Claim Processor jobs at Matrix Absence Management, Inc. - 610 jobs
Experienced Claims Specialist
Geico 4.1
Tampa, FL jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
What Makes This Opportunity Exciting?
Are you a seasoned professional with a track record in insurance claims? As an Experienced Claims Specialist at GEICO, you'll leverage your expertise to manage cases and contribute to your team's success. You'll be at the heart of our commitment to outstanding customer service. You'll manage multiple steps impacting the claims life cycle, providing guidance, support, and solutions to policyholders during times of uncertainty. Your expertise and compassion will make a meaningful impact on their lives while contributing to GEICO's reputation for excellence.
Claims Processing: Efficiently and accurately handle insurance claims, ensuring adherence to company policies and procedures.
Customer Service: Communicate professionally and empathetically with customers, addressing concerns and questions about their claims.
Investigation: Conduct thorough investigations to determine the extent of coverage and assess any potential fraud.
Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction.
Workplace Flexibility: After completing a comprehensive 5-month in-office training and orientation, transition to a hybrid work model with the best of both worlds-spend 80% of your time in the office and 20% working remotely. Plus, take advantage of the GEICO Flex Program, which offers up to four additional weeks of remote work annually for even greater flexibility.
Professional Growth: Access GEICO's industry-leading training programs and development opportunities:
Continuing education at no cost to you.
Leadership development programs and hundreds of eLearning courses to enhance your skills.
Access to GEICO Strive Program, providing associates with tuition assistance and access to high-quality education to advance their career.
Incentives and Recognition:
Pay Transparency: The starting salary for an Experienced Claims Specialist is between $31.62 per hour / $63,714 annually and $36.12 per hour / $72,782 annually.
Sign-On Bonuses: $1,500 for active Florida All-Lines Adjuster License (6-20).
Evening Shift Differentials: Earn a +10% pay differential for eligible shifts.
Weekend Shift Differentials: Earn a +20% pay differential for eligible shifts.
Additional Perks:
Health & Wellness: Comprehensive healthcare and well-being support available on Day 1.
401(k) Match: From day one, you'll be automatically enrolled in our 401(k) plan with a 6% pre-tax contribution. We match 100% of your contributions, up to 6% of your eligible earnings, with employer contributions added to your account each paycheck and vesting immediately.
What We're Looking For:
A passion for providing outstanding customer service.
Strong interpersonal, communication, and problem-solving skills.
Adaptability and attention to detail in a dynamic environment.
2+ years of prior claims experience in the insurance industry.
Active Florida All-Lines Adjuster License (6-20) required.
High School Diploma required, College degree (2-4 year) preferred.
Ability to prioritize and multi-task, while navigating through multiple business applications.
Computer proficiency, including familiarity with Microsoft Office Suite.
Flexibility to work evenings, weekends, and holidays as needed.
#geico600
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$63.7k-72.8k yearly Auto-Apply 1d ago
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Claims Supervisor (Bodily Injury)
Geico 4.1
Richardson, TX jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage:
complex investigations
coverage determinations
liability assessments
bodily injury claim resolutions-through both settlement and litigation.
This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims.
If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors:
Ownership: You take responsibility for outcomes in all scenarios.
Adaptability: You navigate dynamic environments with creativity and resilience.
Leading People: You empower individuals and teams to achieve their best.
Collaboration: You build and strengthen partnerships across organizational lines.
Driving Value: You use data-driven insights to align actions with strategic goals.
What You'll Do:
Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust.
Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims.
Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority
Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations.
Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention.
Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service.
Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence.
Collaborate with leadership and cross-functional teams to identify and implement process improvements.
Serve as a resource for team members on insurance-related questions
providing mentorship and training to build their industry knowledge.
What We're Looking For:
Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases.
Active Adjuster license (required)
Expertise in Casualty claims, including knowledge of industry regulations and best practices
Strong ability to assess needs and guide associates in negotiating claim settlements as needed
Experienced in the use of various claims tools with ability to assist associates
Strong adherence to compliance and regulatory requirements
Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment
Strong results orientation, with a history of meeting or exceeding performance goals
Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations
Ability to analyze data and metrics to inform decision-making and improve customer outcomes
Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence
Why Join GEICO?
Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction.
Inclusive Culture: Join a company that values diversity, collaboration, and innovation.
Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit.
Professional Growth: Access GEICO's industry-leading training programs and development opportunities:
Licensing and continuing education at no cost to you.
Leadership development programs and hundreds of eLearning courses to enhance your skills.
Increased Earnings Potential:
Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually.
Incentives and Recognition:
Corporate wide bonus programs are in place to reward top performers.
Beware of scams! As a recruiter, I will only contact you through a @geico.com email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ***********************.
keywords: litigation, auto liability, liability claims#geico300#LI-AL2
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$49k-73k yearly est. Auto-Apply 5d ago
Personal Injury Examiner
Geico 4.1
Lakeland, FL jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Personal Injury Protection Claims Examiner - Lakeland, FL
Salary: $23.41-$29.41 per hour
What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Lakeland, FL office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S.
As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.
Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Qualifications & Skills:
Bachelor's degree preferred
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
#geico200
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$23.4-29.4 hourly Auto-Apply 4d ago
PIP Examiner
Geico 4.1
Richardson, TX jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Personal Injury Protection Claims Examiner - Richardson, TX
Salary: $25.44 - $32.05 per hour / $51,261.60 - $64,580.75 annually
What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Richardson, TX office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S.
As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.
Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Qualifications:
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
#geico200
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
$51.3k-64.6k yearly Auto-Apply 4d ago
Automotive Claims Representative - Training Provided!
Plymouth Rock Assurance 4.7
Boston, MA jobs
At Plymouth Rock Assurance, our Claims team embodies the traits of Understanding, Engaging, and Energetic, serving as the first point of contact for our policyholders who have experienced an automobile incident.
As a Claims Representative, you will become part of a fast paced, rewarding, and diverse team that appreciates the importance of a healthy work/life balance. We are looking for high potential individuals to join our fast-track claims unit with an in-depth training program, so no prior insurance experience is needed for this role. Many of our Claims Representatives have benefited from internal growth opportunities and have secured more senior Claims or Supervisor level roles within our company. Apply now and start your career at Plymouth Rock!
We are currently a Hybrid work environment- 4 days in the Boston office and 1 day work from home.
Here Is What You Will Do
Customer-centric employee: Conveying a calm, caring attitude, you will provide best-in-class service to customers while processing new claims.
Understanding and providing Empathy is key to this role.
Collaborative partner: Working with internal and external partners, you'll support policyholders while their claims are being processed.
Energetic worker: In our fast-paced environment, you will handle customers' needs-quickly, effectively and in a friendly, caring manner.
Problem solver: No day is predictable; you'll utilize out-of-the-box, creative thinking to resolve a wide variety of claims challenges and customer issues.
Clear communicator: You'll provide policyholders with the information they need by clearly setting expectations and outlining next steps.
Accessibility: Being available for customers via email, text, or phone to walk them step-by-step through the auto claim process and explain existing coverage.
Here Is What You Will Bring To The Table
A history of working customer service facing roles, hospitality, or retail, with previous call center experience a plus.
Being on the phone consistently throughout the day is a requirement of the role.
Excellent organizational and time management skills.
Being able to pivot through different applications throughout the day.
Prioritizing your day and staying organized is key.
An associate or bachelor's degree preferred.
Willingness to continue learning about products, procedures, and technical systems as you grow in this role.
Why work for us
Grow personally and professionally through our collaborative team environment
Gain support and guidance to expedite proficiency through our mentor program
4 weeks accrued paid time off + 9 paid national holidays per year
Onsite Free Parking
LinkedIn Learning Courses
12-week Training Program
Tuition Reimbursement
Low cost and excellent coverage health insurance options (medical, dental, vision)
Robust health and wellness program and fitness reimbursements
Auto and home insurance discounts
2:1 Matching gift opportunities
Annual 401(k) Employer Contribution (up to 7.5% of your base salary)
Company sponsored social events
Various Paid Family leave options including Paid Parental Leave
Salary Range: The pay range for this position is $45,000 to $50,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
About The Company
The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
$45k-50.5k yearly 4d ago
General Liability Claims Supervisor
Network Adjusters, Inc. 4.1
Denver, CO jobs
Network Adjusters is seeking an experienced General Liability/Construction Defect Claims Supervisor to join our third-party administrative insurance handling team. As a Claims Supervisor, you will oversee the full claims process in a fast-paced environment, ensuring compliance and service standards are met. You will hire, onboard, train, and develop a team of adjusters specializing in construction defect claims, guiding them in the proper investigation, documentation, and resolution of first and third party claims. This role offers the opportunity to build and grow a talented claims staff, provide technical support, maintain department protocols, and drive strong customer service outcomes while advancing your own leadership career.
QUALIFICATIONS:
Minimum of three years' experience as a supervisor/manager (preferably in insurance claims).
Minimum of 5 years' experience handling general liability or construction defect claims.
Strong leadership skills, with ability to motivate and develop a team.
Superior working knowledge of case law, statutes, and procedures impacting the handling and value of claims.
Ability to prioritize workload and handle multiple tasks.
Analytical and problem-solving abilities, with a keen attention to detail.
Desire to work in a fast-paced environment.
Excellent evaluation and strategic skills required.
Strong claim negotiation skills.
Proficient in MS Office Suite and other business-related software.
Polished and professional written and verbal communication skills.
Bachelor's degree in a relevant field or equivalent work experience.
RESPONSIBILITIES:
Supervise a Team:
Manage a team of claims adjusters, providing guidance, training, and support to ensure high-quality claim assessments and exceptional customer service.
Coverage Analysis:
Examine claim forms, policies, and other records to determine insurance coverage.
Claims Processing:
Oversee the entire claims process, including the evaluation of damages, determination of loss, settlement negotiations and resolution, while ensuring all compliance regulations are adhered to.
Quality Assurance:
Implement and monitor quality control measures (Best Practices) to ensure accurate and consistent claims handling in compliance with company guidelines and industry standards.
Customer Service:
Collaborate with carriers, attorneys, claimants, and internal policyholders to address inquiries, resolve disputes, and ensure a positive claims experience.
Performance Metrics
: Track and analyze key performance metrics to identify areas for improvement, set performance targets, and implement strategies to meet or exceed goals.
Reporting:
Generate and present regular reports to senior management and clients, highlighting department performance, trends, and areas for improvement.
Compliance:
Stay current with industry regulations and best claims practices to ensure that claims processes are compliant with all legal requirements.
BENEFITS:
401(k) with company match / Retirement planning
Paid time off / Company paid holidays
Comprehensive health plans including dental and vision coverage
Flex Spending Account
Company paid life insurance
Company paid long term disability
Supplemental life insurance
Opportunity to buy into short term disability
Family leave
Employee Assistance Program
This role is based in Denver, CO, and we strongly prefer candidates who can work on-site. Remote arrangements may be considered only for exceptionally well-qualified applicants who meet all required criteria.
The starting salary for this position is $110,000 - $140,000, depending on factors such as licensure, certifications, and relevant experience.
Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All of our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.
$110k-140k yearly 5d ago
Medical Claims Processor
FCE Benefit Administrators, Inc. 4.1
San Antonio, TX jobs
FCE Benefit Administrators, Inc. is seeking a detail-oriented and motivated Medical ClaimsProcessor to join our dynamic and growing team. The ideal candidate will be responsible for the accurate and timely processing of a wide range of claims while ensuring compliance with company standards and regulatory requirements. This role requires strong attention to detail, effective communication skills, and the ability to work efficiently in a fast-paced environment.
Key Responsibilities
Accurately process a variety of claim types, including Medical, Vision, Dental, HRA, Critical Illness, and Accident claims.
Manage the entire claim lifecycle, including adjustments, voids, and payment reissues.
Conduct audits on processed claims to ensure accuracy and compliance with policies.
Serve as a point of contact for claim-related inquiries from members, providers, and internal AE (Account Executive) and CS (Customer Service) teams.
Handle escalated client questions and issues via phone and email with professionalism and urgency.
Participate in special projects and organizational initiatives as assigned.
Assist with training and mentoring team members (for more experienced candidates).
Education
High school diploma or equivalent required.
Associate's degree or vocational training in a related field (e.g., Medical Billing & Coding, Business Administration) preferred.
Experience
1-3 years of experience in medical claims processing, data entry, customer service, or a general administrative role required.
Technical Skills
Proficiency in Microsoft Office Suite (Excel, Word, Outlook).
Strong data entry capabilities and 10-key proficiency.
Familiarity with claims management platforms or Electronic Health Record (EHR) systems preferred.
Soft Skills
Exceptional attention to detail and strong organizational abilities.
Clear written and verbal communication skills.
Strong problem-solving and critical thinking abilities.
Ability to work independently while managing a high volume of tasks in a fast-paced environment.
Commitment to maintaining confidentiality and handling sensitive information with integrity.
Working Conditions
Standard office environment.
Prolonged periods of sitting and computer use may be required.
Ability to lift up to 20 lbs occasionally (e.g., handling physical records or mail).
Benefits Offered
We understand that top talent is attracted to organizations offering competitive compensation, comprehensive benefits, and opportunities for professional growth. FCE offers a robust benefits package including:
Medical, Dental, and Vision Coverage
Disability Insurance
401(k) with Company Match
Flexible Spending Accounts (FSA)
Health Savings Account (HSA) Contributions
Fitness Membership Discounts
Company-paid Life Insurance
Tuition/Professional Development Reimbursement
Employee Assistance Programs
Paid Time Off (PTO)
About FCE Benefit Administrators, Inc.
With nearly 30 years of experience, FCE Benefit Administrators, Inc. has helped hundreds of For-Profit and Not-For-Profit organizations achieve full compliance under the Service Contract Act (SCA), Davis-Bacon Act (DBA), Javits-Wagner-O'Day (JWOD), and related federal legislation. As trusted experts in government contracts, we specialize in the administration of bona-fide fringe benefit plans through an irrevocable funding arrangement, ensuring full compliance with SCA requirements.
Equal Opportunity Employer
FCE is an equal opportunity employer and is committed to creating an inclusive and diverse workplace.
$30k-37k yearly est. 5d ago
Claims Supervisor
Network Adjusters, Inc. 4.1
Denver, CO jobs
Network Adjusters is seeking an
experienced first party property damage Claims Supervisor
to join our expanding team.
As a Property Claims Supervisor, you will play a critical role in our claims department, overseeing the entire claims process in a fast-paced environment to ensure all compliance and service guidelines are met. You will manage a team of Adjusters who specialize in handling Commercial Property losses, ensuring each member of your team is properly investigating, documenting, and resolving their assigned claims. You will offer guidance and support to staff on claims-related technical matters and oversee adherence to department protocols and expectations when dealing with first-party and third-party claims. You will strive to exceed customer service benchmarks, take charge of continued education, and nurture the growth of your team, actively contributing to their career advancement.
Become a part of our dynamic, energetic workforce in which you can make a difference. We are committed to encouraging your professional growth through a variety of development opportunities.
QUALIFICATIONS:
Minimum of five (5) years handling first party property claims; prior claim supervision & commercial claims experience preferred.
Strong leadership skills, with ability to motivate and develop a team.
Superior working knowledge of case law, statutes, and procedures impacting the handling and value of claims.
Ability to prioritize workload and handle multiple tasks.
Analytical and problem-solving abilities, with a keen attention to detail.
Desire to work in a fast-paced environment.
Excellent evaluation and strategic skills required.
Strong claim negotiation skills.
Proficient in MS Office Suite and other business-related software.
Polished and professional written and verbal communication skills.
Bachelor's degree in a relevant field or equivalent work experience.
RESPONSIBILITIES:
Supervise a Team:
Manage a team of claims adjusters, providing guidance, training, and support to ensure high-quality claim assessments and exceptional customer service.
Coverage Analysis:
Examine claim forms, policies, and other records to determine insurance coverage.
Claims Processing:
Oversee the entire claims process, including the evaluation of damages, determination of loss, settlement negotiations and resolution, while ensuring all compliance regulations are adhered to.
Quality Assurance:
Implement and monitor quality control measures (Best Practices) to ensure accurate and consistent claims handling in compliance with company guidelines and industry standards.
Customer Service:
Collaborate with carriers, attorneys, claimants, and internal policyholders to address inquiries, resolve disputes, and ensure a positive claims experience.
Performance Metrics
: Track and analyze key performance metrics to identify areas for improvement, set performance targets, and implement strategies to meet or exceed goals.
Reporting:
Generate and present regular reports to senior management and clients, highlighting department performance, trends, and areas for improvement.
Compliance:
Stay current with industry regulations and best claims practices to ensure that claims processes are compliant with all legal requirements.
BENEFITS:
· 401(k) with company match / Retirement planning
· Paid time off / Company paid holidays
· Comprehensive health plans including dental and vision coverage
· Flex Spending Account
· Company paid life insurance
· Company paid long term disability
· Supplemental life insurance
· Opportunity to buy into short term disability
· Family leave
· Employee Assistance Program
About Network Adjusters, Inc.
Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for almost seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York and Denver to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All of our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.
Please be advised this position is an in-office role located in Denver, CO. No remote opportunities are available at this time.
The starting salary for this position is $85,000 - $110,000; factors such as licensing, certifications, work, and relative experience will be taken into consideration.
$85k-110k yearly 4d ago
Claims Representative, Auto Total Loss
Plymouth Rock Assurance 4.7
Boston, MA jobs
The Total Loss Unit within our Auto Claims Organization is responsible for identifying, negotiating and settling total losses with both insureds and claimants. The Total Loss Claims Representative processes payments and is responsible for the documentation of assigned claims as well as coordinating disposition of the total loss salvage vehicle. He or she is responsible for controlling total loss expenses and salvage recoveries on all total losses assigned.
Perks:
4 weeks accrued paid time off + 9 paid national holidays per year
Robust wellness & health and fitness reimbursement programs
401(k) bonus program
Tuition reimbursement
Auto and home insurance discounts
Volunteer opportunities
2:1 donation matching program
Company-paid life and disability insurance plans
Optional medical, dental, vision, legal, pet insurance, FSA and identity theft protection plans
Responsibilities:
Negotiates and communicates all total loss and diminished value settlements per company and state guidelines. Multi jurisdictions, including MA, NH, CT, NY, and others as required
Understands the total loss evaluation methodology processes with the ability to effectively communicate these to vehicle owners.
Has a basic understanding of vehicle financing / leasing.
Reviews damage estimates to confirm vehicles are total losses.
Documents all settlements and actions in the claim file system.
Works directly with salvage vendor to move vehicles and obtains salvage bids where necessary
Negotiates and settles claims within his/her individual authority. Submits claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate.
Escalates claims to supervisor that are not moving in a positive direction.
Maintains an effective diary system on pending files. Prioritize and handle multiple tasks simultaneously.
Quickly adjusts to fluctuating workload and responsibilities.
Keeps involved parties and agents updated on the status of the claim and emerging issues.
Ensures that service, loss and expense control are maintained at all times.
Adheres to privacy guidelines, law and regulations pertaining to claims handling.
Prepares payments to vehicle owners, banks and lease companies.
This role will report in person to our Boston office, located directly across from South Station.
Knowledge/Skills:
Property and casualty claims handling experience desired
Ability to work independently and in a team environment
Excellent oral and written communication skills
Excellent organizational skills
Solid problem solving skills
Proficient in Word, Excel, MS Outlook
Educational Requirements:
Bachelor's degree from four-year college or university or commensurate work experience preferred
Previous auto claims handling
State Adjusting licenses or the ability to obtain them within 6 months of employment
Salary Range: The pay range for this position is $50,000 to $73,500 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity.
The Plymouth Rock Company and its affiliated group of companies write and manage over $2.2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 2,000 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.
$50k-73.5k yearly 4d ago
Stop Loss Claims Clerk
BCS Financial Corporation 4.2
Oakbrook Terrace, IL jobs
Claims Clerk
Full TimeSME/Specialist
Oakbrook Terrace, IL, US
Salary Range:$50,500.00 To $57,500.00 Annually
The Claims Clerk will be responsible for accurate, timely screening and distribution of incoming electronic claims correspondence. This role will aid the Analysts in timely processing of the claims and help secure a manageable turnaround time for the entire Claims Department. This position will report to the Claims Manager.
Essential Elements
Manage the Secure File Transfer Portal (SFTP) site ensure all reporting received is processed in a timely manner
Download and pivot reports from Power BI, to locate all possible medical and prescription claims.
Identify and review claims data ensuring data integrity
Distributing claim requests for processing
Convert the PDF claims received into an Excel Template for the Claims Analyst to upload and process
Additional duties as assigned
Requirements
Education and Certifications
Associates degree or commensurate experience required
Experience
Excel, Microsoft Office Suite, Power BI, Clerical functions
Travel Required
May need to travel to the home office quarterly
Hybrid workplace
$50.5k-57.5k yearly 2d ago
Complex Claims Examiner -FAIRCO
Transatlantic Reinsurance Company 4.8
New York, NY jobs
For a description, see PDF at: ************ transre. com/wp-content/uploads/2025/10/FAIRCO-Complex-Claims-Examiner.
pdf
$51k-90k yearly est. 26d ago
Property Claims Examiner
Safety Insurance Group, Inc. 4.6
Boston, MA jobs
Safety Insurance is proud to be one of the leading property and casualty insurance providers in Massachusetts. We are committed to supporting independent agents and their customers through our unwavering dedication to excellence. Our success is built on a simple philosophy: deliver the highest quality insurance products at competitive rates while providing exceptional service at every step.
At Safety Insurance, we don't just offer jobs - we offer careers that are challenging, fulfilling, and designed to grow with you.
Our people are our greatest asset. A diverse workforce makes us stronger, more innovative, and better equipped to serve our customers. At Safety, we empower our employees to be their best by fostering an inclusive environment and offering resources that support their careers, education, and families. We also understand the importance of work-life balance. That's why we offer hybrid work options, flexible schedules, and a 37.5-hour workweek. Conveniently located in the heart of Boston's financial district, our downtown office is a positive space where employees can stay connected to both each other and the pulse of the city.
Safety's benefits go beyond the basics. In addition to competitive salaries, our comprehensive benefits package includes:
* 3 weeks accrued paid time off + 11 paid holidays per year
* Health insurance (medical, dental, vision)
* Annual 401(k) Employer Contribution (up to 8% of your base salary)
* 100% tuition reimbursement
* Free on-site fitness center
* Complimentary coffee and breakfast service
* Hybrid work schedules
* Working Advantage Discount Program
* Employee Assistance Program
* …and much more!
Join Safety Insurance and discover a career that's built to support your success - both personally and professionally.
$54k-79k yearly est. 21d ago
Casualty Claim Examiner
Safety Insurance Group, Inc. 4.6
Boston, MA jobs
Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs.
Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district.
Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!
$54k-79k yearly est. 21d ago
Claims Examiner I - Commercial Auto
Athens Administrators 4.0
Lake Mary, FL jobs
Details
Claims Examiner I - Commercial Auto
Department:
Property & Casualty
Reports To:
Claims Supervisor
FLSA Status:
Exempt in all state except California
Job Grade:
9
Career Ladder:
Next step in progression could include Claims Examiner II
ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Claims Examiner I to support our Property & Casualty department. Employees who live less than 26 miles from the 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). 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. 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 through Friday at 37.5 hours per week. The Claims Examiner I is responsible for the timely investigation, evaluation and determination of settlement or denial of minor to moderate multi-line auto property and casualty claims. They will be handling claims from inception to closure. 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:
Knowledge in the following areas: 1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated analytical, decision making and negotiation skills.
Investigate coverage, including evaluate insurance coverage problems and/or disputes
Investigate, evaluate and determine settlement value or denial of liability for all claims
Develop a measure of damage for each loss, establish and maintain appropriate reserves
Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure
Ensure appropriateness of all payments
Negotiate settlement of claim within individual authority ($15,000 unless otherwise noted)
Maintain and update action plans for each claim
May assign and coordinate with vendors, legal counsel, appraisers or experts as necessary
Facilitate between claimants, clients, brokers and attorneys in resolution of liability claims
Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers
Provide customer service and support to insureds and claimants
Assist in training of new employees
Attend meetings and educational seminars for professional development
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
Must possess 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
Additional State Adjuster License(s) may be required within 180 days
Maintain licenses and continuing education requirements in all states
Minimum of three years auto-claims handling experience, at least one-year commercial auto required
Knowledge of property and casualty insurance policies
Knowledge of auto insurance laws, codes, procedures, and liability concepts
Proficiency in investigation and resolution of minor to medium level auto physical damage casualty claims
Strong negotiation skills and ability to achieve optimal settlement results for clients.
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 https://*******************/careers/why-work-here
$40k-59k yearly est. 41d ago
Medicare Claims Examiner Team Lead
Atlantic American Corporation 4.3
Atlanta, GA jobs
The Claim Examiner Team Lead is a key resource for the Claim Examiner team, leveraging advanced expertise in claim adjudication, payment integrity and regulatory compliance. This position does not include direct supervisory responsibilities or formal performance reviews. Instead, the Team Lead provides support, coaching, and technical guidance to claim examiners, ensuring accuracy, efficiency, and adherence to CMS and company standards. Acting as a mentor, process improvement lead, and operational reviewer, the Team Lead drives continuous improvement, supports fraud, waste and abuse (FWA) prevention initiatives and collaborates with cross-functional teams to optimize claims processes and professional development.
Key Responsibilities:
Team Leadership and Enablement
Provide direction, mentorship, and technical support for Claim Examiners, fostering a collaborative and high-performance environment.
Act as the primary resource for escalated claims and technical questions, offering expert advice and facilitating team learning.
Contribute to the development and delivery of training materials and workshops, supporting ongoing professional development.
Lead and support onboarding of new Claim Examiners, ensuring effective orientation to claims processes, company policies, and regulatory requirements.
Serve as a resource for new team members during their initial training period helping them integrate into the team and build foundation skills.
Claim Adjudication and Payment Integrity
Utilize in-depth knowledge of claims adjudication processes to ensure accurate and timely processing of Medicare Supplement claims.
Review and analyze complex claims for proper application of policy provisions and regulatory requirements.
Support payment integrity by verifying claims are processed correctly, assisting in identifying and correcting payment errors, and collaborating on payment integrity reviews.
Fraud, Wast, and Abuse (FWA) Prevention
Review claims for signs of fraudulent activity or proper hilling practices.
Assist in enforcing policies and procedures to prevent, detect and address FWA in claims processing.
Conduct investigations into suspected FWA activities and educate team members on prevention strategies.
Regulatory Compliance and Quality Assurance
Ensure claims processing complies with CMS guidelines, state regulations, and company policies.
Conduct regular audits of claims to maintain high standards of quality and compliance.
Stay informed about changes in Medicare regulations and communicate updates to the team.
Claim Edit Logic Review and Collaboration
Serve as an operational reviewer and subject matter expert for claim edit logic, providing input and feedback to technical, compliance, and analytics team.
Participate in requirements gathering, validation, and documentation of logic changes, supporting audit readiness and continued improvement.
Collaborate with IT and analytics teams on the implementation and optimization of claim edit logic, without direct responsibility for technical development or system configuration.
Process Improvement and Operational Excellence
Identify opportunities for process improvements and efficiencies in claim indexing, queue management and workflow.
Lead or participate in process improvement initiatives, leveraging data analytics and trend analysis to drive operational enhancements.
Prepare actionable insights for management review.
Stakeholder Collaboration and Enablement
Facilitate resolution of complex claims issues and drive alignment with CMS policies.
Provide expert guidance and support to claim examiners and customer service representative regarding claim-related inquiries and escalations.
Collorate with cross-functional teams (compliance, IT, analytics, customer service) to ensure seamless integration of new rules and system enhancements.
Qualifications:
Experience:
3+years of experience in healthcare claims analysis, medical coding, payment integrity or healthcare data analytics.
Experience with Medicare payment methodologies and reimbursement rules preferred.
Experience with clinical coding (CPT, HCPCS, ICD, NDC) and regulatory research preferred.
Certifications:
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA) or similar preferred credentials.
Skills:
Technical and Analytical:
Advanced proficiency in SQL and Excel; experience with data visualization tools (Tableau, Power BI) and large datasets.
Strong analytical, communication and problem-solving skills.
Deep understanding of medical coding systems (CPT, HCPCS, ICD, DRG, NCD) and healthcare reimbursement methodologies.
Communication and Collaboration:
Excellent verbal and written communication skills; able to explain technical concepts to non-technical audiences and document logic/rationale for edits.
Ability to work independently and collaboratively in cross-functional teams (technical, business operations, provider facing).
Quality and Process Improvement
Strong attention to detail and commitment to accuracy in edit development, testing, and documentation.
Experience in quality assurance, UAT testing and continuous improvement of claims editing.
Problem Solving and Initiative:
Demonstrated ability to analyze root causes, troubleshoot issues and propose solutions for claims editing and payment integrity challenges.
Proactive in identifying opportunities for edit optimization, regulatory compliance and operational efficiency.
Work Environment / Physical Requirements:
The work environment is a standard office setting with typical office equipment. This role involves professional collaboration with colleagues and clients. Responsibilities may involve extended periods of sitting, occasional walking between departments or meeting rooms, and periodic standing, reaching, stooping, and lifting office items weighing up to 25 pounds.
$41k-55k yearly est. 30d ago
Commercial Auto Bodily Injury Claims Examiner
King's Insurance Staffing LLC 3.4
New York, NY jobs
Job DescriptionOur client is actively seeking a seasoned Commercial Auto Bodily Injury Claims Adjuster to join their growing NYC team. This person will be responsible for managing a portfolio of moderate to complex claims involving commercial auto exposures, often including litigated files. From first notice to final resolution, you'll drive the claims process with precision, ensuring timely outcomes and outstanding service. Key Responsibilities:
Conduct thorough investigations and evaluations of commercial auto bodily injury claims, exercising sound judgment within designated authority limits to ensure prompt and fair resolution.
Manage a caseload consisting of 100 - 110 Commercial Auto files with bodily injury exposures.
Collaborate with claimants, legal representatives, and other stakeholders to negotiate settlements, issue payments, and bring claims to closure effectively.
Maintain accurate documentation and prepare detailed claim status reports to support transparency and compliance throughout the claims lifecycle.
Requirements:
5 to 7+ years of experience handling Litigated Commercial Auto Bodily Injury claims.
Strong analytical thinking and attention to detail to assess coverage, liability, and damages accurately.
Excellent negotiation and communication skills, with the ability to manage complex interactions confidently.
Proficiency in modern claims management software and related technologies.
Active adjusters license, highly preferred.
Salary & Benefits:
Competitive base salary ranging from $95,000 to $110,000, depending on experience.
Comprehensive benefits package, including health, dental, and vision insurance.
Generous PTO and paid holidays.
Clear pathways for career advancement.
401(k) plan with competitive employer matching.
$38k-45k yearly est. 15d ago
Commercial Auto Bodily Injury Claims Examiner
King's Insurance Staffing 3.4
New York jobs
Our client is actively seeking a seasoned Commercial Auto Bodily Injury Claims Adjuster to join their growing NYC team. This person will be responsible for managing a portfolio of moderate to complex claims involving commercial auto exposures, often including litigated files. From first notice to final resolution, you'll drive the claims process with precision, ensuring timely outcomes and outstanding service. Key Responsibilities:
Conduct thorough investigations and evaluations of commercial auto bodily injury claims, exercising sound judgment within designated authority limits to ensure prompt and fair resolution.
Manage a caseload consisting of 100 - 110 Commercial Auto files with bodily injury exposures.
Collaborate with claimants, legal representatives, and other stakeholders to negotiate settlements, issue payments, and bring claims to closure effectively.
Maintain accurate documentation and prepare detailed claim status reports to support transparency and compliance throughout the claims lifecycle.
Requirements:
5 to 7+ years of experience handling Litigated Commercial Auto Bodily Injury claims.
Strong analytical thinking and attention to detail to assess coverage, liability, and damages accurately.
Excellent negotiation and communication skills, with the ability to manage complex interactions confidently.
Proficiency in modern claims management software and related technologies.
Active adjusters license, highly preferred.
Salary & Benefits:
Competitive base salary ranging from $95,000 to $110,000, depending on experience.
Comprehensive benefits package, including health, dental, and vision insurance.
Generous PTO and paid holidays.
Clear pathways for career advancement.
401(k) plan with competitive employer matching.
$38k-45k yearly est. 60d+ ago
Multiline Auto Claims Examiner
King's Insurance Staffing LLC 3.4
Ephrata, PA jobs
Job DescriptionOur client is seeking a skilled Multiline Auto Claims Examiner to join their team. This key role focuses on investigating and resolving moderate to complex auto liability and bodily injury claims, ensuring fair and efficient outcomes while maintaining compliance with all regulatory standards. The ideal candidate will have a strong background in casualty claims, particularly auto liability, and will demonstrate excellent judgment in evaluating exposures and negotiating settlements.Key Responsibilities:
Investigate and evaluate Auto Liability and Bodily Injury claims to determine coverage, liability, and damages.
Manage claims through all stages, including litigation, negotiation, and settlement.
Review and analyze medical records, accident reports, and legal documentation to accurately assess claims.
Collaborate with defense counsel and other experts to ensure cost-effective and timely resolutions.
Provide clear communication and updates to policyholders, claimants, and brokers.
Maintain accurate claim documentation in the claims management system.
Ensure all claim handling complies with regulatory requirements and internal company guidelines.
Requirements:
3 - 8+ years of experience handling Commercial or Personal Auto Liability and Bodily Injury claims, preferably with an insurance carrier.
Active adjuster license strongly preferred.
Strong negotiation and litigation management skills with a proven ability to drive equitable settlements.
Solid analytical, organizational, and problem-solving skills.
Proficiency with claims management software and Microsoft Office Suite.
Bachelor's degree preferred.
Salary & Benefits:
$70,000 to $90,000+ annual base salary (depending on experience) plus bonus potential
Generous PTO and paid holidays
Competitive 401k with employer matching contributions
Comprehensive health, dental, and vision coverage
Professional growth opportunities within a supportive team environment
$31k-37k yearly est. 13d ago
Insurance And Claims Specialist I
Health Research, Inc. 4.5
Menands, NY jobs
Applications to be submitted by January 05, 2026
Compensation Grade:
P14
Compensation Details:
Minimum: $53,357.00 - Maximum: $53,357.00 Annually
Positions with a designated work location in New York City, Nassau, Rockland, Suffolk, or Westchester Counties will receive a $4,000 annual downstate adjustment (pro-rated for part-time positions).
Department
(OHEHR) AI - AIDS Institute
Job Description:
Responsibilities
The New York State Department of Health, AIDS Institute has established eight Uninsured Care Programs, of which some of these programs have the most comprehensive drug and service coverage in the country. The programs provide access to medical services and medications for all New York State residents with or at risk of acquiring HIV/AIDS. The programs bridge the gap between Medicaid coverage and private insurance and serve as a transition to Medicaid by providing interim assistance to individuals eligible for but not yet enrolled in Medicaid or assistance in meeting spenddown requirements.
The Insurance and Claims Specialist I will be responsible for APIC reimbursement processing; pharmacy, primary care, home care and APIC payment processing; handle complex fiscal hotline calls; assist providers and participants with the coordination of benefits; assist with staff training; other appropriate related duties.
Minimum Qualifications
Bachelor's degree in a related field; OR an Associate's degree in a related field and two years of general office, secretarial, or administrative experience; OR four years of such experience.
Preferred Qualifications
At least one year of experience in a health care program providing services to people living HIV/AIDS.
At least two years of customer service experience in a financial or medical field.
At least two years of medical claims or insurance experience.
Knowledge of COBRA, HIPAA, and coordination of benefits.
Conditions of Employment
Grant funded position. Compliance with funding requirements such as time and effort reporting, grant deliverables, and contract deliverables, is required.
Valid and unrestricted authorization to work in the U.S. is required. Visa sponsorship is not available for this position.
Prior to hire, all HRI employees must reside within a reasonable commuting distance of their official work location and must also be located in, or willing to relocate to, one of the following states: New York, New Jersey, Connecticut, Vermont, or Massachusetts. Telecommuting will not be available.
HRI participates in the E-Verify Program.
Affirmative Action/Equal Opportunity Employer/Qualified Individuals with Disabilities/Qualified Protected Veterans
**********************
About Health Research, Inc.
Join us in our mission to make a difference in public health and advance scientific research! At Health Research, Inc. (HRI), your work will contribute to meaningful change and innovation in the communities we serve! At HRI, we are on a mission to transform the health and well-being of the people of New York State through innovative partnerships and cutting-edge public health initiatives. As a dynamic non-profit organization, HRI plays a crucial role in advancing the strategic goals of the New York State Department of Health (DOH), Roswell Park Comprehensive Cancer Center (RPCCC), and other health-related entities.
HRI offers a robust, comprehensive benefits package to eligible employees, including:
Health, dental and vision insurance - Several comprehensive health insurance plans to choose from;
Flexible benefit accounts - Medical, dependent care, adoption assistance, parking and transit;
Generous paid time off - Paid federal and state holidays, paid sick, vacation and personal leave;
Tuition support - Assistance is available for individuals pursuing educational or training opportunities;
Retirement Benefits - HRI is a participating employer in the New York State and Local Retirement System and offers optional enrollment in the New York State Deferred Compensation Plan. HRI provides a postretirement Health Benefits Plan for qualified retirees to use towards health insurance premiums and eligible medical expenses;
Employee Assistance Program - Provides educational and wellness programs, training, and 24/7 confidential services to assist employees, both personally and professionally;
And so much more!
$53.4k yearly Auto-Apply 9d ago
Claims Processing Expert
The Strickland Group 3.7
Raleigh, NC jobs
Join Our Dynamic Insurance Team - Unlock Your Potential!
Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential.
NOW HIRING:
✅ Licensed Life & Health Agents
✅ Unlicensed Individuals (We'll guide you through the licensing process!)
We're looking for our next leaders-those who want to build a career or an impactful part-time income stream.
Is This You?
✔ Willing to work hard and commit for long-term success?
✔ Ready to invest in yourself and your business?
✔ Self-motivated and disciplined, even when no one is watching?
✔ Coachable and eager to learn?
✔ Interested in a business that is both recession- and pandemic-proof?
If you answered YES to any of these, keep reading!
Why Choose Us?
💼 Work from anywhere - full-time or part-time, set your own schedule.
💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month.
📈 No cold calling - You'll only assist individuals who have already requested help.
❌ No sales quotas, no pressure, no pushy tactics.
🧑 🏫 World-class training & mentorship - Learn directly from top agents.
🎯 Daily pay from the insurance carriers you work with.
🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary
🏆 Ownership opportunities - Build your own agency (if desired).
🏥 Health insurance available for qualified agents.
🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom.
👉 Apply today and start your journey in financial services!
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Results may vary. Your success depends on effort, skill, and commitment to training and sales systems.
)
$27k-34k yearly est. Auto-Apply 48d ago
Learn more about Matrix Absence Management, Inc. jobs