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Liability Claims Representative remote jobs

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  • Workers' Compensation Claims Representative - Hybrid - Fresno, CA

    Insurance Relief

    Remote job

    Workers' Compensation Claims Representative - Hybrid Remote- Fresno, CA Join a well-established insurance agency with a 30-year legacy and a powerful commitment to ethical, honest insurance solutions. They are actively seeking an experienced Workers' Compensation Claims Representative! You will drive success by investigating and evaluating claims, expediting payments, and ensuring proper documentation. Grow your expertise with a team ready to invest in your long-term professional development. What's in it for you? Earn an annual salary of $70,000 - $90,000+, depending on your experience Comprehensive benefits package including Medical, Dental, and Vision insurance 401(k) plan Generous Paid Time Off (PTO) and paid company holidays What we need from you: 3-5+ years of experience in workers' compensation claims Certifications as a Workers Compensation Claims Administrative (WCCA) and Workers Compensation Claims Professional (WCCP) are preferred but not required Knowledge of Worker's Compensation guidelines, Medicare coding, and compliance obligations. Microsoft Office and other database management systems The Position: Assisting with new claims from opening until satisfactory completion, evidence, and fact-gathering surrounding claims Ensuring claims coding is true and accurate Claim files must be accurately recorded in the system Assuring all claims have a workable plan of action Reviewing billing summaries Identifying any signs of fraud and making proper referrals for further investigation Pursue subrogation when necessary and offer superior customer service to all parties involved APPLY NOW! Why Insurance Relief™? As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance Relief™ works with brokers, carriers, and third-party administrators to locate and place the best people for positions ranging from entry-level to senior management. We invest the time to truly understand what you want to accomplish and then do our best to find meaningful opportunities. Insurance Relief™ provides ample opportunities for you to put your skills to work so if this position is not quite the fit for you please give us a call to hear about all of the other opportunities we have available.
    $70k-90k yearly 5d ago
  • Workers Comp Claims Oversight Specialist

    Samuel Hale 4.6company rating

    Remote job

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

    West Bend Mutual Insurance 4.8company rating

    Remote job

    Recognized as a Milwaukee Journal Sentinel Top Workplace for 14 consecutive years, including three years of being honored as number one! Join us at West Bend, where we believe that our associates are our greatest asset. We hire talented individuals who are conscientious, dedicated, customer focused, and able to build lasting relationships. We create and maintain an environment where you feel a sense of belonging and appreciation. Your diversity of thought, experience, and knowledge are valued. We're committed to fostering a welcoming culture, offering you opportunities for meaningful work and professional growth. More than a workplace, we celebrate our successes and take pride in serving our communities. Job Summary Our Claims Specialist manages disputed or litigated insurance claims, investigates facts, works with legal counsel, and negotiates settlements to resolve claims efficiently and in compliance with company and legal standards. The internal deadline to apply is 8/6/25. External applications will be accepted on a rolling basis while the position remains open. Work Location Applicants must currently reside in WI, IL, IN, IA, MN, MI, or OH to be considered. This position offers both remote and hybrid work locations. Candidates who reside within 50 miles of an office location (West Bend, Madison, Appleton) will be offered a hybrid work schedule. Candidates who are fully remote (beyond 50 miles) may occasionally be asked to travel to an office location for in-person engagement activities such as team meetings, training and corporate events. Responsibilities & Qualifications Summary of ResponsibilitiesSpecializes in a specific line of business (i.e. property, casualty, workers compensation). Handle high-exposure claims. Utilize current Claims technology. Provide technical advice and direction to claim adjusters, managers, agents and examiners. Direct activities of defense counsel handling litigated files. Research and provide coverage opinions. Handle special projects as assigned. Participate in training of department personnel. Consistently exhibit a high level of customer service and adherence to department audit guidelines.Preferred Experience and SkillsPrior experience handling complex, large claims Proficiency with computers and current technology Oral and written communication skills Interpersonal skills Negotiation and problem-solving skills Prior experience handling litigated files Preferred Education and TrainingBachelor's degree in Business, Insurance or related field Associate in Claims DesignationCPCU designation or other continuing education Salary Statement The salary range for this position is $85,000-$105,000. The actual base pay offered to the successful candidate will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, business needs, geographical location, and internal equity. Compensation decisions are made by West Bend and are dependent upon the facts and circumstances of each position and candidate. Benefits West Bend offers a comprehensive benefit plan including but not limited to: * Medical & Prescription Insurance * Health Savings Account * Dental Insurance * Vision Insurance * Short and Long Term Disability * Flexible Spending Accounts * Life and Accidental Death & Disability * Accident and Critical Illness Insurance * Employee Assistance Program * 401(k) Plan with Company Match * Pet Insurance * Paid Time Off. Standard first year PTO is 17 days, pro-rated based on month of hire. Enhanced PTO may be available for experienced candidates * Bonus eligible based on performance * West Bend will comply with any applicable state and local laws regarding employee leave benefits, including, but not limited to providing time off pursuant to the Colorado Healthy Families and Workplaces Act for Colorado employees, in accordance with its plans and policies. EEO West Bend provides equal employment opportunities to all associates and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, and promotion.
    $85k-105k yearly Auto-Apply 60d+ ago
  • Casualty Claims Representative

    Harrison Gray Search & Consulting

    Remote job

    Job Description Casualty Claims Representative Harrison Gray Search has been engaged by a mission-driven insurance organization to identify a skilled Claims Representative to join their team in East Lansing, MI. This is a meaningful opportunity to work with a trusted organization that protects Michigan public schools. As a Casualty Claims Representative, you'll handle the full lifecycle of general and professional liability claims-investigating, evaluating, and resolving cases while working closely with school districts and legal partners. Why You'll Want This Role: Purposeful Work: Help safeguard Michigan public schools and support their staff through claims resolution. Top-Tier Benefits: 100% employer-paid medical, dental, and vision, generous PTO, and paid parental leave. Respected Workplace: Recognized as one of Business Insurance's Best Places to Work. What You'll Do: Manage and resolve assigned casualty claims, including investigation, analysis, negotiation, and settlement. Monitor and collaborate with external investigators, attorneys, and medical/legal vendors. Evaluate liability, coverage, and damages; set and adjust reserves accordingly. Represent the organization in mediations, facilitate strategy sessions, and document case activity thoroughly. Ensure timely movement of claims via an internal diary system and claim handling standards. What You Bring: Bachelor's degree plus 2+ years handling general liability and professional liability claims (or equivalent experience). Strong knowledge of complex claims handling, coverage analysis, and liability assessment. Skilled communicator with high emotional intelligence and professionalism. Comfortable working in a fast-paced, collaborative environment with school district representatives, legal professionals, and internal teams. Willingness to travel occasionally and work remotely as needed. If you're looking for meaningful claims work that supports the greater good-and you're ready to join a high-performing, purpose-driven team - apply today!
    $42k-60k yearly est. 3d ago
  • Complex Claims Specialist - Commercial Auto

    Athens Administrators 4.0company rating

    Remote job

    DETAILS Complex Claims Specialist - Property & Casualty Department: Property and Casualty Claims Reports To: Claims Supervisor FLSA Status: Exempt Job Grade: 14 Career Ladder: Next step in progression could include Claims Supervisor ATHENS ADMINISTRATORS Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits-every single day! With offices throughout the United States, Athens Administrators offers Workers' Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Complex Claims Specialist to support our Property & Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA, and WV). This position does allow for work from home if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week. The Complex Claim Specialist is responsible for the review, investigation, analysis, and processing of complex claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure and often entail litigation and complex coverage. The goal of the position is to ensure the delivery of quality service to customers while protecting their interests. Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Advanced knowledge in the following areas: 1) Complex Auto or General Liability claims handling concepts, practices and techniques, to include but not limited to complex coverage issues, and product line knowledge, 2) advanced, functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated advanced analytical, decision making and negotiation skills. Analyze, investigate, and evaluate losses to determine appropriate layers of coverage, settlement value and disposition strategy, including claim merits or denial of liability Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to clients and senior level management Manage the litigation process through the retention of selected counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment Document and manage claims (i.e.: statements, diaries, write reports) from inception to closure Ensure appropriateness of all coverage memorandums and payments Coordinate and work with dedicated vendor services such as law professionals, industry experts, county officials and client executives to manage professional claims and communications Facilitate interactions between insured entities, claimants, client contacts, and attorneys in resolution of severe and complex claims Lead and conduct comprehensive claim reviews and case analysis discussions with various committees or district level authorities Provide superior customer service to all layers of authorities within the county Meet with clients, attend hearings, and assist senior management with planning, forecasting and new business opportunities that may arise in the servicing of the account. May assist management in hiring other account dedicated examiners Provide guidance and serve as a technical expert to less experienced examiners May conduct meetings or training sessions to help develop less experienced examiners Attend all required meetings and educational seminars for professional development Conduct on-sight or frequent claim reviews in Ventura County with the client representatives, as required. Maintain required licenses ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required Possesses a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL preferred Additional State Adjuster License(s), may be required within 180 days Maintain licenses and continuing education requirements in all states Relies on extensive experience and judgement to plan and accomplish goals with a minimum of 8-10 years complex/major claims experience, including proficiency in investigation and resolution of severe to major casualty and general liability claims Experience with relevant insurance laws, codes, and procedures Experience with property and casualty insurance policies, insurance tort laws, codes, and procedures Understanding Auto and General Liability exposure and unique coverage endorsements Understanding of medical, legal terminology and liability concepts Proficiency in investigation and resolution of severe to major level casualty claims Time Management and project management skills Strong negotiation and litigation management skills Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************** This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at *************************************************
    $54k-82k yearly est. 60d+ ago
  • Viral - Content Claiming Specialist

    Create Music Group 3.7company rating

    Remote job

    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.
    $45k-75k yearly est. Auto-Apply 60d+ ago
  • Workers Compensation- Subrogation Claims Rep I

    New Jersey Manufacturers 4.7company rating

    Remote job

    The Workers Comp Legal Claims department is looking for a Worker's Compensation Subrogation Representative I. Reporting to the Supervisor, Workers' Compensation Legal Subrogation, the Worker's Compensation Subrogation Representative is responsible for the daily management and resolution of Workers' Compensation Subrogation Claims in New Jersey. Leveraging technical expertise, the Worker's Compensation Subrogation Representative will be tasked with efficient handling of negotiations and resolution of Workers' Compensation liens while collaborating with other departments and policyholders to proactively share knowledge and expertise. Demonstrate flexibility and pursue challenging tasks. Schedule: Monday through Friday, with work from home opportunities after training is complete. Specific hours are subject to selected start time between 8am-9am pending supervisory approval Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job. Manage the negotiation and resolution of New Jersey Workers' Compensation liens; Interface with internal and external stakeholders, including policyholders, attorneys and insurance carriers; Produce lien correspondences, review of policy and litigation documents relative to third party actions, ensure quality claim documentation; Evaluate New Jersey Workers' Compensation claims and identify subrogation potential; Assist in onboarding and training of subrogation team members; Support Workers' Compensation Claims as needed Required Qualifications: Knowledge, skills & abilities, experience, minimum & desired education, certification and/or license requirements. Experience in Workers' Compensation Claims; Demonstrated skills in MS Word, Excel and other applications; Ability to accurately organize and examine legal and claims documents; Strong verbal and written communication skills with strong attention to detail and customer service; Strong organizational skills with the ability to manage competing priorities; Ability to work independently and collaboratively; Must have the ability to prioritize and proactively manage a large case load; Preferred Qualifications: Workers' Compensation claims or legal experience preferred; Subrogation experience preferred Compensation: Salary is commensurate with experience and credentials. Pay Range: $49,871-$57,881 Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses. Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
    $49.9k-57.9k yearly Auto-Apply 60d+ ago
  • Casualty Claims Representative

    Set Seg 3.8company rating

    Remote job

    Title: Casualty Claims Representative Reports To: Claims Manager Department: Property/Casualty and Workers' Compensation (PC/WC) SET SEG is looking for a Casualty Claims Representative who will be responsible for the investigation, negotiation, adjustment, and resolution of designated PC claims. This position reports to the Claims Manager. WHO WE ARE School Employers Trust (SET) is a non-profit company that was created after a monumental shift in school funding happened in 1965. SET, which began in 1971, served as an employee benefits association focused on offering comprehensive and affordable employee benefit solutions to Michigan public schools and their employees. Two years later, its partner organization School Employers Group (SEG) was formed to administer compensation and fringe benefits for SET. As schools were faced with more challenges related to insurance, SEG evolved and grew into a company that provides workers' compensation and property/casualty services for Michigan public schools. Today, SET SEG continues to expand and find creative ways to meet the specialized needs of its members. This, coupled with a superior member experience, is why SET SEG has maintained its position as an industry leader in the school insurance market. We value those who proactively solve challenges, simplify the complex, thrive in a fast-paced setting, have a customer-first mentality, and seek a collaborative and inclusive work environment. We are also listed on the Business Insurance Best Places to Work. We offer 100% employer paid insurance (medical, dental, and vision), Paid Time off (PTO), and paid parental leave. Our passion is delivering peace of mind to Michigan public schools and we look for team members who are motivated by our cause. To learn more, visit: ******************* WHO YOU ARE You are energized by working with a collaborative team and industry peers to support Michigan public schools through their challenges. You seek understanding and are motivated to tackle projects and problems with the customer in mind. You anticipate needs and preempt challenges and concerns, delivering increasingly relevant customer experiences over time. You value a culture that is rooted in mutual respect, where you can learn from different perspectives and roles. Primary Responsibilities: Manages, investigates, evaluates, negotiates, and adjusts assigned claims in adherence to guidelines within authority Ensures adequacy of reserves and recommends reserve increases on cases in excess of authority Monitors outside investigators and performs outside investigations when assigned. Provides oversight of medical, legal damage estimates, and miscellaneous invoices to determine if they are reasonable and related to designated claims Negotiates any disputed bills or invoices for resolution Assigns litigated claims to approved law firms and/or individual attorneys and monitors progress Follows a uniform system of reserving by reviewing incoming litigation, establishing initial reserves and completing reserve reports Negotiates settlements in accordance with claim handling standards while also considering member preferences when appropriate Attends facilitations/mediations as assigned Manages diary system to move losses to conclusion in a timely manner Participates in strategy sessions with internal business units such as Underwriting and Loss Control Other duties as assigned by the Claims Manager Required Qualifications: Bachelor's Degree plus two years of experience adjusting general liability and professional liability claims or an equivalent combination of education and experience Must have knowledge of coverage, liability, and complex claims handling procedures Ability to handle complex case-related tasks in a fast-paced and changing environment Excellent interpersonal skills and the ability to work in a strong team environment Must be highly organized and detail oriented Must be dependable, reliable, and able to achieve high levels of professionalism when handling cases and interacting with school district representatives and their employees, attorneys, families of injured and fellow employees Must be able to create and maintain high levels of confidentiality when dealing with proprietary information and sensitive situations Must have strong cognitive and analytical skills Ability to initiate, receive, understand, and reply to written and oral communication (verbal, written, telephone, e-mail, etc.) Ability to travel and work remotely on a periodic basis Physical Demands / Work Environment Several hours per day at a sit/stand desk, average mobility to move around an office environment; able to spend several hours per day at a computer. Occasional in-state travel may be required. Punctual, regular, and consistent attendance is required. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.
    $40k-52k yearly est. Auto-Apply 60d+ ago
  • Claims CL Casualty General Liability Representative (GLPD)- remote

    Grange Insurance Careers 4.4company rating

    Remote job

    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. Summary: In this role you will be responsible for investigating, evaluating and negotiating settlement of assigned Commercial General Liability Property Damage claims in accordance with best practices to promote retention or purchase of insurance from Grange Enterprise. 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, allowing for the handling of more complex claims with minimal supervision. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business partner relationships with agents, insureds and Commercial Lines through regular and effective 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. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assist 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 of claims experience. Bachelor's degree preferred. For property focused role, at least two (2) years handling commercial general liability property claims handling exposures or frontline property claims handling experience preferred. Preference to those candidates with Construction Defect experience. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Demonstrated ability to interact with customers and agents 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.
    $34k-45k yearly est. 20d ago
  • Claims Representative

    Berkley 4.3company rating

    Remote job

    Company Details Berkley Small Business Solutions (BSB) is committed to providing small business customers with the next generation of small business solutions, including offering operational, underwriting, and marketing opportunities. We offer insurance products to Small Business Owners for transportation and other main street businesses. We leverage underwriting expertise, data, and analytics, and automation for risk assessment, selection, pricing retention. We champion our customers, distribution always seeking a smarter way to provide a more efficient and better user experience. We are a proud member of W. R. Berkley Corporation, one of the largest commercial lines property casualty insurance holding companies in the United States. With the resources of a large Fortune 500 corporation and the flexibility of a small company, we exclusively work with select independent agents to bring technology solutions that help them build their business. Responsibilities The position is responsible for handling low-complexity claims involving physical damage, property damage, total loss, fuel spills, medical payments, and cargo damage resulting from commercial auto claims. This position will work closely with insureds and stakeholders to ensure timely and accurate claims resolution and provide exceptional customer service. Customer Service Act with urgency in establishing initial and subsequent contact with all parties and key stakeholders. Update appropriate parties as needed, providing new facts as they become available and explaining impact of those facts upon the liability analysis and settlement options. Collaborate with vendors to ensure timely appraisal and evaluation of damages. Coverage Analyze coverage by applying policy information to facts or allegations of each loss. Communicate coverage decisions to insured and stakeholders and update coverage analysis as new facts warrant it. Ensure compliance with jurisdictional requirements, including timeliness of communicating coverage disposition. Data Integrity Maintain discipline in securing and updating information throughout the life of the claim. Ensure data is complete and comply with statutory requirements for reporting. Reserving Establish and maintain appropriate initial, subsequent loss, and expense reserves. Ensure supporting rationale for each reserve is documented within the electronic claim file. Act with urgency in collaborating with internal stakeholders regarding significant changes within claim reserving. Investigation Directly investigate each claim through prompt and strategic contact with appropriate parties including policyholders, witnesses, claimants, law enforcement agencies, agents, medical providers, and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders. Take recorded and/or written statements when appropriate. Evaluate all claims for recovery potential. Directly handle recovery efforts and/or engage and direct Company resources for recovery efforts. Evaluation and Resolution Utilize diary management system to ensure all claims are handled timely and in compliance with jurisdictional requirements and Company guidelines. Collaborate with external vendors, e.g., appraisers and independent adjusters. Manage total loss claims process including vehicle appraisal procedures, diminished value, vendor networks, subrogation demands, salvage procedures and heavy equipment appraisals. May perform other functions as assigned. Remote work arrangements may be considered for qualified candidates who are open to travel as needed. Qualifications 1+ years of casualty claim handling experience; trucking experience preferred. Excellent interpersonal and communication skills. Strong problem-solving and organizational skills. Computer proficiency, including working knowledge of Microsoft Office products. Previous experience in customer service role, or a related field, is preferred but not required. Willingness to learn and expand knowledge. Position will require that Claims Representative obtain independent adjuster's licenses for all states that have requirement, including but not limited to: AL, CT, GA, FL, ME, MS, NY, NC, SC, TN, TX. Licenses must be obtained within 90 days of hire and require course work, testing, and background checks that may include fingerprinting Education College degree preferred or equivalent work experience. Additional Company Details **************************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. • Salary Range: 75k - 90k • Eligible for annual discretionary bonus • Benefits: Health, Dental, Annual Bonus Potential, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. 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.
    $40k-53k yearly est. Auto-Apply 60d+ ago
  • Claims Examiner, Liability - MSI

    The Baldwin Group 3.9company rating

    Remote job

    Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Claims Examiner. The Claims Examiner will be managing insurance claims for our policyholders with low to moderate severity and complexity. The Claims Examiner must have the experience and technical knowledge needed to manage a case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party bodily injury and property damage claims involving low to moderate complexity from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 5+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with willingness to expand licenses as needed. #LI-BM #LI-REMOTE Click here for some insight into our culture! The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
    $42k-67k yearly est. Auto-Apply 9d ago
  • Claim Representative III - Casualty

    Capital Insurance Group 4.4company rating

    Remote job

    Why CIG? At Capital Insurance Group we offer our employees more than just a job. We foster career growth, provide opportunities to give back to our communities, and help you take the next step in your career! CIG was founded in 1898 by a group of earnest farmers in need of protection and today, we are the leading West Coast Property & Casualty insurer. CIG is certified as a Great Place to Work and provides a collaborative, inclusive, and fun work culture for all employees. Why choose CIGs Claims Team? CIG claims department is here to support our insureds throughout their claims process. We work directly with our agency partners and policyholders to accomplish successful claim resolutions. Join the claims operation and you can be part of a team who provides excellent service, build relationships, and achieves successful outcomes for our clients. Benefits * Accrue twenty-one days of Paid Time Off during your first year * Up to eighty-seven percent of benefits covered by CIG for you and your family members * Medical, dental, vision plans * One hundred percent covered plans * Basic Life & AD&D * Employee Assistance * Leave Management * Long Term Disability * Short Term Disability (Outside of CA) * Family Caregiver Support (Homethrive) * Child Care Resources (Tootris) * Business Travel Accident Protection * Voluntary benefit offerings * Short-term (CA only) * Voluntary Life AD&D self, spouse and child plans * Flexible Spending * Health Savings (HSA) * Hospital Indemnity * Accidental Injury * Critical Illness * ARAG Legal Services * Norton LifeLock * Nine paid holidays, plus two floating holidays * Above and Beyond Reward Recognition Program * Kudos & Shout Out Points Program * Quarterly Above and Beyond Bonus Program * Annual Above and Beyond Bonus Program * Competitive compensation * Base compensation * Salary Management Spot Bonuses * Annual Incentive/Profit sharing program, potential payout annually based on company results. * Discount partnerships * Gym memberships, credit union, travel, shopping, restaurants, theme parks, and more * Insurance Educational reimbursement and bonus programs * Employee Referral Bonus Program * Home and Auto Insurance Discount Program. * Paid Volunteer Time Through company planned community events and choose your own adventure PVT in giving back in ways that are meaningful to you! * Retirement savings benefit (401k and Roth + match) * Health & Financial Wellness * Wellness platform, tools and events * Health Savings Account match * Financial Wellness Resources Work Environment This is a hybrid-eligible position, where Monday through Wednesday would be working in one of our offices, with Thursday and Friday eligible for work-from-home days. Office locations include Roseville (CA), Bakersfield (CA). Job Overview The primary purpose of a Claim Representative III - Casualty is to investigate, evaluate, and resolve commercial and personal lines casualty claims. Specific emphasis should be given to analyzing complex coverage issues, duties to defend, larger exposure bodily injuries, negotiating and directing outside counsel. Focus on managing expenses and understanding personal and commercial line policies, including issuance of Reservations of Rights. Demonstrates superior claim service and produces appropriate claim settlements to our clients. It is incumbent upon this individual to understand regulations and the jurisdiction(s) involved in the claims being evaluated. Minimum Requirements * Bachelors degree and four to six years casualty claim handling experience or equivalent experience of six to eight years of claim experience, including three years experience in handling complex claim files. * Knowledge of Current claims laws, specifically civil and tort law and current trends in * Good working knowledge of mathematics and common accounting practices which relate to gross and net income or living-expense calculations. * Proven ability to comprehend contracts pertaining to relationships amongst insured parties and/or landlord/tenant/property management. * Demonstrate strong negotiation skills and communicate complex legal concepts and policy-contract interpretation in writing and orally * Plan, organize, and prioritize work under the pressure of critical deadlines * interpretation in writing and orally * Maintain a valid California Driver License and operate a vehicle Career Path potential * Claim Representative IV Commercial and General Liability * Casualty Claim Manager Salary Range: $71,606-$118,150 The salary range listed here has been provided to comply with local regulations and represents a potential base salary range for this role. Please note that actual salaries may vary within the range above or below, depending on experience and location. We look at compensation for each individual and base our offer on your unique qualifications, experience, and expected contributions. This position may also be eligible for other types of compensation in addition to base salary, such as benefits and bonus programs.
    $39k-52k yearly est. 42d ago
  • Property and Casualty Claims Specialist (Remote)

    SOLV Energy

    Remote job

    SOLV Energy is an engineering, procurement, construction (EPC) and solar services provider for utility solar, high voltage substation and energy storage markets across North America. The Property & Casualty Claim Specialist is responsible for managing and processing insurance claims related to property and casualty losses. This role involves investigating claims, assessing damages, claim reporting, and ensuring timely and accurate claim resolution. The ideal candidate will have a strong understanding of insurance policies, excellent analytical skills, and a commitment to providing outstanding service. : *This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned Position Responsibilities and Duties: Investigate and evaluate property and casualty claims to determine coverage, liability, and damages. Communicate with carriers, adjusters, claimants, and other stakeholders to gather necessary information and documentation. Analyze policy terms and conditions to determine claim eligibility. Coordinate with adjusters, contractors, and other professionals to assess and estimate damages. Work with carrier(s) in settlement negotiations with claimants and ensure fair and equitable claim resolution. Maintain accurate and detailed claim files and documentation. Provide regular internal updates on the status of claims. Ensure compliance with company policies, procedures, and regulatory requirements. Identify and report potential fraud or suspicious activities. Participate in training and development programs to stay current with industry trends and best practices. Minimum Skills or Experience Requirements: Bachelor's degree in a related field or equivalent work experience. Recommended heavy knowledge in Commercial Auto and Builders Risk coverages. Minimum of 5-10 years of experience in property and casualty claims handling - whether at a carrier, broker or with a construction client. Strong knowledge of insurance policies, coverage, and claim processes. Excellent analytical and problem-solving skills. Effective communication and negotiation abilities. Ability to work independently and as part of a team. Strong attention to detail and organizational skills. Customer-focused with a commitment to delivering high-quality service. SOLV Energy Is an Equal Opportunity Employer At SOLV Energy we celebrate the power of our differences. We are committed to building diverse, equitable, and inclusive workplaces that improve our communities. SOLV Energy prohibits discrimination and harassment of any kind against an employee or applicant based on race, color, age, religion, sex, sexual orientation, gender identity or expression, marital status, national origin, or ethnicity, mental or physical disability, veteran status, parental status, or any other characteristic protected by law. Benefits: Employees (and their families) are eligible for medical, dental, vision, basic life and disability insurance. Employees can enroll in our company's 401(k) plan and are provided vacation, sick and holiday pay. Compensation Range: $65,133.00 - $81,416.00 Pay Rate Type: Salary SOLV Energy does not accept unsolicited candidate introductions, referrals or resumes from third-party recruiters or staffing agencies. We require all third-party recruiters to communicate exclusively with our internal talent acquisition team. SOLV Energy will not pay a placement fee to any third-party recruiter or agency that has not coordinated their recruiting activity with the appropriate member of our internal talent acquisition team. In addition, candidate introductions or resumes can only be submitted to our internal talent acquisition recruiting team if a signed vendor agreement is already on file and the third-party recruiter or agency has received formal instructions from our internal talent acquisition team to submit candidates for a particular job posting. Any unsolicited candidate introductions, referrals or resumes sent by third-party recruiters to SOLV Energy or directly to any of our employees, or received through our website or career portal, will be considered property of SOLV Energy and will not be eligible for a placement fee. In the event a third-party recruiter submits a resume or refers a candidate without a previously signed vendor agreement, SOLV Energy explicitly reserves the right to pursue and hire the candidate(s) without financial liability to such third-party recruiter. Job Number: J11771 If you're interested in a meaningful career with a brighter future, join the SOLV Energy Team.
    $65.1k-81.4k yearly Auto-Apply 60d+ ago
  • Coding Claim Review Specialist (IP/OP)

    Corrohealth

    Remote job

    About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. (AHIMA CCS, COC or AAPC CPC certification required) Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. QUALIFICATIONS · 5+ years of directly related experience · Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I) · Medical Terminology and anatomy knowledge is required · Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. · Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines. · Strong Microsoft Excel, PowerPoint, Word and OneNote skills · Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS) · Strong analytical capability, independent thinker and good decision-making skills · Excellent written and verbal communication and presentation skills · Strong computer and technology knowledge and skills · Highly professional demeanor, great client satisfaction skills ESSENTIAL DUTIES AND RESPONSIBILITIES · Become proficient in the use of the PARA Data Editor, our proprietary software; · Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. · Audit all aspects of claim including (but not limited to): o Omitted or incorrect charges, o Review OPPS and CAH charges and apply guidelines. o CMS/Payer specific guidelines o Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) o Departmental review for inaccuracies, omitted data/documentation and charges o NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, o Units of services o E/M Profee/Facility o Units of services o Documentation improvement. · Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries. · Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing. · Participate in presentations to clients and prospective clients, typically over web meetings. · Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant. · Maintain current certifications and accreditations (as applicable). · Research new guidelines, data elements, payer specifications, etc. · Other duties may be assigned as necessary. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
    $34k-54k yearly est. Auto-Apply 10d ago
  • Patient Claims Specialist - Bilingual Only

    Modmed 4.5company rating

    Remote job

    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.
    $66k-101k yearly est. Auto-Apply 3d ago
  • Claims Specialist III

    Caresource 4.9company rating

    Remote job

    The Claims Specialist III is responsible for capturing, resolving/facilitating resolution, and reporting on claim adjustment requests. Essential Functions: Resolve complex COB issues through member information updates and adjustment of claims Maintain accountability for daily tasks and goals to ensure completion of requests within requested SLA and department standards Identify potential process improvements Work with peers to ensure implementation of identified process improvements through the Plan, Do, Study, Act (PDSA) cycle with proper documentation updates and sharing of improvement with team and department Process/adjust a wide variety of claims accurately and timely following established guidelines for accuracy, quality and productivity Act as a technical resource for training, providing job shadowing, departmental communication, and coaching Ensure all assigned provider issues are resolved and communicated to the provider within appropriate timeframes and claims resolutions are coordinated with all appropriate departments in order to resolve Assist providers with inquiries including but not limited to; verifying proper medical coding, explanation of benefits, negative balance requests, claims, and appeal procedures Identify, track and trend claims payment errors in order to determine root causes and actions needed to correct problems. Work directly with Configuration, Network Operations, and Service Center through resolution of payment errors. Ensure reporting on provider inquires and complaints is compliant with current and future regulatory and accreditation bodies such as; ODJFS, MDCH, CMS, OFIR, NCQA and URAC Adhere to all HIPAA, State, and Federal requirements and regulations at all times in existing and future lines of business Perform any other job related instructions, as requested Education and Experience: High School Diploma or equivalent is required Minimum of one (1) year of experience in claims environment or related healthcare operations experience required Previous experience in an HMO or related industry preferred Previous Medicare/Medicaid dual eligible claims experience is preferred Managed Care Organization or related healthcare industry experience preferred Competencies, Knowledge and Skills: Proficient in Microsoft Office Suite, to include Word, Excel and PowerPoint Medical terminology; CPT and ICD coding knowledge strongly preferred Knowledge of medical billing practices Intermediate level data entry skills Excellent written and verbal communication skills Ability to develop, prioritize and accomplish goals Effective listening and critical thinking skills Strong interpersonal skills and a high level of professionalism Ability to coach and provide feedback effectively Effective problem solving skills with attention to detail Ability to work independently and within a team environment Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $40,400.00 - $64,700.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-RW1
    $40.4k-64.7k yearly Auto-Apply 5d ago
  • Claiming Specialist- HAAWK (Remote)

    Sesac Rights Management, Inc. 3.6company rating

    Remote job

    HAAWK is looking for a Claiming Specialist to join our team. In this role you will be responsible for accuracy and integrity of music assets within YouTube's Content Management System (CMS), and play a critical part in ensuring proper monetization, rights enforcement, and conflict resolution across digital content platforms. The ideal candidate is highly detail-oriented, technically proficient, and possesses a strong understanding of YouTube's platforms and policies. What You Will Be Doing: Monitoring and troubleshooting issues related to claims, monetization, and policy enforcement within YouTube CMS. Investigating and resolving disputed claims, reference overlaps, and ownership conflicts to ensure proper asset management. Maintaining accurate metadata, confirming correct ownership, and applying appropriate policies across music assets. Serving as a point of contact for clients and partners, providing timely assistance with content-related issues and conflict resolution. Stay up-to-date and informed on YouTube platform developments, Content ID tools, and industry best practices. What Makes You Qualified: Proficiency in organizing and analyzing data using tools such as Microsoft Excel or Google Sheets. Strong attention to detail, with excellent organizational and analytical problem-solving abilities. Comfortable working with and learning new technologies. Proven ability to work collaboratively in a team environment with a positive, solutions-oriented attitude and a willingness to support others to achieve shared goals. Hands-on experience with YouTube CMS or similar content management systems. Background in music, digital rights management, or copyright is a plus. Solid understanding of popular music and awareness of current and emerging trends in the music industry. Exceptional communication skills with the ability to interact professionally in client-facing situations.
    $30k-46k yearly est. Auto-Apply 54d ago
  • Claims Coverage Specialist

    Hagerty Insurance Agency 4.7company rating

    Remote job

    The Claims Coverage Specialist is a technical resource on the Hagerty Claims Legal team who conducts legal research and assists the Hagerty Claims team with providing accurate and consistent application of policy coverages among all jurisdictions. As a Claims Coverage Specialist, you will play a critical role in providing advice to assist the Claims team with the resolution of insurance claims by analyzing coverage, identifying risks, and supporting the Claims team in making informed decisions. This role requires strong analytical skills, attention to detail, and the ability to collaborate effectively across teams. Ready to get in the driver's seat? Join us! What you'll do Coverage Analysis: Review and interpret insurance policies to provide advice to the Claims team regarding coverage and liability issues. Provide clear, well-reasoned coverage recommendations to claim adjusters and leadership. Support the Claims team by preparing written communications that explain coverage issues. Provide claim adjusters with assistance drafting clear, professional correspondence to communicate coverage positions and decisions to policyholders and other stakeholders. Contribute to the review and updating of policy language to ensure accuracy, compliance, and clarity. Stay current on emerging coverage issues, regulatory changes, and industry trends. Share knowledge and resources with the team. Provide guidance and training to claims staff on coverage matters and best practices. Risk Awareness: Identify potential risks and recommend strategies to mitigate exposure. Support cross-functional initiatives, respond to legal or regulatory inquiries, and assist with projects requiring coverage expertise. This might describe you Education: Juris Doctor and admission to at least one state bar Experience: Minimum of 3+ years in insurance claims, coverage analysis, or related legal/industry work. Auto or casualty insurance experience is a plus. Skills: Strong analytical and problem-solving abilities. Excellent written and verbal communication skills. Comfortable working on multiple priorities in a collaborative environment. Knowledge: Familiarity with insurance coverage principles, claims processes, and regulatory requirements. Litigation or dispute resolution experience is a plus. Excellent written, verbal and interpersonal communication skills Able to prioritize multiple tasks with good time management skills Able to work accurately and effectively in a highly confidential, detail- and results-oriented environment. Able to work independently with minimal direction while functioning well in a team environment Excellent judgment (common sense) and business instincts. Ability to collaborate with employees at all levels across the enterprise and in team settings. Self-managed, self-motivated, and ability to work both independently and as part of a team on assigned tasks. Highest levels of personal and professional integrity. Ability to effectively prioritize and execute tasks in a fast-paced environment. Proven experience in interfacing with executive teams, business management and external law firms. Other things to note This position may require occasional travel to attend industry conferences or training sessions This position is open to U.S. remote work. Say hello to Hagerty Hagerty is an automotive enthusiast brand and the world's largest membership organization. Along with being a best-in-class provider of specialty insurance for enthusiasts, Hagerty is also home to the Hagerty Drivers Foundation, Garage + Social, Hagerty Drivers Club, Marketplace and so much more. Committed to saving driving for future generations, each and every thing Hagerty does is dedicated to the love of the automobile. Hagerty is a rapidly growing company that values a winning culture. We provide meaningful work for and invest in every single team member. At Hagerty, we share the road. We are an inclusive automotive community where all are welcomed, valued and belong regardless of race, gender, age, or car preference. We are united by our shared passion for driving, our commitment to preserve car culture for future generations and our desire to make a positive impact in the world. If you reside in the following jurisdictions: Illinois, Colorado, California, District of Columbia, Hawaii, Maryland, Minnesota, Nevada, New York, or Jersey City, New Jersey, Cincinnati or Toledo, Ohio, Rhode Island, Vermont, Washington, British Columbia, Canada please email ********************** for compensation, comprehensive benefits and the perks that set us apart. #LI-Remote EEO/AA US Benefits Overview Canada Benefits Overview UK Benefits Overview If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
    $33k-46k yearly est. Auto-Apply 8d ago
  • Senior Workers' Compensation Claim Representative

    Travelers Insurance Company 4.4company rating

    Remote job

    **Who Are We?** Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim **Compensation Overview** The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. **Salary Range** $70,400.00 - $116,200.00 **Target Openings** 7 **What Is the Opportunity?** This role is eligible for a sign-on bonus. This position is hybrid and will have the option to work from home up to 2 days per week. This position will office out of the Diamond Bar or Irvine, CA locations. Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered. **What Will You Do?** + Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability. + Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions. + Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. + Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). + Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome + Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. + Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation. + Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment. + Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations. + Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals + Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status + Act as technical resource to others. + Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed. + Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers' Compensation claims. + Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims + Acts as an independent mentor to other Claim Professionals + In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. + Maintain Continuing Education requirements as required. + Perform other duties as assigned. **What Will Our Ideal Candidate Have?** + Education/Course of Study: Work Experience: + Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. + Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. + Negotiation: Advanced evaluation, negotiation and case resolution skills. Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. + General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract. + Principles of Investigation: Intermediate investigative skills including the ability to take statements. Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss. + Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. + Settlement Techniques: Advanced ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package. + Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. + Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed. + WC Technical: + Advanced ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. + Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. + Customer Service: + Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes + Teamwork: + Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result + Planning & Organizing: + Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals **What is a Must Have?** + High school diploma or equivalent required + Minimum of 2 years Workers Compensation claim handling experience **What Is in It for You?** + **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment. + **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. + **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. + **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. + **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice. **Employment Practices** Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences. In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions. If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email (*******************) so we may assist you. Travelers reserves the right to fill this position at a level above or below the level included in this posting. To learn more about our comprehensive benefit programs please visit ******************************************************** .
    $70.4k-116.2k yearly 49d ago
  • Remote Medical Claims Representative

    NTT Data North America 4.7company rating

    Remote job

    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.
    $18 hourly 44d ago

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