Claims Representative Jobs At Clearcover

Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost. Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability. Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve. For more information about Avalon, please visit ****************** Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees. For more about Avalon, please visit our web site at ************************* About the Business Claims Associate: The Business Claims Associate will be a part of the Claims Operations Department and will report to the Claims Operations Supervisor. Responsibilities of the Claims Associate includes the submittal of weekly Provider Reconsideration faxes to multiple health plans and providing follow ups when appropriate. The Claims Associate will also upload faxed confirmations and health plan determination letters to in process tickets and will be expected to monitor Reconsideration queue to identify discrepancies. This role will also include performance of outbound calls and email communications to clients for status updates on tickets submissions to facilitate issue resolution. Additionally, the Claims Associate will evaluate provider issues presented on Provider Support tickets and work with the Senior team and management to determine trends and assist in driving resolution. Additionally, this role will include support of Network Operations. Furthermore, this position will also provide support for Network Operations, which includes the review and research of claims, verification of provider documentation, and the creation of ad-hoc reports This position is eligible for hybrid-remote work and will be required to report to the corporate office in Tampa, Florida for 1-2 days per week. Business Claims Associate Essential Functions and Responsibilities: Submit Provider Reconsideration tickets to multiple Health plans Evaluate disputed claims in Reconsideration process and share findings with Senior staff to determine scope Maintain and update Provider demographic records for network participation. Uploading Health plan determination letters to appropriate Reconsideration tickets Track Provider issues and monitor trends to support their resolution. Update and responds to provider ticket requests within established turnaround times. Provides excellent customer service to providers. Collaborates with other departments to support provider needs. Performs outbound calls to Health Plans to investigate aging reconsideration submissions and claims payment details. Maintenance of various logs Excellent written and verbal communication skills. Research and resolve provider inquiries. Performs other duties as assigned. Storing and maintenance of multiple electronic documents. Ability to multi-task Business Claims Associate Minimum Qualifications: Good customer service and communication skills Attentive to details and organized Intermediate knowledge of Microsoft Office Suite products Excellent interpersonal skills Willingness to learn new skills Experience with using eFax and performing outbound phone calls to clients Business Claims Associate Minimum Qualifications: Associate degree preferred but not required Experience working in the health care industry is preferred but not required Experience with Provider credentialing is preferred but not required

At Swyfft, we're reshaping the way home insurance and commercial package products are priced and bound. We've created an insurance experience that's smart, instant, and designed to deliver unparalleled customer service. Joining Swyfft means becoming part of a dynamic team of forward-thinkers who thrive on moving fast and delivering exceptional products. We pride ourselves on fostering an environment where creativity and positive energy thrive. As we continue to grow and expand, we're on the lookout for experienced professionals like you to join us in transforming the insurance landscape. If you're passionate about leveraging technology to provide the best customer service experience and are ready to be a part of our journey, we welcome you to explore opportunities at Swyfft! About the Position: As a Claims Specialist, Liability & Casualty you will provide a fast and friendly claims experience to Swyfft's policyholders and agents. You will specialize in litigated commercial general liability claims. In this position, you will use your analytical skills to interpret coverage, conduct thorough claim investigations, and make liability determinations. Our ideal candidate is well-versed with industry knowledge, applying legal defenses and immunities, and partnering with legal counsel. *This position is a 100% remote U.S. based opportunity that can be based in one of the following states only: AL, AZ, FL, GA, KY, LA, MA, MO, NC, NJ, NY, OH, OR, PA, SC, TN, TX, UT, VA, WA, WI. Some travel for day-to-day work, team meetings, and training will be required. Key Responsibilities: (What you'll be asked to do) Investigate, analyze, and determine the extent of the insurance company's and policyholders' liability concerning third-party damages and injury with full and final settlement. Ensure that all assigned claims are resolved timely, reserved accurately, and handled fairly. Review litigated complaints for proper handling. Work with multiple attorneys and provide direction related to coverage, liability, and damages. Correspond and communicate with policyholders, agents, experts, and service providers to analyze loss information. Calculate damages payable under the policy and make payments after determining liability on claims. Evaluate and apply the insurance contract as it pertains to claims assigned for resolution. Create and maintain comprehensive claim handling notation in our electronic claims management system and other related applications. The Successful Candidate: (What we're looking for) Ensure that all assigned claims are resolved timely, reserved accurately, and handled fairly and in compliance with company guidelines. You have a skilled technical background and hands-on experience in commercial general liability claims. Proven ability to direct and oversee our defense counsel, in order to establish legal strategies, ensure proper experts are retained, and assist in cost containment. Both internal (your peers) and external clients commend your excellent communication skills and the timeliness of your follow-up skills. You're detail-oriented, organized, and can multi-task like nothing anyone has ever seen before. You're a get the job done, self-starter that thrives in a fast-paced, team-oriented environment. Some Requirements: 10+ years of experience as a casualty/general liability adjuster in the commercial/general liability industry. 5+ years of litigation experience in a multi state environment. You are currently licensed or eligible for licensing as an adjuster in the states of: TX, FL, CA, and NY (we can provide assistance with your licensing fees). Understand basic legal strategies in conjunction with venue limitations. Education: Bachelor's degree or equivalent experience is preferred. High School Diploma or its equivalent (GED) is required. Computer Skills: Must be proficient with MS Office and other internal insurance related programs, systems or applications. (Outlook, Word, PowerPoint, and Excel) Ability to communicate effectively using programs such as Slack & MS Teams. You are comfortable sharing screens and video chatting. Familiarity with claims operating systems (LSS/Symbility). Other: Reliable high-speed internet connectivity required. Designated quiet work from home space. We Have a Great Benefits Package! 20 days of PTO annually Medical, Dental, Vision Short- and Long-Term Disability (Company Paid) Life & AD&D (Company Paid) Healthcare, Dependent Care and Transit FSA 401K with a generous matching contribution and no vesting schedule It is the policy of Swyfft to provide equal employment opportunities to all employees and applicants for employment without regard to race, religion, color, ethnic origin, gender, gender identity, age, marital status, veteran status, sexual orientation, disability, or any other basis prohibited by applicable federal, state, or local law. EOE/AA/M/D/V/F. Please Note: Swyfft is not accepting 3rd party agency resumes for this position, please do not forward resumes to our careers email address or Swyfft employees. Swyfft will not be responsible for any fees related to unsolicited resumes.

***W2 only*** Plastic Card & ATM Representative Work Authorization: USC or GC Holder only Contract: Full time What will your day look like? You will be responsible for all operational aspects of the plastic card portfolio and individual account support. Work involves routine difficulty in resolving issues regarding member accounts. Resources to do the job require reliance on knowledge of credit union policies and procedures. Immediate supervision is received from the Supervisor of Plastic Card Operations. Responsibilities Operations (40%): Responsible for processing exceptions and expedition requests for new and replacement cards (Credit, Debit, & ATM) Process adjustments involving plastic cards Utilize COOP, VISA and Symitar systems to perform: new card setup, ordering, maintenance, and deletions Prepare journal entries as needed and maintain associated reports Work daily report for rejected payments Process card adjustments Assist other departments in the prompt and accurate resolution of member issues/questions Pull card exceptions and settlement adjustments Make appropriate corrections Verify and update address changes on card services platforms Sorts and reviews incoming and returned mail Assist in risk assessments and audits as necessary Projects as assigned by Supervisor/Manager Member Service (40%): Includes timely answering of incoming calls from both internal and external customers related to servicing member accounts Ensures established Service Level Agreements are met and/or exceeded Researches statement requests from members and internal customers. Identifies and researches misapplied payments Responds to basic member and internal customer inquiries via multiple channels; email, telephone and written correspondence Oversees the ordering and delivery of members plastic cards Provides responsive resolutions to all plastic card related issues as they arise Monetary Accounting (20%): Includes the completion, balancing and monetary adjustments as needed/required Introduction to daily settlement and various accounting general ledger reconciliations Operates a variety of office equipment such as fax, copier and personal computer Adhere to and ensure compliance of all business transactions with policy and process of the Bank Secrecy Act and Visa Regulations Ensures compliance with all applicable state and federal laws, company procedures and policies Maintains integrity and ethics in all actions and conversations with or regarding credit union members and their accounts; complies with Privacy Act directives Adhere to and ensure compliance of all business transactions with policy and process of the Bank Secrecy Act. Ensures compliance with all applicable state and federal laws, company procedures and policies. Maintains integrity and ethics in all actions and conversations with or regarding credit union members and their accounts; complies with Privacy Act directives. Qualifications You'll be a great fit if in addition to the completion of a High school Diploma (college degree preferred), and you have 1-2 years experience in customer service and/or credit card operations; or an equivalent combination of training and experience Previous financial institution experience preferred Must have excellent written and verbal communication skills Demonstrated ability to succeed in a fast-paced environment Must be proficient in Microsoft office products including Word and Excel

MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established ourselves as a trusted partner in the industry. We are looking for call center representatives to support our "Get Out the Vote" initiative. In this role, you will make outbound phone calls on behalf of the Republican Party to encourage voter turnout for the presidential election. Ideal candidates will be comfortable representing the Republican Party, have excellent communication skills, be eager to learn, and be highly reliable. To be considered for this role, you must complete a full application on our company careers page, including all screening questions and a brief pre-employment test. -------------- POSITION RESPONSIBILITIES Key Responsibilities: Handle inbound and outbound contacts in a courteous, timely, and professional manner Listen to customers, understand their needs, and resolve customer issues Research systems to find missing information as applicable; coordinate with other departments to resolve issues as applicable Follow the processes of the Client program and perform all tasks in a courteous and professional manner Utilize systems and technology to complete account management tasks Accurately document and process customer claims in appropriate systems Follow all required scripts, policies, and procedures Utilize knowledge base and training to accurately answer customer questions Comply with requirements surrounding confidential information and personal information Appropriately escalate customer issues with the managerial team Escalate customer issues to the appropriate staff and managerial for resolution as needed. Ensure first call resolution through problems solving and effective call handling Attend meetings and training and review all new training material to stay up-to-date on changes to program knowledge, systems, and processes Adhere to all attendance and work schedule requirements STANDARD QUALIFICATIONS WONDER IF YOU ARE A GOOD FIT FOR THIS POSITION? All positive, and driven applicants are encouraged to apply. The Ideal candidates for this position are highly motivated and dedicated and should possess the below qualities: Must be 18 years of age or older High school diploma or equivalent Experience with data-entry utilizing a computer The ability to read and speak English fluently Have a wired, high-speed internet connection (Download speed of 20Mbps+) Excellent organizational, written, and oral communication skills The ability to type swiftly and accurately (20+ words a minute) Ability to work regularly scheduled shifts within our hours of operation including the training period. Basic knowledge of Microsoft Office Suite (Excel, PowerPoint, Word, Outlook) Familiarity with computer and Windows PC applications and the ability to learn new and complex computer system applications Highly reliable with the ability to maintain regular attendance and punctuality The ability to evaluate, troubleshoot, and follow-up on customer issues An aptitude for conflict resolution, problem solving and negotiation Must be customer service oriented (empathetic, responsive, patient, and conscientious) Ability to multi-task, stay focused, and self-manage Strong team orientation and customer focus The ability to thrive in a fast-paced environment where change and ambiguity are prevalent Excellent interpersonal skills and the ability to build relationships with your team and customers Preferred (Not Required) One (1) year of experience in customer service, technical support, inside sales, back-office, chat, or administrative support in a contact center environment Work at home experience State or Federal work experience CONDITIONS All MCI Locations Must be authorized to work in the country where the job is based. Subject to the program and location of the position Must be willing to submit up to a LEVEL II background and/or security investigation with a fingerprint. Job offers are contingent on background/security investigation results. Must be willing to submit to drug screening. Job offers are contingent on drug screening results. PHYSICAL REQUIREMENTS This job operates in a professional office environment. While performing the duties of this job, the employee will be largely sedentary and will be required to sit/stand for long periods while using a computer and telephone headset. The employee will be regularly required to operate a computer and other office equipment, including a phone, copier, and printer. The employee may occasionally be required to move about the office to accomplish tasks; reach in any direction; raise or lower objects, move objects from place to place, hold onto objects, and move or exert force up to forty (40) pounds. COMPENSATION, BENEFITS, INCENTIVES, AND REWARDS WANT AN EMPLOYER THAT VALUES YOUR CONTRIBUTION? At MCI, we believe that your hard work deserves recognition and reward. Our compensation and benefits packages are designed to be competitive and to grow with you over time. Starting compensation is based on experience, and we offer a variety of benefits and incentives to support and reward our team members. What You Can Expect from MCI: We understand the importance of balance and support, which is why we offer a variety of benefits and incentives that go beyond a paycheck. Our team members enjoy: Paid Time Off: Earn PTO and paid holidays to take the time you need. Incentives & Rewards: Participate in daily, weekly, and monthly contests that include cash bonuses and prizes ranging from electronics to dream vacations-and sometimes even cars! Health Benefits: Full-time employees are eligible for comprehensive medical, dental, and vision coverage after 90 days of employment, and all employees have access to MEC medical plans after just 30 days. Benefit options vary by location. Retirement Savings: Secure your future with retirement savings programs, where available. Disability Insurance: Short- and long-term disability coverage is available to help protect you during unexpected challenges. Life Insurance: Access life insurance options to safeguard your loved ones. Career Growth: With a focus on internal promotions, employees enjoy significant advancement opportunities. Paid Training: Learn new skills while earning a paycheck. Fun, Engaging Work Environment: Enjoy a team-oriented culture that fosters collaboration and engagement. Casual Dress Code: Be comfortable while you work. Compensation & Benefits that Fit Your Life MCI takes pride in tailoring our offerings to fit the needs of our diverse team across subsidiaries and locations. While specific benefits and incentives may vary by geography, the core of our commitment remains the same: rewarding effort, providing growth opportunities, and creating an environment where every employee feels valued. If you're ready to join a company that recognizes your contributions and supports your growth, MCI is the place for you. Apply today! DIVERSITY AND EQUALITY At MCI and its subsidiaries, we embrace differences and believe diversity benefits our employees, company, customers, and community. All aspects of employment at MCI are based solely on a person's merit and qualifications. MCI maintains a work environment free from discrimination, where employees are treated with dignity and respect. All employees are responsible for fulfilling MCI's commitment to a diverse and equal-opportunity work environment.

Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. What You'll Do Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. What You'll Need Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass Self-Insurance Test within one (1) year of hire. WCCP preferred. Two (2) years of experience in handling public entity claims is preferred. Effective in verbal and written communication. Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. What's in it For You? To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people: Competitive base salary. Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days. Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options. Company match 401(k) plan - 50% up to 6%! Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers. Opportunity to prioritize your mental health with 24/7 access to licensed therapists. Pet benefits & discounts. Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company. Compensation: The target salary range for this position is $75,000.00 to $105,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but candidate must have California workers' compensation claims experience. Grow, with us Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust. Accretive is passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we're even prouder of the honest, caring relationships that our employees build with our clients every day. Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!

Responsible for overall supervision of a claims department by managing the team, ensuring the client's needs are met, and all claims are being managed in accordance with Keenan's policies and procedures. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. What You'll Do Maintain a high level of high client retention and satisfaction. Review and approve all investigation, subrosa and litigation referrals. Review and approve all settlements over $50,000 and under $100,000. Review and approve all reserve changes over $75,000 and under $200,000. Maintain an active diary on all open claims reserved at or above $75,000. Review and maintain diary on all cumulative traumas, joint coverage, serious & willful, 132a claims and subrogation claims. Review and pre-approve all delays and denials. Review all newly set up indemnity claims for adherence to Best Practices. Conduct internal quarterly audits of all Claims Examiners. Evaluate and recognize office staffing needs. Update staff on labor code/legislation/case law. Update staff on insured/self-insured procedures. Handle the prevention of penalties/maintenance of logs. Provide timely excess claims reporting management to the Reinsurance Manager. Oversee Claims Examiners, Claims Assistants and other designated personnel. Provide a high level of customer service and satisfaction. Provide training, leadership and guidance to the staff. Oversee and attend claims reviews. Handle special projects as assigned. Travel as required. Other duties as assigned. What You'll Need Minimum of five (5) years of experience as a Workers' Compensation Senior Claims Examiner required and two (2) years-experience as a Workers' Compensation Claims Supervisor, preferred. Self-Insurance Certificate (SIP) required. WCCP preferred. Effective self-starter, organizer, and leader requiring minimal supervision. Good verbal and written communication skills. Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. What's in it For You? To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people: Competitive base salary. Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days. Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options. Company match 401(k) plan - 50% up to 6%! Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers. Opportunity to prioritize your mental health with 24/7 access to licensed therapists. Pet benefits & discounts. Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company. Compensation: The target salary range for this position is $95,000.00 to $115,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but must be willing to travel as needed and have California workers' compensation experience. Grow, with us Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust. Accretive is passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we're even prouder of the honest, caring relationships that our employees build with our clients every day. Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!

Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. What You'll Do Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. What You'll Need Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass Self-Insurance Test within one (1) year of hire. WCCP preferred. Two (2) years of experience in handling public entity claims is preferred. Effective in verbal and written communication. Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. What's in it For You? To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people: Competitive base salary. Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days. Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options. Company match 401(k) plan - 50% up to 6%! Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers. Opportunity to prioritize your mental health with 24/7 access to licensed therapists. Pet benefits & discounts. Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company. Compensation: The target salary range for this position is $75,000.00 to $105,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but candidate must have California workers' compensation claims experience. Grow, with us Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust. Accretive is passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we're even prouder of the honest, caring relationships that our employees build with our clients every day. Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!

Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. What You'll Do Maintain current diary. Identify, prevent and mitigate potential penalties. Update claim notes in computer. Provide timely reporting of excess files to the Reinsurance Manager. Report SIU/Fraud. Identify and pursue subrogation. Complete Rehab forms/benefit notices/SJDB/RTW form. Refer all PRIME deletions only to office designee. Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim. Prepare for and attend file reviews. Accept or deny delayed claims within 90 days. Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date. Complete Stipulation and/or Compromise and Release paperwork. Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually. Prepare legal referrals, provide direction to and monitor defense attorney. Return all phone calls within 24 hours. Complete instruction sheets for Assistant/Technician/Claims entry clerk. Review mail daily. Correct error report daily. Maintain client/claimant satisfaction. Update Unit Stat forms. Oversee new set-ups, reserves and instruction sheets. Prepare cover letters to AME/defense QME, AOE/COE evaluations. Negotiate outstanding liens. Make 3-point contact. File Answer/Application. Interaction with nurse on case management. Other duties assigned. What You'll Need Minimum of five (5) years of California Workers' Compensation Claims Examiner experience and a Self-Insurance Certificate, or the ability to pass Self-Insurance Test within one (1) year of hire. WCCP preferred. Two (2) years of experience in handling public entity claims is preferred. Effective in verbal and written communication. Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. What's in it For You? To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people: Competitive base salary. Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days. Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options. Company match 401(k) plan - 50% up to 6%! Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers. Opportunity to prioritize your mental health with 24/7 access to licensed therapists. Pet benefits & discounts. Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company. Compensation: The target salary range for this position is $75,000.00 to $105,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but candidate must have California workers' compensation claims experience. Grow, with us Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust. Accretive is passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we're even prouder of the honest, caring relationships that our employees build with our clients every day. Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!

Responsible for managing complex liability claims, employment & civil rights claims to their conclusion in the most cost-effective way possible for the client. In addition, the Sr. Claims Examiner will be responsible for recognizing claims involving coverage issues and bring to the Claims and Coverage Committees for referral to counsel. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. What You'll Do Review assigned claims within the PLCA guidelines. Prepare appropriate response letter to Government Claims within the required timelines. Assignment of Investigations. Review investigative reports, evaluate damages and make recommendations to clients regarding assigned files. Direct attorneys on litigated files and control defense costs. Prepare timely Reports to Reinsurers. Prepare appropriate write ups for JPA's/ Superpools on a quarterly basis. Monitor/adjust reserves when developments occur. Review files for Subrogation potential and actively pursue subrogation. Review and manage client inquiries. Maintain accurate statistical data in computer. Assist in client file reviews. Attend Court ordered Mediations/MSC's or any meeting required to facilitate settlement. Bill at minimum 80% of the work day. Other duties as assigned. What You'll Need Bachelor's Degree preferred. Minimum of 10 years Property & Casualty liability claims experience required. Public Entity claims handling experience preferred. Good written and verbal communication skills. Must be organized and detail oriented. Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required. Ability to travel as needed. What's in it For You? To help you make the best decision for your personal growth, it's important to us to share a glimpse of what we offer our top asset, our people: Competitive base salary. Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days. Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options. Company match 401(k) plan - 50% up to 6%! Support of your fitness wellness goals! We offer up to 75% off at over 11,000 gyms and fitness centers. Opportunity to prioritize your mental health with 24/7 access to licensed therapists. Pet benefits & discounts. Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company. Compensation: The target salary range for this position is $95,000.00 - $105,000.00 (US Dollar) annually. The actual salary will vary based on applicant's education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant's geographic location. Remote work environment flexibility but must reside in California. Grow, with us Accretive is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust. Accretive is passionate about fueling our clients' innovation and growth. That makes us the perfect place for creative, dynamic people who want to grow their career while helping businesses, families and people thrive. We are proud to be one of the largest brokers in the country, but we're even prouder of the honest, caring relationships that our employees build with our clients every day. Working with us will give you the opportunity to do work that matters while you learn with us, advance with us, and most importantly, grow with us. Accretive is committed to embracing diversity, equity and inclusion to create a workplace that welcomes and thrives on the unique experiences, perspectives and contributions of all team members. Accretive is bringing the best people and most diverse talent forward to drive growth, innovate and think bigger!