Post job

Claim Specialist jobs at QBE Insurance Group

- 21 jobs
  • Claims Specialist - Crop

    QBE Insurance 4.9company rating

    Claim specialist job at QBE Insurance Group

    Primary DetailsTime Type: Full time Worker Type: EmployeeAt QBE, we are always looking to connect with top talent - for current vacancies as well as for future opportunities. It is our aim to continuously build a strong candidate pipeline across all our businesses and key locations in North America. After submitting your interest to this specific hiring profile, our Recruitment Team will review your credentials and areas of expertise. Should there be a current or prospective opportunity that is commensurate with your career experience, we will contact you for an exploratory discussion. We appreciate your consideration of QBE as an employer of choice. The Opportunity This role will deliver prompt and accurate claims service to policyholders and agents for both multi-peril crop insurance (MPCI) and crop hail claims by completing field inspections, communicating with involved parties, performing investigations, determining appropriate adjustments and administering insurance policies to ensure compliance with state and federal regulations. Partner with Field Claims Manager to ensure effective and efficient claims operations. Primary Responsibilities • Distribute and direct losses and claim tracking for defined territory or agency base to support delivery of effective customer service and claim resolution and ensure team alignment with business goals •Accurately document, process and transmit loss information in order to determine potential damages associated with difficult and complex claims •Provide overflow support to Compliance Department of quality control audits for Federal Crop Insurance Corporation (FCIC and Crop Hail) •Complete field inspections, reviews and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company crop insurance policies. Ensure compliant and cost effective application of crop policies by leveraging knowledge of insurance statues and regulations and complying with state and federal regulatory requirements •Provide effective and timely communication with agencies in defined territory on claim status and other inquiries •Build and maintain relationships with customers by providing timely an accurate policy service, answering questions and communicating adjustment determinations •Coach claims adjusting team by supporting and mentoring team members and providing advice and feedback to guide the success of the team and meet service level expectations •Provide information and feedback regarding the quality of agent business and/or policy files of regional claim operations to maximize profit and quality of business •Deliver classroom and field training programs for claims technology applications and crop programs ensuring effective educational resources for clients and alignment of training services with key stakeholders expectations •Participate with internal committee to develop global claims technology solutions that support business need •Attend National Crop Insurance Services (NCIS) regional and state committee meetings to make business aware of any legal issues or changes that will impact the business •Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun Required Education • High School Diploma/GED Required Experience • 5 years relevant experience Preferred Competencies/Skills • Evaluate project outcomes through analyzing current state and desired future state •Utilize effective communication channels for both external and internal customers •Handle complex claims using a logical approach •Provide adjusters detailed instructions for claim procedures and company policy •Support implementation of company strategies •High attention to detail •Solve day-to-day problems, using critical thinking •Train others on process and procedures Preferred Education • Bachelor's Degree or equivalent combination of education and work experience Preferred Experience • 5 years experience in MPCI and Crop Hail claims experience Preferred Licenses/Certifications • Crop Adjuster Proficiency Program (CAPPP); per State Requirements Preferred Knowledge • Working knowledge of claims administration best practices and procedures •Understanding of local, state and industry standards (NCIS) •Understanding of relevant laws and regulations across multiple jurisdictions •Working knowledge of Microsoft Office suite, general computer software and database systems About QBE We can never really predict what's around the corner, but at QBE we're asking the right questions to enable a more resilient future by helping those around us build strength and embrace change to their advantage. We're an international insurer that's building momentum towards realizing our vision of becoming the most consistent and innovative risk partner. And our people will be at the center of our success. We're proud to work together, and encourage each other to enable resilience for our customers, our environment, our economies and our communities. With more than 12,000 people working across 27 countries, we're big enough to make a real impact, but small enough to provide a friendly workplace, where people are down-to-earth, passionate, and kind. We believe this is our moment: What if it was yours too? Your career at QBE - let's make it happen! *************************************************** US Only - Travel Frequency • Frequent (approximately 10+ trips annually) US Only - Physical Demands • Field agents: Work is generally performed in both an office environment and remote external environments that may present exposure to adverse environmental conditions dependent on customer location. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Must be able to walk on uneven ground, climb, bend, stoop, use a step, crawl and/or kneel. Incumbent may be exposed to environments that present hazardous weather, chemicals and/or animals. Incumbent must be able to lift up to 25 lbs. US Only - Disclaimer • To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities. Job Type • Individual Contributor Global Disclaimer • The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee's normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls. Compensation Base pay offered will vary depending on, but not limited to education, experience, skills, geographic location and business needs Annual Salary Range: $68,000 - $102,000 AL, AR, AZ, Fresno, CA, CO (Remote), DE (Remote), FL, GA, IA, ID, IL (Remote), IN, KS, KY, LA, MI, MN, MO, MS, MT, NC, ND, NE, NH, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WI, WV and WY Annual Salary Range: $75,000 - $112,000 CA (Remote, Irvine and Woodland), Greenwood Village CO, CT, Chicago IL, MA, MD, NY (Remote), RI, Houston TX and WA Annual Salary Range: $85,000 - $128,000 San Francisco CA, NJ and New York City NY Benefit Highlights You are more than your work - and QBE is more than a workplace, which is why QBE provides you with the benefits, support and flexibility to help you concentrate on living your best life personally and professionally. Employees scheduled over 30 hours a week will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution and a paid-time off program. In addition, our paid-family and care-giver leaves are available to support our employees and their families. Regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. QBE recognizes that exemplary benefits extend beyond benefits coverage and compensation. Flexibility in your working environment is important to maintaining balance and QBE is dedicated to ensuring employees achieve personal and professional integration by providing the opportunity for hybrid work arrangements. How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.
    $85k-128k yearly Auto-Apply 60d+ ago
  • Lead Casualty Treaty Claims Specialist

    QBE Insurance 4.9company rating

    Claim specialist job at QBE Insurance Group

    Primary DetailsTime Type: Full time Worker Type: Employee The Opportunity Oversee and manage assumed reinsurance excess of loss and proportional business emanating from QBE Re's casualty and property book of business including an emphasis on Cedent audits. Ensure that all claims are being properly reported to QBE Re pursuant to the terms and conditions of the reinsurance contract(s). Location: Ny- New York City Work Arrangement: Hybrid (2-3 days in the office) The salary range for this role is between $126,000 -$189,000 depending on experience Your new role Complete either on-site or remote reinsurance claim audits when necessary Deliver quality claims service to our internal underwriters, actuaries, etc. and external partners (Brokers and Cedent's) Manage a portfolio of reinsurance claims (via our ProSume system) in accordance with QBE Re's Claim Guideline and Procedures to ensure a favorable outcome. Where necessary, conduct investigations on all assigned claims in order to provide timely and accurate facts for evaluation of each assigned claim Interpret the applicable insurance and reinsurance contract(s) and apply that to the exposures presented with each assigned reinsurance claim Complete Large Loss Reports (LLR's) for upper management when required Resolve claims in a timely and fair manner and in accordance with all applicable laws, regulations and statutes Collaborate with QBE's staff attorneys on coverage issues in order to formulate a strategy to achieve a favorable outcome Review reserves on all assigned claim files and recommend changes (ACR's) where necessary to ensure claim and actuarial accuracy Collaborate with other internal Centers of Expertise in a timely manner when indicated to facilitate the delivery of superior claims outcomes Serve as an expert resource on complex claims or assigned claims requiring special handling Undertake claims resolutions activities in accordance with claims best practices and Department of Insurance (DOI) compliance to support quality claim results Provide the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to deliver superior claim outcomes Direct, control, and manage relationships with vendors to deliver accurate, timely, and cost-effective solutions Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility Required Education Bachelor's Degree or equivalent combination of education and work experience Required Experience 5+ years of Reinsurance Claims Experience and/or 10+ yeas of primary insurance claims experience Preferred Competencies/Skills Generate original, innovative solutions to difficult or unusual situations Identify and locate information and facts which are necessary and relevant for the purposes of evaluating a claim Financial and business acumen and awareness of financial responsibility Quickly change direction when working on multiple projects or issues Guide team to properly document investigation findings and preserve evidence in accordance with internal and external laws and procedures Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems Assume a methodical approach to a given situation and develop a systematic procedure as a response Develop effective negotiation strategies and prepare a plan of action Build and capitalize on beneficial internal and external relationships including competitors Coach and encourage employees towards continuously improving performance and mentor team with feedback, on-the-job skill enhancement opportunities and career advice Build and establish constructive and cooperative working relationships and open lines of communication Utilize effective communication skills to influence and persuade decision makers Preferred Education Bachelor's Degree or equivalent combination of education and work experience Preferred Education Specifics JD degree or equivalent highly preferred Preferred Experience Experience handling Casualty and Property Insurance/Reinsurance claims Experience in Auditing primary and umbrella insurance claims Preferred Knowledge Working knowledge of a Reinsurance Contract. Experience managing Casualty Lines claims Working knowledge of current and possible future policies, practices, trends, technology and information affecting the business and organization; knows how the business works Working knowledge of relevant claims legal and technical knowledge for all US jurisdictions Working knowledge of insurance policy and contract language Working knowledge of business and management principles involved in strategic planning, resource allocation, leadership technique, and coordination of people and resources Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team. QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to: Hybrid Working - a mix of working from home and in the office 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis Competitive 401(k) program with company match up to 8% Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice Tuition Reimbursement for professional certifications, and continuing education Employee Network and Community - QBE actively supports six Employee Networks, and many ways to give back to your community To learn more, click here: Benefits | QBE US. Why QBE? What if you could have a positive impact - at work and in the world? At QBE, we're enabling a more resilient future - for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success. Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact. Join us now, so you can be part of our success - and we can be part of yours! *************************************************** QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information. Equal Employment Opportunity: QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status. This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship. Supplementary information Skills: Adaptability, Claims Settlement, Commercial Acumen, Conflict Resolution, Critical Thinking, Insurance Claims Processing, Intentional collaboration, Managing performance, Mentorship, Personal Initiative, Project Delivery, Regulatory Compliance, Reinsurance, Risk Management, Team Development How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.
    $64k-89k yearly est. Auto-Apply 3d ago
  • Senior Professional Liability Claims (Attorney), Claims Construction

    Zurich Na 4.8company rating

    Albany, NY jobs

    129572 **Zurich North America is expanding its nationwide Construction Professional Liability Claims Team with the addition of a dedicated Claims Construction, Professional Liability Claims (Senior or AVP level).** In this highly technical, individual contributor role, the selected candidate will manage complex, litigated construction professional liability claims. These claims typically involve allegations of design errors, omissions, or other professional acts for which our construction clients may be legally responsible. The position offers autonomy and requires strong analytical, negotiation, and litigation management skills. This position can be office, hybrid, or fully remote anywhere in the lower 48 states. **Claims Handling & Investigation:** + Manage a portfolio of highly complex, litigated claims with significant exposures, requiring advanced technical expertise and strategic coordination. + Accurately update and document claim files in accordance with best practices, ensuring data integrity and compliance. + Verify coverage by analyzing policy language, determining applicability to the loss, and drafting clear, well-supported coverage position letters. + Conduct thorough investigations by collecting relevant documentation (e.g., contracts, recorded statements, expert reports) to assess coverage, liability, and damages. **Resolution Strategy & Negotiation:** + Develop and implement effective claim resolution strategies, including case evaluations, issue escalation, and timely disposition planning. + Establish and maintain appropriate reserves throughout the claim lifecycle, ensuring alignment with exposure and developments. + Achieve favorable claim outcomes by exercising sound judgment, applying case-specific resolution strategies, leveraging available tools, negotiating effectively, and operating within established authority limits. **Litigation & Legal Compliance:** + Oversee litigation by selecting counsel, reviewing litigation plans and budgets, coordinating defense efforts, and authorizing legal payments. + Ensure compliance with applicable state and federal laws, regulations, and internal controls throughout the claims process. + Identify and refer claims with subrogation or fraud potential to the appropriate internal teams for further investigation. **Customer Service & Communication:** + Deliver exceptional customer service by proactively communicating with insureds, brokers, and other stakeholders. + Demonstrate empathy and professionalism in all interactions, actively listening to understand customer needs and concerns. + Partner with customers to achieve fair and timely outcomes, ensuring transparency and responsiveness throughout the claim process. + Provide timely updates and clear explanations of claim status, decisions, and next steps, fostering trust and confidence. **Quality Assurance & Risk Reporting:** + Maintain high quality standards by producing accurate, timely work and ensuring thorough documentation in accordance with best practices. + Keep Claims and Business Unit leadership informed of significant risks, emerging exposures, and strategic claim insights. + Resolve issues by applying company policies, procedures, and standards to ensure consistency and quality outcomes. + Support profitable growth by sharing risk insights, trends, and data with internal stakeholders and customers as appropriate. **Expertise, Mentorship & Continuous Learning:** + Maintain subject matter expertise and regulatory compliance by staying informed on insurance laws, industry developments, and best practices. + Mentor and support less experienced claims professionals, fostering technical growth and knowledge sharing. + Serve as a technical resource to internal teams and business partners, offering insights to enhance product design, underwriting, and policy language. + Escalate complex issues to senior colleagues when appropriate, promoting quality outcomes and continuous learning. + Invest in professional development through ongoing education, industry networking, and active participation in professional organizations. **This role will be filled at either the** **Senior or AVP Claims Professional** **Level.** **The hiring manager will determine the appropriate level based upon the selected applicant's experience and skill set relative to the qualifications listed for this position.** Basic Qualifications: AVP Claims Professional: + Bachelors Degree and 8 or more years of experience in the Claims Technical area OR + Juris Doctor and 4 or more years of experience in the Claims and Litigation Management area.OR + High School Diploma or Equivalent and 10 or more years of experience in the Claims and/or Litigation Management area OR + Zurich Certified Insurance Apprentice, including an Associate Degree with 8 or more years of experience in the Claims and/or Litigation Management area AND + Must obtain and retain required adjuster license + Microsoft Office experience + Knowledge of insurance regulations, markets, and products OR Senior Claims Professional: + Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area.OR + Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area.OR + Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area.OR + Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area.OR + High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area.AND + Must obtain and maintain required adjuster license(s) + Microsoft Office experience + Knowledge of insurance regulations, markets, and products Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply-your unique background matters to us. The pay range shown is a national average and may vary by location. The combined salary range for this position is $74,300.00 - $161,000.00. The proposed salary range for this position is $74,300.00 - $121,700.00, with short-term incentive bonus eligibility set at 15%. The proposed salary range for this position is $98,300.00 - $161,000.00, with short-term incentive bonus eligibility set at 20%. We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here .] **Why Zurich?** At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment-so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500 . Join us for a brighter future-for yourself and our customers. Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets. Zurich complies with 18 U.S. Code § 1033. **Please note:** Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal. Location(s): AM - Schaumburg, AM - Addison, AM - Atlanta, AM - Dallas, AM - Maitland, AM - Omaha, AM - Overland Park, AM - Owings Mills, AM - Parsippany, AM - Remote Work (US), AM - Rocky Hill, AM - Woodland Hills Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-LC1 #LI-DIRECTOR #LI-HYBRID EOE Disability / Veterans
    $98.3k-161k yearly 4d ago
  • Crop Claims Adjuster (North Dakota)

    Great American Insurance Company 4.7company rating

    North Dakota jobs

    Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. The Crop Division of Great American has been helping generations of farmers take control of their risks since 1915. The D ivision is also one of a select few private companies authorized by the United States Department of Agriculture Risk Management Agency (USDA RMA) to write MPCI policies. With six regional offices throughout the U.S., the teams provide tremendous expertise in the specific needs of farmers and crops. ********************************** Great American's Crop Division is looking for a Claims Adjuster in Southeast/South-central North Dakota. This individual will work fully remote in this territory and will be required to travel up to 40%. Our ideal candidate will have prior crop insurance claims experience. Essential Job Functions and Responsibilities Manages an inventory of crop related claims to evaluate compensability/liability. Conducts claim investigations to confirm coverage and to determine liability, compensability and damages. This includes crop field work and knowledge of grain marketing. Determines and may negotiate appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners. May authorize payments in accordance with assigned authority limit and ensure payments are made in a timely manner. Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. Performs other duties as assigned. Job Requirements Education: Bachelor's Degree in Agronomy, Crop Management, Ag Business, or a related field, or equivalent experience. Experience: Generally, a minimum of 6 months of experience in general agriculture, ag business/sales, agronomy, and/or grain merchandising. Crop Insurance experience is highly favorable. Physical Requirements Requires continuous and prolonged walking and standing. Requires frequent lifting, carrying, pushing and pulling of objects up to 50 lbs. Requires frequent climbing, bending, twisting, stooping, kneeling and crawling. Requires overhead reaching and grabbing. Requires regular and predictable attendance. Requires ability to conduct visual inspections. Requires work outdoors, in inclement weather conditions. Requires frequent travel. May require ability to operate a motor vehicle. Business Unit: Crop Salary Range: $54,000.00 -$75,000.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
    $54k-75k yearly Auto-Apply 60d+ ago
  • Workers Comp Claims Representative

    Hanover Insurance Group, Inc. 4.9company rating

    Syracuse, NY jobs

    Our Workers Comp Claims team is currently seeking a Claims Representative to join our Level One team in our Worcester, MA, Syracuse, NY, or Itasca, IL offices. This is a full-time/non-exempt role. Responsible for the investigation and resolution of complex medical only and lost time claims of low complexity in accordance with policy provisions, best practices and jurisdictional requirements. Includes the input of claim data and guiding insured's and claimants through the claim process and options. IN THIS ROLE, YOU WILL: Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits. Work within specific limits and authority on assignments of moderate technical complexity. Use discretion and independent judgment in claim handling. Possess functional knowledge and skills reflective of fully competent practitioner. Identify possibly suspicious claims. Investigate, analyze, evaluate and negotiate personal and/or commercial lines claims of minimal to moderate complexity. Responsible for managing all aspects of each claim and maintaining a high level of productivity, confidentiality and customer service. Implement and coordinate the most effective management techniques to mitigate loss and expense payments. Reserving and expense authority levels are moderate. Work with the Special Investigations Unit, where appropriate. May be required to have and maintain sufficient home-based internet connection. WHAT YOU NEED TO APPLY: Typically has 1 - 3 years experience Technical knowledge in WC coverages Excellent written and verbal communication skills Knowledge of medical terminology Must possess organizational skills with regard to time management, task prioritization and integration of information from a variety of sources Excellent and proficient data entry skills High level of proficiency in Word, Excel and use of the Internet Ability to meet and/or exceed the goals and metrics of the role on a consistent basis Self-directed and self-motivated Possesses strong customer service skills and behaviors Makes decisions in an informed, confident and timely manner Maintains constructive working relationships despite differing perspectives Strong organizational and time management skills Ability to negotiate skillfully in difficult situations with both internal and external groups Demonstrates ability to win concessions without damaging relationships Demonstrates strong written and verbal communication skills. Promotes and facilitates free and open communication Understanding of applicable statutes, regulations and case law Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner Easily adapts to new or different changing situations, requirements or priorities Cultivates an environment of teamwork and collaboration Operates with latitude for un-reviewed action or decision Computer experience (MS Office, excel, word, etc) Proficient using Claims systems (i.e. CSS, PMS, etc.) Ability to use a personal computer and other standard office equipment Ability to travel as necessary Ability to sit and/or stand for extended periods Workload requirements may routinely call for work hours in excess of 40 hours per week This job posting provides cursory examples of some of the job duties associated with this position. The examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform.
    $43k-65k yearly est. 25d ago
  • Ocean Marine Claim Specialist

    CNA 4.6company rating

    Warren, NY jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. At CNA, we provide insurance solutions to a wide range of businesses. Our Marine Claims Team handles all lines of ocean and some inland marine claims. We are seeking a motivated claim professional to join us primarily handling Hull, P&I, and Marine Liability claims. There will also be the opportunity to handle Ocean Cargo and Motor Truck Cargo claims. Under general management direction, the individual contributor will analyze, coordinate and resolve litigated and non-litigated claims within an established authority level. JOB DESCRIPTION: Essential Duties & Responsibilities Interprets policy coverages, and determines if coverages apply to claims submitted, escalating issues as needed. Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses. Coordinates and performs investigations and evaluates claims and lawsuits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU. Utilizes negotiation skills to develop settlement packages. Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit. Partners with attorneys, account representatives, agents, underwriters, and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims. Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations. Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes. May provide guidance and assistance to other claims staff and functional areas. Keeps current on state/territory regulations and issues as well as industry activity and trends. Some travel may be required as needed for mediations, settlement conferences, team activities and/or trials. May perform additional duties as assigned. Reporting Relationship Manager. Skills, Knowledge & Abilities Solid knowledge of marine or commercial liability claims, and insurance industry theory and practices. Demonstrated technical expertise and product specific knowledge. Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners. Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines. Strong analytical and problem solving skills enabling viable alternative solutions. Ability to exercise independent judgement, and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis. Solid knowledge of Microsoft Office Suite, as well as other business-related software. Ability to adapt to change and value diverse opinions and ideas. Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports. Ability to handle claims with a proactive long-term view of business goals and objectives. Education & Experience Bachelor's degree or equivalent experience. Professional designations preferred. Typically a minimum three to five years claims experience. In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $54k-103k yearly Auto-Apply 48d ago
  • Claims Specialist - Bodily Injury

    Great American Insurance Group (DBA 4.7company rating

    Ohio, IL jobs

    National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (****************** National Interstate is looking for a Claims Specialist to join their team. This individual will work fully remote from the USA. Essential Job Functions and Responsibilities * Manages a large inventory of complex claims to evaluate compensability/liability. * Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages. * Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. * Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners. * Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. * Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. * May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. * Performs other duties as assigned. Job Requirements Education: Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience. Experience: Generally, a minimum of 9 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC). Scope of Job/Qualifications: Works within broad limits and authority on assignments of the highest technical complexity, requiring specialized knowledge. Demonstrates excellent analytical, negotiation, and problem-solving skills. Maintains strong knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Advanced ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. Viewed as a senior resource within the Claims department and/or organization. Company: NIIC National Interstate Insurance Company Salary Range: $90,000.00 -$100,000.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
    $90k-100k yearly Auto-Apply 60d+ ago
  • Claims CL Casualty General Liability Representative (GLPD)- remote

    Grange Insurance Careers 4.4company rating

    Remote

    If you're excited about this role but don't meet every qualification, we still encourage you to apply! At Grange, we value growth and are committed to supporting continuous learning and skill development as you advance in your career with us. Summary: In this role you will be responsible for investigating, evaluating and negotiating settlement of assigned Commercial General Liability Property Damage claims in accordance with best practices to promote retention or purchase of insurance from Grange Enterprise. What You'll Be Doing: Pursuant to line of business strategies and good faith claim settlement practices, investigates, evaluates, negotiates, and resolves (within authorized limits) assigned claims. Demonstrates technical proficiency, allowing for the handling of more complex claims with minimal supervision. Establishes and maintains positive relationships with both internal and external customers, providing excellent customer service. Assists in building business partner relationships with agents, insureds and Commercial Lines through regular and effective communications. May include face-to-face as needed. Will be the “point person” (when required) for certain identified large customer accounts where specialized communication and handling are required. Establishes and maintains proper reserving through proactive investigation and ongoing review. Assist other departments (when required) with investigations. May be assigned general liability claims during high volume workload periods. Demonstrates effectiveness and efficiencies in managing diary system and handling workload with limited supervision or direction. What You'll Bring To The Company: High school diploma or equivalent education plus five (5) years of claims experience. Bachelor's degree preferred. For property focused role, at least two (2) years handling commercial general liability property claims handling exposures or frontline property claims handling experience preferred. Preference to those candidates with Construction Defect experience. Must possess strong communication and organization skills, critical thinking competencies and be proficient with personal computer. Demonstrated ability to interact with customers and agents in a professional manner. State specific adjusters' license may be required. About Us: Grange Insurance Company, with $3.2 billion in assets and more than $1.5 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home and business insurance protection. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and Wisconsin and holds an A.M. Best rating of "A" (Excellent). Grange understands that life requires flexibility. We promote geographical diversity, allowing hybrid and remote options and flexibility in work hours (role dependent). In addition to competitive traditional benefits, Grange has also created unique benefits based on employee feedback, including a cultural appreciation holiday, family formation benefits, compassionate care leave, and expanded categories of bereavement leave. Who We Are: We are committed to an inclusive work environment that welcomes and values diversity, equity and inclusion. We hire great talent from various backgrounds, and our associates are our biggest strength. We seek individuals that represent the diversity of our communities, including those of all abilities. A diverse workforce's collective ideas, opinions and creativity are necessary to deliver the innovative solutions and service our agency partners and customers need. Our core values: Be One Team, Deliver Excellence, Communicate Openly, Do the Right Thing, and Solve Creatively for Tomorrow. Our Associate Resource Groups help us create a more diverse and inclusive mindset and workplace. They also offer professional and personal growth opportunities. These voluntary groups are open to all associates and have formed to celebrate similarities of ethnicity/race, nationality, generation, gender identity, and sexual orientation and include Multicultural Professional Network, Pride Partnership & Allies, Women's Group, and Young Professionals. Our Inclusive Culture Council, created in 2016, is focused on professional development, networking, business value and community outreach, all of which encourage and facilitate an environment that fosters learning, innovation, and growth. Together, we use our individual experiences to learn from one another and grow as professionals and as people.  We are committed to maintaining a discrimination-free workplace in all aspects, terms and conditions of employment and welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender identity or expression, ancestry, pregnancy, veteran status, and citizenship.
    $34k-45k yearly est. 21d ago
  • Workers Compensation Claims Specialist, East

    CNA Financial Corp 4.6company rating

    New York jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-AR1 #Li-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $54k-103k yearly Auto-Apply 18d ago
  • Ocean Marine Claim Specialist

    CNA Financial Corp 4.6company rating

    New York, NY jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. At CNA, we provide insurance solutions to a wide range of businesses. Our Marine Claims Team handles all lines of ocean and some inland marine claims. We are seeking a motivated claim professional to join us primarily handling Hull, P&I, and Marine Liability claims. There will also be the opportunity to handle Ocean Cargo and Motor Truck Cargo claims. Under general management direction, the individual contributor will analyze, coordinate and resolve litigated and non-litigated claims within an established authority level. JOB DESCRIPTION: Essential Duties & Responsibilities * Interprets policy coverages, and determines if coverages apply to claims submitted, escalating issues as needed. * Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses. * Coordinates and performs investigations and evaluates claims and lawsuits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU. * Utilizes negotiation skills to develop settlement packages. * Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit. * Partners with attorneys, account representatives, agents, underwriters, and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims. * Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations. * Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes. * May provide guidance and assistance to other claims staff and functional areas. * Keeps current on state/territory regulations and issues as well as industry activity and trends. * Some travel may be required as needed for mediations, settlement conferences, team activities and/or trials. * May perform additional duties as assigned. Reporting Relationship * Manager. Skills, Knowledge & Abilities * Solid knowledge of marine or commercial liability claims, and insurance industry theory and practices. * Demonstrated technical expertise and product specific knowledge. * Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners. * Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines. * Strong analytical and problem solving skills enabling viable alternative solutions. * Ability to exercise independent judgement, and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis. * Solid knowledge of Microsoft Office Suite, as well as other business-related software. * Ability to adapt to change and value diverse opinions and ideas. * Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports. * Ability to handle claims with a proactive long-term view of business goals and objectives. Education & Experience * Bachelor's degree or equivalent experience. Professional designations preferred. * Typically a minimum three to five years claims experience. In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $54k-103k yearly Auto-Apply 50d ago
  • General Liability Claims Specialist

    CNA Financial Corp 4.6company rating

    Melville, NY jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). This position enjoys a flexible, hybrid work schedule and is available in any location near a CNA office. JOB DESCRIPTION: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. * Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols. * Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim. * Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. * May serve as a mentor/coach to less experienced claim professionals May perform additional duties as assigned. Reporting Relationship Typically, Manager or above Skills, Knowledge & Abilities * Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. * Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed. * Demonstrated ability to develop collaborative business relationships with internal and external work partners. * Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions. * Demonstrated investigative experience with an analytical mindset and critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Developing ability to negotiate low to moderately complex settlements. * Adaptable to a changing environment. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Demonstrated ability to value diverse opinions and ideas Education & Experience: * Bachelor's Degree or equivalent experience. * Typically, a minimum four years of relevant experience, preferably in claim handling. * Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Professional designations are a plus (e.g. CPCU) #LI-LG1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $54k-103k yearly Auto-Apply 60d+ ago
  • Sr. Claims Specialist (General Liability/Construction)

    Zurich Na 4.8company rating

    New York, NY jobs

    127295 Zurich is seeking an individual interested in growing their claims career with our General Liability team. As a General Liability (GL) Senior Claims Specialist on our IPZ (international Program) team you will work with a team of claims professionals with diverse experiences and backgrounds. This environment will support your development as you hone your technical skill set in GL policy interpretation and coverage analysis to resolve your claims effectively. At this level, you will handle single and multi-party personal or commercial line claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled most efficiently and effectively while delivering a customer-centric claims service. You will be expected to collaborate and develop partnerships with internal and external points of contact including customers, vendors, suppliers, and brokers to provide a quality claims experience. Additionally, you will learn and develop knowledge of established protocols and industry best practices to ensure that claims are handled in the most efficient, effective way while delivering a quality customer-centric claims experience. This position will work from one of the following office locations:Rocky Hill, CT, Atlanta, GA, Schaumburg, IL, Maitland, FL, Parsippany, NJ, OR New York Basic Qualifications: + Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area OR + High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area OR + Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area OR + Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area OR + Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area AND + Must obtain and maintain required adjuster license(s) + Microsoft Office experience + Knowledge of insurance regulations, markets, and products Preferred Qualifications: + Commercial General Liability claims handling experience within the area that includes litigated and severity injury claims + Extensive litigation experience + Construction expereince handling Bodily Injury and Property Damage wrap up policies + Currently hold an active adjusters license + Experience collaborating across work groups ability to develop and maintain strong relationships + Understands claims adjustment process and possesses the ability to determine scope/exposure for losses + Understands the use of vendors and how litigation strategies are developed + Understands and applies financial and actuarial/reserving concepts. + Familiarity with negotiation strategies and experience in suggesting alternative approaches + Negotiation skills + Organizational and time management skills + MS Office + Customer service experience + Strong analytical, critical thinking, and problem-solving skills + Strong verbal and written communication skills Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, Click here (****************************************** . Other rewards may include short term incentive bonuses and merit increases. **C** andidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The starting salary range for this position is $72,800.00 - $119,200.00. As an insurance company, Zurich is subject to 18 U.S. Code § 1033. As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ( ************************************ ). A future with Zurich. What can go right when you apply at Zurich? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500 . Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here (********************************* to learn more. As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers' expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Parsippany, AM - Atlanta, AM - Maitland, AM - New York, AM - Rocky Hill, AM - Schaumburg Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No
    $72.8k-119.2k yearly 51d ago
  • Senior Claims Specialist, General Liability/Construction

    Zurich Na 4.8company rating

    New York, NY jobs

    126205 Zurich is seeking an individual interested in growing their claims career with our General Liability team. As a General Liability (GL) Senior Claims Specialist on our IPZ (international Program) team you will work with a team of claims professionals with diverse experiences and backgrounds. This environment will support your development as you hone your technical skill set in GL policy interpretation and coverage analysis to resolve your claims effectively. At this level, you will handle single and multi-party personal or commercial line claims of moderate to high exposure and complexity within specific authority limits, to ensure that claims are handled most efficiently and effectively while delivering a customer-centric claims service. You will be expected to collaborate and develop partnerships with internal and external points of contact including customers, vendors, suppliers, and brokers to provide a quality claims experience. Additionally, you will learn and develop knowledge of established protocols and industry best practices to ensure that claims are handled in the most efficient, effective way while delivering a quality customer-centric claims experience. This position will work from one of the following office locations: Parsippany, NJ; Rocky Hill, CT, Atlanta, GA; Schaumburg, IL; Maitland, FL; or New York, NY Basic Qualifications: + Bachelor's Degree and 6 or more years of experience in the Claims and/ or Litigation Management area OR + High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area OR + Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area OR + Zurich Certified Insurance Apprentice, including an associate degree with 6 or more years of experience in the Claims and/ or Litigation Management area OR + Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area AND + Must obtain and maintain required adjuster license(s) + Microsoft Office experience + Knowledge of insurance regulations, markets, and products Preferred Qualifications: + 8+ years of experience handling commercial general liability claims within the area that includes litigated and severity ibodily njury and PD claims + 8+ years of experince with litigation management + 8+ construction expereince handling Bodily Injury and Property Damage OCIP/CCIP wrap up policies + Currently hold an active adjusters license + Experience collaborating across work groups ability to develop and maintain strong relationships + Understands claims adjustment process and possesses the ability to determine scope/exposure for losses + Understands the use of vendors and how litigation strategies are developed + Understands and applies financial and actuarial/reserving concepts. + Familiarity with negotiation strategies and experience in suggesting alternative approaches + Negotiation skills + Organizational and time management skills + MS Office + Customer service experience + Strong analytical, critical thinking, and problem-solving skills + Strong verbal and written communication skills Compensation for roles at Zurich varies depending on a wide array of factors including but not limited to the specific office location, role, skill set, and level of experience. As required by local law, Zurich provides in good faith a reasonable range of compensation for roles. For additional information about our Total Rewards, Click here (****************************************** . Other rewards may include short term incentive bonuses and merit increases. **C** andidates with salary expectations outside of the range are encouraged to apply, and will be considered based on experience, skill, and education. The salary provided is a nationwide market range and has not been adjusted for the applicable geographic differential associated with the location where the position may be filled. The starting salary range for this position is $72,800.00 - $119,200.00. As an insurance company, Zurich is subject to 18 U.S. Code § 1033. As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ( ************************************ ). A future with Zurich. What can go right when you apply at Zurich? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500 . Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here (********************************* to learn more. As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers' expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Rocky Hill, AM - Addison, AM - Atlanta, AM - Maitland, AM - New York, AM - Parsippany Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No
    $72.8k-119.2k yearly 4d ago
  • Crop Claims Seasonal Adjuster

    Great American Insurance 4.7company rating

    New York, NY jobs

    Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. The Crop Division of Great American has been helping generations of farmers take control of their risks since 1915. The D ivision is also one of a select few private companies authorized by the United States Department of Agriculture Risk Management Agency (USDA RMA) to write MPCI policies. With six regional offices throughout the U.S., the teams provide tremendous expertise in the specific needs of farmers and crops. ********************************** Great American is currently seeking Seasonal Crop Adjusters. These positions are seasonal and may not be eligible for full-time or part-time benefits. Qualified candidates will cover territory in one of the following states: Alabama Arkansas California Colorado Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Michigan Minnesota Mississippi Missouri Montana Nebraska New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Washington Wisconsin Wyoming Schedule: Seasonal part-time. Hours fluctuate based on seasonal needs. As a Crop Adjuster, you will: Understand and can work claims for all major crops, policy/plan types, in all stages of growth. Complete field inspections, reviews, and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company Crop insurance policies. Review and evaluates coverage and/or liability. Secure and analyze necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims. Ensure compliant and cost effective application of Crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements. Accurately document, process and transmit loss information to determine potential. Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions, or trials as necessary. May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority. Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations. Ensures that claims handling is conducted in compliance with applicable statues, regulations, and other legal requirements, and that all applicable company procedures and policies are followed. Follow regulatory and company rules, policies, and procedures. Performs other duties as assigned. Physical Requirements for employees in the Crop Business Unit/Crop Claims General Adjuster Requires continuous and prolonged walking and standing. Requires frequent lifting, carrying, pushing and pulling of objects up to 50 lbs. Requires frequent climbing grain bins, bending, twisting, stooping, kneeling and crawling. Requires overhead reaching and grabbing. Requires regular and predictable attendance. Requires ability to conduct visual inspections. Requires work outdoors, in inclement weather conditions. Requires frequent travel. May require ability to operate a motor vehicle. Business Unit: Crop Salary Range: $0.00 -$0.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
    $53k-66k yearly est. Auto-Apply 9d ago
  • General Liability & Commercial Auto Claims Representative

    CNA Financial Corp 4.6company rating

    New York jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific accounts(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. * Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols. * Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim. * Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Developing basic knowledge of the commercial insurance industry, products and claim practices. * Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service. * Ability to develop collaborative business relationships with both internal and external work partners. * Able to exercise independent judgement, solve basic problems and make sound business decisions. * Analytical mindset with critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Adaptable to a changing environment * Ability to value diverse opinions and ideas Education & Experience: * High school Diploma required. Associates or Bachelor's Degree preferred. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Prior claim handling, or business experience in the insurance industry and/or customer service is preferred. #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $47,000 to $78,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $47k-78k yearly Auto-Apply 8d ago
  • General Liability & Commercial Auto Claims Representative

    CNA Financial Corp 4.6company rating

    Melville, NY jobs

    You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. This individual contributor position works under direct supervision, and within defined authority limits, to manage commercial claims with low to moderate complexity and exposures for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific accounts(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: * Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. * Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information. * Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, and following company's claim handling protocols. * Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim. * Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes. * Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate. * Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service. * Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim, Recovery or SIU resources for further investigation. * Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements. * Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business. May perform additional duties as assigned. Reporting Relationship Typically Manager or above Skills, Knowledge & Abilities * Developing basic knowledge of the commercial insurance industry, products and claim practices. * Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service. * Ability to develop collaborative business relationships with both internal and external work partners. * Able to exercise independent judgement, solve basic problems and make sound business decisions. * Analytical mindset with critical thinking skills. * Strong work ethic, with demonstrated time management and organizational skills. * Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity. * Knowledge of Microsoft Office Suite and ability to learn business-related software. * Adaptable to a changing environment * Ability to value diverse opinions and ideas Education & Experience: * High school Diploma required. Associates or Bachelor's Degree preferred. * Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable. * Prior claim handling, or business experience in the insurance industry and/or customer service is preferred. #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $47,000 to $78,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.
    $47k-78k yearly Auto-Apply 8d ago
  • Medicaid Claims Processing, Associate, Claims Examiner

    MVP Health Care 4.5company rating

    Schenectady, NY jobs

    At MVP Health Care, we're on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll** **bring:** + High School Diploma required. Associate degree in health, Business or related field preferred + The availability to work Full-Time, Virtual within New York State + Previous related health care experience required + Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. + Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. + Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. + Knowledge of Facets and Macess systems strongly preferred, but not required. + Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. + Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. + Meets or exceeds department quality and work management standards for claims adjudication. + Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. + Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. + Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. + Keeps abreast of all benefit changes. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual, Rochester or Schenectady, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Claims/Operations** **Pay Type** **Hourly** **Hiring Min Rate** **20 USD** **Hiring Max Rate** **24 USD**
    $39k-44k yearly est. 32d ago
  • Medicaid Claims Processing, Associate, Claims Examiner

    Mvp Health Plan Inc. 4.5company rating

    Schenectady, NY jobs

    Qualifications you'll bring: High School Diploma required. Associate degree in health, Business or related field preferred The availability to work Full-Time, Virtual within New York State Previous related health care experience required Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Knowledge of Facets and Macess systems strongly preferred, but not required. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. Meets or exceeds department quality and work management standards for claims adjudication. Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. Keeps abreast of all benefit changes. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual, Rochester or Schenectady, NY
    $39k-44k yearly est. 31d ago
  • Medicaid Claims Processing, Associate, Claims Examiner

    MVP Health Care 4.5company rating

    Rochester, NY jobs

    At MVP Health Care, we're on a mission to create a healthier future for everyone which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you. **What's in it for you:** + Growth opportunities to uplevel your career + A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team + Competitive compensation and comprehensive benefits focused on well-being + An opportunity to shape the future of health care by joining a team recognized as a **Best Place to Work** for and one of the **Best Companies to Work For in New York** **Qualifications you'll** **bring:** + High School Diploma required. Associate degree in health, Business or related field preferred + The availability to work Full-Time, Virtual within New York State + Previous related health care experience required + Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. + Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. + Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. + Knowledge of Facets and Macess systems strongly preferred, but not required. + Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. + Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. + Meets or exceeds department quality and work management standards for claims adjudication. + Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. + Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. + Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. + Keeps abreast of all benefit changes. + Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. **Where you'll be:** Virtual, Rochester or Schenectady, NY **Pay Transparency** MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. **MVP's Inclusion Statement** At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at ******************** . **Job Details** **Job Family** **Claims/Operations** **Pay Type** **Hourly** **Hiring Min Rate** **20 USD** **Hiring Max Rate** **24 USD**
    $39k-44k yearly est. 31d ago
  • Senior Claims Technical Specialist - Financial Lines

    QBE Insurance Group Limited 4.9company rating

    Claim specialist job at QBE Insurance Group

    Primary Details Time Type: Full time Worker Type: Employee Senior Claims Technical Specialist - Financial Lines * Work Arrangement: Hybrid * The salary range for this role is: $126,0000 - $236,000 The Opportunity The purpose of this role is to oversee the examination, evaluation, and processing of complex Claims estimates and paid Claims values, ensuring adherence to policy terms and conditions in alignment with the QBE Claims Philosophy. The role also entails supporting the claims function in specific insurance classes to drive operational efficiency, efficient claims settlement, and fair resolution of claims disputes in line with company guidelines and philosophy. The selected candidate will manage the complete investigation, evaluation and resolution of assigned portfolio of complex claims emanating the lawyers professional and miscellaneous professional liability business segments, Engages, directs and manages external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants across highly complex portfolio of matters. Your new role * Manage a diverse portfolio of complex claims which includes conducting fact, liability and loss investigations and interpreting insurance contracts in an effective and efficient manner * Evaluate and negotiate the resolution of assigned claims in a timely manner, within appropriate authority and in accordance with applicable laws, regulations, statutes, best practices and Department of Insurance (DOI) compliance * Drive the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to deliver superior claim outcomes * Collaborate with outside representative counsel to formulate litigation strategy ensuring achievement of desired outcome and effective litigation management strategies * Directs and manage external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants. * Oversee projects and planning surrounding departmental initiatives to achieve strategic objectives * Analyze, develop and determine appropriate case reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy * Advise on specific professional liability areas of specialization and coordinates efforts to disseminate information and guide learning and thought leadership in those areas; serve as the subject matter expert * Represent QBE by participating in and attending industry seminars or authoring articles pertaining to professional liability subjects * Collaborate with Underwriters to identify, understand and address novel or complex risks to appropriately price and negotiate terms including participation in sales calls and requests for proposals (RFPs) * Manage relationships with external vendors to deliver accurate, timely, and cost-effective solutions. * Take ownership for personal development and career planning, and development of required skills, tools, techniques, and technology to continually add value to the organization. * Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility Required Education * Bachelor's Degree or equivalent combination of education and work experience Required Experience * 8 years relevant experience Preferred Competencies/Skills * Generate original, innovative solutions to difficult or unusual situations * Identify and locate information and facts which are necessary and relevant for the purposes of evaluating a claim * Financial and business acumen and awareness of financial responsibility * Quickly change direction when working on multiple projects or issues * Properly document investigation findings and preserve evidence in accordance with internal and external laws and procedures * Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems * Assume a methodical approach to a given situation and develop a systematic procedure as a response * Develop effective negotiation strategies and prepare a plan of action * Build and capitalize on beneficial internal and external relationships including competitors * Actively contributes towards continuously improving performance and mentor team with feedback, on-the-job skill enhancement opportunities and career advice * Build and establish constructive and cooperative working relationships and open lines of communication * Utilize effective communication skills to influence and persuade decision makers * Manage a diverse and extensive portfolio of management and professional liability claims with varying levels of complexity and activity. * Collaborate with internal resources to resolve difficult claims situations and drive resolution opportunities with internal and external stakeholders Preferred Education * Juris Doctor Global Disclaimer: The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee's normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls. US Only Disclaimer: To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities. US Only - Travel Frequency: Occasional (approximately 5-10 trips annually) US Only - Physical Demands: General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs. Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team. QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to: * Hybrid Working - a mix of working from home and in the office * 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis * Competitive 401(k) program with company match up to 8% * Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice * Tuition Reimbursement for professional certifications, and continuing education * Employee Network and Community - QBE actively supports six Employee Networks, and many ways to give back to your community To learn more, click here: Benefits | QBE US. Why QBE? What if you could have a positive impact - at work and in the world? At QBE, we're enabling a more resilient future - for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success. Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact. Join us now, so you can be part of our success - and we can be part of yours! *************************************************** QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information. Equal Employment Opportunity: QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status. This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship. Supplementary information Skills: Adaptability, Claims Settlement, Commercial Acumen, Conflict Resolution, Critical Thinking, Customer Value Management, Insurance Claims Processing, Intentional collaboration, Managing performance, Mentorship, Personal Initiative, Project Delivery, Regulatory Compliance, Risk Management, Team Development How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.
    $75k-108k yearly est. Auto-Apply 23d ago

Learn more about QBE Insurance Group jobs