Senior claims examiner work from home jobs - 208 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

Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Must work EST core hours. Must pass the NYS Adjuster license exam within 60 days of hire. Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client. DUTIES AND RESPONSIBILITIES: Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto, Auto Med Pay, and/or General Liability Casualty Claims. Oversee and direct outside investigative service providers and work closely with the client and client counsel, and investigative services to advance the claim to conclusion. Maintain an ongoing diary. Continually assess exposure and evaluate for accurate reserves and settlement recommendations. Prepare Loss Reports providing a thorough analysis of coverage, liability, and damages. Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client. Document all correspondence, reports, discussions, and decisions in the claim file record. Provide outstanding service to the client. Position is remote/working from home. Qualifications QUALIFICATIONS REQUIRED: Education/Experience: High School Diploma or GED required; bachelor's degree in related field (preferred) and two years auto and general liability casualty and or No Fault/PIP related experience; or equivalent combination of advanced education and experience. Special Requirements: At least two years of Automobile and General Liability claims experience required. Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge. Demonstrated verbal and written communications skills. Demonstrated advanced analytical, decision-making and negotiation skills. Computer proficiency. Preferred Skills: Ability to communicate effectively and clearly, both orally and in writing. Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers. Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision. Excellent customer service skills. An understanding of the litigation process and case valuation in multiple jurisdictions. Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense. An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision. Time management skills, organizational skills, and ability to prioritize issues and tasks. Ability to effectively operate computer equipment and applications. Independence, flexibility, and creativity. Other Qualifications: Candidate must have adjuster licenses and be willing to obtain the NY license if they do not already have one. Candidate must be willing to work Pacific Time core hours. Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes

*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

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.

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 *******************************.

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.

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 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. 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

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 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. 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

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

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.

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 Auto Claims Supervisor - REMOTE. In this role, you will oversee a team of property damage auto claims adjusters, ensuring accurate evaluations and operational excellence in the claims process. This position is crucial for establishing best practices, coaching adjusters, and ensuring compliance with industry standards. You will have the opportunity to lead process improvements that enhance efficiency and customer satisfaction. Additionally, your strong background in claims handling will be instrumental in managing complex claims and navigating escalated situations.Accountabilities Supervise and mentor a team of property damage adjusters, providing feedback and training. Review complex and escalated auto property damage claims for accuracy and strategy. Ensure compliance with company guidelines and industry regulations. Lead process improvements to increase efficiency and customer satisfaction. Approve final claim settlements within delegated authority. Monitor team KPIs and report performance to senior management. Facilitate regular team meetings and training sessions. Collaborate with internal departments for efficient claims handling. Maintain expert knowledge of property damage claims handling standards. Act as a senior escalation point for concerns from policyholders or agents. Requirements Bachelor's degree in business administration or related field preferred. 5+ years of experience in property damage or auto damage claims handling. Experience in FL, GA, and TX markets preferred. Demonstrated leadership and team performance management. Strong analytical, negotiation, and communication skills. Proficient with claims systems, estimating software, and MS Office. Adjuster's license required. Bilingual preferred, especially in Spanish. Benefits 401(k) Retirement Savings Plan with employer match. Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance. Paid Time Off, Holidays, and Leave programs. Flexible spending accounts. Basic Life Insurance and Voluntary Life/ADD. Short Term and Long-Term Disability. 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-CL1

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

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!