manner. * Demonstrate an understanding of insurance law as it relates to subrogation * High degree of analytical, negotiation and organizational skills * Typically requires knowledge of Microsoft Office Programs. * Leveraging technical expertise and relationships to contribute to strategy and drive business results. * #DFS * #LI-Hybrid How We'll Have Your Back Ally's compensation program offers market-competitive base pay and pay-for-performance incentives (bonuses) based on achieving personal and company goals. Our Total Rewards program includes industry-leading compensation and benefits plus additional incentives that are designed to meet your needs and those of your family so you can get the most out of your career and your life, including: * Time Away: Program starts at 20 paid time off days in addition to 11 paid holidays and 8 hours of volunteer time off yearly (time off days are prorated based on start date and program varies based on full or part-time status and management level). * Planning for the Future: plan for the near and long term with an industry-leading 401K retirement savings plan with matching and company contributions, student loan pay downs and 529 educational save up assistance programs, tuition reimbursement, employee stock purchase plan, and financial learning center and financial coach access. * Supporting your Health & Well-being: flexible health and insurance options including medical, dental and vision, employee, spouse and child life insurance, short- and long-term disability, pre-tax Health Savings Account with employer contributions, Healthcare FSA, critical illness, accident & hospital indemnity insurance, and a total well-being program that helps you and your family stay on track physically, socially, emotionally, and financially. * Building a Family: adoption, surrogacy and fertility assistance as well as paid parental and caregiver leave, Dependent Day Care FSA back-up child and adult/elder care days and childcare discounts. * Work-Life Integration: other benefits including Mentally Fit Employee Assistance Program, subsidized and discounted Weight Watchers program and other employee discount programs. * Other compensations: depending on the role for which you are considered, you may be eligible for travel allowances, relocation assistance, a signing bonus and/or equity. * To view more detailed information about Ally's Total Rewards, please visit this link: ****************************************************************************** Who We Are: Ally Financial is a customer-centric, leading digital financial services company with passionate customer service and innovative financial solutions. We are relentlessly focused on "Doing it Right" and being a trusted financial-services provider to our consumer, commercial, and corporate customers. For more information, visit ************* Ally is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to age, race, color, sex, religion, national origin, disability, sexual orientation, gender identity or expression, pregnancy status, marital status, military or veteran status, genetic disposition or any other reason protected by law. We are committed to working with and providing reasonable accommodation to applicants with physical or mental disabilities. For accommodation requests, email us at *****************. Ally will not discriminate against any qualified individual who is capable of performing the essential functions of the job with or without reasonable accommodation. Base Pay Range: $47840 - $65000 USD An individual's position in the range is determined by the specific role, the scope and responsibilities of the role, work experience, education, certification(s), training, and additional qualifications. We review internal pay, the competitive market, and business environment prior to extending an offer. Incentive Compensation: This position is eligible to participate in our annual incentive plan.

Primary DetailsTime Type: Full time Worker Type: Employee The Opportunity: In this role you will deliver prompt and accurate claims service to policyholders and agents for both multi-peril crop insurance (MPCI) and crop hail claims by completing field inspections, communicating with involved parties, performing investigations, determining appropriate adjustments and administering insurance policies to ensure compliance with state and federal regulations. You will partner with Field Claims Manager to ensure effective and efficient claims operations. • Location: Work Remotely in Tennessee or Kentucky, USA • Work Arrangement: This role is fully remote • The starting salary range for this role is between $69,000-$104,000 Your New Role: • Distribute and direct losses and claim tracking for defined territory or agency base to support delivery of effective customer service and claim resolution and ensure team alignment with business goals •Accurately document, process and transmit loss information in order to determine potential damages associated with difficult and complex claims •Provide overflow support to Compliance Department of quality control audits for Federal Crop Insurance Corporation (FCIC and Crop Hail) •Complete field inspections, reviews and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company crop insurance policies. Ensure compliant and cost effective application of crop policies by leveraging knowledge of insurance statues and regulations and complying with state and federal regulatory requirements •Provide effective and timely communication with agencies in defined territory on claim status and other inquiries •Build and maintain relationships with customers by providing timely an accurate policy service, answering questions and communicating adjustment determinations •Coach claims adjusting team by supporting and mentoring team members and providing advice and feedback to guide the success of the team and meet service level expectations •Provide information and feedback regarding the quality of agent business and/or policy files of regional claim operations to maximize profit and quality of business •Deliver classroom and field training programs for claims technology applications and crop programs ensuring effective educational resources for clients and alignment of training services with key stakeholders expectations •Participate with internal committee to develop global claims technology solutions that support business need •Attend National Crop Insurance Services (NCIS) regional and state committee meetings to make business aware of any legal issues or changes that will impact the business •Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun Required Education •Associate's Degree or equivalent combination of education and work experience Required Experience •4 years relevant experience Required Licenses/Certifications •Crop Adjuster Proficiency Program (CAPP); must possess a valid Driver's License Preferred Competencies/Skills •Evaluate project outcomes through analyzing current state and desired future state •Utilize effective communication channels for both external and internal customers •Handle complex claims using a logical approach •Provide adjusters detailed instructions for claim procedures and company policy •Support implementation of company strategies •High attention to detail •Solve day-to-day problems, using critical thinking •Train others on process and procedures Preferred Experience •5 years experience in MPCI and Crop Hail claims experience Preferred Knowledge •Working knowledge of claims administration best practices and procedures •Understanding of local, state and industry standards (NCIS) •Understanding of relevant laws and regulations across multiple jurisdictions •Working knowledge of Microsoft Office suite, general computer software and database systems QBE, a global insurance leader, is the proud parent company of NAU Country Insurance Company. NAU Country writes in 48 states and has nine locations nationwide. Together, we combine the history, expertise, innovation, and a shared commitment to excellence to provide unparalleled insurance solutions to our customers and communities worldwide. Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team. QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to: Hybrid Working - a mix of working from home and in the office 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis Competitive 401(k) program with company match up to 8% Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice Tuition Reimbursement for professional certifications, and continuing education Employee Network and Community - QBE actively supports six Employee Networks, and many ways to give back to your community To learn more, click here: Benefits | QBE US. Why QBE? What if you could have a positive impact - at work and in the world? At QBE, we're enabling a more resilient future - for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success. Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact. Join us now, so you can be part of our success - and we can be part of yours! *************************************************** Commitment to Diversity QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information. Equal Employment Opportunity: QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status. Supplementary information Skills: Adaptability, Communication, Conflict Management, Critical Thinking, Customer Service, Detail-Oriented, Document Management, Financial Advising, Insurance Claims Processing, Intentional collaboration, Managing performance, Regulatory Compliance, Research Analysis, Risk Management, Standards Compliance How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.

At Lendbuzz, we believe financial opportunity should be more personalized and fair. We develop innovative technologies that provide underserved and overlooked borrowers with better access to credit. From our employees to our dealers, partners, and borrowers, we've built a company and a culture around a resolute belief in the promise and power of diversity. We value independent and critical thinking. We are looking for a Remarketing Auction Representative to manage vehicle remarketing processes with auction partners and support overall corporate objectives. This role focuses on maximizing net proceeds, minimizing inventory turn time, and mitigating residual value loss. Responsibilities include overseeing inventory transport, inspections, pre-sale preparation, and post-sale reporting. The position requires close collaboration with auctions to optimize performance while ensuring full legal compliance. This role reports to the Remarketing Supervisor and is fully remote with traveling involved.Key Responsibilities: Manage and optimize assigned auction relationships, including field visits and negotiating service fees for peak performance Oversee the end-to-end inventory lifecycle, including transport coordination, inspection, reconditioning, and valuation for sale preparation Strategically establish and adjust vehicle floor prices (minimum bids) by leveraging real-time market data to optimize net proceeds while maintaining a high inventory sell-through rate Facilitate seamless communication with auction staff and management via AutoIMS, serving as the primary point of contact for service-related issue resolution Collaborate with auctions to develop and execute targeted sale promotions and marketing strategies Ensure compliance with all legal requirements, including preparation and transmission of legal notices and repossession documentation Maintain financial accuracy by documenting vehicle values and sale results within the remarketing system Validate and process vendor invoices, working proactively to resolve discrepancies before submission for payment Monitor and report on KPIs, tracking auction adherence to guidelines, marketing effectiveness, and overall sale expenses Key Requirements: 2-3 years of experience working with vehicle auctions within the automotive industry required Background in automotive remarketing, auction operations, or related field preferred Demonstrate expertise in regulatory compliance, specifically regarding repossession laws and FDCPA requirements Exhibit strong negotiation and probing skills, utilized in a professional manner to manage vendor relationships and maximize proceeds Meticulous attention to detail for legal documentation and financial reporting Effective time management with the ability to prioritize multi-channel tasks in a fast-paced environment Proficiency in Microsoft Office and the ability to utilize web-based research tools and remarketing software (AutoIMS/Salesforce experience is a plus) $60,000 - $75,000 a year This position offers a base salary plus performance-based incentives. We believe: Diversity is a competitive advantage. We celebrate our differences, and are better when we have a variety of experiences, viewpoints, and backgrounds. Compassion is a strength. We care about our customers and look to build long-term relationships with them. Simplicity is a key feature. We work hard to make our forms and processes as painless and intuitive as possible. Honesty and transparency are non negotiable. We incorporate these traits in all of our interactions. Financial opportunity belongs to everyone. We work every day to improve lives by extending this opportunity. If you believe these things too then we would love to hear from you! A Note on Recruiting Outreach We've been made aware of individuals falsely claiming to represent Lendbuzz using lookalike email addresses (eg @ lendbuzzcareers.com ). Please note that all legitimate emails from our team come from @ lendbuzz.com . We will never ask for sensitive information or conduct interviews via messaging apps.

**General information** **Ref #** 21369 **Remote?** Yes **Ally and Your Career** * Ally Financial only succeeds when its people do - and that's more than some cliché people put on job postings. We live this stuff! We see our people as, well, people - with interests, families, friends, dreams, and causes that are all important to them. Our focus is on the health and safety of our teammates as well as work-life balance and diversity and inclusion. From generous benefits to a variety of employee resource groups, we strive to build paths that encourage employees to stretch themselves professionally. We want to help you grow, develop, and learn new things. You're constantly evolving, so shouldn't your opportunities be, too? **The Opportunity** Are you a highly specialized, skilled technician looking for the next step in your career? We are looking for a Field Adjuster that can appraise and/or adjust physical damage and mechanical claims within an assigned territory and key point or other assigned location for the various Ally Insurance / Dealer Products and Service lines. The ideal candidate must reside in Southern New Jersey, Philadelphia, PA Metro area and be able to travel locally to support the territory. This position also requires flexibility in work schedule, including participating catastrophe losses with extended overnight and weekend travel. This role has the opportunity to create your own schedule and run your assignments. Growth in this role is determined by performance which includes service level agreements and quality of work. Ally Work Location for this role is: Southern New Jersey, Philadelphia, PA Metro area - This role is fully remote with frequent travel locally with high potential to travel to other states to assist other field adjusters. At this time, Ally will not sponsor a new applicant for employment authorization for this position **The Work Itself** * Prepare estimates and reach agreed prices for repairs on insured and claimant vehicles. * Handle catastrophe losses as directed by claim management. * Initiate the total loss handling process for conclusion by the Claim Offices. * Handle Additional Repair Orders (AROs) and special assignments for the Claim Offices. * Assist in other geographic locations at the direction of claim management. * Perform technical tasks required to support ongoing business operations. * Participate in training, educational activities, regulatory compliance awareness and maintain appropriate licensing and continuing education requirements. * May handle sale of salvage and subrogation investigation as assigned by the Claim Office. **The Skills You Bring** * Background as a Service Writer, Dealership Service Technician, Auto Body Shop technician is strongly preferred. * Experience assessing mechanical and/or physical damage is highly recommended * Financial services or auto finance industry is a nice to have * Typically requires advanced knowledge of Microsoft Office Programs * Bachelor's degree in business related discipline preferred * #LI-Remote **How We'll Have Your Back** * Ally's compensation program offers market-competitive base pay and pay-for-performance incentives (bonuses) based on achieving personal and company goals. But Ally's total compensation - or total rewards - extends beyond your paycheck and is designed to support and enrich your personal and professional life, including: * Time Away: competitive holiday and flexible paid-time-off, including time off for volunteering and voting. * Planning for the Future: plan for the near and long term with an industry-leading 401K retirement savings plan with matching and company contributions, student loan and 529 educational assistance programs, tuition reimbursement, and other financial well-being programs. * Supporting your Health & Well-being: flexible health and insurance options including dental and vision, pre-tax Health Savings Account with employer contributions and a total well-being program that helps you and your family stay on track physically, socially, emotionally, and financially. * Building a Family: adoption, surrogacy, and fertility support as well as parental and caregiver leave, back-up child and adult/elder day care program and childcare discounts. * Work-Life Integration: other benefits including LifeMatters Employee Assistance Program, subsidized and discounted Weight Watchers program and other employee discount programs. Who We Are: Ally Financial is a customer-centric, leading digital financial services company with passionate customer service and innovative financial solutions. We are relentlessly focused on "Doing it Right" and being a trusted financial-services provider to our consumer, commercial, and corporate customers. For more information, visit ************* Ally is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to age, race, color, sex, religion, national origin, disability, sexual orientation, gender identity or expression, pregnancy status, marital status, military or veteran status, genetic disposition or any other reason protected by law. Where permitted by applicable law, must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered, if not currently employed by Ally. We are committed to working with and providing reasonable accommodation to applicants with physical or mental disabilities. For accommodation requests, email us at *************. Ally will not discriminate against any qualified individual who is capable of performing the essential functions of the job with or without reasonable accommodation. **_Base Pay Range:_** An individual's position in the range is determined by the scope and responsibilities of the role, work experience, education, certification(s), training, and additional qualifications. We review internal pay, the competitive market, and business environment prior to extending an offer. **Emerging:** 64480 **Experienced:** 71240 **Expert:** 78000 Incentive Compensation: This position is eligible to participate in our annual incentive plan

Hi, we're Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A Little More About The role:We're looking for a Medical Claims Supervisor. The Supervisor manages and oversees the operational and day-to-day performance of department staff. They help lead, manage, champion, and improve the Gravie member experience and ensure overall performance of direct reports, aligns with operational metrics and service standards. You will:· Oversee, mentor and evaluate claims examiners at all levels, including inventory assignment, KPI monitoring and performance management. · Lead claims processing and inventory management to ensure timely, accurate and compliant adjudication of claims. · Analyze quality review findings from the auditing department to identify root causes of financial, payment and procedural errors at the examiner level· Identify operational gaps and provide recommendations, implement continuous improvements related to claims processing, system configuration, and quality outcomes. · Act as the escalation point for complex claims, leading investigation, resolution, and implementation of both short-term and long-term corrective solutions. · Prepare and analyze claims processing reports, leveraging claim data to deliver insights that drive operational efficiency. Partner closely with Data Analytics to identify reporting gaps and ensure consistent achievement of KPI's and Network SLA's. · Compile and present key operational and performance data in a clear, organized, and concise format. Highlighting trends, risks and actionable insights for leadership and key stakeholders. · Collaborate cross-functionally with internal departments such as Clinical, Configuration, Compliance and other departments to develop, refine and improve policies and procedures. · Serve as a backup to the Claims Manager as needed to support business and departmental needs of the business. · Oversee, maintain, and enhance workflows to improve departmental effectiveness, scalability, and efficiency· Lead through change in a fast-paced, evolving environment; demonstrate agility, effectively prioritize shifting demands and communicate urgent issues effectively. · Be willing to maintain a flexible work schedule, based upon the needs of the business and Claims department. · Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and result-driven mindset. You bring: · Dedication and passion around helping people navigate the world of health insurance and benefits. · Strong understanding of medical terminology, CPT/ICD codes, benefit plans, and claims adjudication systems. · Familiarity with state/federal healthcare laws and regulations. · Demonstrated ability to motivate, train, and evaluate staff with a strong focus on achieving departmental goals and meeting SLAs. · Previous experience leading and managing claims examiners, providing direct feedback, and overseeing processes development· Demonstrated success leading special projects and providing impactful results. · Ability to foster positive and trusting rapport with direct reports and meet with team members in 1:1, small group, and large group settings. · Excellent written and verbal skills for team and external interactions. · Ability to meet deadlines and manage multiple priorities simultaneously. · Ability to navigate ambiguity, shift gears comfortably, and decide and act without having the total picture. Extra credit: · Previous experience at a high growth company. · Previous experience using Javelina. · Previous experience managing dynamic inventory. Gravie: In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package. The salary range for this position is $59,250 - $98,750 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. Our unique benefits program is the gravy, i. e. , the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie's package includes alternative medicine coverage, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave. A Little More About Us:At Gravie, we're on a mission to reinvent health benefits for small and midsize businesses-making high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we're building the future of health benefits to reflect just that. We're proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before. And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative-and we're just getting started. At Gravie, we do things differently. We'll challenge you, and we'll welcome you challenging us. Good ideas are everyone's job here. You'll join a team that's smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve. If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you.

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

Primary DetailsTime Type: Full time Worker Type: Employee Claims Adjuster - Crop The Opportunity: In this role you will respond to crop claims by completing field inspections, communicating with involved parties, performing investigations, determining appropriate adjustments and administering insurance policies to ensure compliance with state and federal regulations. •Location: Work Remotely in Wisconsin, USA •Work Arrangement: This role is fully remote; approximately 20% home office work and 80% field work. •The starting salary range for this role is between $53,000-$79,000 Your New Role: •Complete field inspections, reviews and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company crop insurance policies •Ensure compliant and cost effective application of crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements •Build and maintain relationships with customers by providing timely and accurate policy service, answering questions and communicating adjustment determinations •Accurately document, process and transmit loss information in order to determine potential damages •Support business objectives by participating in quality control tasks, audits, risk assessments and field reviews •Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun Required Education •High School Diploma/GED Required Experience •1 year relevant experience Required Licenses/Certifications •Must possess a valid Driver's License Preferred Qualifications •Tertiary Degree or equivalent combination of education and work experience. Required Work Experience •Some relevant work experience. Preferred Competencies/Skills •Effective verbal and written communication skills •Work effectively under pressure; able to comply with tight deadlines •Collaborate with internal staff and external customers •Use relevant information and individual judgment to comply with organizational and legal regulations •Establish and maintain effective, trusting and respectful relationships with others •Complete tasks attentively and thoroughly •High attention to detail •Work independently with little to supervision •Communicate outside the organization and share information as a positive aid to achieve best practices and objectives Preferred Education •Associate's Degree or equivalent combination of education and work experience Preferred Experience •Experience with agriculture and/or farming Preferred Licenses/Certifications •Crop Adjuster Proficiency Program (CAPP) Preferred Knowledge •Applied knowledge of agriculture and crop farming •Working knowledge of crop insurance regulations, policies, procedures and best practices •Working knowledge of investigative techniques and legal research methodologies •Basic knowledge of Microsoft Office Suite QBE, a global insurance leader, is the proud parent company of NAU Country Insurance Company. NAU Country writes in 48 states and has nine locations nationwide. Together, we combine the history, expertise, innovation, and a shared commitment to excellence to provide unparalleled insurance solutions to our customers and communities worldwide. Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team. QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to: Hybrid Working - a mix of working from home and in the office 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis Competitive 401(k) program with company match up to 8% Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice Tuition Reimbursement for professional certifications, and continuing education Employee Network and Community - QBE actively supports six Employee Networks, and many ways to give back to your community To learn more, click here: Benefits | QBE US. Why QBE? What if you could have a positive impact - at work and in the world? At QBE, we're enabling a more resilient future - for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success. Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact. Join us now, so you can be part of our success - and we can be part of yours! *************************************************** Commitment to Diversity QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information. Equal Employment Opportunity: QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status. Supplementary information Skills: Adaptability, Communication, Conflict Management, Critical Thinking, Customer Service, Detail-Oriented, Document Management, Financial Advising, Insurance Claims Processing, Intentional collaboration, Managing performance, Regulatory Compliance, Research Analysis, Risk Management, Standards Compliance How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.

Sana's vision is to make healthcare easy. All of us can agree healthcare is simply too hard in the US. And our members feel that pain day in and day out. We aim to create an experience that simply feels easy when you need to access our healthcare system. If you need something, you know where to go to get it with care that is a click (or as few clicks as possible!) away. What's beautiful about a vision oriented toward “easy” is how it imparts a singular feeling. We instinctively know as humans when something is easy versus hard, even if we can't explain why. We fight as a company to make an easy pathway available to all our members at every stage of their healthcare journey. If you feel passionate about delivering better healthcare to small businesses through a seamless care experience and affordable benefits, join us! We're currently seeking a Claims Processor who will be responsible for processing insurance claims in a timely and accurate manner. This includes gathering and verifying claim information, researching and resolving claim issues, and communicating with claimants to ensure their satisfaction. We are building a distributed team and encourage all applicants to apply, regardless of location.What you will do: Ensure the timely and accurate adjudication and payment of medical claims, following health plan policies and procedures, consulting with team members, care partners and advisors as necessary. Maintain accurate and up-to-date notes of all claims processed. Process appeals and disputes by gathering and verifying claim information, researching and resolving claim issues, and communicating outcomes to appropriate parties. Become an in-house expert on all claims-related matters and provide answers and support to Customer Success and Customer Support teams. Identify operational issues and escalate them to the appropriate internal team. Contribute to teamwide goals to improve claims processes and integrate additional functions into our daily operations. Work independently and as part of a team to meet deadlines and daily processing quotas. Your success will be measured on your ability to complete daily and weekly targets. What you will do: Two-year degree and/or two years of claims adjudication and processing experience Unparalleled attention to detail. You love getting into the weeds to get things done. Excellent written and verbal communication skills. Ability to work independently and as part of a team. Fast learner. Entrepreneurial. Self-directed. Ability to meet deadlines and work under pressure. Experience in claims processing, knowledge of insurance principles and procedures is a plus. Benefits: Stock options in rapidly scaling startup Flexible vacation Medical, dental, and vision Insurance 401(k) and HSA plans Parental leave Remote worker stipend Wellness program Opportunity for career growth Dynamic start-up environment

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

Primary DetailsTime Type: Full time Worker Type: EmployeeAt QBE, we are always looking to connect with top talent - for current vacancies as well as for future opportunities. It is our aim to continuously build a strong candidate pipeline across all our businesses and key locations in North America. After submitting your interest to this specific hiring profile, our Recruitment Team will review your credentials and areas of expertise. Should there be a current or prospective opportunity that is commensurate with your career experience, we will contact you for an exploratory discussion. We appreciate your consideration of QBE as an employer of choice. The Opportunity This role will deliver prompt and accurate claims service to policyholders and agents for both multi-peril crop insurance (MPCI) and crop hail claims by completing field inspections, communicating with involved parties, performing investigations, determining appropriate adjustments and administering insurance policies to ensure compliance with state and federal regulations. Partner with Field Claims Manager to ensure effective and efficient claims operations. Primary Responsibilities • Distribute and direct losses and claim tracking for defined territory or agency base to support delivery of effective customer service and claim resolution and ensure team alignment with business goals •Accurately document, process and transmit loss information in order to determine potential damages associated with difficult and complex claims •Provide overflow support to Compliance Department of quality control audits for Federal Crop Insurance Corporation (FCIC and Crop Hail) •Complete field inspections, reviews and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company crop insurance policies. Ensure compliant and cost effective application of crop policies by leveraging knowledge of insurance statues and regulations and complying with state and federal regulatory requirements •Provide effective and timely communication with agencies in defined territory on claim status and other inquiries •Build and maintain relationships with customers by providing timely an accurate policy service, answering questions and communicating adjustment determinations •Coach claims adjusting team by supporting and mentoring team members and providing advice and feedback to guide the success of the team and meet service level expectations •Provide information and feedback regarding the quality of agent business and/or policy files of regional claim operations to maximize profit and quality of business •Deliver classroom and field training programs for claims technology applications and crop programs ensuring effective educational resources for clients and alignment of training services with key stakeholders expectations •Participate with internal committee to develop global claims technology solutions that support business need •Attend National Crop Insurance Services (NCIS) regional and state committee meetings to make business aware of any legal issues or changes that will impact the business •Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun Required Education • High School Diploma/GED Required Experience • 5 years relevant experience Preferred Competencies/Skills • Evaluate project outcomes through analyzing current state and desired future state •Utilize effective communication channels for both external and internal customers •Handle complex claims using a logical approach •Provide adjusters detailed instructions for claim procedures and company policy •Support implementation of company strategies •High attention to detail •Solve day-to-day problems, using critical thinking •Train others on process and procedures Preferred Education • Bachelor's Degree or equivalent combination of education and work experience Preferred Experience • 5 years experience in MPCI and Crop Hail claims experience Preferred Licenses/Certifications • Crop Adjuster Proficiency Program (CAPPP); per State Requirements Preferred Knowledge • Working knowledge of claims administration best practices and procedures •Understanding of local, state and industry standards (NCIS) •Understanding of relevant laws and regulations across multiple jurisdictions •Working knowledge of Microsoft Office suite, general computer software and database systems About QBE We can never really predict what's around the corner, but at QBE we're asking the right questions to enable a more resilient future by helping those around us build strength and embrace change to their advantage. We're an international insurer that's building momentum towards realizing our vision of becoming the most consistent and innovative risk partner. And our people will be at the center of our success. We're proud to work together, and encourage each other to enable resilience for our customers, our environment, our economies and our communities. With more than 12,000 people working across 27 countries, we're big enough to make a real impact, but small enough to provide a friendly workplace, where people are down-to-earth, passionate, and kind. We believe this is our moment: What if it was yours too? Your career at QBE - let's make it happen! *************************************************** US Only - Travel Frequency • Frequent (approximately 10+ trips annually) US Only - Physical Demands • Field agents: Work is generally performed in both an office environment and remote external environments that may present exposure to adverse environmental conditions dependent on customer location. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Must be able to walk on uneven ground, climb, bend, stoop, use a step, crawl and/or kneel. Incumbent may be exposed to environments that present hazardous weather, chemicals and/or animals. Incumbent must be able to lift up to 25 lbs. US Only - Disclaimer • To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities. Job Type • Individual Contributor Global Disclaimer • The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee's normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls. Compensation Base pay offered will vary depending on, but not limited to education, experience, skills, geographic location and business needs Annual Salary Range: $68,000 - $102,000 AL, AR, AZ, Fresno, CA, CO (Remote), DE (Remote), FL, GA, IA, ID, IL (Remote), IN, KS, KY, LA, MI, MN, MO, MS, MT, NC, ND, NE, NH, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WI, WV and WY Annual Salary Range: $75,000 - $112,000 CA (Remote, Irvine and Woodland), Greenwood Village CO, CT, Chicago IL, MA, MD, NY (Remote), RI, Houston TX and WA Annual Salary Range: $85,000 - $128,000 San Francisco CA, NJ and New York City NY Benefit Highlights You are more than your work - and QBE is more than a workplace, which is why QBE provides you with the benefits, support and flexibility to help you concentrate on living your best life personally and professionally. Employees scheduled over 30 hours a week will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution and a paid-time off program. In addition, our paid-family and care-giver leaves are available to support our employees and their families. Regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. QBE recognizes that exemplary benefits extend beyond benefits coverage and compensation. Flexibility in your working environment is important to maintaining balance and QBE is dedicated to ensuring employees achieve personal and professional integration by providing the opportunity for hybrid work arrangements. How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.

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