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Strategic Claims Director - Remote Leadership & Impact
Coverys, Inc. 4.6
Remote senior claims specialist job
A leading insurance firm in Boston is seeking a Director of Claims to provide strategic and operational leadership in claims handling. This role includes overseeing management staff, collaborating with the Vice President, and ensuring departmental compliance with guidelines. The ideal candidate will have 5-10 years of experience in medical professional liability claims, strong communication skills, and the ability to lead teams. This position requires up to 50% travel and offers a salary range of $168,700 to $228,300.
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$168.7k-228.3k yearly 5d ago
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Remote Auto Claims Supervisor - Sr.
Medium 4.0
Remote senior claims specialist job
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Auto Claims Supervisor - REMOTE. In this role, you will oversee a team of property damage auto claims adjusters, ensuring accurate evaluations and operational excellence in the claims process. This position is crucial for establishing best practices, coaching adjusters, and ensuring compliance with industry standards. You will have the opportunity to lead process improvements that enhance efficiency and customer satisfaction. Additionally, your strong background in claims handling will be instrumental in managing complex claims and navigating escalated situations.
Accountabilities
Supervise and mentor a team of property damage adjusters, providing feedback and training.
Review complex and escalated auto property damage claims for accuracy and strategy.
Ensure compliance with company guidelines and industry regulations.
Lead process improvements to increase efficiency and customer satisfaction.
Approve final claim settlements within delegated authority.
Monitor team KPIs and report performance to senior management.
Facilitate regular team meetings and training sessions.
Collaborate with internal departments for efficient claims handling.
Maintain expert knowledge of property damage claims handling standards.
Act as a senior escalation point for concerns from policyholders or agents.
Requirements
Bachelor's degree in business administration or related field preferred.
5+ years of experience in property damage or auto damage claims handling.
Experience in FL, GA, and TX markets preferred.
Demonstrated leadership and team performance management.
Strong analytical, negotiation, and communication skills.
Proficient with claims systems, estimating software, and MS Office.
Adjuster's license required.
Bilingual preferred, especially in Spanish.
Benefits
401(k) Retirement Savings Plan with employer match.
Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance.
Paid Time Off, Holidays, and Leave programs.
Flexible spending accounts.
Basic Life Insurance and Voluntary Life/ADD.
Short Term and Long-Term Disability.
Why Apply Through Jobgether?
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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$63k-103k yearly est. 1d ago
Sr DI Claims Examiner
Ameritas 4.7
Remote senior claims specialist job
is remote (within the U.S.A.) and does not require regular in-office presence.
What you do:
Evaluates and authorizes disposition of complex claims.
Obtains and analyzes medical records and financial documents.
Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews.
Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer.
Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments.
Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates.
Assists with recoveries from reinsurance carriers.
Performs all claims processing support functions.
What you bring:
Bachelor's degree or equivalent experience is required.
1-3 years of related experience is required.
What we offer:
A meaningful mission. Great benefits. A vibrant culture
Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life.
At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't:
Ameritas Benefits
For your money:
• 401(k) Retirement Plan with company match and quarterly contribution.
• Tuition Reimbursement and Assistance.
• Incentive Program Bonuses.
• Competitive Pay.
For your time:
• Flexible Hybrid work.
• Thrive Days - Personal time off.
• Paid time off (PTO).
For your health and well-being:
• Health Benefits: Medical, Dental, Vision.
• Health Savings Account (HSA) with employer contribution.
• Well-being programs with financial rewards.
• Employee assistance program (EAP).
For your professional growth:
• Professional development programs.
• Leadership development programs.
• Employee resource groups.
• StrengthsFinder Program.
For your community:
• Matching donations program.
• Paid volunteer time- 8 hours per month.
For your family:
• Generous paid maternity leave and paternity leave.
• Fertility, surrogacy, and adoption assistance.
• Backup child, elder and pet care support.
An Equal Opportunity Employer
Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law.
Application Deadline
This position will be open for a minimum of 3 business days or until filled.
This position is not open to individuals who are temporarily authorized to work in the U.S.
$65k-97k yearly est. 2d ago
Commercial Auto & General Liability Claims Examiner III
Tristar Insurance 4.0
Remote senior claims specialist job
Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Must work EST core hours. Must pass the NYS Adjuster license exam within 60 days of hire.
Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.
DUTIES AND RESPONSIBILITIES:
Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto, Auto Med Pay, and/or General Liability Casualty Claims.
Oversee and direct outside investigative service providers and work closely with the client and client counsel, and investigative services to advance the claim to conclusion.
Maintain an ongoing diary.
Continually assess exposure and evaluate for accurate reserves and settlement recommendations.
Prepare Loss Reports providing a thorough analysis of coverage, liability, and damages.
Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
Document all correspondence, reports, discussions, and decisions in the claim file record.
Provide outstanding service to the client.
Position is remote/working from home.
Qualifications
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required; bachelor's degree in related field (preferred) and two years auto and general liability casualty and or No Fault/PIP related experience; or equivalent combination of advanced education and experience.
Special Requirements:
At least two years of Automobile and General Liability claims experience required.
Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge.
Demonstrated verbal and written communications skills.
Demonstrated advanced analytical, decision-making and negotiation skills.
Computer proficiency.
Preferred Skills:
Ability to communicate effectively and clearly, both orally and in writing.
Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.
Excellent customer service skills.
An understanding of the litigation process and case valuation in multiple jurisdictions.
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
Time management skills, organizational skills, and ability to prioritize issues and tasks.
Ability to effectively operate computer equipment and applications.
Independence, flexibility, and creativity.
Other Qualifications:
Candidate must have adjuster licenses and be willing to obtain the NY license if they do not already have one.
Candidate must be willing to work Pacific Time core hours.
Here are some of the benefits you can enjoy in this role:
Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.
Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements
MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects
Visual requirements necessary to perform the job:
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
2. PHYSICAL EFFORT (cont.)
FREQUENCY
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
X Kneeling: Bending legs at knee to come to a rest on knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Frequently
Occasionally
2. PHYSICAL EFFORT (cont.)
FREQUENCY
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.
Frequently
Frequently
Frequently
3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
WORKING CONDITION
ENVIRONMENTAL
FACTOR
NATURE/REASON
OF EXPOSURE
FREQUENCY
Dirt/Dust
Noise
Temperature extremes
Dampness
Vibrations
Equipment movement hazard
Chemicals/solvents
Electrical shock
Significant work pace/pressure
Odors/Fumes
$50k-76k yearly est. 15d ago
Sr USDA Claims Recovery & Analysis Loss Specialist
Carrington Mortgage Services, LLC 4.5
Remote senior claims specialist job
Come join our amazing team and work remote from home! The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses were identified and the financial reconciliation is accurately completed on all liquidated loans. Key reviewer of loss analysis decisions which include validating the determined responsibility and root cause for avoidable losses, ensuring they meet quality expectations and reflect proper decision rationale and supporting evidence and identify any bill back opportunities. Perform all duties in accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay for this position is $23.00/hr - $26.50/hr.
What you'll do:
Review reconciliation of all loan advances once the GSE or Government Mortgage Insured "expense" claim has been paid.
* Confirm all prior tasking in LoanServ has been completed as well as update approval tasks as required per job aid upon the date the action occurs.
* Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as needed.
* Responsible for learning new skills and expand job knowledge to better perform assigned duties.
* Maintain monthly performance in alignment with quality expectations.
* Analyze multiple data elements in order to confirm the proper decision rationale and approve evidentiary support is included and written summaries are accurate.
* Validate research on incurred losses, using analytical skills and subject matter knowledge to confirm responsibility and bill back opportunities.
* Responsible for staying abreast of relevant changes to GSE or Government Mortgage Insured guidelines, industry standards and client expectations.
* Ensure timely completion of projects and tasks when assigned. If unable to meet a deadline, the deadline must be renegotiated prior to the initial deadline date.
* Look for opportunities to improve the department's processes and procedures, to reduce costs and eliminate non-essential and manual processes and activities.
* Keep Team Lead and Supervisor informed of all trends and problems including, but not limited to, exceptions identified in review of Loss Analysis processes.
* Moderate working knowledge of all Default Servicing processes up to and including Loss Mitigation, Bankruptcy, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines.
* Moderate background in financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered.
* Moderate ability to conduct quality assurance reviews.
* Preferred Accounting Background--Must possess the ability to complete financial reconciliations.
* Moderate computer skills with MS Word, Excel.
* Strong attention to details and excellent time management and organizational skills.
* Comprehensive writing skills, including proper punctuation and grammar, organization, and formatting.
* Ability to work under general direction to accomplish department goals and reduce/mitigate financial loss to CMS and its Clients.
* Ability to substantiate facts and properly document them.
* Ability to work effectively and develop rapport with all levels of staff, management, Investors/Insurers and 3rd parties.
* Ability to make decisions that have moderate impact to immediate work unit.
* Ability to identify urgent matters requiring immediate action and properly escalating them.
* Ability to handle multiple tasks under pressure and changing priorities.
What you'll need:
* High School diploma required; Associate/Bachelor Degree in accounting or other related field preferred.
* Two (2) or more years' quality assurance experience.
* Three (3) or more years' Loan Servicing platform experience for all default related activities such as Foreclosure, Bankruptcy, Default MI Claims, Loss Mitigation, etc.
* Previous FHA, VA, USDA and PMI claims experience preferred
Our Company:
Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you'll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: ***************************
What We Offer:
* Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed.
* Access to several fitness, restaurant, retail (and more!) discounts through our employee portal.
* Customized training programs to help you advance your career.
* Employee referral bonuses so you'll get paid to help Carrington and Vylla grow.
* Educational Reimbursement.
* Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org.
Notice to all applicants: Carrington does not do interviews or make offers via text or chat.
#LI-SY1
$23-26.5 hourly 22d ago
Viral - Content Claiming Specialist
Create Music Group 3.7
Remote senior claims specialist job
Create Music Group is currently looking for self-described viral internet culture enthusiasts to join our Viral Department.
Viral Content ClaimingSpecialist perform administrative tasks such as YouTube copyright claiming and asset onboarding, as well as scope out trending memes and social media videos on a daily basis. This position requires a regular workload of data entry/administration in order to carry out the most basic functions of our department but there are plenty of opportunities for more creative and ambitious pursuits if you are so inclined.
This is a full time position which may be done remotely, however our office is located in Hollywood, California, and we are currently only looking for job candidates who are located in California. In the future, you may be encouraged to come into our office for meetings or company functions, so it is best if you are located in the Los Angeles/Southern California area.
Through our Viral team, we collaborate with some of the most prominent viral talent from the TikTok and meme world including Supa Hot Fire (Deshawn Raw), Welven Da Great (Deez Nuts), Verbalase, KWEY B, Hoodnews, presidentofugly1, 10k Caash, dimetrees, Zackass, Supreme Patty, The Man with the Hardest Name in Africa, ViralSnare, Adin Ross, and more.
YouTube monetization provides an alternative consulting and revenue-generating resource for our clients to grow their audience and earnings. We have helped our clients monetize and collected millions in previously unclaimed revenue for content creators, artists and labels.
REQUIREMENTS:
1-3 years work experience
Excellent communication skills, both written and verbal
Internet culture and social media platforms, especially YouTube
Conducting basic level research
Organizing large amounts of data efficiently
Proficiency with Mac OSX, Microsoft Office, and Google Apps
PLUSES:
Strong understanding of the online video market (YouTube, Instagram, TikTok)
Bilingual - any language, although Spanish, Mandarin, and Russian is preferred
RESPONSIBILITIES:
We work directly with our clients and their team to help them break down the data and find potential opportunities to build their career. Daily responsibilities include but are not limited to the following.
Watching YouTube videos for several hours daily
Content claiming
Uploading and defining intellectual assets
Administrative metadata tasks
Researching potential clients
Staying on top of accounts for current client roster
As this is a remote position, you are required to have your own computer and reliable internet connection.
This position may require you to download a great deal of video files (files which may be deleted once onboarding tasks are completed) so please make sure that you have a computer that is up to the task.
Laptops are preferable if you would like to come into our office to work (snacks, soft drinks, and Starbucks coffee are provided at our physical office).
BENEFITS:
Paid company holidays, paid time off, and health benefits (medical, dental, vision, and supplementary policies) are included.
TO APPLY:
Send us your resume and cover letter (in one file). After you apply, you will be redirected to take our Culture Index survey here. Otherwise, copy and paste the link to your web browser: ********************************************************* Info.php?cfilter=1&COMPANY_CODE=cYEX5Omste
Applications without a cover letter and Culture Index survey will not be considered. OPTIONAL: Link relevant social media campaigns and/or writing samples from your portfolio.
$45k-75k yearly est. Auto-Apply 60d+ ago
Senior Claims Examiner (remote)
Switch'd
Remote senior claims specialist job
*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
$80k-94k yearly 60d+ ago
(Remote) Senior Claims Examiner
Efinancial 4.7
Remote senior claims specialist job
Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The SeniorClaims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The SeniorClaims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
* Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
* Review newly reported claims and log them on the pending claims log.
* Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
* Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
* Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
* On claims within the SeniorClaims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
* Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
* Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
* Handle and log specific State and NAIC policy locator searches.
* Mentor and support third-party claims administration staff.
* Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
* Work on special projects and other duties as assigned by the Claims Manager.
* Perform quarterly claim audits focusing on third-party claim handling.
* Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
* Handle Department of Insurance claim complaints or requests in a timely and professional manner.
* Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
* Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
* Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
* Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
* Support M&A activity, if applicable
Qualifications:
* 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
* Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
* Ability to meet deadlines while performing multiple functions.
* Proficient in MS Office applications and the Internet.
* Ability to proactively analyze and resolve problems.
* Attention to detail.
* Flexibility and willingness to adapt to changing responsibilities.
* Excellent written communication, interpersonal and verbal skills.
* Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
* Proactive and outside-the-box thinker.
* Independent and organized work style.
* Ability to maintain strong performance while working remotely and independently, if applicable.
* Strong judgment and discretion when handling highly confidential business, employee, and customer information.
* Team player and creative, critical thinker highly desired.
Licenses + Certifications:
* Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
* Legal or Paralegal Certifications optional but useful
Essential Functions:
* This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
* Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
* Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
* Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
* When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
* Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
* Salary Range: $70,720 - $91,520
* Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
* Dental Insurance: Coverage for preventive, basic, and major dental services.
* Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
* Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
* Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
* 401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
* PTO and Sick Time accrue each pay period: Take time off when you need it
* Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 49d ago
(Remote) Senior Claims Examiner
Your Journey Starts Here
Remote senior claims specialist job
Who We Are
Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The SeniorClaims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The SeniorClaims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
Review newly reported claims and log them on the pending claims log.
Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
On claims within the SeniorClaims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
Handle and log specific State and NAIC policy locator searches.
Mentor and support third-party claims administration staff.
Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
Work on special projects and other duties as assigned by the Claims Manager.
Perform quarterly claim audits focusing on third-party claim handling.
Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
Handle Department of Insurance claim complaints or requests in a timely and professional manner.
Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
Support M&A activity, if applicable
Qualifications:
5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
Ability to meet deadlines while performing multiple functions.
Proficient in MS Office applications and the Internet.
Ability to proactively analyze and resolve problems.
Attention to detail.
Flexibility and willingness to adapt to changing responsibilities.
Excellent written communication, interpersonal and verbal skills.
Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
Proactive and outside-the-box thinker.
Independent and organized work style.
Ability to maintain strong performance while working remotely and independently, if applicable.
Strong judgment and discretion when handling highly confidential business, employee, and customer information.
Team player and creative, critical thinker highly desired.
Licenses + Certifications:
Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
Legal or Paralegal Certifications optional but useful
Essential Functions:
This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
Salary Range: $70,720 - $91,520
Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
Dental Insurance: Coverage for preventive, basic, and major dental services.
Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
PTO and Sick Time accrue each pay period: Take time off when you need it
Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 47d ago
Senior Claims Representative
Liberty Mutual 4.5
Remote senior claims specialist job
Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As a Commercial Insurance Claims Representative, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual.
The preference is for the candidates to be located close to a hub and be in the office a minimum of 2 days/week (Hubs: Plano, TX, Suwanee, GA, Westborough, MA, Hoffman Estates, IL, Indianapolis, IN and Eugene. OR, and Phoenix, AZ) although candidates from any location will be considered. Please note this policy is subject to change.
Responsibilities:
Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
Determines and negotiates settlement amount for damages claimed within assigned authority limits.
Writes simple to moderately complex property damage estimates or review auto damage estimates.
Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed.
Qualifications
Bachelor's Degree preferred. High school diploma or equivalent required.
1-2 years of experience. Claims handling skills preferred.
Strong customer service and technology skills.
Able to navigate multiple systems, strong organizational and communication skills.
License may be required in multiple states by state law.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
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$69k-113k yearly est. Auto-Apply 20h ago
Sr Claims Examiner- MSI
The Baldwin Group 3.9
Remote senior claims specialist job
Why MSI? We thrive on solving challenges.
As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs.
We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners.
Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle.
Bring on your challenges and let us show you how we build insurance better.
The Sr Claims Examiner is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr Claims Examiner must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision
PRIMARY RESPONSIBILITIES:
• Analyzes insurance policies and other documents to determine insurance coverage.
• Investigates and analyzes claim information to determine extent of liability.
• Handles claims 1st Party Property Claims with complex to major severity.
• Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
• Sets timely, adequate reserves in compliance with the company's reserving philosophy.
• Engages experts to assist in the evaluation of the claim.
• Monitors vendor performance and controls expense costs.
• Evaluates, negotiates and determines settlement values.
• Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
• Handles all claims in accordance with Best Practices.
• Responsible for monitoring and completing assigned claims inventory.
• Acquire and maintain a state adjuster's license and meet state continuing education requirements.
• Provides Best-In-Class customer service for insureds and agents.
• Develops and maintains relationships with external and internal stakeholders.
• Acts as a mentor for less experienced Claims Examiners.
• Updates and maintains the claim file.
• Identifies opportunities for subrogation and ensures recovery interests are protected.
• Identifies fraud indicators and refers files to SIU for further investigation.
• Participates in claims audits, internal and external.
• Provides oversight of TPAs
• Assists with special projects
KNOWLEDGE, SKILLS & ABILITIES:
EDUCATION & EXPERIENCE:
High School/GED
10+ year's experience in claims
Must have Property & Casualty Insurance License
#LI-BM1
#LI-REMOTE
Click here for some insight into our culture!
The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The ClaimsSpecialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
* Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
* Communication via telephone, email, and text with employees, employers, attorneys, and others
* Review and interpret medical records, utilizing resources as appropriate
* Complete financial calculations
* Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
* Apply contract/policy provisions to ensure accurate eligibility and liability decisions
* Demonstrate and apply analytical and critical thinking skills
* Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
* Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
* Leverage a broad spectrum of resources, materials, and tools to render claims decisions
* Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
* Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
* Work independently as well as within a team structure
* Deliver refresher trainings as appropriate to the claim team
* Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
* Prepare reports for management on claim outcomes and performance metrics.
* Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
* Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
What You Will Bring
* Bachelor's degree or equivalent work experience
* 3 disability claims administration experience
* Prior leadership experience as a team lead or manager
* Exceptional customer service skills
* Maintains positive and effective interaction with challenging customers
* Strong knowledge of disability and leave laws and regulations
* Ability to handle sensitive information with confidentiality and professionalism
* Group Disability Claims experience
* Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
* Experience working with the Fineos Claim Management System
* Exceptional written and oral communication skills demonstrated in previous work experience
* Excellent organizational and time management skills with ability to multitask and prioritize deadlines
* Ability to manage multiple and changing priorities
* Detail oriented; able to analyze and research contract information
* Demonstrated ability to operate with a sense of urgency
* Experience in effectively meeting/ exceeding individual professional expectations and team goals
* Demonstrated analytical and math skills
* Ability to exercise critical thinking skills, risk management skills and sound judgment
* Ability to adapt, problem solve quickly and communicate effective solutions
* High level of flexibility to adapt to the changing needs of the organization
* Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
* Continuous improvement mindset
* A commitment to support a work environment that fosters diversity and inclusion.
* Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
About the Role
At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859.
Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) Claims Examiner to join our team! The ClaimsSpecialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.
What You'll Be Doing
· Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
· Communication via telephone, email, and text with employees, employers, attorneys, and others
· Review and interpret medical records, utilizing resources as appropriate
· Complete financial calculations
· Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
· Apply contract/policy provisions to ensure accurate eligibility and liability decisions
· Demonstrate and apply analytical and critical thinking skills
· Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
· Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
· Leverage a broad spectrum of resources, materials, and tools to render claims decisions
· Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
· Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
· Work independently as well as within a team structure
· Deliver refresher trainings as appropriate to the claim team
· Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
· Prepare reports for management on claim outcomes and performance metrics.
· Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills.
· Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits\: Equitable Total Rewards Program
What You Will Bring
· Bachelor's degree or equivalent work experience
· 3+ disability claims administration experience
· Prior leadership experience as a team lead or manager
· Exceptional customer service skills
· Maintains positive and effective interaction with challenging customers
· Strong knowledge of disability and leave laws and regulations
· Ability to handle sensitive information with confidentiality and professionalism
· Group Disability Claims experience
· Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
· Experience working with the Fineos Claim Management System
· Exceptional written and oral communication skills demonstrated in previous work experience
· Excellent organizational and time management skills with ability to multitask and prioritize deadlines
· Ability to manage multiple and changing priorities
· Detail oriented; able to analyze and research contract information
· Demonstrated ability to operate with a sense of urgency
· Experience in effectively meeting/ exceeding individual professional expectations and team goals
· Demonstrated analytical and math skills
· Ability to exercise critical thinking skills, risk management skills and sound judgment
· Ability to adapt, problem solve quickly and communicate effective solutions
· High level of flexibility to adapt to the changing needs of the organization
· Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
· Continuous improvement mindset
· A commitment to support a work environment that fosters diversity and inclusion.
· Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
**********
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE\: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
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
- 5+ years 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 ~80 claims per day with 98% accuracy.
- 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
Our client is seeking to add a Senior Commercial Auto Litigation Claims Examiner to their team. This individual will be responsible for overseeing complex commercial auto claims, with a strong focus on litigated matters and severe casualty exposures. The role requires managing the claim process from initial intake through final resolution, including evaluating coverage, directing litigation strategy, and negotiating settlements across multiple jurisdictions. This position offers the ability to work fully remote. Key Responsibilities:
Investigate, evaluate, and resolve litigated Commercial Auto claims from inception through closure.
Analyze liability, damages, and legal exposure to determine appropriate resolution strategies.
Establish timely and appropriate reserves based on investigation and litigation progression.
Partner with defense counsel, insureds, and other experts to effectively manage claims and litigation costs.
Conduct coverage analysis and issue detailed coverage position letters when necessary.
Prepare reports and updates for senior leadership, clients, and other stakeholders.
Maintain consistent communication with policyholders, attorneys, and internal teams throughout the claim lifecycle.
Ensure timely file documentation in compliance with company, client, and regulatory standards.
Negotiate settlements in line with company/client authority and jurisdictional requirements.
Stay current on evolving laws, regulations, and litigation trends impacting commercial auto liability.
Requirements:
10+ years of Commercial Auto / Trucking Bodily Injury Litigation claims handling experience.
Must have 4+ years of Commercial Trucking experience.
Strong knowledge in MCS 90 is strongly desired.
Active Adjuster's License required.
Proven experience managing litigated claims and working directly with defense counsel.
Strong negotiation, litigation management, and analytical skills.
Excellent written and verbal communication skills, including drafting detailed coverage letters and litigation reports.
Highly organized, self-motivated, and able to independently manage a remote workload.
Proficient in Microsoft Office and claims management systems.
Salary & Benefits:
$90,000 - $120,000+ annually (depending on experience)
Comprehensive Medical, Dental, and Vision coverage
401(k) with company match
Paid Time Off and holiday benefits
Professional development and career advancement opportunities
$37k-48k yearly est. 60d+ ago
Liability Claims Adjuster
Porch Group 4.6
Remote senior claims specialist job
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.
$67.5k-94.5k yearly Auto-Apply 41d ago
Patient Claims Specialist - Bilingual Only
Modmed 4.5
Remote senior claims specialist job
We are united in our mission to make a positive impact on healthcare. Join Us!
South Florida Business Journal, Best Places to Work 2024
Inc. 5000 Fastest-Growing Private Companies in America 2024
2024 Black Book Awards, ranked #1 EHR in 11 Specialties
2024 Spring Digital Health Awards, “Web-based Digital Health” category for EMA Health Records (Gold)
2024 Stevie American Business Award (Silver), New Product and Service: Health Technology Solution (Klara)
Who we are:
We Are Modernizing Medicine (WAMM)! We're a team of bright, passionate, and positive problem-solvers on a mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. Our vision is a world where the software we build increases medical practice success and improves patient outcomes. Founded in 2010 by Daniel Cane and Dr. Michael Sherling, we have grown to over 3400 combined direct and contingent team members serving eleven specialties, and we are just getting started! ModMed's global headquarters is based in Boca Raton, FL, with a growing office in Hyderabad, India, and a robust remote workforce across the US, Chile, and Germany.
ModMed is hiring a driven Patient ClaimSpecialist who will play a pivotal role in shaping a positive patient experience within our passionate, high-performing Revenue Cycle Management team. As a critical team member, you will support patients receiving care from ModMed BOOST service providers and doctors, ensuring their account needs are met excellently. This direct interaction with our customers' patients makes you an integral part of ModMed's business. It opens the door to an exhilarating career path for individuals driven by a passion for healthcare and exceptional customer service within a fast-paced Healthcare IT company that is genuinely Modernizing Medicine!
Your Role:
Serve as primary contact for all inbound and outbound patient calls regarding patient balance inquiries, claims processing, insurance updates, and payment collections
Initiate outbound calls to patients of RCM clients to understand and address any account/payment issues, such as demographic and insurance updates
Input and update patient account information and document calls into the Practice Management system
Special Projects: Other duties as required to support and enhance our customer/patient-facing activities
Skills & Requirements:
High School Diploma or GED required
Availability to work 9:30-5:30pm PST or 11:30am to 8:30 pm EST
Minimum of 1-2 years of previous healthcare administration or related experience required
Basic understanding of medical billing claims submission process and working with insurance carriers required (e.g., Medicare, private HMOs, PPOs)
Manage/ field 60+ inbound calls per day
Bilingual is a requirement (Spanish & English)
Proficient knowledge of business software applications such as Excel, Word, and PowerPoint
Strong communication and interpersonal skills with an emphasis on the ability to work effectively over the telephone
Ability and openness to learn new things
Ability to work effectively within a team in order to create a positive environment
Ability to remain calm in a demanding call center environment
Professional demeanor required
Ability to effectively manage time and competing priorities
#LI-SM2
ModMed Benefits Highlight:
At ModMed, we believe it's important to offer a competitive benefits package designed to meet the diverse needs of our growing workforce. Eligible Modernizers can enroll in a wide range of benefits:
India
Meals & Snacks: Enjoy complimentary office lunches & dinners on select days and healthy snacks delivered to your desk,
Insurance Coverage: Comprehensive health, accidental, and life insurance plans, including coverage for family members, all at no cost to employees,
Allowances: Annual wellness allowance to support your well-being and productivity,
Earned, casual, and sick leaves to maintain a healthy work-life balance,
Bereavement leave for difficult times and extended medical leave options,
Paid parental leaves, including maternity, paternity, adoption, surrogacy, and abortion leave,
Celebration leave to make your special day even more memorable, and company-paid holidays to recharge and unwind.
United States
Comprehensive medical, dental, and vision benefits
401(k): ModMed provides a matching contribution each payday of 50% of your contribution deferred on up to 6% of your compensation. After one year of employment with ModMed, 100% of any matching contribution you receive is yours to keep.
Generous Paid Time Off and Paid Parental Leave programs,
Company paid Life and Disability benefits, Flexible Spending Account, and Employee Assistance Programs,
Company-sponsored Business Resource & Special Interest Groups that provide engaged and supportive communities within ModMed,
Professional development opportunities, including tuition reimbursement programs and unlimited access to LinkedIn Learning,
Global presence and in-person collaboration opportunities; dog-friendly HQ (US), Hybrid office-based roles and remote availability for some roles,
Weekly catered breakfast and lunch, treadmill workstations, Zen, and wellness rooms within our BRIC headquarters.
PHISHING SCAM WARNING: ModMed is among several companies recently made aware of a phishing scam involving imposters posing as hiring managers recruiting via email, text and social media. The imposters are creating misleading email accounts, conducting remote "interviews," and making fake job offers in order to collect personal and financial information from unsuspecting individuals. Please be aware that no job offers will be made from ModMed without a formal interview process, and valid communications from our hiring team will come from our employees with a ModMed email address (*************************). Please check senders' email addresses carefully. Additionally, ModMed will not ask you to purchase equipment or supplies as part of your onboarding process. If you are receiving communications as described above, please report them to the FTC website.
$66k-101k yearly est. Auto-Apply 27d ago
Claims Specialist - Life Global Claims
Gen Re Corporation 4.8
Remote senior claims specialist job
Shape Your Future With UsGeneral Re Corporation, a subsidiary of Berkshire Hathaway Inc., is a holding company for global reinsurance and related operations, with more than 2,000 employees worldwide. It owns General Reinsurance Corporation and General Reinsurance AG, which conducts business as Gen Re.
Gen Re delivers reinsurance solutions to the Life/Health and Property/Casualty insurance industries. Represented in all major reinsurance markets through a network of 38 offices, we have earned superior financial strength ratings from each of the major rating agencies.
Gen Re currently offers an excellent opportunity for a ClaimsSpecialist in our Life Health Global Claims unit to work remotely based out of our Stamford, CT office.
Role Description
The ClaimSpecialist is responsible for the delivery of the reinsurance claim risk management on multiple lines of business to both internal and external Gen Re clients. This includes, but is not limited to, the risk assessment of reinsurance liability and may include client training development and delivery, audit activities as well as representing the company and/or speaking at various industry conferences, as requested.
Responsibilities:
Responsible timely decision making and accuracy of reinsurance determinations on multiple lines of claim submissions. Incumbent contributes to the accurate and efficient adjudication of claims by supporting the department and client's investigation or coaching/mentoring on claims in all ranges of complexity to ensure compliance with policy provisions, state/federal regulations and reinsurance treaties in effect.
Maintains a working knowledge of state and federal regulatory issues and keeps on the cutting edge of changes within the incumbent's area of expertise.
Deliver high levels of customer service to internal and external customers in a professional, reliable and responsive manner.
The incumbent works with claims management to develop, prioritize and execute a claim management strategy for each assigned client.
Responsible for influencing a variety of constituents at various levels and not within one's direct employ. Thus, being accountable for the effective development, ongoing maintenance and consistent application of client communications and relationships.
As an expert claim resource within a specific line of business, the ClaimSpecialist monitors national verdict/settlement trends and legal developments pertaining to their particular line of business. The incumbent researches, drafts and publishes articles and training oriented to educating clients on best practices gleaned.
Responds to ad hoc reporting /projects from manager. Timely and accurate reporting of statistical information to management. Provides a broad range of regular (monthly/quarterly) management information in support of the Claims Department. Responsible for synthesizing a large amount of information from a variety of sources.
May participate in client / TPA due diligence activities such as supporting audit activity, identifying emerging trends and themes not only in the client's inventory but within the industry; supporting manager with industry gleaned best practices via building and delivering customer specific training programs and seminars; emphasizing and implementing technical solutions to business needs to achieve desired improvements when asked.
May participate in client meetings or with prospective accounts.
Role Qualifications and Experience
Prior claims experience in insurance and/or reinsurance operations.
Prior experience managing claims (preferably LTC or Income Protection) thereby equipping the incumbent with the ability to assess reinsurer responsibility in its broadest sense (e.g. reviewing and offering risk management insights and recommendations on facultative and consultative claim submissions).
Experience auditing claim files. Audit work of reinsured claims remotely or in client locations is an expectation. The audit process requires the ability to quickly adapt to the multitude of imaged systems in use by clients. The audit process may involve analyzing and verifying coverage and/or corresponding payments issued. The audit process may consist of managing internal and external communication with client executives in various areas such as claims, financial and legal resources, actuarial resources, etc. Thus, demonstrating an ability to emphasize and implement solutions to help clients manage risk and developing an in-depth knowledge of the management and organization of each assigned account.
Holds insurance adjuster's license or a willingness to secure same within 1 year of hire
Strong working knowledge of key coverage lines especially health (Long Term Care, Individual Disability) type claims
Strong written and verbal communication skills
Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously or as an effective member of a team
Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to detail
Flexibility to travel for business purposes, approximately less than 10 trips per year
Strong client relationship, influencing and interpersonal skills
Proven initiative, prioritization, presentation, and training abilities.
Experience with and proficiency in Microsoft Suite of Products (WORD, EXCEL, PowerPoint), Visio, Power BI, developing and running queries etc.
Salary Range
91,000.00 - 152,000.00 USD
The annual base salary range posted represents a broad range of salaries around the US and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training.
Our Corporate Headquarters Address
General Reinsurance Corporation
400 Atlantic Street, 9th Floor
Stamford, CT 06901 (US)
At
General Re Corporation, we celebrate diversity and are committed to creating an inclusive environment for all employees. It is the General Re Corporation's continuing policy to afford equal employment opportunity to all employees and applicants for employment without regard to race, color, sex (including childbirth or related medical conditions), religion, national origin or ancestry, age, past or present disability , marital status, liability for service in the armed forces, veterans' status, citizenship, sexual orientation, gender identity, or any other characteristic protected by applicable law. In addition, Gen Re provides reasonable accommodation for qualified individuals with disabilities in accordance with the Americans with Disabilities Act.
$53k-73k yearly est. 34d ago
Claims Specialist
Creative Financial Staffing 4.6
Senior claims specialist job in Reynoldsburg, OH
Our client in the medical supply industry is seeking a ClaimsSpecialist to support a high-impact revenue recovery project tied to recent Medicare and Tricare processing changes. Salary is $41,600-$52,000, DOE
ABOUT OUR CLIENT
A well-established provider of medical equipment in the Columbus-area
Known for supporting both private and government healthcare networks
Collaborative, detail-driven office culture focused on accuracy and results
Casual work environment with an emphasis on professional accountability
Opportunity to make a measurable impact on recovering aged receivables and strengthening cash flow as the ClaimsSpecialist
RESPONSIBILITIES OF THE CLAIMSSPECIALIST
The ClaimsSpecialist will post claims in Bonafide, ensuring all data meets current HCPC and Tricare standards
The ClaimsSpecialist will reconcile and correct rejected or pending claims, attaching required documentation and resubmitting for processing
Communicate directly with Medicare and Tricare representatives to verify claim receipt, payment status, and issue resolution
Track, document, and report claim and cash recovery progress to leadership
PREFERRED QUALIFICATIONS FOR THE CLAIMSSPECIALIST
Must have hands-on experience with both Tricare and Medicare billing
Must have direct experience using Bonafide billing software
Knowledge of claims processing, EOB reconciliation, and appeals workflow
Experience with Excel is a plus (basic to intermediate proficiency)
Salary is $41,600-$52,000, DOE
$41.6k-52k yearly 23h ago
Claims Specialist - Auto
Philadelphia Insurance Companies 4.8
Senior claims specialist job in Dublin, OH
Marketing Statement:
Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.
We are looking for a ClaimsSpecialist - Auto to join our team.
JOB SUMMARY
Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.
JOB RESPONSIBILITIES
Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
Communicates with all relevant parties and documents communication as well as results of investigation.
Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
Travel is required to attend customer service calls, mediations, and other legal proceedings.
JOB REQUIREMENTS
High School Diploma; Bachelor's degree from a four-year college or university preferred.
10 plus years related experience and/or training; or equivalent combination of education and experience.
• National Range : $82,800.00 - $97,300.00
• Ultimate salary offered will be based on factors such as applicant experience and geographic location.
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Benefits:
We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at *****************************************