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Liability Claims Examiner remote jobs - 492 jobs

  • Workers Comp Claims Oversight Specialist

    Samuel Hale 4.6company rating

    Remote job

    Join Our Dynamic Team as a Workers' Comp Claims Oversight Specialist! Claims Oversight Specialist Job Type: Full-time Exempt Salary: $71,000 - $95,000 Who We Are: EmployInsure LLC delivers Engineered Employment Products designed to eliminate gaps from antiquated practices and enable Frictionless Employment for customers across the employment value chain. Our Mission is to inspire and redefine the relationship between industry and individual by transparently connecting all buyers and sellers of talent to create maximum value . Our diverse team is powered by forward-thinkers, innovators, and rapid problem-solvers. We are committed to making a significant impact to scale the company. We believe in fostering a collaborative and inclusive work environment where every voice is heard and valued. EmployInsure is the parent company of its brands; Samuel Hale and Evoove, in exclusive partnership with the PACT. To learn more about us and our family of companies, check out our websites! Home - Samuel Hale - California Workers' Comp Fraud Savings Evoove | Centralized Staffing Solutions The PACT Life - Welcome to The PACT Our Core Values: Entrepreneurial Spirit: A mindset that involves seeking out change, taking risks, and pursuing new opportunities. Quest for a Deeper Understanding: A true professional never stops getting better at their craft. They practice and measure, and debate over their understanding of the truth, embodying a growth mindset. The Stockdale Paradox: We confront the brutal honesty of our current reality while always maintaining an unwavering faith in our ability to overcome all challenges that get in our way. We have toughness, determination, and passionate belief! Job Description: We seek to hire an experienced Claims Oversight Specialist to join our claims oversight team. The ideal candidate will have experience in California workers' compensation, denying, settling, or authorizing payments to workers' comp claims. In this role, you will be responsible for corresponding with policyholders, claimants, witnesses, attorneys, etc., to gather important information to support contested claims. Investigating claims and compiling reports within the given timeframe after receipt of the first injury report Preparing and delivering claims updates and reviews to internal stakeholders and clients Strategically handle investigations and tactically tackle issues Requesting records as required Notifying the employer of his or her claim determination based on findings Collecting and evaluating claims and authorizing payments Keeping in contact with the injured worker and the medical professionals concerning the status of the injury and plans for treatment Contacting the claimant's employers or doctors for additional information if the claim is questionable Assessing settlement decisions and opportunities Being present at mediations, either by phone or in person Ensuring that injured workers are taken care of appropriately and on time Basic Qualifications: 2+ years of direct workers' comp claims experience 1+ years of California workers' comp experience Good time management skills Adequate knowledge of relevant regulations Skilled customer service skills and attention to detail Demonstrated experience investigating workers' comp claims Excellent customer support Extensive claim review experience Prior claim settlement experience Insurance claims management software experience and technical proficiency We Offer a Best-in-Class Professional Benefits Package to Support our Employees: Comprehensive premium Healthcare Coverage: Medical, dental, and vision plans: Employees 100% covered by the company. Low deductibles for spouse/partner and dependents Generous Paid Time Off: Unlimited paid time off policy and paid holidays Profit Sharing Plan: Share in the success of the company Retirement Savings Plans: 401(k) with 5% company match to help you secure your financial future Lifetime pension plan: Vest into our pension plan for a lifetime income Wellness Support: Access to wellness programs, mental health resources, financial counseling, legal support, and employee assistance programs. Professional Growth Opportunities: Learning resources to help you thrive. Death Benefits: Company-paid to protect you and your loved ones. Flexible Work Options: Hybrid or remote work arrangements (where applicable). Exclusive Perks: Employee discounts, commuter benefits, and more. Join us and experience a benefits package designed to empower your well-being, career growth, and personal goals! Samuel Hale is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. Samuel Hale is an E-Verify company. For more information, please review our Participation and Your Right to Work. California Privacy Notice for Job Applicants If you are a California resident, we collect and use the personal information you provide in your application for recruiting, hiring, and compliance purposes in accordance with the CCPA/CPRA. We do not sell or share applicant personal information as those terms are defined by law. For details about what we collect, how we use it, and your privacy rights, please review our California Applicant & Employee Privacy Notice at ********************************* or contact us at ****************************.
    $71k-95k yearly 4d ago
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  • Commercial Property Claims Examiner

    CWA Recruiting

    Remote job

    Commercial Property Claims Examiner - Property & Casualty Insurance Remote but must be in NYC About the Role Handle commercial property claims by investigating losses; managing and controlling independent adjusters and experts; interpreting the policy to make proper coverage determinations; addressing reserves; writing coverage letter and reports; and providing good customer service. Assure timely reserving and handling of a claim from assignment to completion by investigating that claim and interpreting coverage. Manage independent adjusters and experts. Inside desk adjusting role - 100% Remote for now - NYC based. Responsibilities Investigate losses Manage and control independent adjusters and experts Interpret the policy to make proper coverage determinations Address reserves Write coverage letters and reports Provide good customer service Assure timely reserving and handling of a claim from assignment to completion Manage independent adjusters and experts Qualifications Bachelor's degree is required Required Skills 3-5 years of first party property claims handling is required Experience with Microsoft Office 365 is required Preferred Skills Experience with ImageRight is a plus Availability to work extended hours in a CAT situation
    $35k-65k yearly est. 3d ago
  • Workers Compensation Indemnity Adjuster

    Optech 4.6company rating

    Remote job

    Why work with the OpTech family of companies? We are woman-owned, value your ideas, encourage your growth, and always have your back! When you work with us, you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! Job Title: Workers' Compensation Indemnity Specialist Terms: Direct Hire, FTE Role (Salaried + Benefits + Bonus) We are seeking an experienced Indemnity Claims Specialist to manage a complex workers' compensation desk with a strong emphasis on Kentucky, Indiana, Illinois, and Michigan lost-time and litigated claims. This role handles primarily indemnity and complex files, with limited medical-only exposure, and requires collaboration with internal leadership and external stakeholders to ensure high-quality, compliant claim outcomes. RESPONSIBILITIES: Manage a caseload of approximately 135 open indemnity and complex workers' compensation claims, including lost-time files Handle a desk that is at least 50% litigated, working closely with defense attorneys Demonstrate strong working knowledge of Kentucky & Indiana Workers' Compensation regulations and practices Apply Michigan and Illinois jurisdictional knowledge as required by assigned files Investigate claims, determine compensability, establish reserves, and manage ongoing exposure Coordinate medical care, wage loss benefits, and return-to-work efforts Communicate effectively with all stakeholders, including attorneys, injured workers, employers, carriers, and medical providers Utilize claims management systems to document activity, manage workflows, and meet service expectations Adhere to quality standards, production benchmarks, and client service level agreements (SLAs) Participate in internal reviews, audits, and performance evaluations Performance Measures Compliance with quality and accuracy standards Meeting production expectations for claim handling and resolution Adherence to client service level agreements (SLAs) Stakeholders External: Defense attorneys, injured workers, employers, clients, carriers, medical providers Internal: Supervisor, Manager, Account Manager QUALIFICATIONS: Experience & Knowledge 2-3 years of workers' compensation claims experience, with a strong focus on indemnity and lost-time claims Extensive Kentucky and Indiana workers' compensation experience required Illinois claims experience required Michigan experience preferred and may be eligible for additional consideration Prior experience handling litigated claims is required Licenses & Education Michigan, Indiana, and Kentucky Adjuster's License required Reciprocal licenses (Florida or Texas) accepted Illinois Experienced Examiner Certification Bachelor's degree or equivalent relevant work experience Technical Skills Proficiency in Microsoft Office (Teams, Outlook/Email, Word) Experience using CareMC claims system preferred (not required) Strong documentation, organization, and time-management skills OpTech/GTech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
    $50k-66k yearly est. 3d ago
  • Commercial Auto & General Liability Claims Examiner III

    Tristar Insurance 4.0company rating

    Remote job

    Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Must work EST core hours. Must pass the NYS Adjuster license exam within 60 days of hire. Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client. DUTIES AND RESPONSIBILITIES: Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto, Auto Med Pay, and/or General Liability Casualty Claims. Oversee and direct outside investigative service providers and work closely with the client and client counsel, and investigative services to advance the claim to conclusion. Maintain an ongoing diary. Continually assess exposure and evaluate for accurate reserves and settlement recommendations. Prepare Loss Reports providing a thorough analysis of coverage, liability, and damages. Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client. Document all correspondence, reports, discussions, and decisions in the claim file record. Provide outstanding service to the client. Position is remote/working from home. Qualifications QUALIFICATIONS REQUIRED: Education/Experience: High School Diploma or GED required; bachelor's degree in related field (preferred) and two years auto and general liability casualty and or No Fault/PIP related experience; or equivalent combination of advanced education and experience. Special Requirements: At least two years of Automobile and General Liability claims experience required. Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge. Demonstrated verbal and written communications skills. Demonstrated advanced analytical, decision-making and negotiation skills. Computer proficiency. Preferred Skills: Ability to communicate effectively and clearly, both orally and in writing. Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers. Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision. Excellent customer service skills. An understanding of the litigation process and case valuation in multiple jurisdictions. Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense. An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision. Time management skills, organizational skills, and ability to prioritize issues and tasks. Ability to effectively operate computer equipment and applications. Independence, flexibility, and creativity. Other Qualifications: Candidate must have adjuster licenses and be willing to obtain the NY license if they do not already have one. Candidate must be willing to work Pacific Time core hours. Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes
    $50k-76k yearly est. 18d ago
  • Sr DI Claims Examiner

    Ameritas 4.7company rating

    Remote job

    is remote (within the U.S.A.) and does not require regular in-office presence. What you do: Evaluates and authorizes disposition of complex claims. Obtains and analyzes medical records and financial documents. Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews. Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer. Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments. Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates. Assists with recoveries from reinsurance carriers. Performs all claims processing support functions. What you bring: Bachelor's degree or equivalent experience is required. 1-3 years of related experience is required. What we offer: A meaningful mission. Great benefits. A vibrant culture Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life. At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't: Ameritas Benefits For your money: • 401(k) Retirement Plan with company match and quarterly contribution. • Tuition Reimbursement and Assistance. • Incentive Program Bonuses. • Competitive Pay. For your time: • Flexible Hybrid work. • Thrive Days - Personal time off. • Paid time off (PTO). For your health and well-being: • Health Benefits: Medical, Dental, Vision. • Health Savings Account (HSA) with employer contribution. • Well-being programs with financial rewards. • Employee assistance program (EAP). For your professional growth: • Professional development programs. • Leadership development programs. • Employee resource groups. • StrengthsFinder Program. For your community: • Matching donations program. • Paid volunteer time- 8 hours per month. For your family: • Generous paid maternity leave and paternity leave. • Fertility, surrogacy, and adoption assistance. • Backup child, elder and pet care support. An Equal Opportunity Employer Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law. Application Deadline This position will be open for a minimum of 3 business days or until filled. This position is not open to individuals who are temporarily authorized to work in the U.S.
    $65k-97k yearly est. 1d ago
  • Claims Examiner, Liability - MSI

    The Baldwin Group 3.9company rating

    Remote job

    Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Claims Examiner. The Claims Examiner will be managing insurance claims for our policyholders with low to moderate severity and complexity. The Claims Examiner must have the experience and technical knowledge needed to manage a case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party bodily injury and property damage claims involving low to moderate complexity from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 5+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with willingness to expand licenses as needed. #LI-BM1 #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
    $42k-67k yearly est. Auto-Apply 7d ago
  • Senior Claims Examiner (remote)

    Switch'd

    Remote job

    *5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
    $80k-94k yearly 60d+ ago
  • PART TIME Remote Claims Adjuster - Bilingual (Spanish)

    Responsive Auto Insurance Company

    Remote job

    Department: Claims Schedule: Monday to Friday; 4-6 hours daily Salary: Commensurate based on experience and qualifications About Responsive Founded in 2007 and headquartered in Plantation, Florida, Responsive is a leading provider of personal auto insurance in Florida. We collaborate with thousands of agents from the most respected insurance agencies to deliver world-class service and claims experiences. Responsive stands for making auto insurance simple, affordable, and hassle-free; a promise we deliver through innovation, feedback, and a commitment to excellence. What You'll Do As a Claims Adjuster, you'll guide customers through the claims process with empathy and expertise. From investigating coverage to resolving disputes, you'll handle claims from start to finish while maintaining strong relationships with customers and stakeholders. Responsibilities include: Investigating, evaluating, and resolving insurance claims. Reviewing policies to verify coverage and address coverage issues. Managing customer interactions with professionalism and accuracy. Responding to demands, requests, and questions with clear, well-documented communication. Collaborating with attorneys, medical providers, and other stakeholders. Maintaining detailed and timely records. Ensuring compliance with federal, state, and company regulations. Other duties as assigned Requirements What We're Looking For Education: Bachelor's degree. Licensing: Active Florida 6-20 All Lines Adjuster License. Language Skills: Fluent in Spanish and English (written and verbal proficiency required). Skills: Strong analytical, problem-solving, and communication skills. Proficiency in Microsoft Office. Experience: Customer-focused with experience in high-volume environments that require time management and attention to detail. Minimum of 2 years of experience as an auto property damage claims adjuster Mindset: Self-motivated, team-oriented, and adaptable. Our Culture Responsive is a dynamic, inclusive workplace where integrity, innovation, and collaboration thrive. We foster an environment where employees are encouraged to: Adapt: Embrace change and continuously improve. Collaborate: Work transparently and respectfully with others. Engage: Show curiosity and a commitment to serving customers and teammates. Be Data-Driven: Leverage insights to drive decisions and improvements. Responsive provides equal employment opportunities (EEO) to all employees and applicants, fostering a diverse and inclusive workplace. #claimsadjuster
    $43k-53k yearly est. 60d+ ago
  • Sr. Disability & Leave Management (Group Insurance) Claims Examiner (REMOTE)

    EQH

    Remote job

    About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required. What You'll Be Doing · Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved · Communication via telephone, email, and text with employees, employers, attorneys, and others · Review and interpret medical records, utilizing resources as appropriate · Complete financial calculations · Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication · Apply contract/policy provisions to ensure accurate eligibility and liability decisions · Demonstrate and apply analytical and critical thinking skills · Verify on-going liability and develop strategies for return-to-work opportunities as appropriate · Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication · Leverage a broad spectrum of resources, materials, and tools to render claims decisions · Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards · Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities · Work independently as well as within a team structure · Deliver refresher trainings as appropriate to the claim team · Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review. · Prepare reports for management on claim outcomes and performance metrics. · Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. · Oversee the ongoing management of complex, high-priority or escalated cases and callers. Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs. The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits\: Equitable Total Rewards Program What You Will Bring · Bachelor's degree or equivalent work experience · 3+ disability claims administration experience · Prior leadership experience as a team lead or manager · Exceptional customer service skills · Maintains positive and effective interaction with challenging customers · Strong knowledge of disability and leave laws and regulations · Ability to handle sensitive information with confidentiality and professionalism · Group Disability Claims experience · Prior experience managing Paid Family Leave for multiple state Preferred Qualifications · Experience working with the Fineos Claim Management System · Exceptional written and oral communication skills demonstrated in previous work experience · Excellent organizational and time management skills with ability to multitask and prioritize deadlines · Ability to manage multiple and changing priorities · Detail oriented; able to analyze and research contract information · Demonstrated ability to operate with a sense of urgency · Experience in effectively meeting/ exceeding individual professional expectations and team goals · Demonstrated analytical and math skills · Ability to exercise critical thinking skills, risk management skills and sound judgment · Ability to adapt, problem solve quickly and communicate effective solutions · High level of flexibility to adapt to the changing needs of the organization · Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment · Continuous improvement mindset · A commitment to support a work environment that fosters diversity and inclusion. · Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word Skills Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. About Equitable At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more. ********** Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE\: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
    $60k-65k yearly Auto-Apply 60d+ ago
  • Sr. Disability & Leave Management (Group Insurance) Claims Examiner (REMOTE)

    AXA Equitable Holdings, Inc.

    Remote job

    About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required. What You'll Be Doing * Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved * Communication via telephone, email, and text with employees, employers, attorneys, and others * Review and interpret medical records, utilizing resources as appropriate * Complete financial calculations * Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication * Apply contract/policy provisions to ensure accurate eligibility and liability decisions * Demonstrate and apply analytical and critical thinking skills * Verify on-going liability and develop strategies for return-to-work opportunities as appropriate * Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication * Leverage a broad spectrum of resources, materials, and tools to render claims decisions * Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards * Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities * Work independently as well as within a team structure * Deliver refresher trainings as appropriate to the claim team * Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review. * Prepare reports for management on claim outcomes and performance metrics. * Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. * Oversee the ongoing management of complex, high-priority or escalated cases and callers. Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs. The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program What You Will Bring * Bachelor's degree or equivalent work experience * 3 disability claims administration experience * Prior leadership experience as a team lead or manager * Exceptional customer service skills * Maintains positive and effective interaction with challenging customers * Strong knowledge of disability and leave laws and regulations * Ability to handle sensitive information with confidentiality and professionalism * Group Disability Claims experience * Prior experience managing Paid Family Leave for multiple state Preferred Qualifications * Experience working with the Fineos Claim Management System * Exceptional written and oral communication skills demonstrated in previous work experience * Excellent organizational and time management skills with ability to multitask and prioritize deadlines * Ability to manage multiple and changing priorities * Detail oriented; able to analyze and research contract information * Demonstrated ability to operate with a sense of urgency * Experience in effectively meeting/ exceeding individual professional expectations and team goals * Demonstrated analytical and math skills * Ability to exercise critical thinking skills, risk management skills and sound judgment * Ability to adapt, problem solve quickly and communicate effective solutions * High level of flexibility to adapt to the changing needs of the organization * Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment * Continuous improvement mindset * A commitment to support a work environment that fosters diversity and inclusion. * Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word Skills Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. About Equitable At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more. Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
    $60k-65k yearly 60d+ ago
  • Claims Adjuster II | Midwest

    EIG Services

    Remote job

    Claims Adjuster II (Workers' Compensation)- Midwest | 100% Remote Opportunity The Work comp Claims Adjuster II is responsible for timely and accurate management of workers' compensation claims with moderate medical and indemnity benefit exposure, including litigation. Essential Duties and Responsibilities Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability and develop of plan of action. Completes and maintains accurate claim system data as it pertains to work comp insurance claims. Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers. Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed. Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure. Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement and works within authority to resolve claims. Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Other duties as assigned. Requirements 2 - 5 years' work comp claims adjusting or insurance experience. 3 years experience managing work comp claims at a high level (compensability and claim reopening investigation skills, accurate benefit calculation and delivery, accurate claim reserving, proactive medical management, litigation avoidance and negotiation skills) Ability and willingness to manage additional jurisdictions as needed. Excellent communication and customer service skills and knowledge of an imaged environment. Demonstrated knowledge of workers' compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. Self-motivated with excellent analytical, problem solving and decision-making skills. Strong ability to multi-task and prioritize. High school diploma or equivalent required. Equivalent combinations of education and experience may be considered. Certification If state certification or license is required, must meet requirements and obtain certification within state mandated timeframe and maintain any required license through continuing education. WCCP, AIC, ARM, CPCU or other insurance certification preferred. Education Bachelor's degree or equivalent business experience preferred. Work Environment Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace. Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $50,000-$75,000 and a strong comprehensive benefits package, don't forget to follow the link to our benefits page for details, too many benefits to list! EMPLOYERS Benefits and Perks About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote Click our link to learn more! About EMPLOYERS
    $50k-75k yearly 5d ago
  • (Remote) Senior Claims Examiner

    Efinancial 4.7company rating

    Remote job

    Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards. In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused. About Fidelity Life & eFinancial Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued. In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences. Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth. Job Summary The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: * Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. * Review newly reported claims and log them on the pending claims log. * Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. * Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. * Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. * On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. * Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. * Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. * Handle and log specific State and NAIC policy locator searches. * Mentor and support third-party claims administration staff. * Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. * Work on special projects and other duties as assigned by the Claims Manager. * Perform quarterly claim audits focusing on third-party claim handling. * Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. * Handle Department of Insurance claim complaints or requests in a timely and professional manner. * Stay current on all laws, regulations, and industry updates that impact claim handling and compliance * Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. * Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights * Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact * Support M&A activity, if applicable Qualifications: * 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: * Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. * Ability to meet deadlines while performing multiple functions. * Proficient in MS Office applications and the Internet. * Ability to proactively analyze and resolve problems. * Attention to detail. * Flexibility and willingness to adapt to changing responsibilities. * Excellent written communication, interpersonal and verbal skills. * Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. * Proactive and outside-the-box thinker. * Independent and organized work style. * Ability to maintain strong performance while working remotely and independently, if applicable. * Strong judgment and discretion when handling highly confidential business, employee, and customer information. * Team player and creative, critical thinker highly desired. Licenses + Certifications: * Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. * Legal or Paralegal Certifications optional but useful Essential Functions: * This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. * Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. * Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. * Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. * When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. * Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Our Culture We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: * Salary Range: $70,720 - $91,520 * Medical Insurance: Choose from a variety of plans to fit your healthcare needs. * Dental Insurance: Coverage for preventive, basic, and major dental services. * Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. * Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. * Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. * 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. * PTO and Sick Time accrue each pay period: Take time off when you need it * Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
    $70.7k-91.5k yearly 51d ago
  • (Remote) Senior Claims Examiner

    Your Journey Starts Here

    Remote job

    Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards. In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused. About Fidelity Life & eFinancial Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued. In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences. Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth. Job Summary The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. Review newly reported claims and log them on the pending claims log. Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. Handle and log specific State and NAIC policy locator searches. Mentor and support third-party claims administration staff. Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. Work on special projects and other duties as assigned by the Claims Manager. Perform quarterly claim audits focusing on third-party claim handling. Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. Handle Department of Insurance claim complaints or requests in a timely and professional manner. Stay current on all laws, regulations, and industry updates that impact claim handling and compliance Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact Support M&A activity, if applicable Qualifications: 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. Ability to meet deadlines while performing multiple functions. Proficient in MS Office applications and the Internet. Ability to proactively analyze and resolve problems. Attention to detail. Flexibility and willingness to adapt to changing responsibilities. Excellent written communication, interpersonal and verbal skills. Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. Proactive and outside-the-box thinker. Independent and organized work style. Ability to maintain strong performance while working remotely and independently, if applicable. Strong judgment and discretion when handling highly confidential business, employee, and customer information. Team player and creative, critical thinker highly desired. Licenses + Certifications: Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. Legal or Paralegal Certifications optional but useful Essential Functions: This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Our Culture We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: Salary Range: $70,720 - $91,520 Medical Insurance: Choose from a variety of plans to fit your healthcare needs. Dental Insurance: Coverage for preventive, basic, and major dental services. Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. PTO and Sick Time accrue each pay period: Take time off when you need it Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
    $70.7k-91.5k yearly 50d ago
  • Claims Manager - Professional Liability

    Counterpart International 4.3company rating

    Remote job

    Claims Manager (Professional Liability) Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk . As a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider for our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share. YOU WILL Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes. Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you. Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution. Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters). Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards. Support our data collection efforts and models by effectively using our Agentic Claim Experience (ACE) system to fully and accurately capture critical details about each claim assigned to you. Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments. Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems. Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision. YOU HAVE At least 10 years of professional experience, with at least 5 years of experience litigating or managing professional liability claims. Previous carrier experience is a plus. Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred. Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire. Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed. High level of personal initiative and leadership skills. Exceptional time management, problem solving and organizational skills. Comfort and skill operating in a paperless claims environment. Familiarity with Google Workplace is preferred, but not required. Willingness to quickly adapt to change and use creative thinking and data-driven insights to overcome obstacles to resolution. Strong communication skills, both verbal and written. Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%). WHO YOU WILL WORK WITH Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group. Jaclyn Vogt, Senior Claims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College. Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims. WHAT WE OFFER Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan. Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members. 401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement. Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay. Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it. Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year. Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories. Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.) Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests. Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise. No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones. Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart. COUNTERPART'S VALUES Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others. Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met. Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal. Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected. Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there. Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life. Our estimated pay range for this role is $150,000 to $180,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience. We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives. We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.
    $150k-180k yearly Auto-Apply 60d+ ago
  • Claims Adjuster Trainee

    TWAY Trustway Services

    Remote job

    Our Company: At AssuranceAmerica, we are more than a unique blend of insurance assets. We believe in creating a culture where every associate can learn and grow. We strive to create a work environment to meet associate needs and we are determined to achieve excellence in everything we do. This is an opportunity to join a dynamic team in a company that is a leader in the minimum limits auto insurance space and functions with a small company, entrepreneurial style. This position will require someone with an understanding that one needs to have a “roll up your sleeves” attitude to help make things happen. Job Summary: The Claims Adjuster Trainee will complete a series of Self-Study courses, classroom training and On The Job training to prepare for promotion to Adjuster Level 1 position. In addition, the Claims Adjuster Trainee will complete the necessary pre-requisite course work required to take and pass the Georgia Resident Adjuster Property and Casualty examination. The Claims Adjuster Trainee is responsible for investigating, reserving, negotiating and settling assigned property and casualty claims within provided authority. Ensures that all assigned claims are resolved timely and fairly in accordance with the policy contract based on the damages presented. The Claims Adjuster Trainee will work with minimal authority under direct supervision. Job Responsibilities: • Complete required training courses with a successful score • Obtain State of Georgia Resident Adjuster Property and Casualty license and maintain license through completion of state mandated Continuing Education. • Provide quality service to all parties involved in assigned claims. • Conduct thorough investigations into coverage, liability and damages for assigned claim in accordance with Claims Best Practices. Qualifications: Required • Bachelor's degree • Ability to pass State of Georgia Resident Adjuster Property and Casualty licensing exam. Preferred • Bilingual (Spanish) Core Competencies: • Attention to detail and ability to multi-task. • Excellent verbal and written communication skills. • A high degree of motivation and team orientation. • Strong computer skills. • Desire to develop new skills and grow in career. Our Values: We are direct, results driven, and dedicated to the success of the business and each other. In addition, we operate against these five key values, reflected in how we work with each other every day: • Honor: We do what is right, even when no one is looking. We play by the rules; integrity is of utmost importance. • Discipline: We are most efficient and resourceful in how we work… striving to be better than our competition. • Common Sense: We are relentlessly logical. We value an approach to our business that acknowledges the obvious and errs on the side of simplicity. • Financial Strength: Fundamental to our prosperity is an ever-vigilant focus on rigorous financial discipline. These practices enable us to navigate through all business cycles. • Dedication: We demonstrate a deep-seated respect for our Associates and customers. We listen and respond as best we can - for without them, our business would not exist. This indicates the essential responsibilities of the job. The duties described are not to be interpreted as being all-inclusive to any specific associate. Management reserves the right to add to, modify, or change the work assignments of the position as business needs dictate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. This job description does not represent a contract of employment. Employment with AssuranceAmerica is at-will. The at-will relationship can be terminated at any time , with or without reason or notice by either the employer or the associate. AssuranceAmerica is an Equal Opportunity Employer
    $45k-57k yearly est. Auto-Apply 24d ago
  • Claims Adjuster

    Fetch Pet Insurance

    Remote job

    Fetch Pet Insurance, a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and health advice. Put simply, Fetch makes vet bills affordable. We offer a comprehensive product that does not have any restrictions based on breed, age, or size. We are believers in helping pets get through their bad days but also focus on extending the good days. How do we do that? - through a wide portfolio of products + offerings, which include Fetch Health Forecast, our pet health and lifestyle blog, The Dig, and our partnerships with Project Street Vet and animal no-kill shelters across North America. Our business is growing and we are looking for compassionate professionals that want to join a team that works hard and celebrates success! You will have an opportunity to hone your skills and develop new skills as you learn the ins-and-outs of Fetch pet insurance and support our pet parents. Your success is our success! RESPONSIBILITIES. Adjudicate assigned claims in accordance with the Terms & Conditions of the individual pet's policy Review medical records, lab results, invoices, and claims forms for complete and thorough assessment Process claims determinations to include assessment and payment for submitted claims Verify claims coverage through in-depth knowledge of policy Terms & Conditions Consult with treating veterinary practices regarding medical records evaluation and necessary documentation Maintain an average quality assurance score above department minimums Complete assigned tasks within compliance deadlines Maintain an average productivity rate above department minimums Provide feedback on process opportunities to further strengthen SOPs REQUIRED SKILLS. Comprehensive understanding of disease processes and veterinary medical terminology Ability to read and interpret veterinary medical records and invoices Ability to identify chronic and acute medical conditions Adapt quickly in a fast-paced, ever-changing environment and operate multiple computer systems simultaneously Work independently in a remote capacity, while also fostering teamwork and collaborating with others Superior communication skills for collaboration with team members and support from managers Demonstrated problem solving skills and ability to work through complex medical/vet-related scenarios affecting a pet's diagnosis and/or treatment plan QUALIFICATIONS. Minimum of five years experience as a veterinary technician Bachelor's degree in veterinary science OR CVT or equivalent preferred Property and Casualty Adjuster license in good standing preferred Complete and pass state adjuster licensing Be reliable with good attendance Able to work a minimum of 42 hours per week, with occasional weekends and extra hours as needed WORK-FROM-HOME SET-UP. Subscription to reliable high-speed internet connection (minimum of 100 Mbps download and 30 Mbps upload speed) A quiet, dedicated place to work in your home that is not easily disrupted by background noises or distractions Office workspace must be large enough to accommodate two 19” dual monitors, laptop, mouse, keyboard, and headset Ability to set up and connect (with instructions and remote IT team assistance) equipment that is shipped to your home -ABOUT FETCH- Fetch is a high-growth, Warburg-Pincus portfolio company. We are a passionate group of 200+ employees and partners across the U.S. and Canada dedicated to helping pets live their best lives. We have two offices (New York City, NY, and Winnipeg, Canada), and we currently provide security to over 360,000 pet parents. We don't just accept differences - we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. We are proud to be an equal opportunity employer. We recruit, hire, pay, grow and promote no matter of gender, race, color, sexual orientation, religion, age, protected veteran status, physical and mental abilities, or any other identities protected by law.
    $51k-66k yearly est. 60d+ ago
  • Auto Insurance Claims Adjuster - Work from Home!

    Claims Management Resources 4.1company rating

    Remote job

    Lucrative Compensation Plan! Base of $15 per hour to start, PLUS monthly bonuses! Do you thrive in a competitive environment? Would you describe yourself as a go-getter? Determine how much you can make while investigating and resolving claims. Get your career started, no college degree required! Who We Are We are in the business of subrogation - companies trust us to recover payments on damage claims so that the party responsible is the one paying for the damage that was caused. We strive to provide excellent customer service to both our customers and the other parties involved in a claim. In short, we help our customers focus on theirs. Our business is driven by our Core Four principles : Process, Results, Culture, and Experience. Our dedication to practicing these has enabled our current and future success . We're passionate about throwing company events that bring us together and celebrate each other's achievements. We're also big on taking time out to give back to the community and host several volunteer events throughout the year. We believe in a healthy work-life balance. Join our team and thrive in an environment that values both efficiency and effective processes as well as a casual, comfortable atmosphere. Who We're Looking For We are looking for someone comfortable working from home who can positively interact with homeowners, business owners, contractors, insurance companies, and utility company field technicians over the phone. We need a “get it done”, high-energy, professional approach to recover claims effectively. The Insurance Claims Adjuster is responsible for recovering payments for damage claims involving motor vehicles in remote, work-from-home environment. The claims adjuster interacts with homeowners, business owners, contractors, insurance companies, and utility company field technicians. You'll have the support of a collaborative team and ongoing coaching from leaders. We'll also teach you the insurance stuff - providing in-depth training on property damage and establishing liability so you can confidently and independently recover claims. Be The Captain of Your Own Destiny Determine how much money you want to make by earning bonuses based on the level of fees you recover. Earn between $1,000 and $5,500 in bonuses! Bonuses are paid out each month. Bonuses: $65,000 total fees = $1,000 $75,000 total fees = $1,200 $85,000 total fees = $1,400 $95,000 total fees = $1,800 $100,000 total fees = $2,000 $115,000 total fees = $2,500 $125,000 total fees = $3,500 $140,000 total fees = $4,000 $150,000 total fees = $5,000 Base Pay: First 30 days: $15.00/hour 30 - 60 days: $13.00/hour 60 days and beyond: $11.54/hour Stuff You Should Know Department hours are 7am - 4pm, Monday thru Friday This position is fully remote On a Typical Day, You'll Investigate claims issues and provide information to damagers and utility company field technicians Negotiate settlements with damagers and insurance companies as applicable Review claim information and request/research additional reference material to complete the claim record File subrogation packages with insurance companies Dispute resolution and response to damager objections Enter data into customized claims systems Tracks fees, closed and open claims, and other claims information Qualifications Teamwork Makes the Dream Work Your success is our success. We stress the group's success because we are all working towards a common goal - resolving as many claims as possible to benefit both ourselves and our customers. With lots of room for career advancement and growth, we are always looking to move our employees up to bigger roles within the company. Requirements Insurance Adjuster License (must obtain license within 4 months of moving into position) Excellent computer skills, must be familiar with using Outlook, Teams, Word and Excel Negotiating skills experience Excellent verbal and written communication skills Excellent attendance record High School Diploma or equivalent Must have a high-speed internet connection available in your home Bilingual in English and Spanish a plus! Okay, But What Are the Perks Obtain your adjuster's license on our dime, including: 3-day prep class Time off to take the test Career growth and learning opportunities Tiered bonus system based on team accomplishments Full menu of benefits including a matched 401k Consistent scheduling including nights and weekends off Paid time off as well as paid holidays CMR pays $50/month towards your internet service costs Christmas bonus CMR is a 2024 The Oklahoman Top Workplaces winner! Pre-employment drug screenings and criminal background checks are mandatory CMR is an Equal Opportunity Employer
    $45k-54k yearly est. 18d ago
  • Remote - Claims Adjuster - Automotive

    Reynolds and Reynolds Company 4.3company rating

    Remote job

    ":"* This is a full-time, remote position working from 9:45am to 6:15pm CST American Guardian Warranty Services, Inc. (AGWS), an affiliate of Reynolds and Reynolds, is seeking Claims Adjuster - Automotive for our growing team. In this role you will work remotely and be responsible for investigating, evaluating and negotiating minor to complex vehicle repair costs to accurately determine coverage and liability. You will take inbound calls to determine coverage based on contracts in order to appropriately resolve customer issues. Responsibilities will include, but are not limited to: -\tAnswering inbound calls -\tProvide information about claim processing and explain the different levels of contract coverage and terms -\tAccurately establish, review and authorize claims -\tEntering claim and contract information into the AGWS' system A home office package will be provided for this position. This includes two computer monitors, a laptop, keyboard and mouse. ","job_category":"Customer Service","job_state":"AZ","job_title":"Remote - Claims Adjuster - Automotive","date":"2026-01-18","zip":"85001","position_type":"Full-Time","salary_max":"55,000. 00","salary_min":"50,000. 00","requirements":"2+ years of experience as an automotive mechanic within a service department, dealership, or independent shop~^~2+ years of experience adjusting automobile mechanical claims~^~ASE certification is a plus~^~Must have a quiet designated work space to work from home~^~Must have reliable internet with at least a download speed of 50mbps~^~Must be able to work effectively under pressure in a fast paced environment~^~Strong communication skills~^~Strong organizational and multi-tasking skills~^~High school diploma","training":"On the job","benefits":"We strive to offer an environment that provides our associates with the right balance between work and family. We offer a comprehensive benefits package including: - Medical, dental, vision, life insurance, and a health savings account - 401(k) with up to 6% matching - Professional development and training - Promotion from within - Paid vacation and sick days - Eight paid holidays - Referral bonuses Reynolds and Reynolds promotes a healthy lifestyle by providing a non-smoking environment. Reynolds and Reynolds is an equal opportunity employer. ","
    $36k-43k yearly est. 7d ago
  • Senior Workers' Compensation Claim Representative

    Travelers Insurance Company 4.4company rating

    Remote job

    **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $70,400.00 - $116,200.00 **Target Openings** 1 **What Is the Opportunity?** This role is eligible for a sign-on bonus. This position is hybrid and will have the option to work from home up to 2 days per week. This position will office out of the Diamond Bar or Irvine locations. Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered. **What Will You Do?** + Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability. + Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions. + Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. + Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). + Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome + Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. + Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation. + Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment. + Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations. + Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals + Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status + Act as technical resource to others. + Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed. + Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers' Compensation claims. + Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims + Acts as an independent mentor to other Claim Professionals + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + Maintain Continuing Education requirements as required. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Education/Course of Study: Work Experience: + Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. + Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. + Ability to effectively present file resolution to internal and/or external stakeholders. + Negotiation: Advanced evaluation, negotiation and case resolution skills. + Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. + General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract. + Principles of Investigation: Intermediate investigative skills including the ability to take statements. + Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss. + Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. + Settlement Techniques: Advanced ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package. + Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. + Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed. + WC Technical: + Advanced ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. + Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. + Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. + Customer Service: + Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. + Teamwork: + Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. + Planning & Organizing: + Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. **What is a Must Have?** + High school diploma or equivalent. + 2 years Workers Compensation claim handling experience. **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .
    $70.4k-116.2k yearly 12d ago
  • Sr. Commercial Trucking Litigation Claims Examiner | Remote

    King's Insurance Staffing 3.4company rating

    Remote job

    Our client is seeking to add a Senior Commercial Auto Litigation Claims Examiner to their team. This individual will be responsible for overseeing complex commercial auto claims, with a strong focus on litigated matters and severe casualty exposures. The role requires managing the claim process from initial intake through final resolution, including evaluating coverage, directing litigation strategy, and negotiating settlements across multiple jurisdictions. This position offers the ability to work fully remote. Key Responsibilities: Investigate, evaluate, and resolve litigated Commercial Auto claims from inception through closure. Analyze liability, damages, and legal exposure to determine appropriate resolution strategies. Establish timely and appropriate reserves based on investigation and litigation progression. Partner with defense counsel, insureds, and other experts to effectively manage claims and litigation costs. Conduct coverage analysis and issue detailed coverage position letters when necessary. Prepare reports and updates for senior leadership, clients, and other stakeholders. Maintain consistent communication with policyholders, attorneys, and internal teams throughout the claim lifecycle. Ensure timely file documentation in compliance with company, client, and regulatory standards. Negotiate settlements in line with company/client authority and jurisdictional requirements. Stay current on evolving laws, regulations, and litigation trends impacting commercial auto liability. Requirements: 10+ years of Commercial Auto / Trucking Bodily Injury Litigation claims handling experience. Must have 4+ years of Commercial Trucking experience. Strong knowledge in MCS 90 is strongly desired. Active Adjuster's License required. Proven experience managing litigated claims and working directly with defense counsel. Strong negotiation, litigation management, and analytical skills. Excellent written and verbal communication skills, including drafting detailed coverage letters and litigation reports. Highly organized, self-motivated, and able to independently manage a remote workload. Proficient in Microsoft Office and claims management systems. Salary & Benefits: $90,000 - $120,000+ annually (depending on experience) Comprehensive Medical, Dental, and Vision coverage 401(k) with company match Paid Time Off and holiday benefits Professional development and career advancement opportunities
    $37k-48k yearly est. 60d+ ago

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