Senior claims representative work from home jobs - 271 jobs

Scheduled Hours 40 Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management. Job Description Primary Duties & Responsibilities: * Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files with guidance of legal counsel. Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; evaluates liability and financial exposure, approves expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value. Attends mediation, arbitration, and/or trial. * Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carriers, and when applicable, coordinates with external agency investigations, i.e., professional Board inquiries. Responds to general claim inquiries. * Establishes indemnity and expense reserves based on the reserving policy. Negotiates settlements within authority. Reviews and approves defense counsel related invoices and expenses. * Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation. Arrange for attorneys to attend depositions with physicians when necessary. Mentors less experienced claims managers. * Performs other duties as assigned. Working Conditions: Job Location/Working Conditions * Normal office environment Physical Effort * Typically sitting at a desk or a table Equipment * Office equipment The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time. Required Qualifications Education: Bachelor's degree Certifications/Professional Licenses: No specific certification/professional license is required for this position. Work Experience: Analyzing Or Interpreting Medical Or Other Technical Evidence That Compares In Level Of Complexity To Medical Treatment (5 Years) Skills: Not Applicable Driver's License: A driver's license is not required for this position. More About This Job Preferred Qualifications: * Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered. * General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care. * Knowledge of methods and techniques of individual case study, recording and file maintenance. * Seven years' experience in medical malpractice claims management. Preferred Qualifications Education: No additional education unless stated elsewhere in the job posting. Certifications/Professional Licenses: No additional certification/professional licenses unless stated elsewhere in the job posting. Work Experience: No additional work experience unless stated elsewhere in the job posting. Skills: Analytical Thinking, Defining Problems, Detail-Oriented, Disease Diagnosis, Disease Management, Group Presentations, Injury Treatment, Joint Commission Regulations, Organizational Savvy, Patient Safety, Report Preparation Grade G13 Salary Range $65,900.00 - $112,700.00 / Annually The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget. Questions For frequently asked questions about the application process, please refer to our External Applicant FAQ. Accommodation If you are unable to use our online application system and would like an accommodation, please email **************************** or call the dedicated accommodation inquiry number at ************ and leave a voicemail with the nature of your request. All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Pre-Employment Screening All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening. Benefits Statement Personal * Up to 22 days of vacation, 10 recognized holidays, and sick time. * Competitive health insurance packages with priority appointments and lower copays/coinsurance. * Take advantage of our free Metro transit U-Pass for eligible employees. * WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%. Wellness * Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more! Family * We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We've got you covered. * WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us. For policies, detailed benefits, and eligibility, please visit: ****************************** EEO Statement Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University's policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information. Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment - fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.

Porch Group is a leading vertical software and insurance platform and is positioned to be the best partner to help homebuyers move, maintain, and fully protect their homes. We offer differentiated products and services, with homeowners insurance at the center of this relationship. We differentiate and look to win in the massive and growing homeowners insurance opportunity by 1) providing the best services for homebuyers, 2) led by advantaged underwriting in insurance, 3) to protect the whole home. As a leader in the home services software-as-a-service (“SaaS”) space, we've built deep relationships with approximately 30 thousand companies that are key to the home-buying transaction, such as home inspectors, mortgage companies, and title companies. In 2020, Porch Group rang the Nasdaq bell and began trading under the ticker symbol PRCH. We are looking to build a truly great company and are JUST GETTING STARTED. Job Title: Liability Claims Examiner Location: United States Workplace Type: Remote Homeowners of America is a provider of Personal Lines Insurance products. We're always looking to add talented and passionate people to our team. We value the knowledge that comes from experienced individuals with diverse backgrounds and strengths that can contribute to the various departments within our company. Our shared values are no jerks, no egos, be ambitious, solve each problem, care deeply and together we win. Summary The Liability Claims Examiner is responsible for managing complex and litigated 3rd party claims arising under homeowners' insurance policies. This role involves investigating losses, evaluating coverage, assessing liability exposures, and directing litigation strategies to achieve fair and timely resolution of claims. The examiner will work closely with insureds, claimants, field adjusters, defense counsel, experts, and internal stakeholders ensuring compliance with company guidelines and regulatory requirements while mitigating risk and controlling costs. Liability Claims Examiners are responsible for requesting payments, documenting files, and preparing and issuing claim payment letters or denial letters when appropriate. What you Will Do As A Liability Claims Examiner Responsibilities: May include any or all the following. Other duties may be assigned. Investigate and Evaluate Claims: Review policy language, coverage issues, and liability exposures. Analyze incident reports, statements, expert opinions, and other evidence to determine liability and damages. Handles claims from all types of policies, including homeowners, dwelling fire, tenant, condo, and renters. Confers with legal counsel on claims involving coverage, legal, or complex matters Effectively manage difficult or emotional customer situations Litigation Management: Direct and oversee defense counsel in litigated matters, including strategy development, budgeting, and case progression. Attend mediations, settlement conferences, and trials as needed. Evaluate litigation reports and provide recommendations for resolution. Negotiation and Settlement: Negotiate settlements within authority limits to achieve equitable outcomes. Collaborate with legal counsel to resolve complex coverage and liability disputes. Financial Oversight: Establish and adjust reserves based on claim developments and litigation exposure. Monitor litigation costs and ensure adherence to budget guidelines. Seeking out and utilizing top vendors that build quality, increase efficiency, and reduce cost Communication and Documentation: Maintain accurate and detailed claim files, including litigation plans and correspondence. Communicate effectively with insureds, claimants, attorneys, and internal teams. Enters claims payments when applicable and maintains clean, concise, and accurate file documentation Manages correspondence and communication with various parties involved in the claim Draft and prepare letters and other correspondence related to the claim Compliance and Best Practices: Ensure adherence to claims handling guidelines, regulatory requirements, and ethical standards. Identify opportunities for process improvement and cost containment. Take on assignments and duties as requested by the management team What you Will Bring As A Liability Claims Examiner Bachelor's degree or equivalent experience Minimum 5+ years of liability claims experience, with a strong focus on litigated 3rd party claims Appropriate state adjuster license and continuing education credits In-depth knowledge of homeowners liability and med pay coverage, policy language, and litigation processes Strong negotiation, analytical, and decision-making skills Excellent written and verbal communication skills Ability to manage multiple complex cases and meet deadlines in a fast-paced environment Proficiency in claims management systems and Microsoft Office suite (Outlook, Word, Excel, PowerPoint) Works with integrity and ethics Exceptional customer service skills Effectively manages difficult or emotional customer situations Ability to read, write, and interpret routine correspondence, policies, and reports Makes decisions and completes activities in a confident and timely manner Follows Claims Handling Guidelines, policies and procedures Maintains confidentiality Works independently, with the ability to assess workload and plan accordingly to meet competing deadlines Cultivates environment of teamwork and collaboration Comprehensive and up-to-date knowledge of General Liability and P&C insurance, contractual policy language requirements and the implications of that language as it pertains to denial of claims Demonstrated commitment to continuing education in the industry through licensing or designations applicable to property and liability insurance field is preferred. Certificates, Licenses, Registrations Appropriate state adjuster license and continuing education credits. The application window for this position is anticipated to close in 2 weeks (10 business days) from December 17th, 2025. Please know this may change based on business and interviewing needs. At this time, Porch Group does not consider applicants from the following states for remote positions: Alaska, Arkansas, Delaware, Hawaii, Iowa, Maine, Mississippi, Montana, New Hampshire, and West Virginia. What You Will Get As A Porch Group Team Member Pay Range*: Annually$67,500.00 - $94,500.00 *Please know your actual pay at Porch will reflect a number of factors among which are your work experience and skillsets, job-related knowledge, alignment with market and our Porch employees, as well as your geographic location. Our benefits package will provide you with comprehensive coverage for your health, life, and financial wellbeing. Our traditional healthcare benefits include three (3) Medical plan options, two (2) Dental plan options, and a Vision plan from which to choose. Critical Illness, Hospital Indemnity and Accident plans are offered on a voluntary basis. We offer pre-tax savings options including a partially employer funded Health Savings Account and employee Flexible Savings Accounts including healthcare, dependent care, and transportation savings options. We provide company paid Basic Life and AD&D, Short and Long-Term Disability benefits. We also offer Voluntary Life and AD&D plans. Both traditional and Roth 401(k) plans are available with a discretionary employer match. Headspace is part of our employer paid wellbeing program and provides employees and their families access to on demand guided meditation and mindfulness exercises, mental health coaching, clinical care and online access to confidential resources including will preparation. Brio Health is another employer paid wellbeing tool that offers quarterly wellness challenges and prizes. LifeBalance is a free resource to employees and their families for year-round discounts on things like gym memberships, travel, appliances, movies, pet insurance and more. Our wellness programs include flexible paid vacation, company-paid holidays of typically nine per year, paid sick time, paid parental leave, identity theft program, travel assistance, and fitness and other discounts programs. #LI-JS1 #LI-Remote What's next? Submit your application and our Porch Group Talent Acquisition team will be reviewing your application shortly! If your resume gets us intrigued, we will look to connect with you for a chat to learn more about your background, and then possibly invite you to have virtual interviews. What's important to call out is that we want to make sure not only that you're the right person for us, but also that we're the right next step for you, so come prepared with all the questions you have! Porch is committed to building an inclusive culture of belonging that not only embraces the diversity of our people but also reflects the diversity of the communities in which we work and the customers we serve. We know that the happiest and highest performing teams include people with diverse perspectives that encourage new ways of solving problems, so we strive to attract and develop talent from all backgrounds and create workplaces where everyone feels seen, heard and empowered to bring their full, authentic selves to work. Porch is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable laws, regulations, and ordinances. Porch Group is an E-Verify employer. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.

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

Overview Workers' Compensation Claim Consultant (CA Jurisdiction Only) - Remote Salary: $77,000-$87,000 annually Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Experience Required: 5+ Years (Litigated & Some Complex Claims) 🚨 Please Note This is not an HR, risk management, or consulting position. This is an experienced California Workers' Compensation adjusting role requiring hands-on claim investigation, evaluation, negotiation, and settlement. Candidates must have direct experience investigating, evaluating, reserving, negotiating, and resolving claims as an adjuster or adjuster supervisor within a carrier, TPA, or similar claims environment. Applicants without hands-on adjusting experience will not be considered. Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job Summary We're seeking an experienced Workers' Compensation Claim Consultant to handle California jurisdiction claims for a multi-account desk supporting clients in the trucking & warehouse, valet/shuttle services, and staffing agency industries. This fully remote position requires strong litigated claim handling experience, the ability to independently manage complex files, and a commitment to CCMSI's best practice standards. You'll join a collaborative team of four other consultants, working together to deliver high-quality, timely, and accurate claim service to our clients. Responsibilities When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems. Conduct timely 3-point contact per CCMSI best practices. Investigate, evaluate, and adjust California workers' compensation claims with independence and sound judgment. Establish, maintain, and justify detailed reserve levels. Administer indemnity and award payments in accordance with CA jurisdictional requirements. Negotiate settlements consistent with corporate standards, client instructions, and state law. Maintain a current and thorough diary, ensuring all deadlines and statutory requirements are met. Pursue subrogation recovery as applicable. Prepare claim status reports, reserve analyses, and updates for client meetings. Conduct claim reviews with clients and participate in discussions as needed. Communicate effectively with injured workers, employers, providers, and attorneys throughout the claim lifecycle. Ensure all documentation meets CCMSI best practice requirements. Qualifications Qualifications - Required 5+ years of California WC adjusting experience, including litigated files and some complex exposure. Adjuster designation required. Strong working knowledge of California WC laws, timelines, benefits, and litigation processes. Proficiency with Microsoft Office (Word, Excel, Outlook). Excellent written and verbal communication skills, critical thinking, and decision-making ability. Nice to Have SIP certification preferred. Strong documentation habits per CCMSI best practices. Experience presenting or conducting client reviews. Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Work Environment & Travel Remote role reporting to the Irvine, CA branch. Occasional travel to the office may be required for rare mandatory in-office meetings. Why You'll Love Working Here 4 weeks PTO + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: Quality claim handling - thorough investigations, strong documentation, well-supported decisions • Compliance & audit performance - adherence to jurisdictional and client standards • Timeliness & accuracy - purposeful file movement and dependable execution • Client partnership - proactive communication and strong follow-through • Professional judgment - owning outcomes and solving problems with integrity • Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us. Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #WorkersCompJobs #CaliforniaAdjuster #RemoteJobs #ClaimsConsultant #InsuranceCareers #AdjusterLife #NowHiring #LI-Remote

GEMCORE's continued success has earned us national recognition with Inc. Magazine's list of America's Fastest-Growing Companies and with the Cleveland Plain Dealer as a Top Workplace six years running! GEMCORE is a rapidly growing multi-state family of companies headquartered in Hudson, OH. Are you looking to begin or further your career in the medical supply industry where you are able to contribute to the success of the business, and build lasting relationships? All while allowing for personal time every evening, weekend, and holiday? Edwards Health Care Services (EHCS), a division of GEMCORE , is a well-established and growing national direct-to home medical supply provider. We are seeking a highly motivated Medical Claims Representative to join our high energy team. The Medical Claims Representative's primary role is to determine the root cause of denials and payment delays. We are a fast-growing company with advancement opportunities! This position offers the ability to work unique problems and to apply complex problem solving skills. This is a full-time, non-exempt, position. Once training is complete, this position will potentially be part of a hybrid remote work schedule. This position is located in Hudson, OH. Schedule is 8:00 am - 4:45 pm, Monday through Friday. Employer paid vacation. Benefits available include medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan. Key Responsibilities Analyze reports on insurance payment differences, appeals and rebills. Work claim denials. Identify denial trends and suggest process improvements. Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures. Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes. Job requirements Key requirements: Self-starter with the ability to work independently to achieve desired results. Clinical background or medical terminology knowledge helpful but not necessary. Demonstrated proficiency in Microsoft Outlook and Excel with 30 WPM typing skills. Strong organizational skills and multitasking ability. Excellent telephone skills required. Good cognitive reasoning ability. Detailed and thorough work orientation. Minimum 1-2 years of experience in a consumer service organization or healthcare environment. Education/Experience High School Diploma or GED Equivalent About Edwards Health Care Services, Inc. Edwards Health Care Services, Inc. (EHCS) is a national direct-to home medical supply provider of high quality medical and diabetes products that support the needs of individuals with diabetes and other conditions. For over 25 years, EHCS have been lighting the way to better health by providing customers an easier way to have products delivered directly to their door. By partnering with healthcare professionals, product manufacturers, and a large network of government and private insurers, EHCS prides itself on personalized customer service and a simplified, seamless order process for every customer…every time! For more information, visit *************** About GEMCORE GEMCORE, a family of companies headquartered in Hudson, Ohio - Edwards Health Care Services, GEMCO Medical, GemCare Wellness, and GEM Edwards Pharmacy - offers a core set of healthcare solutions by partnering with manufacturers, providers, employer groups, insurance groups, and patients to deliver high quality healthcare products and innovative services to proactively better lives. For more information, visit ********************** All done! Your application has been successfully submitted! Other jobs

Ready to lead and shape Hospital Professional Liability claims strategy? Apply to this senior-level claims leader position, Claims Manager II. Join a high-performing team leading the Hospital Professional Liability claims unit for IronHealth/NAS Claims. We're looking for a seasoned Claims Manager with deep Hospital Professional Liability experience who wants to lead a technical team, shape claims strategy, and drive measurable improvements across a portfolio of complex and high-severity matters consistent with the standards of Liberty International Underwriters. *This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. This policy is subject to change. The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, and the overall cost of labor for that region, and based on you location you may not qualify for the top salary listed in the range. Responsibilities Responsible for performance, development and coaching of staff (including hiring, terminating, performance and salary management). Serve as technical resource not only for claims staff, but also cross-functional partners, including Underwriting (UW), Actuarial, Finance and Operations. Work with claims team and external attorneys to review coverages, investigate claims, analyze liability and damages, establish adequate indemnity and expense reserves, develop strategies and resolve claims, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions. Perform quality assurance reviews/observations and provide feedback to team as well as action plan for development of team, where necessary. Actively pursue all avenues of recovery including, but not limited to timely recovery of deductibles from insureds and manage subrogation activities. Provide regular reports to claims management regarding losses either exceeding or likely to exceed the authority level in accordance with best practices. Must be able to present effectively, produce appropriate reports and develop team and train team in these skills Partner with underwriting managers/team to provide excellent customer service and to market and meet with brokers, risk managers and reinsurers. Serve as external face claims leader for product line and demonstrate ability to forge and maintain relationships with external customers, effectively resolving concerns where necessary. Ability to effectively articulate the claims value proposition in claims advocacy meetings, account renewals and new business prospecting. Present at industry conferences or publishes external industry content. Lead short to medium-term strategic claims activities/priorities for the product line, with alignment with the strategic priorities of IronHealth and NAS Claims. Oversee projects assigned by the department head. Direct and manage the Claims participation and content for multidisciplinary reviews, monthly UW connectivity meetings, and quarterly actuarial meetings. Ensure timely feedback to senior management, underwriting and actuaries regarding relevant losses, account issues, and trends. Assist and coordinate with underwriting team regarding new policy forms, product development and/or product rollouts and provide timely feedback to senior management and underwriting regarding recommendations. Ability to achieve fluency in Loss Triangle interpretation and Product Level Profitability Understanding/Awareness. Other duties as assigned, including delivery on established operational goals and objectives. Qualifications Qualifications - what will make you successful! Bachelors' degree or equivalent training; advanced degrees or certifications preferred. A minimum of 8+ years of relevant and progressively more responsible work experience required, including at least 2 years of supervisory experience. At least 5 years claims handling within a technical specialty. Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace. Requires advanced knowledge of a technical specialty. Knowledge of law and insurance regulations in various jurisdictions. The ability to effectively interact with brokers and internal departments is also required. Strong verbal and written communications and organizational skills. Strong negotiation, analytical and decision-making skills also required. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. This is a remote work from home opportunity. Summit Risk Services is seeking a Professional Liability Adjuster, Attorney and /or JD required, to join our growing team! The Professional Liability Adjuster is responsible for evaluating coverage, managing claims, and overseeing defense strategies to ensure fair and cost-effective resolutions. This role involves interpreting policy language, assigning and supervising defense counsel, attending mediations, and providing high-quality claims handling in collaboration with an experienced legal and claims professional. How You Will Contribute: Reviewing various insurance policies; determine whether the carrier has a duty to provide a defense and/or indemnification to the insured; prepare coverage correspondence, if there is a duty to defend, assign approved defense counsel. Oversee the work of defense counsel who will report generally in 90-day intervals. Attend mediations. Determine the most cost-effective way to effectuate resolution of the claims. You will be working with and reporting to someone with 27 years legal and claims experience. Some travel required. Skills & Experience to Be Successful: Juris Doctorate degree (JD) from an accredited U.S. law school and licensed to practice law. Excellent verbal and written communication skills required. Excellent time management skills needed. Must have strong organizational skills and ability to multi-task. Excellent PC skills with working knowledge of Microsoft Office suite. About Us: Our group is a Claims Management Third Party Administrator Specializing in Professional Liability Claims Management. We are publicly traded on NYSE and our team includes lawyers who serve as Claim Management Specialists for various insurance companies in the United States. Pay Range $100,000 - $105,000 Annual The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits : Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance Financial Benefits : ESPP; 401k; Student Loan Assistance; Tuition Reimbursement Mental Health & Wellness : Free Mental Health & Enhanced Advocacy Services Beyond Benefits : Paid Time Off, Holidays, Preferred Partner Discounts and more. Not reflective of all benefits. Enrollment waiting periods or eligibility criteria may apply to certain benefits. Benefit details and offerings may vary for subsidiary entities or in specific geographic locations. The Power To Be Yourself As an Equal Opportunity Employer, we are committed to fostering an inclusive environment comprised of people from all backgrounds, with a variety of experiences and perspectives, guided by our Diversity, Inclusion & Belonging (DIB) motto, “The Power to Be Yourself”.

Job Description Casualty Claims Representative Harrison Gray Search has been engaged by a mission-driven insurance organization to identify a skilled Claims Representative to join their team in East Lansing, MI. This is a meaningful opportunity to work with a trusted organization that protects Michigan public schools. As a Casualty Claims Representative, you'll handle the full lifecycle of general and professional liability claims-investigating, evaluating, and resolving cases while working closely with school districts and legal partners. Why You'll Want This Role: Purposeful Work: Help safeguard Michigan public schools and support their staff through claims resolution. Top-Tier Benefits: 100% employer-paid medical, dental, and vision, generous PTO, and paid parental leave. Respected Workplace: Recognized as one of Business Insurance's Best Places to Work. What You'll Do: Manage and resolve assigned casualty claims, including investigation, analysis, negotiation, and settlement. Monitor and collaborate with external investigators, attorneys, and medical/legal vendors. Evaluate liability, coverage, and damages; set and adjust reserves accordingly. Represent the organization in mediations, facilitate strategy sessions, and document case activity thoroughly. Ensure timely movement of claims via an internal diary system and claim handling standards. What You Bring: Bachelor's degree plus 2+ years handling general liability and professional liability claims (or equivalent experience). Strong knowledge of complex claims handling, coverage analysis, and liability assessment. Skilled communicator with high emotional intelligence and professionalism. Comfortable working in a fast-paced, collaborative environment with school district representatives, legal professionals, and internal teams. Willingness to travel occasionally and work remotely as needed. If you're looking for meaningful claims work that supports the greater good-and you're ready to join a high-performing, purpose-driven team - apply today!

Title: Casualty Claims Representative Reports To: Claims Manager Department: Property/Casualty and Workers' Compensation (PC/WC) SET SEG is looking for a Casualty Claims Representative who will be responsible for the investigation, negotiation, adjustment, and resolution of designated PC claims. This position reports to the Claims Manager. WHO WE ARE School Employers Trust (SET) is a non-profit company that was created after a monumental shift in school funding happened in 1965. SET, which began in 1971, served as an employee benefits association focused on offering comprehensive and affordable employee benefit solutions to Michigan public schools and their employees. Two years later, its partner organization School Employers Group (SEG) was formed to administer compensation and fringe benefits for SET. As schools were faced with more challenges related to insurance, SEG evolved and grew into a company that provides workers' compensation and property/casualty services for Michigan public schools. Today, SET SEG continues to expand and find creative ways to meet the specialized needs of its members. This, coupled with a superior member experience, is why SET SEG has maintained its position as an industry leader in the school insurance market. We value those who proactively solve challenges, simplify the complex, thrive in a fast-paced setting, have a customer-first mentality, and seek a collaborative and inclusive work environment. We are also listed on the Business Insurance Best Places to Work. We offer 100% employer paid insurance (medical, dental, and vision), Paid Time off (PTO), and paid parental leave. Our passion is delivering peace of mind to Michigan public schools and we look for team members who are motivated by our cause. To learn more, visit: ******************* WHO YOU ARE You are energized by working with a collaborative team and industry peers to support Michigan public schools through their challenges. You seek understanding and are motivated to tackle projects and problems with the customer in mind. You anticipate needs and preempt challenges and concerns, delivering increasingly relevant customer experiences over time. You value a culture that is rooted in mutual respect, where you can learn from different perspectives and roles. Primary Responsibilities: Manages, investigates, evaluates, negotiates, and adjusts assigned claims in adherence to guidelines within authority Ensures adequacy of reserves and recommends reserve increases on cases in excess of authority Monitors outside investigators and performs outside investigations when assigned. Provides oversight of medical, legal damage estimates, and miscellaneous invoices to determine if they are reasonable and related to designated claims Negotiates any disputed bills or invoices for resolution Assigns litigated claims to approved law firms and/or individual attorneys and monitors progress Follows a uniform system of reserving by reviewing incoming litigation, establishing initial reserves and completing reserve reports Negotiates settlements in accordance with claim handling standards while also considering member preferences when appropriate Attends facilitations/mediations as assigned Manages diary system to move losses to conclusion in a timely manner Participates in strategy sessions with internal business units such as Underwriting and Loss Control Other duties as assigned by the Claims Manager Required Qualifications: Bachelor's Degree plus two years of experience adjusting general liability and professional liability claims or an equivalent combination of education and experience Must have knowledge of coverage, liability, and complex claims handling procedures Ability to handle complex case-related tasks in a fast-paced and changing environment Excellent interpersonal skills and the ability to work in a strong team environment Must be highly organized and detail oriented Must be dependable, reliable, and able to achieve high levels of professionalism when handling cases and interacting with school district representatives and their employees, attorneys, families of injured and fellow employees Must be able to create and maintain high levels of confidentiality when dealing with proprietary information and sensitive situations Must have strong cognitive and analytical skills Ability to initiate, receive, understand, and reply to written and oral communication (verbal, written, telephone, e-mail, etc.) Ability to travel and work remotely on a periodic basis Physical Demands / Work Environment Several hours per day at a sit/stand desk, average mobility to move around an office environment; able to spend several hours per day at a computer. Occasional in-state travel may be required. Punctual, regular, and consistent attendance is required. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

Insight Global is looking for an Outpatient Facility Claim Follow Up Representative to support a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity, for three acute hospital centers in Washington, DC. This role focuses on resolving underpayments, denials, and contract interpretation issues-not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with payers. This team focuses on facility claims only, and this role is focused only on outpatient claims follow up, specifically to BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.). Primary Responsibilities: Claims Management: - Take ownership of outpatient hospital claims after billing, especially those that are denied or underpaid. - Determine what was paid, what was denied, and why. - Identify and resolve technical denials related to coding, coordination of benefits (COBs), charge discrepancies, contract interpretation, etc. Payer Interaction: - Handle all outpatient claims for Blue Cross Blue Sheild CareFirst and/or BlueCard. - Understand and navigate multiple contracts. - Utilize BCBS portal to follow up and resolve outstanding claim issues. Analytical Review: - Differentiate between pricing errors vs. payment errors. - Accurately price claims based on contract terms and identify variances. Scope of Work: - Outpatient facility claims ONLY - Technical denials ONLY We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to ********************.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: **************************************************** Skills and Requirements - High school diploma or equivalent - Outpatient hospital billing experience - Experience with facility claims follow-up & appeals handling o Experience with UB04 forms o This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.) - Strong experience working with BlueCross BlueShield CareFirst and/or BlueCard o Familiarity using payer portal, their escalation process, how to read and interpret contracts - Experience meeting a productivity standard of following up on ~55 claims per day. - Knowledgeable of ICD + CPT Codes - Attention to Detail: o Must be able to spot errors and inconsistencies in claims and contracts. - Analytical Thinking: o Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly. - Independent & Fast Learner - Tech Savvy (Excel, Teams, etc.) and experience working fully remotely - Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

Company Details Berkley Small Business Solutions (BSB) is committed to providing small business customers with the next generation of small business solutions, including offering operational, underwriting, and marketing opportunities. We offer insurance products to Small Business Owners for transportation and other main street businesses. We leverage underwriting expertise, data, and analytics, and automation for risk assessment, selection, pricing retention. We champion our customers, distribution always seeking a smarter way to provide a more efficient and better user experience. We are a proud member of W. R. Berkley Corporation, one of the largest commercial lines property casualty insurance holding companies in the United States. With the resources of a large Fortune 500 corporation and the flexibility of a small company, we exclusively work with select independent agents to bring technology solutions that help them build their business. Responsibilities The position is responsible for handling low-complexity claims involving physical damage, property damage, total loss, fuel spills, medical payments, and cargo damage resulting from commercial auto claims. This position will work closely with insureds and stakeholders to ensure timely and accurate claims resolution and provide exceptional customer service. Customer Service Act with urgency in establishing initial and subsequent contact with all parties and key stakeholders. Update appropriate parties as needed, providing new facts as they become available and explaining impact of those facts upon the liability analysis and settlement options. Collaborate with vendors to ensure timely appraisal and evaluation of damages. Coverage Analyze coverage by applying policy information to facts or allegations of each loss. Communicate coverage decisions to insured and stakeholders and update coverage analysis as new facts warrant it. Ensure compliance with jurisdictional requirements, including timeliness of communicating coverage disposition. Data Integrity Maintain discipline in securing and updating information throughout the life of the claim. Ensure data is complete and comply with statutory requirements for reporting. Reserving Establish and maintain appropriate initial, subsequent loss, and expense reserves. Ensure supporting rationale for each reserve is documented within the electronic claim file. Act with urgency in collaborating with internal stakeholders regarding significant changes within claim reserving. Investigation Directly investigate each claim through prompt and strategic contact with appropriate parties including policyholders, witnesses, claimants, law enforcement agencies, agents, medical providers, and technical experts to determine the extent of liability, damages, and contribution potential. Interview witnesses and stakeholders. Take recorded and/or written statements when appropriate. Evaluate all claims for recovery potential. Directly handle recovery efforts and/or engage and direct Company resources for recovery efforts. Evaluation and Resolution Utilize diary management system to ensure all claims are handled timely and in compliance with jurisdictional requirements and Company guidelines. Collaborate with external vendors, e.g., appraisers and independent adjusters. Manage total loss claims process including vehicle appraisal procedures, diminished value, vendor networks, subrogation demands, salvage procedures and heavy equipment appraisals. May perform other functions as assigned. Remote work arrangements may be considered for qualified candidates who are open to travel as needed. Qualifications 1+ years of casualty claim handling experience; trucking experience preferred. Excellent interpersonal and communication skills. Strong problem-solving and organizational skills. Computer proficiency, including working knowledge of Microsoft Office products. Previous experience in customer service role, or a related field, is preferred but not required. Willingness to learn and expand knowledge. Position will require that Claims Representative obtain independent adjuster's licenses for all states that have requirement, including but not limited to: AL, CT, GA, FL, ME, MS, NY, NC, SC, TN, TX. Licenses must be obtained within 90 days of hire and require course work, testing, and background checks that may include fingerprinting Education College degree preferred or equivalent work experience. Additional Company Details **************************** The Company is an equal employment opportunity employer We do not accept any unsolicited resumes from external recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. • Salary Range: 75k - 90k • Eligible for annual discretionary bonus • Benefits: Health, Dental, Annual Bonus Potential, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. Not ready to apply? Connect with us for general consideration.

Requirements 2+ years handling property insurance claims required Candidate must have an active Xactimate account Can handle partial and full assignments Commercial and personal lines experience preferred A qualified candidate must have their own transportation, equipment and software Good writing and technology skills

Department Claims Administration & Adjusting Employment Type Permanent - Full Time Location Home United States Workplace type Fully remote Compensation $68,000 - $75,000 / year Reporting To Kenneth Krause Key Responsibilities Skills, knowledge & expertise Benefits About Davies We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses. We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management. Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.

Job Description A dynamic organization supplying quality claims outsource solutions to insurance carriers, countrywide is seeking multi-line adjusters in your area. There are many competing vendors in our marketplace, but we are not your typical “vendor”. Our company was built by insurance company claims executives to support insurance companies' claim operations to help them meet their organizations goal of providing quality claims solutions at a reasonable cost. We excel in providing professional, knowledgeable claims professionals to handle large losses, catastrophe claims, business interruption and daily property claims, as well as handle complete liability investigations, task assignments including scene investigations and property damage appraisals, construction defect claims as well as first party automobile claims for personal and commercial insurance policyholders. Position Summary: A national independent insurance adjusting firm has immediate openings for Multi-Line Claims adjusters that possess the ability to work remotely and have the experience to handle both property and liability claims. The candidate must possess the ability to adjust commercial and residential property losses and must also have a working knowledge of how to determine negligence and assess damages. The candidate should be able to perform all tasks with modest supervision. The candidate must possess the ability to understand coverage, how to investigate a variety of property and negligence claims, how to value and estimate property damage as well as the ability to evaluate Bodily Injury damages for settlement. Requirements: Minimum 5 years first-party commercial and/or residential property and liability adjusting experience Maintain own current estimating software; Xactimate preferred Working computer; internet access and Microsoft Word required Must demonstrate strong time management and customer service skills Ability to take recorded statements in the field or with legal representatives Experience in preparing Statements of Loss, Proofs of Loss, and denial letters State adjuster's license where required Must have valid driver's license Knowledge and Skills: In-depth knowledge of property and liability insurance coverage and industry standards Prepare full captioned reports by collecting and summarizing information required by client Strong verbal and written communications skills Prompt, reliable, and friendly service Must submit to background check; void in states where prohibited Experience in industry specific areas a plus, but not necessary: fire departments, agricultural, lumber mills, high value or historic buildings or Construction Defects, Automobile Liability, Subrogation Recovery investigations Responsibilities: Completes residential and commercial field property inspections utilizing Xactimate software and general liability field investigations to determine negligence and damages Investigate claims by obtaining recorded statements from insureds, claimants or witnesses; by interviewing fire, police or other governmental officials as well as inspecting claimed damages Recommend claim reserves based on investigation, through well supported reserve report Obtain and interpret official reports Review applicable coverage forms and endorsement, providing thorough analysis of coverage and any coverage issues in well documented initial captioned report to client Maintain acceptable product quality through compliance with established Best Practices of client Preferred but Not Required: College Degree AIC, or other professional designations All candidates must pass a full background check Powered by JazzHR ICpt60WgbM

External candidates: In order for your application to be correctly processed please sign-in before you apply Internal candidates: Please go to Workday and click "Find Jobs" link under Career Thank you for considering opportunities with us! Job Title Commercial Casualty Litigation Adjuster (Remote) Requisition Number R7516 Commercial Casualty Litigation Adjuster (Remote) (Open) Location Colorado - Home Teleworkers Additional Locations Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arizona - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers, Nebraska - Home Teleworkers {+ 19 more} Job Information We're Mobilitas, a commercial insurance company created by CSAA Insurance. Our mission is to reinvent commercial insurance in the mobility space by providing technologically advanced solutions for today's way of doing business. At Mobilitas, we believe in what's possible, we use our inventive skills to create new opportunities - we're not chasing the status quo, we're chasing a shared vision. We're looking for motivated, innovative individuals who think big, move fast and are dedicated to creating a company from the ground up, without the constraints of a traditional insurance company. We're excited to push the boundaries of commercial insurance and are looking for enthusiastic team members to help us reimagine insurance. We are actively hiring for a Commercial Casualty Litigation Adjuster! Your Role: As a Commercial Casualty Litigation Adjuster, you will be assigned as owning adjuster when injury exposures are identified. Claims will include catastrophic injuries, fatalities, and litigation. In this role, you will be responsible for management of the claim through conclusion, including trial, of litigated claims. May own claims within other specialized lines of business or during catastrophes. You will provide input and direction to defense counsel and be responsible for ultimate resolution through providing settlement authority and participating in negotiations with limited oversight. You will also be responsible for effective management of defense costs and indemnity. May handle first party non-liability-based injury claim (Medical Payment, PIP, Inland Marine, auto physical damage). Your Work: Assigned as owning adjuster when injury exposure is identified. Handles complex 1st and 3rd party auto liability cases involving injury, including complexity litigated cases with defense attorney involvement. May handle 1st party medical payment and PIP claims. Responsible for managing, investigating, and negotiating claims, including collaborating with defense counsel to identify strategy for negotiations. Provides input as the face of the organization via phone or in attendance on video or in-person at mediations and settlement conferences for litigation claims. Interacts directly with defense counsel providing direction, authority for resolution (i.e., settle or go to trial) and ensures appropriate outcome in balancing defense costs and indemnity on litigation claims. Making coverage determinations and advising customers as to proper course of action related to coverage issues. Conducting investigative work of a complex nature (interviewing witnesses; obtaining and analyzing evidence, including medical records; deciding whether an independent medical examination is warranted; etc.). Direct defense counsel in non-litigated or litigated claims. May require appearing at and representing the insureds at arbitrations and trials. May require testimony in a deposition setting. Evaluate defense counsel fees and cost for reasonableness and resolve. Evaluating potential for subrogation and initiating initial notice of subrogation request. Making final decisions to settle within settlement authority, without supervisory approval, and developing negotiating strategies. Presenting cases in Committee setting when seeking above settlement authority level; thereafter, independently negotiating and settling the claim. Will develop and present executive summaries on individual claims to external clients and internal executives in a virtual setting to gain alignment with client on next steps, and settlements. Handles most commercial product types including but not limited to auto, fleet, last mile delivery, and trucking. Will handle claims in most geographic venues. Handles claims involving any vehicle types that may include, but is not limited to auto, motorcycles, scooters, recreational vehicles, trucks, and remote-controlled delivery vehicles. Understands and handles claims in line with any applicable insurance program agreements, claim service level agreements. Plays a direct role in the development of other adjusters through mentorship, training, and coaching. Required Experience, Education, & Skills: 6+ years of claims experience. 3+ years of experience in a Casualty claims role within P&C insurance industry with a minimum of 1 year in a Sr. Casualty role or equivalent Complex Casualty / Litigation experience. BA/BS in business, insurance or related area, or equivalent combination of education and experience. Must hold an Adjuster licensed for all applicable states or obtain license(s) within 90 days of filling position as a condition of employment. What would make us excited about you? 6+ years of Casualty claims adjusters experience. 3+ years of experience in a Commercial claims role Bilingual a plus. Proficiency or ability to obtain proficiency in the handling of minor, moderate and complex litigated claims. Strong analytical, problem-solving, and organizational skills. Proficient in ability to work independently. Strong decision-making ability. Extensive understanding of statutory and regulatory requirements, and ability to develop proficiency in standards of civil procedure. Ability to travel and to work extended hours and/or weekends. Proficient oral and written communication skills and ability to organize and present complex facts to executive management. Strong math skills, basic computer skills and ability to type at least 30 words per minute. Mobilitas Careers At Mobilitas, we're proudly devoted to protecting our customers, our employees, our communities, and the world at large. We are on a climate journey to continue to do better for our people, our business, and our planet. Taking bold action and leading by example. We are citizens for a changing world, and we continually change to meet it. Join us if you… BELIEVE in a mission focused on building a community of service, rooted in inclusion and belonging. COMMIT to being there for our customers and employees. CREATE a sense of purpose that serves the greater good through innovation. Recognition: We offer a total compensation package, performance bonus, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at careers.mobilitasinsurance.com In most cases, you will have the opportunity to choose your preferred working location from the following options when you join us: remote, hybrid, or in-person. Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don't miss important updates from us. If a reasonable accommodation is needed to participate in the job application or interview process, please contact *************************** As part of our values, we are committed to supporting inclusion and diversity. We actively celebrate colleagues' different abilities, sexual orientation, ethnicity, and gender. Everyone is welcome and supported in their development at all stages in their journey with us. We are always recruiting, retaining, and promoting a diverse mix of colleagues who are representative of the U.S. workforce. The diversity of our team fosters a broad range of ideas and enables us to design and deliver a wide array of products to meet customers' evolving needs. Mobilitas is an equal opportunity employer. If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education. Must have authorization to work indefinitely in the US Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska. #LI-CH1 .

AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs-wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states. Job Details This position performs highly technical and specialized functions for Capstone. In addition to reviewing & analyzing coding documentation from medical records, the Client Services Liaison also coordinates the “care” of the client. The primary function of this position is to promote retention, growth, and satisfaction through coordinated communication with the client. Responsibilities Completes quarterly assessment for assigned panel with input from all Capstone departments, including but not limited to coding, auditing, & quality assurance. Assesses client needs based on structured assessments every quarter. Coordinates all Capstone services to the clients in the assigned panel via quarterly plans including client visits, conference calls, surveys, etc. Develops and strengthens risk adjustment client relationships in defined assignment panel. Works with CVHC Account Management team and Capstone internal team to coordinate new client onboarding. Monitor client needs and recommend additional services and/or improvements to current services, when appropriate. Responsible for ensuring customer satisfaction by resolving issues quickly and creatively. Assist the client with navigating and optimizing the use of service offerings and reports. Provide additional training and education to the clients (other than quarterly review) via webinar. Including additional audit reviews, CPS reports, CDI, etc. as identified. Provides support and assistance to other Capstone teams in relationship to assigned client panel. Develops and maintains master schedules for all clients in assigned client panel. Participates in internal interdisciplinary calls regarding clients in assigned client panel. Maintains professional license and certifications (where applicable) and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise. Reviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical ICD-10 CM coding and documentation. Understands and adheres to The Health Insurance Portability and Accountability Act (HIPPA) requirements. Participates as requested in department meetings, client calls, and annual performance evaluation. Performs other duties and responsibilities as required. Completes miscellaneous projects for Capstone as assigned or requested. This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts, or working conditions associated with the position. While this description is intended to be an accurate reflection of the current position, management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (e.g., emergencies, change in personnel, workload, rush jobs, or technological developments). Qualifications These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required: Associate Degree; Preferred: B.S, B.A., or B.S.N Required: Minimum three years of experience providing clinical documentation Improvement training. Required: Minimum three years of experience in Hierarchical Condition Categories (HCC) or risk adjustment. Preferred: Knowledge of or experience in Risk Adjusted contracting or provider groups. Preferred: Experience with Risk Adjustment Analytics strongly preferred. Skills & Abilities Proficient with MS Word, Excel, PowerPoint, and Comfortable with learning and becoming an expert on new and proprietary software. Highly skilled in written and verbal communication. Highly skilled at establishing priorities and coordinating work activities. Excellent presentation skills Skilled at performing multiple and complex tasks. Have exceptional initiative and follow-through on projects with minimal supervision or guidance. Must be detail oriented, follow instructions, and work independently with minimal supervision with highly confidential information per HIPAA regulations. Comfortable working in a fast paced, rapidly changing environment. Physical Demands Requires manual and finger dexterity and eye-hand coordination to use computer and office equipment and the ability to lift/carry up to 30 pounds using appropriate body mechanics. Must be able to sit for extended periods of time at a computer. Must be able to communicate verbally and in writing. Must be able to handle a multitude of projects simultaneously, work well under pressure, meet deadlines and maintain confidential and sensitive information. Must be an independent thinker who is willing to take on extra responsibility and work independently with little supervision. Must be able to work well with others, at many levels and of many backgrounds. Schedule This is a remote position. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel Overnight travel may be required for meetings and on-site client visits. AnewHealth offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire . AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.

JOIN THE ASSURANCEAMERICA TEAM Do you want to be part of an organization where you are valued, and your ideas and opinions have an impact? Join the AssuranceAmerica team. For more than 25 years, AssuranceAmerica has provided superior property and casualty insurance products through contracted independent agents and directly to customers. Our team succeeds through diversity of thought, experiences, skills, and backgrounds. Liability Adjuster II The Liability Adjuster II is responsible for managing a caseload of complex liability and coverage claims, including those involving minor bodily injuries. This role requires the execution of thorough investigations to gather all necessary facts, along with a strong understanding of policy language to ensure accurate and timely coverage and liability determinations. While working with a degree of autonomy, the Adjuster will collaborate with their supervisor for guidance on more nuanced or high-exposure cases. About the ROLE Each day at AssuranceAmerica is different, but as a Liability Adjuster II you will: Conduct thorough investigations and evaluations of coverage, liability, and damages across all lines of personal automobile insurance/. Accurately assess exposure and evaluate injury claims in a fair, consistent, and equitable manner based on the facts and extent of damages. Negotiate timely and appropriate settlements, ensuring all required documentation is obtained to support proper claim resolution and closure. Manage low-complexity, attorney-represented injury claims with sound judgement and attention detail, maintaining compliance with internal guidelines and industry standards. Control expenses and adhere to company reserving philosophy by maintaining proper reserves on all pending claims/potential exposures. Meet and maintain general file handling goals and procedures as outlined by the company including maintaining a 1:1 closing ratio and status on diary reviews. Properly utilize underwriting and policy systems and understand its features and functionality, as needed. Attend any available seminars and classes applicable to this position and the skills required to meet the job duties and responsibilities. Continually ask questions and have a desire to develop additional skills to better investigate and evaluate claims. About YOU Excellent communication skills with demonstrative ease with both verbal and written formats. Attention to detail and ability to multi-task. A high degree of motivation and team orientation. Direct, results driven, and dedicated to the success of the business and each other. Required Minimum three years of experience handling auto claims. Minimum of two years of experience handling complex liability and coverage issues and unrepresented bodily injury cases. Preferred Bachelor's degree or equivalent. Non-standard experience. Adjuster's license in relevant state or the ability to obtain one quickly. Bilingual (English-Spanish). Physical Requirements Prolonged periods sitting at a desk and working on a computer. Must be able to lift 15 pounds at times. Must be able to navigate various departments of the organization's physical premises. About US We are direct, results-driven, and dedicated to the success of our business and each other. We are a diverse group of thinkers and doers. We offer many opportunities to grow in your professional skills and career. We fight homelessness by directing 5% of our earnings from each policy we sell to organizations that help those in need. We call it our Generous Policy. WHAT WE OFFER AssuranceAmerica provides these benefits to Associates: Premium healthcare plans: All full-time Associates and part-time Associates working a regular schedule of 30 hours, or more, are eligible for benefits including Medical, Dental, Vision, Voluntary Life, Flexible Spending Accounts, and a Health Savings Account. Employer Paid Benefits: We enroll all eligible Associates in Group Life and AD&D Insurance, Short- and Long-Term Disability Plans, Employee Assistance Program, Travel Assist, and the Benefit Resource Card which includes Teladoc™, Pet Insurance and Health Advocate. Additional Benefits: 401(k) Employer Match: We want to help you prepare for the future, now. All full-time and part-time Associates over age 21 are eligible to participate in the 401(k) Savings Plan. AssuranceAmerica will match 100% of the first 4% of an Associate's contributions. Engagement Events. We make time for fun activities that strengthen Associate relationships in all our locations. Annual Learning Credit: Want to learn something new? We'll reimburse you for approved educational assistance. Time Off: Paid Time Off (PTO), Parental Leave Pay, Volunteer Time Off (VTO), Bereavement Pay, Military Leave Pay, and Jury Duty Pay.

Full-time Description Description Department: Claims Schedule: Monday to Friday; flexibility for additional hours as needed. Salary: $60,000 - $75,000; negotiable About Responsive Founded in 2007 and headquartered in Plantation, Florida, Responsive is a leading provider of personal auto insurance in Florida. We collaborate with thousands of agents from the most respected insurance agencies to deliver world-class service and claims experiences. Responsive stands for making auto insurance simple, affordable, and hassle-free; a promise we deliver through innovation, feedback, and a commitment to excellence. Why Join Responsive? At Responsive, we're committed to supporting our team with comprehensive benefits and a positive work environment, including: Employer-Paid Healthcare: Medical, dental, and vision plans with free preventative care. Retirement Savings: 401(k) with company match. Wellness Programs: Mental health support and wellness initiatives. Career Development: Training and growth opportunities in a collaborative environment. What You Will Do As a Bilingual PIP Adjuster, you'll work closely with customers, attorneys, medical providers, other insurance carriers, and vendors in resolving coverage, and liability from start to finish. You'll plan and schedule work needed to process claims, interview claimants and witnesses, investigate claims, negotiate to reach a fair and equitable settlement of the PIP exposure, and identify situations where claims may require special investigation. You'll maintain strong relationships with customers while resolving auto injury claims efficiently. You'll perform the duties below, along with other work as assigned. Investigate, evaluate, and settle insurance claims (e.g., establish coverage and qualification for injured parties; negotiate claims with providers to reach a fair and equitable settlement of the PIP exposure). Maintain a well-organized and accurate diary to ensure timeliness in handling claims as well as detailed, accurate, and timely records. Write clear and accurate responses in response to demands, requests, or questions. Display courtesy, accuracy, and uniformity when interacting with others (on the phone, in person). Be familiar with tools such as ISO, TLO, & other public sites such as buycrash.com, MDCC, BCC, FDHSMV, and Google Maps. Continuously develop knowledge and expertise (e.g., keep current on job-relevant laws, regulations, trends, and emerging issues). Conduct activities in compliance with applicable Federal & State laws, and company regulations and guidelines. Requirements At least 2 years PIP Adjuster experience with Automobile Property Damage Claims to operate in the state of Florida Licensed Adjuster - All Lines required (FL 620 license) Bi-lingual (English/Spanish) required Bachelor's degree preferred Demonstrated ability to develop and maintain relationships with others Oral communication skills, especially active listening Written communication skills Well organized Strong analytical, problem-solving, and critical thinking skills Demonstrated experiences in a production environment where time management, workload prioritization, case management, recordkeeping and documentation, accountability, and follow-up are key priorities Team player Curious (e.g., ability to identify the right questions to ask customers) Self-motivated Openness to feedback and a strong desire to learn Proficiency with software programs such as Word and Outlook Responsive provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, veteran, marital, or domestic partner status.

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here. For more than 25 years, NTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy. NTT DATA currently seeks a Remote **Medical Claims Representative** to join our team in **for a remote position** . This is a US based, W-2 project. All candidates will be paid through NTT DATA only. **Role Responsibilities** **- Pay rate is $18.00** -Processing of Professional claim forms files by provider -Reviewing the policies and benefits -Comply with company regulations regarding HIPAA, confidentiality, and PHI -Abide with the timelines to complete compliance training of NTT Data/Client -Work independently to research, review and act on the claims -Prioritize work and adjudicate claims as per turnaround time/SLAs -Ensure claims are adjudicated as per clients defined workflows, guidelines -Sustaining and meeting the client productivity/quality targets to avoid penalties -Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. -Timely response and resolution of claims received via emails as priority work -Correctly calculate claims payable amount using applicable methodology/ fee schedule **-Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities** **-Time management with the ability to cope in a complex, changing environment** **-Ability to communicate (oral/written) effectively in a professional office setting** **Required Skills/Experience** + 1+ year(s) hands-on experience in **Healthcare Claims Processing** + **Previously performing - in P&Q work environment; work from queue; remotely** + 2+ year(s) using a computer with Windows applications using a keyboard, **navigating multiple screens and computer systems, and learning new software tools** + Key board skills and computer familiarity - + **Toggling back and forth between screens** /can you navigate multiple systems. + Working knowledge of MS office products - Outlook, MS Word and **MS-Excel** . **Preferences** Amisys &/or Xcelys Preferred About NTT DATA: NTT DATA is a $30+ billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate, optimize, and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting, data and artificial intelligence, industry solutions, as well as the development, implementation and management of applications, infrastructure, and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at us.nttdata.com. NTT DATA is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team. Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is **$18.00/hourly** . This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.