Claims Analyst jobs at Planate Management Group

Self Financial is a venture-backed, high-growth FinTech company with a mission to increase economic inclusion and financial resilience by empowering people to build credit and build savings. We're looking for people who share our passion and are driven to tackle challenges, find solutions and make the financial space better for the communities we serve. Our team is passionate about challenging the status quo of the credit industry by providing people accessible tools to take control of their credit. Executing on our mission requires deep collaboration across our teams to ensure our products reach the people who can benefit from them the most, particularly the 100 million+ Americans who have no or low credit. We celebrate diversity and are committed to creating an inclusive environment for all employees. To that end, we seek to recruit, develop and retain the most talented people from a diverse candidate pool. About the Role We are seeking a Security Operations Center (SOC) Analyst to join our cybersecurity team and help protect our cloud infrastructure and enterprise systems. The ideal candidate will have hands-on experience working in a SOC environment, leveraging Splunk Enterprise Security (ES) as the primary SIEM to monitor, detect, and respond to security incidents. A strong background in Enterprise IT is preferred, as this knowledge will be key in helping to analyze alerts and logging. You will play a critical role in triaging alerts, conducting threat analysis, and contributing to continuous improvement of our detection and response capabilities. Key Responsibilities Monitor, analyze, and respond to security events and incidents using Splunk Enterprise Security. Investigate alerts from multiple security sources including AWS CloudTrail, GuardDuty, Palo Alto Networks firewalls, Okta, CrowdStrike Falcon, Netskope, and Wiz. Correlate logs and telemetry across cloud and on-prem environments to identify potential threats or policy violations. Develop and fine-tune correlation rules, dashboards, and alerts in Splunk ES. Participate in incident response processes including containment, eradication, and recovery. Document incidents, root cause analyses, and lessons learned to strengthen operational playbooks. Assist in maintaining SOC processes aligned with SOC 1/SOC 2 and PCI DSS compliance frameworks. Assist in audit evidence collection and documentation in defense of audit requirements. Collaborate with IT, DevOps, and Engineering teams to harden infrastructure and improve detection fidelity. Support continuous improvement of threat detection, response workflows, and automation initiatives. Required Skills & Qualifications 3+ years of experience in a SOC analyst or cybersecurity operations role. Expertise in Splunk Enterprise Security (ES) or similar SIEM platforms. Strong understanding of AWS services including CloudTrail, GuardDuty, and IAM. Hands-on experience with: Palo Alto Networks firewalls and security policies Okta identity and access management CrowdStrike Falcon endpoint detection and response Wiz cloud security posture management Familiarity with SOC 1/2 and PCI DSS compliance requirements. Solid background in IT systems administration, including Windows, Linux, and networking fundamentals. Demonstrated ability to work collaboratively in a security team environment. Strong analytical, communication, and documentation skills. Preferred Qualifications Industry certifications such as Splunk Certified Power User / ES Analyst, CompTIA Security+, GSEC, GCIA, or AWS Security Specialty. Experience with automation/orchestration tools (e.g., SOAR, Python scripting). Knowledge of threat intelligence and MITRE ATT&CK framework. +3 years in IT administration to have a foundational understanding of Enterprise IT systems. Base salary range: $76,000-112,000 annually. Individual pay is based on factors unique to each candidate, including skill set, experience, location, and other job-related reasons. Benefits and Perks: We have the compensation and benefits you expect. But there's one thing that Self Financial can offer that many companies cannot: we can positively change the world, while making a profit. We are a team of Builders, empowering our customers to build their dreams. We have a Do the Right Thing ethos in all that we do, and we hope you value that approach, too. Our perks include: Company equity in the form of Stock Options Performance-based bonuses Generous employer-paid health, vision and dental insurance coverage Flexible vacation policy Educational assistance Free gym membership Casual dress code Team building events and activities Remote work arrangements/ flexible work schedule Paid parental leave Self Financial requires all employees hired to successfully pass a background check. We are an Equal Opportunity Employer. At this time, we are only able to consider applicants who are U.S. Citizens or Green Card Holders for employment opportunities. We appreciate your understanding.

Sr. Ambulatory Application Analyst (No 3rd party, No C2C, No 1099) Start: ASAP Length: FTE Salary range: 88-115K Onsite/Remote: starting 50% hybrid but could move to 100% onsite and need someone that will be okay with that Job Scope/Summary: Serves as a mentor and technical resource for junior analyst to gain expertise on more specialized and complex clinical applications and functions. Contributes to the planning of application development and deployment, looking at existing information to identify areas for improvement. Independently provides viable resolution to end-user inquiries and problems related to applications, consulting with appropriate vendors where needed. Develops or modifies established processes and procedures, leveraging market and industry research, to support application efficiency and improvement. Generates and analyzes reports for a specific application in order to inform Memorial's decision making process, improve efficiency, and to outline workflow and processes. Maintains advanced knowledge of current operational workflows that are supported through the business or clinical applications. Maintains assigned application through partnership with technical experts, vendors, and technology teams to ensure the application continues to support end-users and to mitigate any functional or operational issues. Tests and troubleshoots existing and proposed systems in order to resolve and anticipate application issues, but also to verify accuracy and compliance with Memorial procedures. Requirements/Certifications: Ambulatory certification - preferred. Will also consider Epic Certification in other applications like Phoenix, Bones, ClinDoc, Orders, Optime, Beacon, ASAP, Wisdom 3--5 years of Epic Build experience

A pediatric provider is working towards Epic go-live in March of 2026 and is looking for a SME to support the Willow Ambulatory implementation from the Revenue Cycle operations side of the house. This person should understand Willow Ambulatory builds and be able to work cross functionally with internal teams and Epic, to ensure a smooth and successful implementation and build. Strong experience in content, retail, and out patient pharmacy is a must have. This consultant will be the right hand to the Operations Leader. Must be willing to travel when epic is onsite to fully support the team. We CANNOT hire in: California, Illinois, Indiana, Massachusetts, Nevada, Ohio, Pennsylvania, Washington, or Wisconsin. Travel Dates: 1/6/26 - 1/8/26: 60-Day GLRA + End-User Training Kickoff 2/3/26 - 2/5/26: 30-day GLRA (last monthly onsite) 2/13 - 2/15 case conversion weekend 3/1 - 3/21 Job Type & Location This is a Contract position based out of Kansas City, MO. Pay and Benefits The pay range for this position is $95.00 - $120.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 16, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Client: Leading Investment Bank Contract Term: Onsite role Note: we do not take visa transfers or support sponsorship. This is not a C2C / 1099 role. We are seeking an AML Compliance Analyst Basic for a very important client. Pluses that could set you apart! • Hands on AML, KYC, fraud, or investigations experience. • SAR (Suspicious Activity Report) writing skills. • Excel expertise in VLOOKUPs and Pivot Tables. • Bachelor's Degree, preferably in Criminal Justice or a similar field. Job Responsibilities • Collect and analyze data, including alert, transactions, customer demographics and relevant account information to identify potential suspicious activity • Disposition and fully document the investigation, including supporting data, analysis, and rationale for disposition within the case management system • Complete the Suspicious Activity Report (SAR) form , if applicable, in accordance with Financial Crimes Enforcement Network (FinCEN) requirements • Effectively communicate with associates, management and various stakeholders on risks identified, possible typologies and recommend next steps • Balance inventory queues, deadlines, and priorities to achieve departmental standards and production goals. • Demonstrate teamwork by accepting ad-hoc requests to assist other associates on inventory Interpretation of AML Risk standards, guidelines, policies and procedures. Make risk based determination through Quality Analysis whether alerts were properly cleared by Compliance Alerts Analysts. Ensure Alert data has been accurately collected and documented, including but not limited to: Investigations data, Suspicious Activity Reports (SARS) & Currency Transaction Reports (CTR), Know Your Customer (KYC) information, any relevant account and transaction data and all required information which would assist in an investigation. Strong research, analytical and comprehension skills, with ability to analyze large amounts of data. The ideal candidate will possess the following qualifications: Required Qualifications, Capabilities, and Skills • Exceptional written and verbal communication skills • Strong analytical, interpretive, organizational skills • Strong attention to detail, ability to prioritize and manage tasks • Independent decision maker, able to make time-sensitive assessments and articulate findings to senior investigators or managers • Knowledge of banking products and services • Understanding of regulatory concepts including, but not limited to, the Bank Secrecy Act, Office of Foreign Assets Control sanctions, and the USA PATRIOT Act • Proficient in MS Office (Outlook/Word/Excel/Access/PowerPoint)

A pediatric provider is working towards Epic go-live in March of 2026 and is looking for a SME to support the Willow Ambulatory implementation from the Revenue Cycle operations side of the house. This person should understand Willow Ambulatory builds and be able to work cross functionally with internal teams and Epic, to ensure a smooth and successful implementation and build. Strong experience in content, retail, and out patient pharmacy is a must have. This consultant will be the right hand to the Operations Leader. Must be willing to travel when epic is onsite to fully support the team. We CANNOT hire in: California, Illinois, Indiana, Massachusetts, Nevada, Ohio, Pennsylvania, Washington, or Wisconsin. Travel Dates: 1/6/26 - 1/8/26: 60-Day GLRA + End-User Training Kickoff 2/3/26 - 2/5/26: 30-day GLRA (last monthly onsite) 2/13 - 2/15 case conversion weekend 3/1 - 3/21 Job Type & Location This is a Contract position based out of Kansas City, MO. Pay and Benefits The pay range for this position is $95.00 - $120.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 16, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Mid-Level Epic PB/PB Claims Analyst Contract Type: 6-Month Contract-to-Hire Vaccination Requirement: None About Our Client Our Client is seeking a Mid-Level Epic PB/PB Claims Analyst to join their team. This role will primarily focus on ticket support with opportunities to contribute to project work. Role Overview + Work Breakdown: + 70% Ticket Support (initial focus) + 30% Project Work + Scope of Work: + Supporting Our Client with approximately 1,200 providers and 12 hospitals. Key Responsibilities + Conduct audits, including updating claims and rule logic + Perform charge reviews + Drive process improvements by increasing automation + Manage project work from start to finish Required Knowledge + Provider-based billing: understanding of what it is and how it works + Familiarity with different billing models + Awareness of Rural Health updates Skills + Community Connect + Epic PB + Epic Claims + Build + Epic Certified + Healthcare Implementation Top Skills Details + Community Connect + Epic PB + Epic Claims + Build + Epic Certified Additional Skills & Qualifications Education: + Associate's degree in healthcare, computer, or related field + Bachelor's degree in healthcare, computer, or related field preferred Licensure/Certification: + 3-5 years of experience in ticket resolution and project execution + Certifications: Epic PB/PB Claims, SBO Soft Skills: + Customer-centric mindset + Ability to work seamlessly in a team environment Experience Level Intermediate Level Job Type & Location This is a Contract to Hire position based out of Fort Wayne, IN. Pay and Benefits The pay range for this position is $50.00 - $80.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 22, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following: + Adjudicate claims by following departmental policies, operating memos, and corporate guidelines. + Resolve claims and related issues in compliance with policy provisions. + Compare claims applications and provider statements with policy files and other records to ensure completeness and validity. + Process payments for claims that are approved. Job Responsibilities: + Processes Professional and Facility claims for payment in accordance with members Certificate of Coverage, established medical policies and procedures, and plan benefit interpretation while maintaining a high level of confidentiality. + Reviews claims to ensure compliance with proper billing standards and completeness of information. + Obtains additional information from appropriate person and/or agency as needed. Skills claims processing, claims adjudication, call center, medicaid, Coding Qualifications + High school diploma or equivalent preferred. + 2-4 years claims processing experience required + Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. + Past experience using QNXT Claims Workflow a plus + Prior experience with ACA, Medicaid, or similar health plans preferred not required + Coding experience preferred not required Job Type & Location This is a Contract to Hire position based out of Milwaukee, WI. Pay and Benefits The pay range for this position is $19.25 - $19.25/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 18, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established policies and procedures. Key responsibilities of this position include the following: + Adjudicate claims by following departmental policies, operating memos, and corporate guidelines. + Resolve claims and related issues in compliance with policy provisions. + Compare claims applications and provider statements with policy files and other records to ensure completeness and validity. + Process payments for claims that are approved. Additional Skills & Qualifications + High school diploma or equivalent preferred. + 2-4 years claims processing experience required + Knowledge of current procedural terminology (CPT) and international classification of diseases (ICD-9 and ICD-10). Medical terminology, COB processing, subrogation. + Past experience using QNXT Claims Workflow a plus + Prior experience with ACA, Medicaid, or similar health plans preferred. + Coding experience preferred. Job Type & Location This is a Contract to Hire position based out of Brookfield, WI. Pay and Benefits The pay range for this position is $19.25 - $19.25/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 19, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Commercial Trucking | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? + Apply your Commercial Trucking Bodily Injury claims knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. **ARE YOU AN IDEAL CANDIDATE?** If you have 5+ years of experience as a Claims Examiner working on Complex Commercial Bodily Injury Trucking Claims and would like to join one of the premier teams in the industry, we are looking for someone with your level of expertise. This role will be responsible for analyzing and processing **complex commercial trucking transportation claims** by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE** + Processes complex commercial trucking claims, including bodily injury, and ensures claim files are properly documented and coded correctly. + Responsible for litigation process on litigated claims. + Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. + Reports large claims to excess carrier(s). + Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. + Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. + Communicates claim action/processing with insured, client, and agent or broker when appropriate. **QUALIFICATIONS** **Education & Licensing** + Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. Licensing / Jurisdiction Knowledge: (list any preferred and/or required here) **TAKING CARE OF YOU** + Referral incentive program. + Opportunity to work in an agile or remote environment. + Career development and promotional growth opportunities. + A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000- $90,000 USD annual salary. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ **Always accepting applications.** The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. \#LI-REMOTE Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Resolute PB Claims Analyst you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you'll do/Responsibilities As a Project Delivery Senior Analyst (PDSA) at Deloitte, you will work within an engagement team and be responsible for supporting the overall project goals and objectives. In this role, you will interact with stakeholders and cross-functional teams. It is expected that you will be able to perform independent tasks as well as provide technical guidance to team members, as needed. * Work with the implementation team to plan and complete build, implement end-to-end Epic. * Work command center shifts to investigate during go-live, document, and resolve break-fix tickets. * Conduct and document root cause analysis and complete any assigned system maintenance. * Assist in low level design, operational discussions, build, test, and migrate Epic build, provide go-live support following migration of new build. * Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management. The Team Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation. AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector. Qualifications Required * Current Epic Certification in Epic Professional Billing * 3+ years' experience in Epic Professional Billing * Experience in Epic implementation or enhancement processes * Experience in application design, workflows, build, troubleshooting, testing, and support. * Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience * Limited immigration sponsorship may be available. * Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve Preferred * Hospital or Clinic operations experience * Additional Epic Certifications * ITIL process knowledge * Analytical/ Decision Making Responsibilities * Analytical ability to manage multiple projects and prioritize tasks into manageable work products * Can operate independently or with minimum supervision * Excellent Written and Communication Skills * Ability to deliver technical demonstrations Additional Requirements Information for applicants with a need for accommodation: ************************************************************************************************************ Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. Check out recruiting tips from Deloitte recruiters. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. Learn more about what working at Deloitte can mean for you. Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our clients' most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte's purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities. Learn more. Professional development From entry-level employees to senior leaders, we believe there's always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. As used in this posting, "Deloitte" means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see ********************************* for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law. Requisition code: 316852 Job ID 316852

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our medlogix technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients' needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers' compensation insurance carriers; third party administrators (TPAs); and government entities we serve. Position: Claims Processor Location: 100% Remote FMLA: Exempt, Full-Time Schedule: M-F 8am-4:30pm Job Description: As a processor, you will be responsible for reviewing and processing insurance claims by verifying policy coverage, gathering necessary information, evaluating claim validity, and determining the appropriate payout amount based on policy terms, ensuring all documentation is complete and accurate while adhering to company guidelines and regulations. You will often interact with policyholders, agents, and other stakeholders to facilitate the claims process efficiently and ensure compliance with HIPPA regulations, including confidentiality. Ability to work in multiple claim systems and provide support to multiple departments, including litigation and legal departments. Responsibilities: Account Searches and police reports Make initial contact and document file upon receipt of first notice of loss Send appropriate claim forms to claimants, insureds, and/or representatives Review file for proper reserves and document file Request missing documentation needed to appropriately manage file Provide support to litigation/legal departments with Disputes, Appeals, Pre-suits Provide support with Post Service appeals, assignments, Dispute Awards Settlements and/or withdrawals Make appropriate payments for awards, settlements, and interest where applicable Ability to re-route documentation when a claim is not in system Cycle time file reviews for missing or pending documents, open billing and file closure Required Skills/ Abilities: Excellent organizational skills and attention to detail Conducts interactions with sensitivity, maturity and professionalism Knowledge of claims systems and procedures Excellent written and verbal communication skills Ability to maintain confidential information Comfortable in a high-volume, fast, team-oriented environment Proficient in Microsoft Office Suite Manage day-to-day operations to ensure SOPs are being followed as defined in our clients' SLAs Education and Experience: Bachelor's degree or relevant experience required Prior carrier or adjuster experience Knowledge of New Jersey No Fault PIP regulation, 2-3 years preferred Minimum 2 years medical billing or claims processing background EEOC STATEMENT: Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.

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

Kforce has a client that is seeking a Liability Claims Manager. This position can be 100% fully remote but if the candidate lives in a city with a regional office, it will be 3 days in office, 2 days work from home. In this role, you will be responsible for overseeing and managing the claims process related to liability claims insurance. This role involves a combination of administrative, analytical and customer service duties ensuring that claims are handled efficiently. This client offers outstanding benefits.* 5+ years of experience in claims management, focusing on Liability claims is a must * Knowledge of software relevant to claims management * Knowledge of applicable laws and regulations related to liability claims insurance * Strong analytical and problem-solving skills * Excellent communications and negotiation abilities

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner, Bodily Injury | Remote | Litigation PRIMARY PURPOSE: To analyze and process complex auto bodily injury transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Processes complex auto claims, including bodily injury and ensures claim files are properly documented and coded correctly. Responsible for litigation process on litigated claims. Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. Reports large claims to excess carrier(s). Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. Communicates claim action/processing with insured, client, and agent or broker when appropriate. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. Experience Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. Skills & Knowledge In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws Knowledge of medical terminology for claim evaluation and Medicare compliance Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. Strong oral and written communication, including presentation skills PC literate, including Microsoft Office products Strong organizational skills Strong interpersonal skills Good negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Enjoy flexibility and autonomy in your daily work, your location, and your career path. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? No day is ever the same assisting our public entity clients with their claims! If you are an agile multi-line examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims, we want to talk to you! This examiner will primarily handle liability for the following lines of coverage: General Liability, Auto Liability, Employment Practices Liability, Law Enforcement Liability and Public Officials Liability. Texas adjuster license is a plus. PRIMARY PURPOSE: To analyze complex or technically difficult multi-product line claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; assesses damages; manages claims through well-developed action plans to an appropriate and timely resolution. Assesses and resolves claims within evaluation. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Secures and disposes of salvage. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant, insured, client and agent or broker as appropriate; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 to $95,000 USD annual salary . Bonus eligible role. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. #LI-REMOTE #claimsexaminer #remote Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Multi-Line | Public Entity | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Enjoy flexibility and autonomy in your daily work, your location, and your career path. + Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. + Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **ARE YOU AN IDEAL CANDIDATE?** No day is ever the same assisting our public entity clients with their claims! If you are an agile multi-line examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims, we want to talk to you! This examiner will primarily handle liability for the following lines of coverage: General Liability, Auto Liability, Employment Practices Liability, Law Enforcement Liability and Public Officials Liability. Texas adjuster license is a plus. **PRIMARY** **PURPOSE** : To analyze complex or technically difficult multi-product line claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; assesses damages; manages claims through well-developed action plans to an appropriate and timely resolution. + Assesses and resolves claims within evaluation. + Negotiates settlement of claims within designated authority. + Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. + Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. + Prepares necessary state fillings within statutory limits. + Manages the litigation process; ensures timely and cost effective claims resolution. + Coordinates vendor referrals for additional investigation and/or litigation management. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. + Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Secures and disposes of salvage. + Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant, insured, client and agent or broker as appropriate; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Travels as required. **QUALIFICATION** **Education & Licensing** Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. **Experience** Five (5) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Good interpersonal skills + Excellent negotiation skills + Ability to work in a team environment + Ability to meet or exceed Service Expectations **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is _$80,000 to $95,000 USD annual salary_ . Bonus eligible role. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. \#LI-REMOTE #claimsexaminer #remote Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Claims Examiner | Commercial Trucking | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Apply your Commercial Trucking Bodily Injury claims knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. ARE YOU AN IDEAL CANDIDATE? If you have 5+ years of experience as a Claims Examiner working on Complex Commercial Bodily Injury Trucking Claims and would like to join one of the premier teams in the industry, we are looking for someone with your level of expertise. This role will be responsible for analyzing and processing complex commercial trucking transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages. ESSENTIAL RESPONSIBLITIES MAY INCLUDE Processes complex commercial trucking claims, including bodily injury, and ensures claim files are properly documented and coded correctly. Responsible for litigation process on litigated claims. Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. Reports large claims to excess carrier(s). Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. Communicates claim action/processing with insured, client, and agent or broker when appropriate. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. Experience Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. Licensing / Jurisdiction Knowledge: (list any preferred and/or required here) TAKING CARE OF YOU Referral incentive program. Opportunity to work in an agile or remote environment. Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000- $90,000 USD annual salary. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always accepting applications. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. #LI-REMOTE Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

For over 25 years, G&A Partners has been helping entrepreneurs grow their businesses, take better care of their employees, and enjoy a higher quality of life by providing proven HR solutions and technology. A growing, Houston-based professional services firm, G&A Partners is currently seeking an Unemployment Insurance Claims Specialist to join its team with the ability to work 100% remote. A competitive compensation and benefits package is available to include health benefits and 401(k), recognition awards and bonuses and the opportunity to work for a highly respected and award-winning company. Summary The Unemployment Claim Specialist functions as the state expert for screening claims and responding to state documents for our clients. This position acts as a liaison between our customers and state unemployment agencies and is responsible for analyzing and responding to claim-related documents within pre-determined time limits. Reasonable Accommodations Statement: To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions. Responsibilities Receives and prioritizes claims, questionnaires, and other unemployment related data. Analyzes individual case information by reviewing data accessed through the PC, from documented telephone calls or document images, to determine if the facts warrant a response. Using the details regarding an employee's separation provided by the client, interprets and applies state laws and regulations in response to unemployment documents. Responds to a state agency with all pertinent details within the time frame allowed by the state or departmental procedures. Initiates timely telephone calls, faxes, or emails to customers, completed by co-workers, to obtain, document, or pass along needed information. Works as a team member with our Unemployment Insurance Consultants to ensure accurate and necessary information retrieved from customers is documented clearly and thoroughly into our database. Investigates and resolves state agency concerns with supervisor, other departments and/or State Relationship Managers promptly. Other Duties: Performs any additional functions needed to meet the goals of the department. Overtime may be required periodically to meet deadlines. Qualifications Education: An associate degree (A.A.) or equivalent from two-year college or technical school; or two years customer service-related experience and/or training; or equivalent combination of education and experience. Skills & Experience: Previous office experience emphasizing organization of work duties and performing job functions independently is required. Previous experience with Unemployment Insurance and the Unemployment Claims process. Experience dealing with dated material and/or strict adherence to guidelines is required. 2-3 weeks of immediate, mandatory, and uninterrupted training is required. Computer Skills: Proficiency with Microsoft Office PC applications including Word, Excel, and Outlook is required. Ability to type 35 WPM is required. Certifications/Licenses: None required. Equal Opportunity Employer Statement G&A Partners as an Equal Opportunity Employer considers all applicants and prohibits discrimination of any type on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and pregnancy-related conditions), gender identity or expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, genetic information, or any other characteristic protected by applicable federal, state or local laws and ordinances. Our management team is dedicated to providing a work environment free of discrimination and harassment based on any of these characteristics. We are committed to this policy and achieving a diverse workforce with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities, access to facilities and programs and general treatment during employment. Salary Starting wage is $24.04/hr. up to $26.00/hr. The starting range represents the low and high end of the G&A Partners' range for this position. Actual wages will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. The range listed is just one component of G&A's total compensation package for employees. Other rewards may include commissions, annual bonuses, and program specific rewards. In addition, G&A Partners provides a variety of benefits to employees, including health, dental, vision, life insurance, short-term and long-term disability, flexible spending, ancillary benefits, retirement savings plan, paid holidays, and paid time off (PTO). Application close date is 10/26/2025

ComPsych Ⓡ is the worldwide leader in organizational mental health, well-being, and absence management, dedicated to igniting human potential in workplaces across the globe. For over 40 years, we have combined the best in technology with unmatched human expertise to help individuals and their organizations thrive. Our GuidanceResources Ⓡ and AbsenceResources Ⓡ solutions deliver end-to-end mental health, well-being, work-life, health navigation, and absence support to more than 75,000 customers worldwide, touching more than 160 million lives across 200 countries. Visit compsych.com to find out why 40% of the Fortune 500 choose ComPsych for their mental health and absence management needs. Job Summary As a Bilingual Absence Claims Specialists you are responsible for processing medical certifications in a high production environment while answering emails and corresponding with customers. This individual will report to a Claims Team Lead and must have strong attention to detail, clerical/administrative experience, and commitment to quality. Primary Responsibilities Review the Family Medical Leave Act (FMLA), state, company and other absence certifications as mandated by state and federal guidelines and in coordination with our customer's policies Provide accurate, professional, and timely responses to communications from internal and external partners Contact medical providers to obtain or clarify medical facts supporting the need for a leave of absence Maintain complete and accurate documentation of leaves within our proprietary database Correspond with clients regarding leave status and assist with decision making Process reports for clients and short term disability partners Input and analyze data Demonstrate respect, sensitivity, and confidentiality, while maintaining professionalism at all times. Meet and adhere to production and quality goals as well as performance metrics. Responsible and accountable for maintaining and protecting personal, confidential claimant health information. Must maintain a high level of confidentiality and abide by HIPAA rules and regulations. Engage in ongoing education and training around laws, policies and service delivery. Support management with special projects as necessary Other duties as assigned Job Qualifications Bachelor's Degree preferred, High School Degree or equivalent required 1+ years of human resource, claim management or leave and disability experience Exceptional verbal and written communication skills, with a strong focus on customer service Proficiency in Microsoft Office Suite Quick thinking, high energy, positive, and professional with demonstrated multi-tasking and critical thinking skills Strong time management and deliverable ownership Ability to work independently Strong attention to detail Good analytical skills Bilingual Spanish is a plus High-speed internet and a professional workspace that is free from distraction, disruption or outside noise Benefits and Perks Full benefits package, including Paid Time Off (PTO), medical, dental, vision, 401(k) with match, robust EAP, wellness program, and much more EEO ComPsych is an equal opportunity employer. All applicants will be considered for employment regardless of race, color, age, genetics, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status and any other characteristic protected by federal, state or local laws. ComPsych Corporation maintains a drug free workplace.