Senior claims examiner jobs near me - 250 jobs

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 Senior Claim 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.

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.

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

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.

*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

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Sr. Claims Examiner. The Sr Claims Examiner is considered an expert in managing insurance claims and will be handling claims with high severity and complexity, both pre-suit and in suit. The Sr Claims Examiner must have the experience and technical knowledge needed to manage a complex case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party claims involving complex and severe bodily injury or property damage from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 10+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with a willingness to expand licenses as needed. #LI-BM1 #LI-REMOTE Click here for some insight into our culture!

The Senior Claims 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 Senior Claims 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 Senior Claims 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. 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

The Senior Claims 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 Senior Claims 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 Senior Claims 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. 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

The Sr Claims Examiner I is an independent and self-sufficient professional who handles death claims with moderate complexity. This may include processing claims within Life, Annuity, RPS, or a combination of the three. This role ensures accurate processing in accordance with contract provisions, policies, and regulatory guidelines. While capable of handling routine and moderately complex cases independently, highly complex or unusual cases are escalated for review. This position serves as a developmental senior role, building expertise and judgment for future advancement. Responsibilities Review and adjudicate standard and moderately complex life and annuity claims in compliance with policies and regulations. Adjudicates and pays claims within established service level agreements (SLAs) up to $1M. Validate beneficiary designations and process payments accurately within documented procedures and team SLAs. Applies established procedures and regulatory guidelines to determine if requests are in “good order.” Identify and escalate highly complex or unusual cases to senior team members or management. Maintain accurate records and documentation for all claims handled. Communicate effectively with beneficiaries, agents, and internal stakeholders to resolve inquiries and champion strong relationship building and customer service. Navigate multiple administrative systems, workflows, and imaging tools simultaneously with a high level of organization and attention according to standard operating procedures (SOPs). Participate in training and development activities to enhance technical knowledge and skills. 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 Strong attention to detail and organizational skills. Ability to work independently and manage assigned workload efficiently. Foundational knowledge of life insurance products and claims processes. Strong customer service mindset with demonstrated professionalism, empathy, accountability and ownership. Strong analytical mindset with proven problem-solving abilities and math skills. Effective written and verbal communication skills. Proficiency with digital tools and claims systems. Demonstrated accuracy, organization skills, and ability to work to meet deadlines and SLAs. Ability to learn and adapt to changing procedures and regulations. Ability to work with others in a collaborative team environment. Demonstrated ability to learn and apply new digital tools, including AI applications such as Microsoft CoPilot. Education Bachelor's degree preferred or equivalent work experience. Experience 3-5 years of experience in life, annuity, or RPS claims or related field. Certifications Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) are a plus but not required. Salary Range: $55,000- $65,000 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.

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

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

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

Full-time Description 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. Salary Description $80,000-$100,000 Annually

Cottingham & Butler Claims Services (CBCS) was built upon driven, ambitious people like yourself. “Better Every Day” is not just a slogan, it is a promise we make to ourselves and our clients. We are looking to hire an experienced Southeast Work Comp Claims Supervisor to our team. We are looking for someone who is eager to motivate and develop adjusters of all levels. If you're ready to make a significant impact and drive excellence, we want to hear from you! Key Expectations for the Claims Supervisor Role: Accountability and Feedback: Ensure that the team receives regular, high-quality feedback to drive accountability. Team Metrics: Maintain weekly metrics in the green. If a team member is not meeting expectations, develop and document plans with the Claims Manager to improve performance. Quality Service Review (QSR) Scores: Achieve monthly QSR scores of 90%+ for the team and address any underperformance with actionable plans. Monthly Meetings: Arrange monthly meetings with the team to align on goals, discuss challenges, provide training, and foster collaboration. Customer Service Survey Scores: Maintain an average score of 1.30 or less. Use survey results as coaching opportunities and ensure follow-up discussions. Mentorship and Teammate Development: Act as a mentor and actively contribute to developing your team of adjusters. Experience Requirements: The ideal candidate must have substantial experience in the Southeast region and possess a strong background in achieving results. We are looking for a critical thinker who is eager to collaborate with other like-minded professionals to drive growth and strengthen our business. A minimum of 1-5 years of claims supervision is required. Do you think this might be a fit for you? Send us your resume - we'd love to talk! Pay & Benefits Salary - Flexible based on your experience level. Most Benefits start Day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/ Defined Contribution (1-year waiting period) PTO/ Paid Holidays Company-paid ST and LT Disability Maternity Leave/ Parental Leave Company-paid Term Life/ Accidental Death Insurance About the company At Cottingham & Butler Claims Services, we sell a promise to help our clients through life's toughest moments. To ensure we keep that promise, we hold ourselves to a set of principles that we believe position our clients and our company for long-term success. Our Guiding Principles are not just words on paper, they are a promise we make to ourselves and our clients. These principles have become a driving force of our culture and share many common themes with the values of our clients. First, we hire and develop amazing people that have an insatiable desire to succeed, are committed to learning, and thrive on challenges. Secondly, we pride ourselves on serving our clients' best interests through quality service, innovative solutions, and constantly evaluating our performance. Third, we have embraced and are guided by the theme of "better every day" constantly pushing ourselves to be better than yesterday. Ultimately, we get more energy from the future we are creating for our people, our clients, and our company than from our past success. As an organization, we are very optimistic about the future and have incredibly high expectations for our people and our performance. We also understand that our growth is fueled by becoming better, not bigger - growth funds investments in new resources to better serve our clients and provide the career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Claims Supervisor - REMOTE. In this role, you will oversee a team responsible for handling claims efficiently while ensuring adherence to quality standards and enhancing customer service. The role plays a crucial part in achieving the department's goals, requiring dedication and a supportive approach to team management. Your leadership will foster a high-performance environment, providing ongoing training and performance evaluations. As a Claims Supervisor, your expertise in claims procedures will significantly impact the overall effectiveness of the claims team.Accountabilities Supervises claims staff in their day-to-day operations Assists in recruitment, interviewing, and onboarding new staff Ensures compliance with Workers' Compensation laws and regulations Facilitates team performance through training and coaching Provides technical guidance on claims issues Acts as a liaison for resolution of claim-specific requests Participates in customer claim reviews and presentations Completes additional duties as assigned Requirements Minimum of 3-5 years of workers compensation claims handling experience Bachelor's degree or equivalent experience Excellent communication skills, both written and verbal Strong leadership and motivational abilities Demonstrated customer service skills under pressure Proficient in MS Office and technical aptitude Effective time management and organizational skills Knowledge of claims administration and case management Benefits Comprehensive benefits package including medical, dental, and vision 401K and ROTH 401K options Flexible spending account options Paid time off Opportunity for career advancement Supportive work culture Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.#LI-CL1We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Come join our amazing team and work remote from home! The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses were identified and the financial reconciliation is accurately completed on all liquidated loans. Key reviewer of loss analysis decisions which include validating the determined responsibility and root cause for avoidable losses, ensuring they meet quality expectations and reflect proper decision rationale and supporting evidence and identify any bill back opportunities. Perform all duties in accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay for this position is $23.00/hr - $26.50/hr. What you'll do: Review reconciliation of all loan advances once the GSE or Government Mortgage Insured "expense" claim has been paid. * Confirm all prior tasking in LoanServ has been completed as well as update approval tasks as required per job aid upon the date the action occurs. * Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as needed. * Responsible for learning new skills and expand job knowledge to better perform assigned duties. * Maintain monthly performance in alignment with quality expectations. * Analyze multiple data elements in order to confirm the proper decision rationale and approve evidentiary support is included and written summaries are accurate. * Validate research on incurred losses, using analytical skills and subject matter knowledge to confirm responsibility and bill back opportunities. * Responsible for staying abreast of relevant changes to GSE or Government Mortgage Insured guidelines, industry standards and client expectations. * Ensure timely completion of projects and tasks when assigned. If unable to meet a deadline, the deadline must be renegotiated prior to the initial deadline date. * Look for opportunities to improve the department's processes and procedures, to reduce costs and eliminate non-essential and manual processes and activities. * Keep Team Lead and Supervisor informed of all trends and problems including, but not limited to, exceptions identified in review of Loss Analysis processes. * Moderate working knowledge of all Default Servicing processes up to and including Loss Mitigation, Bankruptcy, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines. * Moderate background in financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered. * Moderate ability to conduct quality assurance reviews. * Preferred Accounting Background--Must possess the ability to complete financial reconciliations. * Moderate computer skills with MS Word, Excel. * Strong attention to details and excellent time management and organizational skills. * Comprehensive writing skills, including proper punctuation and grammar, organization, and formatting. * Ability to work under general direction to accomplish department goals and reduce/mitigate financial loss to CMS and its Clients. * Ability to substantiate facts and properly document them. * Ability to work effectively and develop rapport with all levels of staff, management, Investors/Insurers and 3rd parties. * Ability to make decisions that have moderate impact to immediate work unit. * Ability to identify urgent matters requiring immediate action and properly escalating them. * Ability to handle multiple tasks under pressure and changing priorities. What you'll need: * High School diploma required; Associate/Bachelor Degree in accounting or other related field preferred. * Two (2) or more years' quality assurance experience. * Three (3) or more years' Loan Servicing platform experience for all default related activities such as Foreclosure, Bankruptcy, Default MI Claims, Loss Mitigation, etc. * Previous FHA, VA, USDA and PMI claims experience preferred Our Company: Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you'll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: *************************** What We Offer: * Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed. * Access to several fitness, restaurant, retail (and more!) discounts through our employee portal. * Customized training programs to help you advance your career. * Employee referral bonuses so you'll get paid to help Carrington and Vylla grow. * Educational Reimbursement. * Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org. Notice to all applicants: Carrington does not do interviews or make offers via text or chat. #LI-SY1

Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As a Commercial Insurance Claims Representative, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual. The preference is for the candidates to be located close to a hub and be in the office a minimum of 2 days/week (Hubs: Plano, TX, Suwanee, GA, Westborough, MA, Hoffman Estates, IL, Indianapolis, IN and Eugene. OR, and Phoenix, AZ) although candidates from any location will be considered. Please note this policy is subject to change. Responsibilities: Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments. Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers. Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues. Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims. Determines and negotiates settlement amount for damages claimed within assigned authority limits. Writes simple to moderately complex property damage estimates or review auto damage estimates. Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate. Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations. Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed. Qualifications Bachelor's Degree preferred. High school diploma or equivalent required. 1-2 years of experience. Claims handling skills preferred. Strong customer service and technology skills. Able to navigate multiple systems, strong organizational and communication skills. License may be required in multiple states by state law. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

--------------------------------------------------------------- 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. --------------------------------------------------------------- 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. 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.

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!