Liability Claims Representative remote jobs - 278 jobs

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

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

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

Create Music Group is currently looking for self-described viral internet culture enthusiasts to join our Viral Department. Viral Content Claiming Specialist perform administrative tasks such as YouTube copyright claiming and asset onboarding, as well as scope out trending memes and social media videos on a daily basis. This position requires a regular workload of data entry/administration in order to carry out the most basic functions of our department but there are plenty of opportunities for more creative and ambitious pursuits if you are so inclined. This is a full time position which may be done remotely, however our office is located in Hollywood, California, and we are currently only looking for job candidates who are located in California. In the future, you may be encouraged to come into our office for meetings or company functions, so it is best if you are located in the Los Angeles/Southern California area. Through our Viral team, we collaborate with some of the most prominent viral talent from the TikTok and meme world including Supa Hot Fire (Deshawn Raw), Welven Da Great (Deez Nuts), Verbalase, KWEY B, Hoodnews, presidentofugly1, 10k Caash, dimetrees, Zackass, Supreme Patty, The Man with the Hardest Name in Africa, ViralSnare, Adin Ross, and more. YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for content creators, artists and labels. REQUIREMENTS: 1-3 years work experience Excellent communication skills, both written and verbal Internet culture and social media platforms, especially YouTube Conducting basic level research Organizing large amounts of data efficiently Proficiency with Mac OSX, Microsoft Office, and Google Apps PLUSES: Strong understanding of the online video market (YouTube, Instagram, TikTok) Bilingual - any language, although Spanish, Mandarin, and Russian is preferred RESPONSIBILITIES: We work directly with our clients and their team to help them break down the data and find potential opportunities to build their career. Daily responsibilities include but are not limited to the following. Watching YouTube videos for several hours daily Content claiming Uploading and defining intellectual assets Administrative metadata tasks Researching potential clients Staying on top of accounts for current client roster As this is a remote position, you are required to have your own computer and reliable internet connection. This position may require you to download a great deal of video files (files which may be deleted once onboarding tasks are completed) so please make sure that you have a computer that is up to the task. Laptops are preferable if you would like to come into our office to work (snacks, soft drinks, and Starbucks coffee are provided at our physical office). BENEFITS: Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included. TO APPLY: Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.

Gainwell Technologies is seeking a dedicated and customer-focused professional to join our Claims EDI Helpdesk team supporting the Indiana Medicaid account. This fully remote role involves providing front-line support to providers and trading partners regarding electronic claims submissions and EDI-related inquiries. The ideal candidate will be comfortable handling a high volume of phone calls and delivering exceptional service in a fast-paced environment. Key Responsibilities Respond to inbound calls and emails from providers and trading partners regarding EDI claim submissions, rejections, and processing issues. Troubleshoot and resolve technical issues related to electronic data interchange (EDI) formats, transactions, and connectivity. Document all interactions and resolutions in the appropriate tracking systems. Collaborate with internal teams to escalate and resolve complex issues. Educate callers on EDI processes, requirements, and available resources. Maintain up-to-date knowledge of Indiana Medicaid policies and Gainwell Technologies systems. Qualifications Required Qualifications High school diploma or equivalent; associate degree or higher preferred. 1+ years of experience in customer service, helpdesk support, or healthcare claims processing. Familiarity with EDI formats (e.g., 837, 999, 277CA) and Medicaid claims systems is a plus. Strong verbal communication skills and phone etiquette. Ability to work independently in a remote environment with minimal supervision. Proficiency in Microsoft Office and helpdesk ticketing systems. Work Environment This is a fully remote position. Must be available to work standard business hours (Eastern Time). Requires being on the phone for most of the workday.

Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client's needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative. As a Medical Claims Appeal Specialist, you are responsible for contacting providers to educate on NSA process/payments, respond to appeals for various products, and negotiate these post pay appealed claims to resolve payment disputes. Primary Responsibilities Monitor and manage your post payment queues. Conduct outreach, education, and negotiation calls to providers for post payment claims. Effectively communicate with providers to verify/confirm understanding of NSA claims payments and regulations. Effectively communicate with providers to explain claim payments for various pricing products. Maintain compliance, including but not limited to Confidentiality and HIPAA requirements. Maintain acceptable levels of production including but limited to turn around time standards as mandated by the regulation(s). Document all conversations and record name, phone number, and email of contact person if available, payment rates offered on behalf of clients, and any counter offers by the provider. Adhere to client specific and Reliant protocols, scripts, and other requirements. Develop a comprehensive understanding of the state and federal regulations that will impact payments to providers. Develop a comprehensive understanding of our various products. Perform other job-related duties and special projects as required. Qualifications 2-3 years of related job experience - appeals, negotiations, medical billing. Experience conducting outreach to providers via phone calls or other communication means. Experience understanding Reliant critical behaviors and compliance requirements. Broad healthcare policy and payment understanding. Experience with claims workflow tools or systems. Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role. Pay Transparency$50,000-$60,000 USDBenefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Equal Employment Opportunity: At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business-and our society-stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

Multi-Line Claim Specialist (Hybrid) - Scottsdale, AZ Salary Range: $70,000-$80,000 annually (DOE) Schedule: Monday-Friday, 8:00 AM-4:30 PM MST Work Model: Hybrid (1 mandatory weekly office day + additional in-office time for team meetings, trainings, and claim reviews as needed) Reports To: Claim Supervisor Account: Single dedicated account Build Your Career With Purpose at CCMSI At CCMSI, we don't just adjust claims-we support people. As one of the largest employee-owned Third Party Administrators in the country and a certified Great Place to Work , we offer manageable caseloads, a collaborative culture, and the stability of employee ownership. Here, you'll have the autonomy to do meaningful work-and the support to grow your career. Job Summary We are seeking an experienced Multi-Line Claim Specialist, to join our Scottsdale liability team. This hybrid role is ideal for a high-performing claim professional skilled in managing bodily injury (BI) and property damage (PD) claims, including mid-level injuries, represented and unrepresented claimants, and files that may be in suit. You will independently handle a caseload files for a single dedicated Waste Management industry account, delivering high-quality service, thorough investigations, and timely resolutions. This position offers growth potential and may serve as an advanced training pathway toward senior-level claim roles. Responsibilities Investigate, evaluate, and adjust multi-line claims in accordance with CCMSI standards, jurisdictional laws, and client requirements. Handle bodily injury and property damage claims involving mid-level injuries, represented and unrepresented claimants, and files in suit. Establish reserves and make recommendations within assigned authority levels. Review and approve medical, legal, and vendor invoices for relatedness and reasonableness; negotiate disputed charges. Authorize payments and negotiate settlements in alignment with client expectations, state regulations, and corporate standards. Coordinate and oversee external vendors such as defense counsel, surveillance, and case management when required. Maintain claim documentation, diary entries, and communication logs in the claim system. Assess and monitor subrogation opportunities. Prepare status reports, reserve updates, and client-facing documentation as requested. Attend mediations, hearings, and informal conferences as appropriate. Participate in claim reviews and training sessions with internal stakeholders and the client. Uphold CCMSI's Core Values through client service excellence and collaborative team engagement Qualifications Qualifications - Required 5+ years of multi-line liability claim experience (PD/BI). Experience handling represented and unrepresented claimants and files with mid-level injuries. Ability to manage 125 active files with accuracy, organization, and timely follow-up. At least one valid home state adjuster license (additional licenses a plus). Strong written and verbal communication skills. Solid analytical, investigative, and negotiation abilities. Proficiency with Microsoft Office and ability to learn claim system platforms. Reliable and consistent attendance during client service hours. Nice to Have Prior experience with Waste Management or transportation-related accounts. Strong technical BI evaluation skills. Comfort participating in client presentations or claim reviews. Training & Support Training Duration: As long as needed-tailored to your experience level. You will join a large, supportive claim organization of 80+ team members, with ~40 dedicated to liability. You'll have access to peer support, leadership guidance, technical resources, and client interaction opportunities that strengthen your long-term growth path. How We Measure Success Audit results Claim review performance File quality and timeliness Client satisfaction Annual performance evaluation Compensation & Compliance Compensation: $70,000-$80,000 annually, based on experience. Visa Sponsorship: CCMSI is unable to provide visa sponsorship for this position. ADA Accommodations: Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Equal Opportunity Employer: CCMSI is proud to be an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. 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. #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #CCMSICareers #CCMSIWesternLiability #EmployeeOwned #ESOP #MultiLineClaims #GreatPlaceToWorkCertified #RemoteWork #CargoClaims #APDClaims #InsuranceJobs #ClaimsAdjuster #LiabilityAdjuste #LI-Hybrid We can recommend jobs specifically for you! Click here to get started.

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

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

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

We are looking to add a Liability Claims Specialist to join our Creative Risk Solutions team. This team member will provide high-quality claims handling and expertise for CRS customers, including investigating, evaluating, and resolving auto and general liability claims, potentially involving litigated files. We offer a forward-thinking, innovative, and vibrant company culture, along with the opportunity to share your unique potential, there really is no place like Creative Risk Solutions! Essential Responsibilities: · Review coverage for commercial auto and general liability claims. · Adjudicate claims, investigate bodily injury/liability claims, and negotiate settlements using "Best Practices for Claims." · Maintain accurate loss information and establish/maintain reserves within authority. · Research and respond to questions and complaints from insureds, claimants, agency partners, and carriers. · Monitor and control litigated claims, ensuring timely responses and protection of insureds' and carriers' interests. · Participate in claim reviews and Risk Control Workshops. · Identify and pursue subrogation and report fraud when applicable. · Train and mentor Liability Claims Specialists I and II. Qualifications: · Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. · Licensing: Active state specific Life & Health/Property Casualty Insurance agent's license required or the ability to acquire license within three months of hire. · Experience: 5+ years of adjusting property and casualty claims. Prior agency involvement preferred. · Skills & Technical Competencies: Knowledge of both general and auto liability coverages, claims processing procedures, perform complex mathematical calculations, ability to learn multiple state insurance regulations and pass state licensing exams. Understand and apply claims principles, practices, and insurance coverage interpretation for consulting, evaluating, and resolving claims. Contributes to workflows while utilizing resources to deliver a world-class client experience and ensure compliance. Fosters relationships by understanding relevant parties, prioritizing problem-solving, and collaborating to deliver impactful solutions. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: · Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! · Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. · 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. · Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. · Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. · DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! · Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. · Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1

Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently-empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. We are looking to add a Workers' Compensation Claims Specialist to join our team. Experience handling claims in Minnesota, South Dakota, Wisconsin, Pennsylvania, and Iowa is preferred. Essential Responsibilities: Receives, gathers and accurately transmits workers' compensation information to the company, from communications with the insured, claimants, and internal staff in a timely manner. Investigates, evaluates, and resolves Workers' Compensation claims. Mediates situations as they arise between the insured and the insurance company, with some support from leader as needed, to include researching coverage issues. Enters and maintains accurate information on a computer system during the claim process, to include final settlement information. Generates checks for indemnity and medical payments daily. Develops and monitors consistency in procedural matters of the claims handling process with CRS. Compiles and interprets Workers' compensation reports on designated accounts, as requested. Ability to adjudicate lost time claims. Participates in claim reviews and attends Risk Control Workshops when requested by agency partners or insureds. These could be in person or by phone. Performs special projects and other duties as requested. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Willingness and ability to obtain additional state specific licenses during duration of employment as needed. Experience: 2-4 years claims experience with strong background in Workers' Compensation coverage. Technical Competencies: Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Invests in the understanding and application of claims principles and practices and insurance coverage interpretation as it relates to consulting, evaluating, and resolving claims. Here's a little bit about us: At Creative Risk Solutions, you'll be part of a collaborative, innovative team that values trust, communication, and client focus. We offer competitive compensation, comprehensive benefits, and opportunities for professional growth within the Holmes Murphy family. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $45,800- $78,800. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. Holmes Murphy & Associates is an Equal Opportunity Employer. #LI-SM1

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: ************** Job Description Crum & Forster is looking for a claims adjuster who enjoys being a key part of a dynamic team. As an Executive Specialist, you will manage an assigned pending of claims arising primarily from our Security Profit Center. You will also be expected to operate under appropriate levels of supervision and within established authority. The position will report to assigned Manager, Director or Vice President, as determined by business needs. What you will do for C&F: Receives claims assignments, verifies and determines applicability of coverage. Ability to not only interpret complex coverage issues, but possess the ability to write appropriate reservation of rights and declination of coverage letters. Determines the method and extent of investigation for each claim as required by company Best Practices. Reviews and manages outstanding files, as assigned, for adequacy and timeliness of investigation, evaluation and reserve and maintains a timely diary for each case. Evaluates and adjusts claims within the adjuster's authority level. Reports directly on technical matters to supervisor or management. Evaluates and manages litigated claims, determines future course of handling and proper method of disposition. Consults with the claim manager on those claims in which assistance and consultation is needed, as well as on those claims, which exceed assigned authority. Assesses recovery potential and is responsible for the development of information required to successfully pursue recovery. Meets with current and prospective customers to discuss C&F claims capabilities and address specific claim needs. Accountable for the equitable and prompt adjustment and management of assigned claims to disposition in accordance with company Best Practices. Responsible for providing superior customer service to all agents, insureds, and others encountered during the claims handling process. What you will bring to C&F Minimum of six - eight years' litigation experience handling complex claims; College degree is required; a designation and/or insurance related courses are a plus. Obtain and maintain required state licenses. Excellent verbal and written communication skills are essential and the ability to communicate with all levels within the organization. Computer skills with a working knowledge of the Microsoft Office suite of programs a must. Travel occasionally required. What C&F will bring to you Competitive compensation package Generous 401K employer match Employee Stock Purchase plan with employer matching Generous Paid Time Off Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family's wellness, including your physical, mental and financial wellbeing A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path A dynamic, ambitious, fun and exciting work environment We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community At C&F you will BELONG If you require special accommodations, please let us know. We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit **************************************************************** for more information. Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $64,700.00 to a maximum of $121,600.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee's contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs. #LI-AV1 #LI-Remote

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year medical billing/medical office experience CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to professional billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. Communicates problems hindering workflow to management in a timely manner. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 UHA Patient Financial Services

We are united in our mission to make a positive impact on healthcare. Join Us! South Florida Business Journal, Best Places to Work 2024 Inc. 5000 Fastest-Growing Private Companies in America 2024 2024 Black Book Awards, ranked #1 EHR in 11 Specialties 2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold) 2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara) Who we are: We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany. ModMed is hiring a driven Patient Claim Specialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine! Your Role: Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates Input and update patient account information and document calls into the Practice Management system Special Projects: Other duties as required to support and enhance our customer/patient-facing activities Skills & Requirements: High School Diploma or GED required Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST Minimum of 1-2 years of previous healthcare administration or related experience required Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs) Manage/ field 60+ inbound calls per day Bilingual is a requirement (Spanish & English) Proficient knowledge of business software applications such as Excel, Word, and PowerPoint Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone Ability and openness to learn new things Ability to work effectively within a team in order to create a positive environment Ability to remain calm in a demanding call center environment Professional demeanor required Ability to effectively manage time and competing priorities #LI-SM2 ModMed Benefits Highlight: At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits: India Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk, Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees, Allowances: Annual wellness allowance to support your well-being and productivity, Earned, casual, and sick leaves to maintain a healthy work-life balance, Bereavement leave for difficult times and extended medical leave options, Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave, Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind. United States Comprehensive medical, dental, and vision benefits 401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep. Generous Paid Time Off and Paid Parental Leave programs, Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs, Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed, Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning, Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles, Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters. PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.

Overview Advanced Hearing Providers (“AHP”) coordinates hearing healthcare services for employees with workers' compensation claims. We connect patients with our nationwide network of qualified hearing healthcare providers on behalf of our clients; the payers and third-party administrators of workers' compensation claims. We are seeking hard-working, self-motivated candidates with a positive attitude who are passionate about patient care and want to help people hear better. The position of Claims Specialist I (“CS I”) plays a critical role in the operation of the organization. The main function of an AHP CS I is coordinating authorized hearing healthcare for covered injured workers, demonstrating basic to intermediate competency within the role and duties assigned. AHP staff work as a TEAM and CARE- this is crucial! We expect team members to build trust and respect for each other by producing consistent results and going above and beyond, especially to help each other. Even though each CS will be working on their own assigned cases, interaction with other team members, clients, providers, and patients will occur often. This is a fully remote position; however, candidates must be able to work the core hours of 11:30 AM - 8:00 PM EST Responsibilities - Obtain a complete, thorough understanding of the workers' compensation claims administration process, fees and participants. - Adhere to customer Service Level Agreements (SLAs) by maintaining contact with clients, providers, and claimants/patients as prescribed to ensure all parties are kept informed of the process status. - Successfully prioritize the workday utilizing our task-based systems, resulting in achieving daily completion of all required tasks (ensuring SLA compliance). - Ensure orders are properly documented in a timely manner. - Demonstrate an understanding of the workers' compensation referral and RFA process - Demonstrate an understanding of navigating client/claimant requirements to ensure billable item eligibility is reviewed prior to submitting requests to client - Perform verification of all HCPC/CPT codes that will be requested. This includes not only verifying eligibility but confirming whether NCCI edits and/or a state fee schedule (SFS), is applicable. - Coordinate the completion of necessary documentation to be filed with state agencies when applicable. - Maintain a high degree of detail and accuracy throughout the claim administration process. - Cross utilize phone, email, and fax for communication to ensure efficient processing time. - Assist with phone answering and intake related duties. - Demonstrate basic to intermediate level process understanding and ability to critically think and solution for complex situations that arise. - Other duties as assigned by the manager Qualifications - HS Diploma or equivalent - Advanced knowledge and experience with computer systems and business software programs, in particular Salesforce, Word, Excel, Outlook, Office 365 Apps and Adobe Acrobat - Previous workers' compensation, insurance claims management, and/or hearing healthcare industry experience is preferred - Bilingual skills will be extremely helpful with some patients - Excellent grammar and written skills - Ability to type at a minimum of 40 WPM - Ability to travel for training and occasional on-site meetings Other Personal Characteristics and Experience - Communicate clearly, professionally and in a timely manner. - Manage multiple tasks simultaneously in a proficient manner. - Ability to maintain professional client and provider relationships. - Work collaboratively with colleagues, including regularly providing direct support by completing team members' tasks for them as needed. - Understand when situational discretion must be employed in the handling and sharing of client, provider, and/or claimant information. - Self-motivated; ability to work independently - Must have a high attention to detail - Must be coachable and receptive to feedback - Must be dependable and consistent - Ability to take a proactive approach to all situations - Driven by a focus on reaching a specific objective or accomplishing a given task - Eagerness to adapt to new methods - Obtain satisfaction from delivering great customer service - Willing to try new things/operate outside of your comfort zone This role works remotely. You will need the following when working from home: - Reliable and secure Internet Service Provider at home (no public WiFi) for duration of working hours - Sufficient room to set up a laptop, monitors, keyboard and mouse - Comfortable space to work for duration of working hours - Quiet, private and secure space in which to work What we have to offer: Medical, dental, prescription, and vision benefits 24/7 virtual medical care Employee Assistance Program for you and your family 401(k) with company match Company-paid life insurance Supplemental insurance for yourself, your spouse/partner, and your children Short-term and long-term disability insurance Pre-tax Health Savings Account and Flexible Spending Accounts for Health Care or Dependent Care Pet Insurance Commuter accounts The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status. The pay range for this position is expected to be between $18.90-22.05 hourly; however, while the salary range is effective as of the date of this posting, fluctuations in the job market may necessitate adjustments to pay ranges. Further, final pay determinations will depend on various factors, including but not limited to experience level, knowledge, skills, and abilities. The total compensation package for this position may also include other elements, such as bonus, commissions, or discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. #Birdsong #LI-JB1 #LI-REMOTE

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

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Remote **Medical Claims Representative** to join our team in **for a remote position** . This is a US based, W-2 project. All candidates will be paid through NTT DATA only. **Role Responsibilities** **- Pay rate is $18.00** -Processing of Professional claim forms files by provider -Reviewing the policies and benefits -Comply with company regulations regarding HIPAA, confidentiality, and PHI -Abide with the timelines to complete compliance training of NTT Data/Client -Work independently to research, review and act on the claims -Prioritize work and adjudicate claims as per turnaround time/SLAs -Ensure claims are adjudicated as per clients defined workflows, guidelines -Sustaining and meeting the client productivity/quality targets to avoid penalties -Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. -Timely response and resolution of claims received via emails as priority work -Correctly calculate claims payable amount using applicable methodology/ fee schedule **-Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities** **-Time management with the ability to cope in a complex, changing environment** **-Ability to communicate (oral/written) effectively in a professional office setting** **Required Skills/Experience** + 1+ year(s) hands-on experience in **Healthcare Claims Processing** + **Previously performing - in P&Q work environment; work from queue; remotely** + 2+ year(s) using a computer with Windows applications using a keyboard, **navigating multiple screens and computer systems, and learning new software tools** + Key board skills and computer familiarity - + **Toggling back and forth between screens** /can you navigate multiple systems. + Working knowledge of MS office products - Outlook, MS Word and **MS-Excel** . **Preferences** Amisys &/or Xcelys Preferred About NTT DATA: NTT DATA is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com. NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is **$18.00/hourly** . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

Job DescriptionOur client, an A-rated Insurance Carrier, is seeking to add a Senior Commercial General Liability Claims Specialist to their team. This person would be responsible for directly handling moderate to complex non-litigated Commercial General Liability claims including Slip and Falls, Premise Liability, and Bodily Injury losses throughout the country. Responsibilities of this position include coverage analysis, investigation, evaluation, negotiation and settlement of assigned claims. This person would have the ability to work remotely. Handle a pending of 90 - 110 Commercial General Liability files. Analyze coverage as it relates to the facts and allegations of the claim. Prepare Reservation of Rights and Declination of Coverage letters. Possess strong litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. Perform coverage, liability, and damage analysis on all claim's assignments Investigate allegations and determine facts based on evidence and interviews Maintain a high level of communication internally with Claims Management team and externally with Insureds, claimants, attorneys, and brokers. Identify and pursue appropriate cost containment, loss mitigation and subrogation recovery opportunities. Requirements: 5+ years of Commercial General Liability claims experience. Must have experience working directly for an Insurance Carrier. Well versed in drafting coverage position letters. Must hold an active adjuster's license. Strong verbal and written communication skills, including the capability to write routine reports and correspondence, speak effectively before groups of customers or employees and handle litigations and negotiations. Bachelor's Degree strongly desired but not required. Salary/Benefits: $105,000 to $120,000+ annual base salary plus 10-20% bonus Ability to work remotely Extremely competitive Medical, Dental, Vision and Life plans Employer matching 401(k) plan Lucrative PTO plan Promotional opportunities very likely