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Sr DI Claims Examiner - Remote USA Position-Ameritas HQ is Lincoln, NE
Ameritas 4.7
Remote senior claims analyst job
Back Sr DI Claims Examiner #5667 Remote USA Position-Ameritas HQ is Lincoln, Nebraska, United States Apply X Facebook LinkedIn Email Copy Position Locations Remote USA Position-Ameritas HQ is Lincoln, Nebraska, United States Area of Interests Insurance Full-Time/Part Time Full-time Job Description
This position is remote (within the U.S.A.) and does not require regular in-office presence.
What you do:
Evaluates and authorizes disposition of complex claims.
Obtains and analyzes medical records and financial documents.
Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews.
Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer.
Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments.
Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates.
Assists with recoveries from reinsurance carriers.
Performs all claims processing support functions.
What you bring:
Bachelor's degree or equivalent experience is required.
1-3 years of related experience is required.
What we offer:
A meaningful mission. Great benefits. A vibrant culture
Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life.
At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't:
Ameritas Benefits
For your money:
* 401(k) Retirement Plan with company match and quarterly contribution.
* Tuition Reimbursement and Assistance.
* Incentive Program Bonuses.
* Competitive Pay.
For your time:
* Flexible Hybrid work.
* Thrive Days - Personal time off.
* Paid time off (PTO).
For your health and well-being:
* Health Benefits: Medical, Dental, Vision.
* Health Savings Account (HSA) with employer contribution.
* Well-being programs with financial rewards.
* Employee assistance program (EAP).
For your professional growth:
* Professional development programs.
* Leadership development programs.
* Employee resource groups.
* StrengthsFinder Program.
For your community:
* Matching donations program.
* Paid volunteer time- 8 hours per month.
For your family:
* Generous paid maternity leave and paternity leave.
* Fertility, surrogacy, and adoption assistance.
* Backup child, elder and pet care support.
An Equal Opportunity Employer
Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law.
Application Deadline
This position will be open for a minimum of 3 business days or until filled.
This position is not open to individuals who are temporarily authorized to work in the U.S.
About this Position's Pay The pay range posted reflects a nationwide minimum to maximum covering all potential locations where the position may be filled. The final determination on pay for any position will be based on multiple factors including role, career level, work location, skill set, and candidate level of experience to ensure pay equity within the organization. This position will be eligible to participate in our comprehensive benefits package (see above for details). This position will be eligible to participate in our Short-Term Incentive Plan with the annual target defined by the plan. Job Details Pay Range Pay RangeThe estimated pay range for this job. Disclosing pay information promotes competitive and equitable pay.
The actual pay rate will depend on the person's qualifications and experience. $24.23 - $38.76 / hour Pay Transparency Pay transparency is rooted in principles of fairness, equity, and accountability within the workplace. Sharing pay ranges for job postings is one way Ameritas shows our commitment to equitable compensation practices.
$24.2-38.8 hourly 2d ago
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Sr Field Claims Specialist
Argonaut Management Services, Inc.
Remote senior claims analyst job
Argo Group International Holdings, Inc.and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions.
Job Description
PURPOSE OF THE JOB:
The position assumes responsibility for handling property claims including high severity and complex losses within a specified territory.
ESSENTIAL FUNCTIONS:
Inspects the damage of the loss.
Determines the investigative needs to assess damages, the cause of the loss, and the coverage.
Interviews the claimants and witnesses.
Conducts additional research or identifies additional investigation needs and resources, as needed.
Identifies potential fraud indicators.
Assesses the salvage/subrogation potential and monitors to them to the conclusion.
Completes the risk evaluation for underwriting and claims purposes.
Verifies and interprets the policy coverage, deductibles, and liability; and analyzes what may be covered.
Reviews and documents the facts of the loss and estimates the cost of the repairs and/or replacements including detailed diagrams, reports and estimates.
Communicates and explains the process, estimates, etc., to the policyholder.
Negotiates with the insured, contractors, and vendors, as needed.
Maintains contact with claimants, agents, and attorneys, regarding the ongoing status of claims files.
QUALIFICATIONS:
High school diploma.
Five or more years of experience in insurance, construction or related field
State license and/or ability to obtain one.
SPECIAL POSITION REQUIREMENTS:
The position involves considerable physical exertion, such as regular climbing of ladders, lifting of heavy objects (up to 80 pounds) on a highly frequent basis and/or assuming awkward positions for long periods of time.
A person in this position is expected to make independent decisions in accordance with the company's policies and procedures.
Full time remote position
Travel required.
PREFERENCES:
Bachelor's Degree
Property Claims Handling Experience ideally including Commercial, Farm and Ranch experience
Field adjusting and estimating knowledge.
Insurance designations such as Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC) or SeniorClaim Law Associate (SCLA).
Salary range is $68100 - $125000
PLEASE NOTE:
Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.
If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at .
Notice to Recruitment Agencies:
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.
We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
The collection of your personal information is subject to our HR Privacy Notice
Benefits and Compensation
We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.
$68.1k-125k yearly 3d ago
E&S Litigation Claims Manager - Remote
Selective Insurance 4.9
Remote senior claims analyst job
About Us
At Selective, we don't just insure uniquely, we employ uniqueness.
Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years. Selective's unique position as both a leading insurance group and an employer of choice is recognized in a wide variety of awards and honors, including listing in Forbes Best Midsize Employers in 2025 and certification as a Great Place to Work in 2025 for the sixth consecutive year.
Employees are empowered and encouraged to Be Uniquely You by being their true, unique selves and contributing their diverse talents, experiences, and perspectives to our shared success. Together, we are a high-performing team working to serve our customers responsibly by helping to mitigate loss, keep them safe, and restore their lives and businesses after an insured loss occurs.
Overview
Selective Insurance is seeking a E&S Litigation Claims Manager who proactively manages a litigation claims unit in our Excess & Surplus Lines unit in accordance with Company claim policies, practices and procedures within delegated authority. Candidate is responsible for the management of the E&S Litigation Claims Specialist; driving optimum claims outcomes, supporting operational goals and objectives while delivering superior customer service to our policyholders and agents, all in support of our commitments to our stakeholders. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Candidate will be responsible for assisting staff with resolution of coverage issues and working with Legal and outside coverage counsel in the resolution of coverage litigation.
Responsibilities
Plans, controls and coordinates claims activity and workflow within claims unit/department in order to maintain the highest professional customer service and technical standards, and to ensure work is produced in a timely fashion and that all deadlines are met.
Ensures the timely settlement of claims and maintains acceptable closing ratios for the department.
Prepares operating budget for unit/department and monitors and controls expenses.
Recommends claims procedural changes and plans, organizes and implements these changes in accordance with company guidelines. Keeps current on all changes affecting work production.
Maintains override capability, authorizes settlements up to designated authority limits, and submits recommendations to designated officials for those claims in excess of authority level.
Oversees combined loss ratio and productivity numbers and ensures they are in compliance with company standards.
Oversees and controls allocated claims expenses.
Provides performance management activities for personnel measured against business objectives and claims activity.
Plans reviews and conducts claims reviews and settlement conferences. Mediates complaints and disputes regarding claim resolution.
Must be able to drive an automobile to travel within territory. Car travel represents approximately 0-10% of employee's time and a valid driver's license.
Qualifications
Knowledge and Requirements
Ability to lead a team of litigation claims specialist with varying degrees of experience.
Excellent people and management skills to properly performance manage staff and assist with training initiatives.
Ability to analyze reports and trend analysis to identify issues.
Experience in E&S claims, complex coverage analysis and significant large loss evaluations preferred.
Superior communication, strategic thinking and problem-solving skills.
Excellent presentation skills.
Moderate proficiency with standard business-related software (including Microsoft Outlook, Work Excel, and PowerPoint).
Sufficient keyboarding proficiency to enter data accurately and efficiently.
Must have valid state-issued driver's license in good standing and be able to drive an automobile.
Education and Experience
College degree preferred.
Law degree preferred, but not required,
10+ years claims experience and 3-5 year's claims supervisory experience.
Experience handling or supervising E&S Claims and/or experience handling coverage litigation preferred.
Total Rewards
Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and 20 days of paid time off. Additional details about our total rewards package can be found by visiting our benefits page.
The actual base salary is based on geographic location, and the range is representative of salaries for this role throughout Selective's footprint. Additional considerations include relevant education, qualifications, experience, skills, performance, and business needs.
Pay Range
USD $135,000.00 - USD $204,000.00 /Yr.
Additional Information
Selective is an Equal Employment Opportunity employer. That means we respect and value every individual's unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences - and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions.
For Massachusetts Applicants
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
$135k-204k yearly 5d ago
Claims Examiner
Firstsource 4.0
Remote senior claims analyst job
Job Title:Medical Claims Examiner-Work From Home
Job Type:Full Time
FLSA Status:Non-Exempt/Hourly
Grade:H
Function/Department:Health Plan and Healthcare Services
Reporting to:Team Lead/Supervisor - Operations
Role Description:The Claims Examiner evaluates insurance claims to determine whether their validity and how much compensation should be paid to the policyholder. The Claims Examiner is responsible for reviewing all aspects of the claim, including reviewing policy coverage, damages, and supporting documentation provided by the policyholder.
Roles & Responsibilities
* Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions.
* Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information.
* Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements.
* Conduct investigations, when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts.
* Analyze policy coverage to determine the extent of liability and benefits payable to claimants.
* Evaluate the extent of loss or damage and determine the appropriate settlement amount.
* Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates.
* Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing.
* Maintain accurate and organized claim files and records.
* Stay updated on industry regulations and maintain compliance with legal requirements.
* Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders.
* Strive for high efficiency and accuracy in claims processing, minimizing errors and delays.
* Stay informed about industry trends, insurance products, and evolving claims management best practices.
* Generate and submit regular reports on claims processing status and trends.
* Perform other duties as assigned.
Top of Form
Qualifications
The qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Top of Form
Top of FormEducation
* High School diploma or equivalent required
Work Experience
* Medical claims processing experience required, including use of claims processing software and related tools
Competencies & Skills
* Highly-motivated and success-driven
* Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills
* Exceptional analytical and problem-solving skills
* Strong attention to detail with a commitment to accuracy
* Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads
* Basic mathematical skills
* Intermediate typing skills
* Basic computer skills
* Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred
* Knowledge of insurance policies, regulations, and best practices preferred
Additional Qualifications
* Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements
* Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position may work onsite or remotely from home.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device. Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds.
Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law.
Firstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.
About Firstsource
Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes.
We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals.
Our clientele includes Fortune 500 and FTSE 100 companies.
Job Type: Full-time
Benefits:
401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
Paid time off
Referral program
Vision insurance
Work Location: Remote
$27k-37k yearly est. 3d ago
Professional Liability Senior Claims Analyst
Omsnic
Remote senior claims analyst job
OMS National Insurance Co. is a nationwide company in search of nationwide talent.
We have one simple mission at OMSNIC - We are dedicated to serving and protecting oral and maxillofacial surgeons and dental professionals nationwide.
If you are an experienced medical malpractice claims professional based in the U.S, and would like to join us in our mission, we invite you to apply for this remote opportunity.
Our claimsanalysts have direct contact with our policyholders and are regarded as trusted partners, managing an assigned caseload of claims. This includes the investigation, evaluation, and resolution of both pre-litigation and litigated matters.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Evaluate coverage
Assign, collaborate with, and oversee outside defense counsel
Review and analyze medical records
Investigate and evaluate issues of liability, causation, and damages, proactively moving the files toward resolution
Participate in the formulation of case strategy
Negotiate claims in a settlement posture
Evaluate indemnity and expense reserves
Prepare comprehensive claims reports
Present claims to management and for internal review
Regularly communicate with policyholders, keeping them informed of status and strategies
Timely and accurately document claim files
Help maintain claim file data for accurate reporting
Review and approve invoices
General:
Contribute to departmental and company goals, initiatives and projects
May attend or participate in training and development programs
Planning and participation in Risk Management and Defense Counsel Seminars
May participate in the training and development of new hires
May participate in planning, development, and testing of technology solutions
Competencies:
Strong organizational and time management skills, ability to meet deadlines
Effective written and oral communication skills to provide information in a clear and concise manner and to communicate with a variety of stakeholders
Effective analytical and critical thinking skills to analyze facts and draw conclusions to make recommendations and resolve issues
Ability to prepare robust reporting yet provide a broad scope overview and summary, when appropriate
Superior customer service skills and ability to actively listen
Strong interpersonal skills with ability to interact with policyholders, legal professionals, management, co-workers, agents, committee and board members, and external vendors
Strong mediation and negotiation skills
Microsoft Office Suite proficiency with emphasis on Word, Excel, and PowerPoint
Education and Experience:
Bachelor's Degree required
JD preferred but not required
Minimum 5 years' experience in medical professional liability claims management field
Work Environment:
Fully remote
Travel required as needed
Salary : $100,000-$140,000
The salary range represents the entirety of the pay grade for this role. Specific salaries will be determined using a variety of factors, including specific skills, years of experience, location, and comparison to team members already in this role
Benefits:
Medical, Dental, and Vision Insurance
401(k)
Short and Long-term disability
Life Insurance
Employee Assistance Program
Long-term incentive plan
Educational Assistance and rewards program
Paid Time Off
Paid Holidays
Paid parental leave
Home office stipend
#LI-Remote
$41k-68k yearly est. Auto-Apply 60d+ ago
REMOTE SR. Claims Business Analyst
Insight Global
Remote senior claims analyst job
Insight Global is looking for a Sr. Business Analyst working remotely for a company in Virginia Beach, VA. This candidate will be working with the business side of the company helping the many migration projects and helping to finalize implementations for medical plans and looking in system for inconsistencies. They will be sending out files and receiving back error reports in which they will be updating the reports for the members.
Compensation:
$52.00/hr to $56.00/hr
Exact compensation may vary based on several factors, including skills, experience, and education.
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: ****************************************************
Skills and Requirements
- 3-5 years as a Business Analyst
- Experience with QNXT
- Experience with SQL
- Experience with Power BI
-a very analytical thinker
-experience with claims, benefits, or enrollment
-EDI 834/837 experience
-Edifecs experience
-Strong Excel knowledge
-Strong communication skills
$52-56 hourly 14d ago
Senior Claims Examiner (remote)
Switch'd
Remote senior claims analyst job
*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
$80k-94k yearly 60d+ ago
Sr Claims Examiner II
Penn Mutual 4.8
Remote senior claims analyst job
The Sr Claims Examiner II is a subject matter expert responsible for handling highly complex and sensitive claims within Life, Annuity, RPS, or a combination of all three, including escalated cases, requiring advanced judgment and interpretation. This role provides leadership in process improvements, mentors junior examiners, and serves as a key resource for technical guidance. The position requires deep expertise, strong analytical skills, and the ability to manage risk effectively.
Responsibilities
Independently adjudicate highly complex life, annuity, and/or RPS death claims, ensuring compliance with all regulatory and contractual requirements.
Exercise sound judgement and utilize appropriate medical and risk resources, adhering to referral policies, and transferring claims to appropriate risk level in timely manner.
Demonstrate strong relationship building, customer service and communication when interacting with customers and business partners.
Serve as an escalation point for unusual or disputed cases, providing expert analysis and resolution.
Lead investigations into complex claims and collaborate with legal, compliance, and other departments as needed.
Mentor and provide technical guidance to Sr Claims Examiner I and other team members.
Identify and implement process improvements to enhance efficiency and accuracy.
Represent the claims function in cross-functional projects and initiatives.
Adheres to Service Level Agreements (SLAs) and individual/team metrics.
Ability to work core business hours between 8:30 AM to 6:00 PM EST.
Knowledge, Skills, and Abilities
Expert knowledge of life insurance products, claims processes, and regulatory requirements.
Advanced analytical and decision-making skills with ability to interpret complex contracts.
Ability to multitask and adapt to a changing environment.
Detail oriented, organized and accurate.
Strong leadership and mentoring capabilities.
Excellent communication and relationship building skills with a customer service mindset.
Proficiency in claims systems and advanced digital tools.
Ability to manage risk and drive continuous improvement initiatives.
Proven experience implementing AI tools to automate or improve work processes.
Education
Bachelor's degree required
Master's degree preferred
Experience
Minimum 5-7 years of experience in life, annuity, and/or RPS (combined) claims required
10+ years preferred for complex case handling
Certifications
Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) strongly preferred.
Base Salary Range - $65,000 - $75,000
For over 175 years, Penn Mutual has empowered individuals, families and businesses on the journey to achieve their financial goals. Through our partnership with Financial Professionals across the U.S., we help instill the confidence and reliability that comes from a stronger financial future. Penn Mutual and its affiliates offer a comprehensive suite of competitive products and services to meet the unique needs of Financial Professionals and their clients, including life insurance, annuities, wealth management and institutional asset management. To learn more, including current financial strength ratings, visit *******************
Penn Mutual is committed to Equal Employment Opportunity (EEO). We provide employment and advancement opportunities to all qualified applicants and associates, according to applicable laws. This is reflected in our practices for hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment, compensation, selection or training, and all other terms and conditions of employment. All employment-related decisions and practices are free from unlawful discrimination. This includes: race, creed, color, national origin, ancestry, citizenship age, gender (including pregnancy), sexual orientation, gender identity or expression, domestic partnership or civil union status, marital status, genetic information, disability, religious observance or practice, liability, veteran status or any other classification protected under applicable law.
$65k-75k yearly Auto-Apply 9d ago
(Remote) Senior Claims Examiner
Your Journey Starts Here
Remote senior claims analyst job
Who We Are
Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The SeniorClaims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The SeniorClaims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
Review newly reported claims and log them on the pending claims log.
Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
On claims within the SeniorClaims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
Handle and log specific State and NAIC policy locator searches.
Mentor and support third-party claims administration staff.
Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
Work on special projects and other duties as assigned by the Claims Manager.
Perform quarterly claim audits focusing on third-party claim handling.
Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
Handle Department of Insurance claim complaints or requests in a timely and professional manner.
Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
Support M&A activity, if applicable
Qualifications:
5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
Ability to meet deadlines while performing multiple functions.
Proficient in MS Office applications and the Internet.
Ability to proactively analyze and resolve problems.
Attention to detail.
Flexibility and willingness to adapt to changing responsibilities.
Excellent written communication, interpersonal and verbal skills.
Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
Proactive and outside-the-box thinker.
Independent and organized work style.
Ability to maintain strong performance while working remotely and independently, if applicable.
Strong judgment and discretion when handling highly confidential business, employee, and customer information.
Team player and creative, critical thinker highly desired.
Licenses + Certifications:
Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
Legal or Paralegal Certifications optional but useful
Essential Functions:
This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
Salary Range: $70,720 - $91,520
Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
Dental Insurance: Coverage for preventive, basic, and major dental services.
Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
PTO and Sick Time accrue each pay period: Take time off when you need it
Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 43d ago
(Remote) Senior Claims Examiner
Efinancial 4.7
Remote senior claims analyst job
Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The SeniorClaims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The SeniorClaims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
* Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
* Review newly reported claims and log them on the pending claims log.
* Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
* Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
* Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
* On claims within the SeniorClaims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
* Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
* Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
* Handle and log specific State and NAIC policy locator searches.
* Mentor and support third-party claims administration staff.
* Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
* Work on special projects and other duties as assigned by the Claims Manager.
* Perform quarterly claim audits focusing on third-party claim handling.
* Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
* Handle Department of Insurance claim complaints or requests in a timely and professional manner.
* Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
* Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
* Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
* Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
* Support M&A activity, if applicable
Qualifications:
* 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
* Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
* Ability to meet deadlines while performing multiple functions.
* Proficient in MS Office applications and the Internet.
* Ability to proactively analyze and resolve problems.
* Attention to detail.
* Flexibility and willingness to adapt to changing responsibilities.
* Excellent written communication, interpersonal and verbal skills.
* Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
* Proactive and outside-the-box thinker.
* Independent and organized work style.
* Ability to maintain strong performance while working remotely and independently, if applicable.
* Strong judgment and discretion when handling highly confidential business, employee, and customer information.
* Team player and creative, critical thinker highly desired.
Licenses + Certifications:
* Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
* Legal or Paralegal Certifications optional but useful
Essential Functions:
* This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
* Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
* Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
* Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
* When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
* Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
* Salary Range: $70,720 - $91,520
* Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
* Dental Insurance: Coverage for preventive, basic, and major dental services.
* Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
* Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
* Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
* 401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
* PTO and Sick Time accrue each pay period: Take time off when you need it
* Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 45d ago
Sr Claims Examiner- MSI
The Baldwin Group 3.9
Remote senior claims analyst job
Why MSI? We thrive on solving challenges.
As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs.
We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners.
Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle.
Bring on your challenges and let us show you how we build insurance better.
The Sr Claims Examiner is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision
PRIMARY RESPONSIBILITIES:
• Analyzes insurance policies and other documents to determine insurance coverage.
• Investigates and analyzes claim information to determine extent of liability.
• Handles claims 1st Party Property Claims with complex to major severity.
• Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
• Sets timely, adequate reserves in compliance with the company's reserving philosophy.
• Engages experts to assist in the evaluation of the claim.
• Monitors vendor performance and controls expense costs.
• Evaluates, negotiates and determines settlement values.
• Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
• Handles all claims in accordance with Best Practices.
• Responsible for monitoring and completing assigned claims inventory.
• Acquire and maintain a state adjuster's license and meet state continuing education requirements.
• Provides Best-In-Class customer service for insureds and agents.
• Develops and maintains relationships with external and internal stakeholders.
• Acts as a mentor for less experienced Claims Examiners.
• Updates and maintains the claim file.
• Identifies opportunities for subrogation and ensures recovery interests are protected.
• Identifies fraud indicators and refers files to SIU for further investigation.
• Participates in claims audits, internal and external.
• Provides oversight of TPAs
• Assists with special projects
KNOWLEDGE, SKILLS & ABILITIES:
EDUCATION & EXPERIENCE:
High School/GED
10+ year's experience in claims
Must have Property & Casualty Insurance License
#LI-JW2
#LI-REMOTE
Click here for some insight into our culture!
The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
* Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
* Communication via telephone, email, and text with employees, employers, attorneys, and others
* Review and interpret medical records, utilizing resources as appropriate
* Complete financial calculations
* Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
* Apply contract/policy provisions to ensure accurate eligibility and liability decisions
* Demonstrate and apply analytical and critical thinking skills
* Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
* Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
* Leverage a broad spectrum of resources, materials, and tools to render claims decisions
* Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
* Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
* Work independently as well as within a team structure
* Deliver refresher trainings as appropriate to the claim team
* Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
* Prepare reports for management on claim outcomes and performance metrics.
* Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
* Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
What You Will Bring
* Bachelor's degree or equivalent work experience
* 3 disability claims administration experience
* Prior leadership experience as a team lead or manager
* Exceptional customer service skills
* Maintains positive and effective interaction with challenging customers
* Strong knowledge of disability and leave laws and regulations
* Ability to handle sensitive information with confidentiality and professionalism
* Group Disability Claims experience
* Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
* Experience working with the Fineos Claim Management System
* Exceptional written and oral communication skills demonstrated in previous work experience
* Excellent organizational and time management skills with ability to multitask and prioritize deadlines
* Ability to manage multiple and changing priorities
* Detail oriented; able to analyze and research contract information
* Demonstrated ability to operate with a sense of urgency
* Experience in effectively meeting/ exceeding individual professional expectations and team goals
* Demonstrated analytical and math skills
* Ability to exercise critical thinking skills, risk management skills and sound judgment
* Ability to adapt, problem solve quickly and communicate effective solutions
* High level of flexibility to adapt to the changing needs of the organization
* Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
* Continuous improvement mindset
* A commitment to support a work environment that fosters diversity and inclusion.
* Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
About the Role
At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859.
Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
· Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
· Communication via telephone, email, and text with employees, employers, attorneys, and others
· Review and interpret medical records, utilizing resources as appropriate
· Complete financial calculations
· Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
· Apply contract/policy provisions to ensure accurate eligibility and liability decisions
· Demonstrate and apply analytical and critical thinking skills
· Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
· Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
· Leverage a broad spectrum of resources, materials, and tools to render claims decisions
· Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
· Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
· Work independently as well as within a team structure
· Deliver refresher trainings as appropriate to the claim team
· Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
· Prepare reports for management on claim outcomes and performance metrics.
· Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
· Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits\: Equitable Total Rewards Program
What You Will Bring
· Bachelor's degree or equivalent work experience
· 3+ disability claims administration experience
· Prior leadership experience as a team lead or manager
· Exceptional customer service skills
· Maintains positive and effective interaction with challenging customers
· Strong knowledge of disability and leave laws and regulations
· Ability to handle sensitive information with confidentiality and professionalism
· Group Disability Claims experience
· Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
· Experience working with the Fineos Claim Management System
· Exceptional written and oral communication skills demonstrated in previous work experience
· Excellent organizational and time management skills with ability to multitask and prioritize deadlines
· Ability to manage multiple and changing priorities
· Detail oriented; able to analyze and research contract information
· Demonstrated ability to operate with a sense of urgency
· Experience in effectively meeting/ exceeding individual professional expectations and team goals
· Demonstrated analytical and math skills
· Ability to exercise critical thinking skills, risk management skills and sound judgment
· Ability to adapt, problem solve quickly and communicate effective solutions
· High level of flexibility to adapt to the changing needs of the organization
· Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
· Continuous improvement mindset
· A commitment to support a work environment that fosters diversity and inclusion.
· Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
**********
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE\: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
$60k-65k yearly Auto-Apply 60d+ ago
Claims Supervisor
Aspire General Insurance Company
Remote senior claims analyst job
Job DescriptionDescription:
Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service.
Our company values can best be described with ABLE: to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success.
What You'll Do
Under moderate supervision of Management, the Claims Supervisor performs the essential functions of the position, which includes but is not limited to supervising a team of Claims Representatives and Claims Support Specialists. Ensure that the team meets service standards and performs essential functions at or above the quality and service standards of Aspire General Insurance Company.
DUTIES AND RESPONSIBILITIES:
· Review of automobile claim investigations.
· Make handling recommendations and provide directions to subordinates.
· Ensure ongoing adjudication of claims within company standards and industry best practices and regulations.
· Determine, recommend and grant authority for settlement and payment processes.
· Responsible for overall file handling and work product quality of subordinates.
· Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation.
· Assist in the operations of the claims department, including making recommendations and implementing an organizational structure adequate for achieving the department's goals and objectives.
· Maintain a documented system of claims policies, systems, procedures and workflows to ensure smooth operations.
· Provide feedback to Management on process and system improvement initiatives for the department.
· Report to Management as soon as there is an awareness of any issues or concerns which may be detrimental to the department or Company; recommend policies and procedures to Management regarding quality issues that may arise.
· Staff Training-Foster a highly focused training and development environment within the Claims Department.
· Complies with state and federal laws, Department of Insurance criteria, insurance carrier criteria and follows and enforces Aspire General Insurance Company and partner's policies, procedure and work rules.
· Communicate and provide timely notification to the Human Resources Department for all things related to employee attendance, punctuality or possible leave related situations.
· Provide timely and thorough documentation for all things related to employee performance, training, recognition and/or coaching.
· Evaluate subordinates' performance and administer personnel actions as required in coordination with human resources department.
Ensure the Department has adequate scheduling, including time-off requests, work shift management, etc
Assist to identify, recruit, hire and develop top talent.
· Ability to achieve targeted performance goals
Maintain that sensitive information regarding employees and the Company is kept confidential
Regular and predictable punctuality and attendance.
· Other duties as necessary.
Requirements:
· Three plus years' experience in Property and Casualty insurance industry.
· Must have a clear understanding of insurance industry practices, standards and terminology.
· Experience in handling subrogation, property damage and injury claims required.
· Must be able to pass a background check.
· Must have the ability to work in a high volume, fast-paced environment while managing multiple priorities.
· Must have a disciplined approach to all job-related activities.
· Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills.
· Must have strong keyboard skills as well as proficiency in Windows and MS Office products.
INTER-RELATIONSHIP COMPONENT:
Ability to develop excellent working relationships with Staff, Partners, Clients and outside agencies.
Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of goodwill, indicative of a professional environment and atmosphere.
Ability to be a team player and work cohesively with other Aspire General Insurance and Partner Companies' staff to achieve company goals.
Able to represent the Company in a professional manner and contribute to the corporate image.
Able to consistently provide excellent service.
WORKING CONDITIONS:
This is an exempt position which complies with an alternative work schedule when applicable.
This work environment is fast-paced, and accuracy is essential to successful task completion.
The office is that of a highly technical company supporting a paperless environment.
Travel may be required.
Requires extended periods of computer use and sitting.
This is a remote position.
Benefits: Medical, Dental, Vision, HSA*, PTO, 401k, Company observed Holidays
Individuals seeking employment at Aspire General Insurance Services LLC are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation in accordance with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
*Dependent on plan selected
Compensation may vary based on several factors, including candidate's individual skills, relevant work experience, location, etc.
$70k-126k yearly est. 21d ago
Supervisor, Claims | California
Employers Holdings, Inc.
Remote senior claims analyst job
Supervisor, Claims - California| 100% Remote (WFH) Opportunity The Workers' Compensation Claims Supervisor is responsible for leading a team to successfully and proactively analyze and manage work comp claims assigned to the unit. The supervisor monitors and directs team effectiveness, guiding compliance with work comp state statutes within best practices to ensure claims move efficiently to closure. Participates in establishing team goals and objectives, participates in strategic and budgetary planning; monitors team effectiveness and supervises personnel and provides direct oversight on issues exceeding their authority. Successfully supports, coordinates and delegates objectives that support the company's mission and financial success.
Preference given to those candidates with experience in the California
Essential Duties and Responsibilities
* Leads, supervises and manages a Workers' Compensation claims team to achieve company objectives and department goals by promoting and ensuring compliance with Company procedures and guidelines.
* Demonstrates leadership by creating an environment that fosters teamwork, values diversity, and supports and respects all team and company staff members, internal and external customers, and vendors.
* Responsible for managing, developing, coaching, and motivating your work comp claims team. Conducts regular performance reviews.
* Communicates effectively and assists with the interpretation and practical implementation of processes, workflows and systems. Provides technical and jurisdictional guidance to the team.
* Responsible for monitoring the quality and quantity of work produced and coaching towards improved performance.
* Fosters inter-departmental collaboration to build relationships throughout the organization to help drive success through partnership. Works closely with Corporate Claims and Quality Assurance for compliance.
* Participates in the recruitment, selection and hiring of team members and facilitates training of new hires.
* Exemplifies excellent customer service and models this for the team. Conduct business at all times with the highest standards of personal, professional and ethical conduct. Ability to maintain confidentiality.
* Participates in conference calls, meetings with adjusters, insureds, and agents.
* Provides superior customer service by addressing inquiries from agents and policyholders.
* Reviews and approves reserves, settlements, payments and other assigned tasks within level of authority.
* Performs regular claim reviews based upon best practices, procedures and guidelines. Collaborates with the team for proactive claims management.
* Other duties as assigned.
Requirements
* Must have a minimum of 10 years of technical claims experience in Workers' Compensation to include claim, coverage and compensability investigation, claim reserving, settlement negotiation and litigation management, regulatory compliance, and mentoring, training and developing adjusters.
* At least two years of which must have been in a supervisory capacity.
* Demonstrated business knowledge including effective communication, customer focus, the ability to collect and analyze information, problem solving and decision making in accordance with policies and regulations.
* Demonstrated computer proficiency and comfortable using an internet-based claims system, reports, spreadsheets and databases.
* Strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, customers, and other departments within the company.
* Previous formal presentation experience.
* Demonstrated technical PC skills to include MS Word, Excel, PowerPoint, and Windows, strong interpersonal skills and ability to create and maintain mutually beneficial relationships with insurance company partners, clients, and other departments within the company.
Certification
* Active, current California Adjuster license
* Insurance designation preferred (WCCP, ARM, AIC, CPCU, etc.) preferred.
Education
* Bachelor's Degree preferred or equivalent industry experience
Work Environment:
* Remote: This role is remote, and only open to candidates currently located in the United States and able to work without sponsorship.
* It requires a suitable space that provides a private and quiet workplace.
* Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
* Travel: May be required to travel to off-site location(s) to attend meetings, as necessary
Salary Range: $80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details! *********************************************************
About EMPLOYERS
As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work!
We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS!
Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees.
We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other!
At EMPLOYERS, you'll discover an energetic environment that inspires top achievement. As "America's small business insurance specialist", we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote
Our client is seeking to add a Senior Commercial Auto Litigation Claims Examiner to their team. This individual will be responsible for overseeing complex commercial auto claims, with a strong focus on litigated matters and severe casualty exposures. The role requires managing the claim process from initial intake through final resolution, including evaluating coverage, directing litigation strategy, and negotiating settlements across multiple jurisdictions. This position offers the ability to work fully remote. Key Responsibilities:
Investigate, evaluate, and resolve litigated Commercial Auto claims from inception through closure.
Analyze liability, damages, and legal exposure to determine appropriate resolution strategies.
Establish timely and appropriate reserves based on investigation and litigation progression.
Partner with defense counsel, insureds, and other experts to effectively manage claims and litigation costs.
Conduct coverage analysis and issue detailed coverage position letters when necessary.
Prepare reports and updates for senior leadership, clients, and other stakeholders.
Maintain consistent communication with policyholders, attorneys, and internal teams throughout the claim lifecycle.
Ensure timely file documentation in compliance with company, client, and regulatory standards.
Negotiate settlements in line with company/client authority and jurisdictional requirements.
Stay current on evolving laws, regulations, and litigation trends impacting commercial auto liability.
Requirements:
10+ years of Commercial Auto / Trucking Bodily Injury Litigation claims handling experience.
Must have 4+ years of Commercial Trucking experience.
Strong knowledge in MCS 90 is strongly desired.
Active Adjuster's License required.
Proven experience managing litigated claims and working directly with defense counsel.
Strong negotiation, litigation management, and analytical skills.
Excellent written and verbal communication skills, including drafting detailed coverage letters and litigation reports.
Highly organized, self-motivated, and able to independently manage a remote workload.
Proficient in Microsoft Office and claims management systems.
Salary & Benefits:
$90,000 - $120,000+ annually (depending on experience)
Comprehensive Medical, Dental, and Vision coverage
401(k) with company match
Paid Time Off and holiday benefits
Professional development and career advancement opportunities
$37k-48k yearly est. 60d+ ago
Claims Manager - Professional Liability
Counterpart International 4.3
Remote senior claims analyst job
Claims Manager (Professional Liability)
Counterpart is an insurtech platform reimagining management and professional liability for the modern workplace. We believe that when businesses lead with clarity and confidence, they become more resilient, more innovative, and better prepared for what's ahead. That's why we built the first Agentic Insurance™ system - where advanced AI and deep insurance expertise come together to proactively assess, mitigate, and manage risk. Backed by A-rated carriers and trusted by brokers nationwide, our platform helps small businesses grow with confidence. Join us in shaping a smarter future, helping businesses Do More With Less Risk .
As a Claims Manager (Professional Liability), you will be responsible for managing a large and diverse caseload of professional liability claims. In this role, you will apply and further develop your expertise by investigating, evaluating, and resolving claims in a way that reinforces our brand and values. You will also play a vital part in supporting the advancement of our systems and processes through ongoing feedback and collaboration with internal partners. In addition, you will be a key feedback provider for our active claims management processes and systems. Your input will help to shape and improve how we fulfill our mission of providing world-class service through tightly managing legal costs, making data-driven decisions when analyzing a claim's value, and ensuring that other potentially responsible parties pay their fair share.
YOU WILL
Achieve or exceed claims management case load and goals, applying sound judgment and legal knowledge to produce efficient and fair outcomes.
Complete accurate and timely investigations into the coverage, liability, and damages for each claim assigned to you.
Actively manage each claim assigned to you in a way that produces the most timely and cost-effective resolution.
Build and maintain positive and productive working relationships with internal and external customers, including policyholders, brokers, carrier partners, and Risk Engineers (underwriters).
Direct and monitor assignments to experts and outside counsel, and hold those vendors accountable for meeting or exceeding our service standards.
Support our data collection efforts and models by effectively using our Agentic Claim Experience (ACE) system to fully and accurately capture critical details about each claim assigned to you.
Identify and escalate insights into emerging claims trends across industries, geographies, and key business segments.
Offer user-level feedback and insights to support the continuous improvement of our claim handling processes, guidelines, and systems.
Ensure that every touchpoint with our insureds and brokers is representative of our brand, mission, and vision.
YOU HAVE
At least 10 years of professional experience, with at least 5 years of experience litigating or managing professional liability claims. Previous carrier experience is a plus.
Bachelor's degree required; law degree (J.D.) and professional designations (RPLU, AIC, etc.) highly preferred.
Must possess all required state claim adjuster licenses, or be able to obtain them within 90 days of hire.
Proven ability to work both independently on complex matters and collaboratively as a team player to assist others as needed.
High level of personal initiative and leadership skills.
Exceptional time management, problem solving and organizational skills.
Comfort and skill operating in a paperless claims environment. Familiarity with Google Workplace is preferred, but not required.
Willingness to quickly adapt to change and use creative thinking and data-driven insights to overcome obstacles to resolution.
Strong communication skills, both verbal and written.
Ability to succeed in a full remote workplace environment, and travel as necessary (approximately 10-15%).
WHO YOU WILL WORK WITH
Eric Marler, Head of Claims: An industry veteran, Eric has more than 20 years of experience working with or for insurers offering management liability solutions. He is a licensed attorney who began his career in private practice before transitioning in-house. Prior to joining Counterpart, Eric held leadership roles at Great American Insurance Group and The Hanover Insurance Group.
Jaclyn Vogt, SeniorClaims Manager: Jaclyn is a licensed adjuster with over 15 years of experience handling Employment Practices Liability, Management Liability and Workers Compensation claims. Jaclyn received her bachelor's degree from Centre College.
Katherine Dowling, Claims Manager: Katherine is a licensed attorney, mediator and adjuster with over a decade of experience handling professional liability and management liability litigation and claims. Katherine practiced law for several years with two of Atlanta's largest insurance defense firms prior to joining a wholesale specialty insurance carrier where she managed complex Professional Liability and Commercial General Liability claims.
WHAT WE OFFER
Stock Options: Every employee is able to participate in the value that they create at Counterpart through our employee stock option plan.
Health, Dental, and Vision Coverage: We care about your health and that of your loved ones. We cover up to 100% of your monthly contributions for health, dental, and vision insurance and up to 80% coverage for family members.
401(k) Retirement Plan: We value your financial health and offer a 401(k) option to help you save for retirement.
Parental Leave: Birthing parents may take up to 12 weeks of parental leave at 100% of their regular pay following the birth of the employee's child, and can choose to take an additional 4 unpaid weeks. Non-birthing parents will receive 8 weeks of parental leave at 100% of their regular pay.
Unlimited Vacation: We offer flexible time off, allowing you to take time when you need it.
Work from Anywhere: Counterpart is a fully distributed company, meaning there is no office. We allow employees to work from wherever they do their best work, and invite the team to meet in person a couple times per year.
Home Office Allowance: As a new employee, you will receive a $300 allowance to set up your home office with the necessary equipment and accessories.
Wellness stipend: $100 per month to spend toward an item or service that supports your wellness (i.e. massage or gym membership, meditation app subscription, etc.)
Book stipend: To support your intellectual development, we offer a book stipend that allows you to purchase books, e-books, or educational materials relevant to your role or professional interests.
Professional Development Reimbursement: We provide up to $500 annually for you to invest in relevant courses, workshops, conferences, or certifications that will enhance your skills and expertise.
No working birthdays: Take your birthday off, giving you the opportunity to relax, enjoy your special day, and spend time with loved ones.
Charitable Contribution Matching: For every charitable donation you make, we will match it dollar for dollar, up to a maximum of $150 per year. This allows you to amplify your charitable efforts and support causes close to your heart.
COUNTERPART'S VALUES
Conjoin Expectations - it is the cornerstone of autonomy. Ensure you are aware of what is expected of you and clearly articulate what you expect of others.
Speak Boldly & Honestly - the only failure is not learning from mistakes. Don't cheat yourself and your colleagues of the feedback needed when expectations aren't being met.
Be Entrepreneurial - control your own destiny. Embrace action over perfection while navigating any obstacles that stand in the way of your ultimate goal.
Practice Omotenashi (“selfless hospitality”) - trust will follow. Consider every interaction with internal and external partners an opportunity to develop trust by going above and beyond what is expected.
Hold Nothing As Sacred - create routines but modify them routinely. Take the time to reflect on where the business is today, where it needs to go, and what you have to change in order to get there.
Prioritize Wellness - some things should never be sacrificed. We create an environment that stretches everyone to grow and improve, which is fulfilling, but is only one part of a meaningful life.
Our estimated pay range for this role is $150,000 to $180,000. Base salary is determined by a variety of factors, including but not limited to, market data, location, internal equitability, and experience.
We are committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives.
We are an Equal Opportunity Employer. We do not discriminate against qualified applicants or employees on the basis of race, color, religion, gender identity, sex, sexual preference, sexual identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, military status, or any other characteristic protected by federal, state, or local law, rule, or regulation.
$150k-180k yearly Auto-Apply 60d+ ago
Claims Examiner II
Careoregon 4.5
Remote senior claims analyst job
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The Claims Examiner II is an intermediate level position responsible for the timely review, investigation and adjudication of all types of Medicaid, Medicare, group and individual medical, dental, and mental health claims.
Estimated Hiring Range:
$22.82 - $27.89
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
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Essential Responsibilities
Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures.
Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed.
Consistently meet or exceed the quality and production standards established by the department and CareOregon.
Provide excellent customer service to internal and external customers.
Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals.
Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed.
Investigate third party issues as directed.
May review, process and post refunds and claim adjustments or re-adjudications as needed.
Report any overpayments, underpayments or other possible irregularities to the Lead or Supervisor as appropriate.
Generate letters and other documents as needed.
Proactively identify ways to improve quality and productivity.
Continuously learn and stay up to date with changing processes, procedures and policies.
Organizational Responsibilities
Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
§ Minimum 2 years' experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.)
Preferred
Experience using QNXT, Facets, Epic systems
Knowledge, Skills and Abilities Required
Knowledge
Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding
Knowledge of medical, dental, mental health and health insurance terminology
Skills and Abilities
Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and Medicaid/Medicare industry
Ability to perform fast and accurate data entry
Strong spoken and written communication skills
Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed
Good customer service skills
Ability to participate fully and constructively in meetings
Strong analytical and sound problem-solving skills
Detail orientation
Strong organizational skills and time management skills
Ability to work in a fast-paced environment with multiple priorities
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, hear, speak, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to lift, carry, reach and/or pinch small objects for at least 1-3 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
Schedule: Monday - Friday, 8:00 AM to 5:00 PM
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
$22.8-27.9 hourly Auto-Apply 9d ago
Claims Processor
Allied Benefit Systems 4.2
Remote senior claims analyst job
The Claims Processor will use independent judgement and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical and dental claims, as well as various types of invoices, based upon specific knowledge and application of each client's customized plan(s).
ESSENTIAL FUNCTIONS:
Process a minimum of 1,200 medical, dental, and vision claims per week while maintaining quality goals.
Read, analyze, understand, and ensure compliance with clients' customized plans
Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
Independently review, analyze and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud.
Review, analyze and add applicable notes using the QicLink system.
Review billed procedure and diagnosis codes on claims for billing irregularities.
Analyze claims for billing inconsistencies and medical necessity.
Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
Review Workflow Manager daily to document and release pended claims, if applicable.
Review Pend and Suspend claim reports to finalize all claim determinations timely.
Assist and support other Claims Specialists as needed and when requested.
Attend continuing education classes as required, including but not limited to HIPAA training.
EDUCATION:
High School Graduate or equivalent required.
EXPERIENCE & SKILLS:
Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/Medicaid does not count towards the experience) required.
Prior experience with a Third-party Administrator (TPA) is highly preferred.
Applicants must have knowledge of CPT and ICD-10 coding.
Applicants must have strong analytical skills and knowledge of computer systems.
Prior experience with dental and vision processing is preferred, but not required.
COMPETENCIES
Communication
Customer Focus
Accountability
Functional/Technical Job Skills
PHYSICAL DEMANDS:
Office setting and ability to sit for long periods of time.
WORK ENVIRONMENT:
Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Protect Yourself from Hiring Scams
Important Notice About Our Hiring Process
To keep your experience safe and transparent, please note:
All interviews are conducted via video.
No job offer will ever be made without a video interview with Human Resources and/or the Hiring Manager.
If someone contacts you claiming to represent us and offers a position without a video interview, it is not legitimate. We never ask for payment or personal financial information during the hiring process.
For your security, please verify all job opportunities through our official careers page: Current Career Opportunities at Allied Benefit Systems
Your security matters to us-thank you for helping us maintain a fair and trustworthy process!
$40k-53k yearly est. 12d ago
Casualty Claims Examiner
TWAY Trustway Services
Remote senior claims analyst job
This position is responsible for the oversight of complex and large exposure losses and will report to the
National Casualty Claims Manager. The Casualty Claims Examiner will work alongside claims management,
providing direction and oversight ensuring that compliance with best practices and state/local guidelines
is achieved. In addition, this position will report findings and make recommendations on current practices
including the claim department's performance on meeting regulatory standards.
Job Responsibilities
· Review home office casualty files, provide direction as required to ensure that handling is within
best practice guidelines and local jurisdiction regulations.
· Responsible for providing guidance and direction to claims staff in order to ensure proper
handling and risk mitigation.
· Provide authority and guidance on all bodily injury claims regarding coverage, liability and
damages, as required.
· Provide feedback to leadership and adjusting staff as required for continually improved file
handling.
· Responsible for collaboration with claims staff, front line claims management, seniorclaims
management and legal counsel.
· Available to answer questions and participate in roundtable discussions with claims staff and
management to provide feedback and guidance on claim handling procedures.
· Complete research pertaining to complex coverage issues, industry trends, and related topics.
· May assist with targeted audits of a particular process or function (e.g. total loss handling, BI
evaluations, cycle times, regulatory reviews, customer service skills, etc.) and/or management
re-audits to verify calibration and accuracy of the first level reviews completed.
· Assist in designing and delivering casualty training as needed to ensure compliance and proper claim handling
Job Qualifications
Formal Education & Certification
Bachelor's degree or equivalent work experience
Knowledge & Experience
· A minimum of five years of adjusting claims. At least two years adjusting/overseeing casualty
claims with high complexity.
· Prior claims management experience and/or auditing preferred.
Skills & Competencies
· Communication and analytical ability at a level to interact with associates, managers, agents and
vendors.
· Demonstrated team building and coordination skills.
· Must possess strong interpersonal skills and the ability to present critical information to Senior
Management.
· Ability to manage multiple priorities and work independently.
· Leadership abilities are necessary, with the ability to make autonomous decisions based on
multiple facts.
· Must be able to work in a fast-paced automated production environment and possess
solid planning and organizational skills including time management, prioritization, and
attention to detail.
· Must meet company guidelines for attendance and punctuality and professional
appearance/decorum.
This indicates the essential responsibilities of the job. The duties described are not to be
interpreted as being all-inclusive to any specific associate. Management reserves the right to add to,
modify, or change the work assignments of the position as business needs dictate. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions of
the job. This job description does not represent a contract of employment. Employment with
AssuranceAmerica is at-will. The at-will relationship can be terminated at any time, with or without
reason or notice by either the employer or the associate.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.