Liability Claims Examiner remote jobs

**Role Overview**Mercor is collaborating with a top-tier AI research group to model real-world claims workflows for property and casualty insurance. We are seeking experienced independent contractors-particularly claims adjusters, examiners, and investigators-to execute and evaluate a wide range of P&C insurance tasks. This project supports the development of AI systems capable of understanding, simulating, and automating complex insurance operations. It is a short-term, high-impact engagement ideal for professionals with strong technical and compliance knowledge. **Key Responsibilities** - Execute full-cycle claims tasks including FNOL intake, coverage verification, reserve setting, and liability determination - Simulate real-world workflows using structured tools and mock systems such as Guidewire ClaimCenter and Xactimate - Review and synthesize third-party documentation including police reports, medical records, and vendor estimates - Draft structured outputs such as coverage memos, repair estimates, and liability assessments - Identify inconsistencies or red flags in claim statements and documentation - Evaluate claim compliance, document regulatory deadlines, and assess communication quality - Flag fraud indicators and recommend SIU referrals where applicable - Document all work clearly for auditability and quality review **Ideal Qualifications** - 5+ years handling property, auto, bodily injury, or general liability claims - Familiarity with systems such as Guidewire, Duck Creek, Xactimate, Hyland OnBase, or FileNet - Deep understanding of coverage interpretation, state compliance standards, and claims file documentation - Experience reviewing third-party documentation (e. g. , police reports, medical summaries, contractor estimates) - Strong written communication and analytical skills **More About the Opportunity** - Remote and asynchronous - control your own work schedule - **Expected commitment: min 30 hours/week** - **Project duration: ~6 weeks** **Compensation & Contract Terms** - $100-150/hour - Independent contractor arrangement - Paid weekly via Stripe Connect **Application Process** - Submit your resume followed by domain expertise interview and short form **About Mercor** - Mercor is a talent marketplace that connects top experts with leading AI labs and research organizations - Our investors include Benchmark, General Catalyst, Adam D'Angelo, Larry Summers, and Jack Dorsey - Thousands of professionals across domains like insurance, law, engineering, and research partner with Mercor to shape the next era of AI

Scheduled Hours 40 Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management. Job Description Primary Duties & Responsibilities: * Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files with guidance of legal counsel. Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; evaluates liability and financial exposure, approves expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value. Attends mediation, arbitration, and/or trial. * Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carriers, and when applicable, coordinates with external agency investigations, i.e., professional Board inquiries. Responds to general claim inquiries. * Establishes indemnity and expense reserves based on the reserving policy. Negotiates settlements within authority. Reviews and approves defense counsel related invoices and expenses. * Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation. Arrange for attorneys to attend depositions with physicians when necessary. Mentors less experienced claims managers. * Performs other duties as assigned. Working Conditions: Job Location/Working Conditions * Normal office environment Physical Effort * Typically sitting at a desk or a table Equipment * Office equipment The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: Bachelor's degree Certifications/Professional Licenses: No specific certification/professional license is required for this position. Work Experience: Analyzing Or Interpreting Medical Or Other Technical Evidence That Compares In Level Of Complexity To Medical Treatment (5 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job Preferred Qualifications: * Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered. * General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care. * Knowledge of methods and techniques of individual case study, recording and file maintenance. * Seven years' experience in medical malpractice claims management. Preferred Qualifications Education: No additional education unless stated elsewhere in the job posting. Certifications/Professional Licenses: No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: No additional work experience unless stated elsewhere in the job posting. Skills: Analytical Thinking, Defining Problems, Detail-Oriented, Disease Diagnosis, Disease Management, Group Presentations, Injury Treatment, Joint Commission Regulations, Organizational Savvy, Patient Safety, Report Preparation Grade G13 Salary Range $65,900.00 - $112,700.00 / Annually The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email **************************** or call the dedicated accommodation inquiry number at ************ and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal * Up to 22 days of vacation, 10 recognized holidays, and sick time. * Competitive health insurance packages with priority appointments and lower copays/coinsurance. * Take advantage of our free Metro transit U-Pass for eligible employees. * WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness * Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family * We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We've got you covered. * WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: ****************************** EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University's policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information. Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment - fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.

Who We Are Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we're shaping a healthier, more engaged future. Responsibilities Ready to Lead Complex Healthcare Data Integrations That Power Enterprise Excellence? We're seeking a strategic, technically adept professional who can serve as technical and analytical lead for managing complex healthcare claims data integrations across multiple platforms and partners. As our Senior Claims Integration Specialist, you'll oversee the end-to-end lifecycle of claims ingestion, transformation, and validation while mentoring team members and optimizing integration workflows. What makes this role different: ✓ Technical leadership: Configure, design, and optimize integration workflows while leading root-cause analysis for data anomalies ✓ Mentorship opportunity: Guide junior team members on best practices in claims data management and automation ✓ Cross-platform expertise: Ensure data quality, compliance, and operational stability across Personify's entire claims ecosystem ✓ Strategic impact: Combine technical proficiency with strategic mindset to enhance process efficiency, scalability, and accuracy What You'll Actually Do Lead carrier partnerships: Serve as primary liaison with healthcare carriers to establish and maintain data exchange partnerships while communicating and enforcing universal data specifications. Manage data ingestion: Collaborate on analysis of inbound healthcare claims data feeds to identify and triage validation or data quality issues using SQL and transformation logic. Optimize integration workflows: Map carrier-specific data fields into company's universal data model while implementing ingestion processes ensuring data integrity and compliance with internal standards. Troubleshoot complex issues: Understand and troubleshoot ingestion pipelines, resolving data quality issues and ingestion failures while diagnosing root causes of data anomalies. Ensure system accuracy: Verify claims data is accurately processed and routed to all relevant internal systems including client servicing platforms, analytics tools, and operational dashboards. Implement quality controls: Execute robust data validation, reconciliation, and quality control processes while monitoring ingestion performance and proactively resolving discrepancies. Maintain comprehensive documentation: Create and maintain requirement documentation including business rules, file mapping, and transformation process specifications for all inbound claims files. Collaborate strategically: Partner with product, operations, technology, data engineering, and architecture teams to support downstream use cases and optimize database structures. Qualifications What You Bring to Our Mission The educational foundation: Bachelor's or Master's degree in Health Informatics, Information Systems, Business/Statistics/Information Science, or related field 3+ years experience in healthcare data integration, claims processing, or payer-provider data exchange The technical expertise: Strong understanding of healthcare claims formats (EDI 837, NCPDP, proprietary formats) and wide variety of claims formats and coding standards (CPT, ICD, DRG) Strong SQL skills with ability to write and tune complex queries against large-scale datasets Proven experience managing external partnerships and internal cross-functional teams Familiarity with data warehousing, ETL tools, and cloud-based data platforms is plus The strategic competencies: Data architecture mastery: Design and optimize data models to support scalable ingestion and integration of healthcare claims data Schema translation expertise: Translate complex or varying carrier-specific schemas into normalized structures aligned with enterprise data standards Cross-functional collaboration: Work effectively with carriers and internal departments to ensure claims data is structured for downstream applications Industry standards knowledge: Knowledge of industry standard specifications such as FHIR, HL7, and EDI preferred The professional qualities: Excellent communication and project management skills Self-motivated with critical thinking and problem-solving abilities Strong understanding of data governance, master data management (MDM), and data quality frameworks preferred Proven ability to bridge technical and business domains to deliver data-driven solutions Experience with claims data reconciliation and migration projects preferred Experience working in or with analytics-focused organizations, data consultancies, or enterprise data platforms preferred Why You'll Love It Here We believe in total rewards that actually matter-not just competitive packages, but benefits that support how you want to live and work. Your wellbeing comes first: Comprehensive medical and dental coverage through our own health solutions (yes, we use what we build!) Mental health support and wellness programs designed by experts who get it Flexible work arrangements that fit your life, not the other way around Financial security that makes sense: Retirement planning support to help you build real wealth for the future Basic Life and AD&D Insurance plus Short-Term and Long-Term Disability protection Employee savings programs and voluntary benefits like Critical Illness and Hospital Indemnity coverage Growth without limits: Professional development opportunities and clear career progression paths Mentorship from industry leaders who want to see you succeed Learning budget to invest in skills that matter to your future A culture that energizes: People Matter: Inclusive community where every voice matters and diverse perspectives drive innovation One Team One Dream: Collaborative environment where we celebrate wins together and support each other through challenges We Deliver: Mission-driven work that creates real impact on people's health and wellbeing, with clear accountability for results Grow Forward: Continuous learning mindset with team events, recognition programs, and celebrations that make work genuinely enjoyable The practical stuff: Competitive base salary plus that rewards your success Unlimited PTO policy because rest and recharge time is non-negotiable Benefits effective day one-because you shouldn't have to wait to be taken care of Ready to create a healthier world? We're ready for you. No candidate will meet every single qualification listed. If your experience looks different but you think you can bring value to this role, we'd love to learn more about you. Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $68,000 to $85,000. Note that compensation may vary based on location, skills, and experience. This position is eligible for 10% target bonus/variable compensation as well as health, dental, vision, mental health and other benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to **************************. All of our legitimate openings can be found on the Personify Health Career Site.

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-BM #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.

*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

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is looking for an experienced Claims Specialist supporting Disability and Leave Management claims 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. Key Job Responsibilities * 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. The base salary range for this position is $60,000 - $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 Required Qualifications * 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. #LI-Remote 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. 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 *******************************.

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary Arch Insurance Group Inc., AIGI, has an opening with the Claims Division on the Excess Casualty Team as a Sr. Claims Examiner. In this role, the responsibilities include actively managing commercial claims for unsupported Excess Casualty high severity, complex general liability, and auto accounts and providing oversight to underlying carrier(s) claims handlers for coverage, liability, and damages in jurisdictions throughout the United States. $20k Sign-on Eligible (Open to remote work location if home location outside designated Arch office) Responsibilities Specific duties include but not limited to the below: * Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis * Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care * Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures * Maintain contact with the underlying carrier(s)' claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary * Investigate claims and review the insureds' materials, pleadings, and other relevant documents * Identify and review each jurisdiction's applicable statutes, rules, and case law * Review litigation materials including depositions and expert's reports * Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues * Retain counsel when necessary and direct counsel in accordance with resolution strategy * Analyze coverage, liability and damages for purposes of assessing and recommending reserves * Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves * Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter * Negotiate resolution of claims * Select and utilize structure brokers * Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims Experience & Required Skills * Seven to ten (7-10) years of working experience with a primary and or excess carrier supporting commercial accounts for Casualty claims; professional liability claims experience with Energy Casualty and Construction a plus * Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines * Strong time management and organizational skills * Demonstrated ability to take part in active strategic discussions * Demonstrated ability to work well independently and in a team environment * Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word * Willing and able to travel 10% Education * Bachelor's degree required * Proper & active adjuster licensing in all applicable states #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. $107,900- $160,000/year * Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. * Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn't the right fit but you're interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch's Talent Acquisition team. For Colorado Applicants - The deadline to submit your application is: July 15, 2025 14400 Arch Insurance Group Inc.

Workers' Compensation Claim Consultant Schedule: Monday-Friday, 8:00 AM-4:30 PM PT Salary Range: $80,000-$85,000 annually Build Your Career With Purpose at CCMSI At CCMSI, we don't just process claims-we support people. As a leading Third Party Administrator and a certified Great Place to Work , we offer manageable caseloads, employee ownership, and a collaborative culture. Our employee-owners are empowered to grow, contribute, and make a meaningful impact. Job Summary The Workers' Compensation Claim Consultant is responsible for handling California workers' compensation claims for a single dedicated Alternate Dispute Resolution (ADR) client account. This role requires California jurisdiction experience and an active CA Adjuster's License, along with the Self-Insurance Administrator Certificate (SIP). You'll join a team of 10 adjusters and play a key role in ensuring quality claim handling through compliance with client guidelines, state laws, and CCMSI claim standards. Performance is measured by accuracy, timeliness, and client satisfaction, with a focus on no penalties, current diary management, complete documentation, and timely payments. Responsibilities Investigate, evaluate, and adjust assigned California workers' compensation claims in compliance with jurisdictional requirements and ADR processes. Establish and monitor reserves, authorize claim payments, and negotiate settlements within authority and client guidelines. Review medical, legal, and vendor invoices to confirm accuracy and appropriateness. Maintain thorough documentation and diary updates in the claim system. Communicate effectively with clients, claimants, and involved parties throughout the claim process. Participate in claim reviews, hearings, and mediations as needed. Ensure compliance with state laws, CCMSI claim handling standards, and client-specific requirements. Qualifications Three or more years of experience adjusting California workers' compensation claims California Adjuster's License Self-Insurance Administrator Certificate (SIP) Strong written and verbal communication skills Proficiency with Microsoft Office Suite (Word, Excel, Outlook) Nice to Have Experience with Alternate Dispute Resolution (ADR) claims Strong organization, multitasking, and customer service skills What We Offer Employee Stock Ownership Plan (ESOP): We're employee-owned, so your success is our success. Comprehensive Benefits Package: Includes medical, dental, vision, life insurance, disability, and 401(k). Generous Time Off: 4 weeks of paid time off in your first year, plus 10 paid holidays. Career Growth: Structured training, career progression pathways, and opportunities to advance within CCMSI. Supportive Environment: Manageable caseloads and a collaborative, team-focused culture. Compensation & Compliance The posted hourly rate reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. Visa Sponsorship CCMSI does not provide visa sponsorship for this position. ADA Accommodations CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. If you need assistance or accommodation, please contact our team. Equal Opportunity Employer CCMSI is an Affirmative Action / Equal Employment Opportunity employer. We comply with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks are conducted only after a conditional offer of employment. Our Core Values At CCMSI, our Core Values guide how we work: integrity, client service, employee ownership, continuous improvement, collaboration, and enthusiasm for what we do. #CaliforniaAdjuster #WorkersCompensation #ADRClaims #InsuranceCareers #ClaimsConsultant #CaliforniaJobs #RemoteAdjuster #SIPCertified #InsuranceProfessionals #ClaimsManagement #CareerGrowth #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #LI-Remote

Why work with us? The North American branch of Generali Global Assistance offers a diverse and inclusive work environment while employees work towards making real difference in the lives of our clients. As an Organization, we pride ourselves with offering white glove service while being mindful of corporate responsibility and our environmental footprint. Employees enjoy a plethora of benefits to include: A diverse, inclusive, professional work environment Flexible work schedules Company match on 401(k) Competitive Paid Time Off policy Generous Employer contribution for health, dental and vision insurance Company paid short term and long term disability insurance Paid Maternity and Paternity Leave Tuition reimbursement Company paid life insurance Employee Assistance program Wellness programs Fun employee and company events Discounts on travel insurance Who are we? Generali Global Assistance is proudly part of the Europ Assistance Group brand and our products utilize a number of corporate and product brands. The brands for our North American team include the following: CSA: US travel insurance brand for retail and lodging partners. Learn more here. Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products. Learn more here. GMMI: the industry standard for global medical cost containment and medical risk management solutions. Learn more here. Iris, Powered by Generali: identity and digital protection solution. Learn more here. Trip Mate: US travel insurance brand for tour operator, cruise and airline partners. Learn more here. What you ll be doing. Job Summary: The Liability Claims Adjuster will be reporting to the Supervisor, Liability Claims. This position is responsible for analyzing and processing insurance claims to determine the extent of the insurance carrier s liability in a manner that supports the mission, values, and standards of the Company. Primary responsibilities include efficient adjudication of insurance claims, both phone and written communication with insureds, claimants, attorneys, medical facilities, and others, as well as maintaining all state Department of Insurance regulations for claims files. Principal Duties and Responsibilities: Moderate to severe complexity third-party bodily injury and property damage claims. Responsible for the investigation and resolution of litigated and non-litigated claims. Document claims files with findings of investigation, evaluate liability, and negotiate settlements. Prepare releases of all interested parties, issue reservation of rights letters, and denials of liability. Prepare Large Loss reports on Claims involving severe injuries. Maintaining rapport and open communications with client. Requirements: 5+ years of multi-line claims handling at an insurer or TPA. 5+ years working in liability claims Experience with premises liability claims and injury evaluation. Prior experience handling complex bodily injury claims. Ideal candidate will have CPCU, AIC, SCLA or other industry related training or educational course work, a NYS claims adjuster license as well as other state adjusting licenses. Excellent verbal and written communication, investigation, organization, and analytical skills. An in-depth knowledge of commercial lines coverage and exposure as well as strong decision making, judgment and negotiating skills are needed. Experience working with files in litigation and effective communication skills are a must. Performs work under minimal supervision. Handles complex issues and problems and refers only the most complex issues to higher-level staff. Possesses comprehensive knowledge of subject matter. Provides coaching and/or mentoring to less experienced employees. Education/Certifications: High School Diploma or Equivalent (GED) required. 6+ years liability claims adjusting experience. Must have FL State Adjuster s License. Must secure and maintain a multi-state adjuster license. Salary Range: $55,000 - $100,000 annually Where you ll be doing it. This is a hybrid role based out of our San Diego office. As a hybrid role, you will be working onsite 2-3 days a week and working from home 2-3 days a week. When you ll be doing it. While there is some flexibility in the hours, this position will be Monday-Friday during regular business hours (approximately 8:00am-5:00pm). Occasional overtime may be required according to business need. Apply today to begin your next chapter. Don t meet every single requirement? At Generali Global Assistance, we are dedicated to building a diverse, inclusive and enriching workplace, so if you re excited about this role but your past experience doesn t align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles. California Residents - Privacy Notice for California Residents Seeking Employment with Generali Global Assistance is available here: *************************************************************************************************** The Company is committed to providing equal employment opportunity in all our employment programs and decisions. Discrimination in employment on the basis of any classification protected under federal, state, or local law is a violation of our policy. Equal employment opportunity is provided to all employees and applicants for employment without regard age, race, color, religion, creed, sex, gender identity, gender expression, transgender status, pregnancy, childbirth, medical conditions related to pregnancy or childbirth, sexual orientation, national origin, ancestry, ethnicity, citizenship, genetic information, marital status, military status, HIV/AIDS status, mental or physical disability, use of a guide or support animal because of blindness, deafness, or physical handicap, or any other legally protected basis under applicable federal, state, or local law. This policy applies to all terms and conditions of employment, including, but not limited to, recruitment and hiring, classification, placement, promotion, termination, reductions in force, recall, transfer, leaves of absences, compensation, and training. Any employees with questions or concerns about equal employment opportunities in the workplace are encouraged to bring these issues to the attention of Human Resources. The Company will not allow any form of retaliation against individuals who raise issues of equal employment opportunity. All Company employees are responsible for complying with the Company s Equal Opportunity Policy. Every employee is to treat all other employees equally and fairly. Violations of this policy may subject an employee to disciplinary action, up to and including termination of employment.

This role ensures timely and accurate processing of claims, supports internal and external audits, and contributes to operational efficiency. The Sr. Associate works cross-functionally to resolve issues and maintain high standards of data integrity and client service. BA/BS degree in business administration with an emphasis in accounting/finance or equivalent work experience Advanced degree or industry certification preferred 3 years of experience in life claims administration and adjudication Understanding of claim treaty provisions, adjudication thresholds, and regulatory compliance. Strong analytical and decision-making skills with attention to detail and accuracy. Strong problem-solving skills and the ability to navigate and resolve complex issues. Strong analytical and organizational skills. Proficiency in claims systems and reporting tools. Ability to work independently and collaboratively across teams. Excellent communication and problem-solving skills. Pay Range for roles performed in NC: $72,000-$88,000 base salary per year. Actual salaries may vary based on various factors including but not limited to location, experience, role and performance. The range listed is just one component of SCOR's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives. In addition, we provide a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement saving plan, paid holidays and paid time off. Perform adjudication of life claims for assigned clients, including standard and contestable cases. Review claim documentation such as death certificates, claimant statements, and policy records to verify eligibility. Assess claim validity based on treaty terms, policy provisions, and underwriting guidelines. Assist with performance of client adjudication audits for assigned clients to ensure compliance with treaty terms and adjudication standards. Serve as liaison to clients for claim-related inquiries Review and approve claims in accordance with claim payment approval hierarchy. Review, enhance, and sign settlements to ensure timely client payments Process claim refunds appropriately and timely. Monitor workflow and identify potential claims processing issues. Work cross-functionally to resolve system impediments to claim payment processing. Identify opportunities for improvement and contribute to process enhancements. Assist with internal and external audits and ensure all ICS controls are properly documented. Establish requirements for system enhancements and log tickets for tracking, testing, and implementation. Creation and maintenance of reports allowing for analysis of claim workflow and data fields to ensure accuracy of claim data. Analyze client trending data to understand financial results and identify potential future impact. Produce ad-hoc reports and claims metrics for management and other stakeholders. Perform monthly and quarterly reporting requirements for performance measurement and to meet quarter end deliverables. May perform other duties as required.

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. 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

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. 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

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.

Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can't wait to meet you. About the role Come join an amazing and collaborative team! We are seeking a highly organized and customer-focused General Liability Adjuster to join our team. The successful candidate will be responsible for speaking to customers on the phone, educating and helping the customer work through their claim to the best possible outcome. Your role will also be responsible for handling an inventory of claims, triaging critical claims, and delivering service to all constituents of the claim. The ideal candidate has a willingness to work through a design process that supports the quickest claim resolution with the best outcome. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements. Who you are Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org. Passionate adjuster who cares about the customer and their experience. Empathetic. You exercise empathy and patience towards everyone you interact with. Sense of urgency - at all times. That does not mean working at all hours. Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured's best interest. Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution. Anti-status quo. You don't just wish things were done differently, you action on it. Communicative. (we'd love to know what this means to you) And did we mention, you have a sense of humor. Claims are hard enough as it is. You are collaborative and a team player. What we need We need you to do all the things typical to the role: Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests Gather necessary information from customers to initiate the claim and explain policy, coverage, and appropriate course of action Manage an inventory of claims, analyze coverage and identify any potential coverage issues. Establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim Ability to handle all aspects of general liability claims not limited to but including Slip and Falls, Habitational, Risk Transfer, Construction, and New York Labor Law Ensure compliance with specific state regulations, policy provisions, and standard operating procedures Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority Provide input for continuous development of claims guidelines, best practices, and process improvements Oversee and direct outside investigative service providers, client counsel and investigative services to resolve the claim while closely with the client. Engage in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications Requirements Bachelor's degree. JD, Professional insurance designations strongly preferred. Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license Minimum of 5 years of experience ideally with; General Liability (Premise, Habitational, Auto, Garagekeepers, BOP's, Dwelling) Construction Liability. Employers Liability. Liquor Liability/Dram Shop. Complex claims involving litigation. Policy interpretation. Drafting Reservation of Rights letters, coverage declinations. Third-party bodily injury. Third-party litigated bodily injury/property damage. Willing to obtain all licenses within 45 days, including completing state required testing Knowledge of state regulations, policy provisions, and standard operating procedures Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures Curious and motivated by problem solving and questioning the status quo Desire to engage in learning opportunities and continuous professional development Ability to collaborate with colleagues within and outside your department Willingness to travel for client and claims needs Benefits Generous health-insurance package with nationwide coverage, vision, & dental 401(k) retirement plan with employer matching Competitive PTO policy - we want our employees fresh, healthy, happy, and energized! Generous family leave policy after 8 months of continuous work Work from anywhere to facilitate your work life balance Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder! Additionally, we will Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role Work toward reducing and eliminating all the administrative work from an adjuster role Foster a culture of empathy, transparency, and empowerment in a remote-first environment At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!

Medical Only Claims Adjuster (Workers' Compensation) | 100% Remote Opportunity (covering the states of - GA, SC, NC, and VA) Must have experience in one or more of the following states: Georgia, South Carolina, North Carolina, Virginia General Summary Using claims system automation and capabilities, the Medical Only Claims Adjuster is responsible for timely and accurate management of a high volume of workers' compensation claims requiring minor or simple medical treatment and escalating them or moving them efficiently to closure. Essential Duties and Responsibilities Receives and reviews information related to new claims involving no or minimal lost time from work. Under direct supervision, may handle a small number of fast-track indemnity claims that have low exposure or complexity. Communicate with injured workers, employers, and medical providers to obtain necessary additional information and evaluate claims for exceptions or escalations. Confirms or determines coverage and compensability as needed within state statutes and claims best practices. Reviews and responds to mail, emails, telephone calls and faxes from employers, providers, and injured workers within 24 hours. Reviews and responds to mail, emails, telephone calls and faxes from employers, providers and injured workers. Takes action to handle communication within established best practices and statutory requirements. 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. Manages or coordinates medical treatment and communicates with providers in a timely manner to continue to move the claim forward. Reviews medical bills and makes appropriate determinations. Reviews case facts to identify and report fraud or abuse throughout the course of the claim. Reviews claims for closure and proactively takes action to guide claims in that direction. Other duties as assigned. Requirements Minimum of 1 year general office experience or equivalent combination of education and experience. Minimum 6 months experience working in workers' compensation insurance environment or an equivalent combination of education and qualifying experience. Experience in one or more of the following states: - GA, SC, NC, and VA Working knowledge of medical terminology Excellent written and oral communication, customer service and telephone skills. Knowledge of MS Office software and an imaged environment. Demonstrated ability to understand and adhere to statutes, regulations, and company policies and practices. Demonstrated skills in multi-tasking and prioritizing, adhering to deadlines and completing assignments. Always conduct business with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality. Claims Insurance industry experience preferred. Education / Certifications If State Certification is required, must meet certification within the state mandated time frame. AIC, ARM, or CPCU certification Preferred, not required Must have High School Diploma or GED equivalent. 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 Hourly Pay Rate: $20.00 - $26.00 and a comprehensive benefits package, please follow the link to our benefits page for details! ********************************************************* About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As “America's small business insurance specialist”, we have the resources, a solid reputation, and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

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

Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As a Commercial Insurance Claims Representative, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual. The preference is for the candidates to be located close to a hub and be in the office a minimum of 2 days/week (Hubs: Plano, TX, Suwanee, GA, Westborough, MA, Hoffman Estates, IL, Indianapolis, IN and Eugene. OR, and Phoenix, AZ) although candidates from any location will be considered. Please note this policy is subject to change. Responsibilities: Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments. Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers. Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues. Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims. Determines and negotiates settlement amount for damages claimed within assigned authority limits. Writes simple to moderately complex property damage estimates or review auto damage estimates. Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate. Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations. Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed. Qualifications Bachelor's Degree preferred. High school diploma or equivalent required. 1-2 years of experience. Claims handling skills preferred. Strong customer service and technology skills. Able to navigate multiple systems, strong organizational and communication skills. License may be required in multiple states by state law. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

":"* 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":"UT","job_title":"Remote - Claims Adjuster - Automotive","date":"2025-11-18","zip":"84101","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. ","

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 7 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, CA 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 required * Minimum of 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 *********************************************************