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  • Senior Triage Examiner

    Insurance Company of The West

    Remote senior examiner job

    Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The purpose of this job is to manage new Workers' Compensation losses for the first 10 days of the life of the claim. This job takes necessary steps to assess and summarize new losses, prepare an action plan, set diaries, and reserve the file, all in preparation for assigning the file to an examiner for permanent handling. ESSENTIAL DUTIES AND RESPONIBILITIES Administers benefits to injured workers in accordance with statutory and case law as well as pertinent regulations for the first 10 days of the claim. Represents the Workers' Compensation Department and ICW Group when interacting with injured workers. Communicates with insureds to obtain information necessary for processing claims. Contacts and/or interviews injured workers, doctors, medical specialists, attorneys, and employers to get additional information. Communicates claim activity and processing with the injured worker and insured. Maintains professional client relationships. Communicates effectively with other Company departments. Creates reserves in a timely manner to ensure reserving activities are consistent with company standards and best practices guidelines. Manages complex claims and approves payment of benefits within higher designated authority level. Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. Prepares an action plan and set diaries, in preparation for assigning the file to an examiner for permanent handling. Assists with special projects and development of more junior team members as needed. SUPERVISORY RESPONSIBILITIES This role does not have supervisory responsibilities but may mentor and/or train junior team members. EDUCATION AND EXPERIENCE High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred. Minimum of 2-3 years of insurance or claims related experience, or equivalent combination of education and experience required. Minimum 1-2 years of workers' compensation claims experience required. CERTIFICATES, LICENSES, REGISTRATIONS California Only : All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required. California Only: California Workers' Compensation Claims Administration (WCCA) and Workers' Compensation Claim Professional (WCCP) certifications preferred. All other jurisdictions: State Workers' Compensation License as required. KNOWLEDGE AND SKILLS Understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written communication skills, time management and organizational skills. Requires a high level of attention to detail. Team oriented and a sense of urgency for execution. Able to resolve conflicts fairly and equitably. Problem solving and decision-making ability, PHYSICAL REQUIREMENTS Office environment - no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear. WORK ENVIRONMENT This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. We are currently not offering employment sponsorship for this opportunity #LI-ET1 #LI-Hybrid The current range for this position is $61,979.26 - $97,736.56 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work. WHY JOIN ICW GROUP? Challenging work and the ability to make a difference You will have a voice and feel a sense of belonging We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match Bonus potential for all positions Paid Time Off Paid holidays throughout the calendar year Want to continue learning? We'll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. ___________________ Job Category Claims
    $62k-97.7k yearly Auto-Apply 16d ago
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  • Member of Compliance, FIU & Fraud

    Anchorage Digital

    Remote senior examiner job

    At Anchorage Digital, we are building the world's most advanced digital asset platform for institutions to participate in crypto. Anchorage Digital is a crypto platform that enables institutions to participate in digital assets through custody, staking, trading, governance, settlement, and the industry's leading security infrastructure. Home to Anchorage Digital Bank N.A., the first federally chartered crypto bank in the U.S., Anchorage Digital also serves institutions through Anchorage Digital Singapore, Porto by Anchorage Digital, and other offerings. The company is funded by leading institutions including Andreessen Horowitz, GIC, Goldman Sachs, KKR, and Visa, with its Series D valuation over $3 billion. Founded in 2017 in San Francisco, California, Anchorage Digital has offices in New York, New York; Porto, Portugal; Singapore; and Sioux Falls, South Dakota. Learn more at anchorage.com, on X @Anchorage, and on LinkedIn. As a Member of Compliance, Fraud, you will collaborate with leadership to advance Anchorage Digital's blockchain analytics and fraud investigation capabilities. This role entails collaboratively working with the FCC's fraud control tools, identifying and evaluating blockchain-based risks, and spearheading initiatives to enhance the organization's comprehension and utilization of blockchain technology and anti-fraud technology. The role also entails working with Digital Asset and Fiat Data. This role merges technical expertise with strategic foresight to guarantee effective blockchain data management, Fiat activity, and the recognition of emerging trends and risks within the digital asset ecosystem. The role is essential to the Bank's defense against money laundering, terrorist financing and fraud, as well as the expansion of the Global FCC Model.Technical Skills: Demonstrates expert advisory support across multiple teams, ensuring that the organization remains resilient against blockchain-based financial crimes and adheres to evolving regulatory requirements. SAR form completion and filing expertise Provides investigative/analytic support for complex, technical, and/or highly sensitive investigations and initiatives across the FCC functional teams. Partners with the FCC functional teams to accurately apply attribution to entities behind cryptocurrency addresses and contracts in support of the FCC and serviced entities. Develops and delivers training materials and sessions to internal teams to improve awareness and understanding of blockchain technology, compliance issues, and emerging risks. Utilizes blockchain analytics tools to trace the flow of digital assets across multiple networks and identify bad actors. Continuously monitors and conducts in-depth analysis of digital asset and Fiat data to uncover patterns, trends, and suspicious activities across blockchain networks and Banking partners. Provides technical analysis for high-risk escalations to assess findings beyond initial flags and/or risk indicators. Complexity and Impact of Work: Capable of navigating challenges and exercising expert judgment in the selection of processes, techniques, and criteria for obtaining efficient results, working diligently in a fast paced environment where change in prioritization is fluent. Provides expert advice and support to compliance, legal, and regulatory teams on investigations related to digital assets, Fiat, risk mitigation strategies, and the Digital Asset Support Framework. Works with FCC leadership to boost operational efficiency and scale through strategic alignment, process improvements, technical integration, automation, knowledge transfer, training, risk mitigation, compliance, proactive insights, and adaptability. Offers expert guidance and support the development, implementation, and enhancement of digital asset compliance programs and controls to align with international AML and CTF standards, ensuring compliance with evolving regulations concerning digital assets, DeFi, and VASPs, across global operations. Assists in creating policies and procedures for monitoring and reporting suspicious digital asset activities, and assist the Financial Crime Compliance Teams in reviewing secondary market risk of Bank-issued stablecoins, internal attribution, and TRM Labs blockchain analytics alerts, as needed. Assists in conducting QC work of L1 Analyst reviews. Independently completes projects within the team with minimal supervision from leadership, including collaborating tasks among team members. Consistently demonstrates on-time delivery and high quality work product. Where a deadline or commitment is at risk, escalates to manager to help manage priorities, if appropriate, and alerts affected stakeholders so "no surprises." Organizational Knowledge: Is aware of the strategy of Anchorage Digital to guarantee its successful implementation and is considered when defining the planning and goals of the team. Has a deep understanding of Anchorage Digital's objectives and works with leadership to ensure regulatory compliance is being met. Ensures that knowledge is shared amongst Anchorage Digital, and more specifically, the FCC Team, and does not position themselves or others as a single point of failure. Serves as a representative of Anchorage Digital to provide Fiat technical knowledge and blockchain tracing expertise during training events/conferences, prospective client meetings/demonstrations, and client support/planning, as needed. Communication and Influence: Stays up-to-date with regulatory developments in the digital asset space and advise on the implications for the business, working closely with internal teams (e.g., Legal, Risk, Compliance, IT) to ensure blockchain or anti-fraud initiatives are aligned with business objectives, risk management, and regulatory compliance. Engages with external partners (law enforcement, regulators, and blockchain analytics firms) to share insights and strengthen digital asset or fraud intelligence capabilities. Collaborates with internal teams (e.g., security, and compliance) to coordinate rapid response to blockchain-related incidents, ensuring appropriate Financial Crime Compliance teams are notified and provided sufficient details, as needed. Mentors and guides others within the FCC Team, helping to understand the strategic goals of the compliance department and how their work relates to the broader company. Able to collaborate with leadership in a professional manner in order to convey insights, recommendations, conclusions and ideas on how to improve the FCC Team. Consistently expresses clear, thoughtful, analytical and solutions-oriented communications, whether in high-impact slides/decks, written communications in slack or email, or verbal communications. You may be a fit for this role if you have: Blockchain tracing expertise-across multiple chains Fiat fraud case expertise Expertise in the unique aspects of different layer 1s, along with smart contracts, staking pools, etc. Excellent writing and presentation skills Experience reviewing transaction monitoring alerts and performing thorough case investigations Although not a requirement, bonus points if: Investigation certifications from either TRM Labs or Chainalysis or Elliptic Experience using Sentilink or LexisNexis Threatmetrix Previous experience with regulated digital asset or Financial Institution compliance About Anchorage Digital: Who we are The Anchorage Village, what we call our team, brings together the brightest minds from platform security, financial services, and distributed ledger technology to provide the building blocks that empower institutions to safely participate in the evolving digital asset ecosystem. As a diverse team of more than 600 members, we are united in one common goal: building the future of finance by providing the foundation upon which value moves safely in the new global economy. Anchorage Digital is committed to being a welcoming and inclusive workplace for everyone, and we are intentional about making sure people feel respected, supported, and connected at work-regardless of who you are or where you come from. We value and celebrate our differences and we believe being open about who we are allows us to do the best work of our lives. Anchorage Digital is an Equal Opportunity Employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. Anchorage Digital considers qualified applicants regardless of criminal histories, consistent with other legal requirements. “Anchorage Digital” refers to services that are offered either through Anchorage Digital Bank National Association, an OCC-chartered national trust bank, or Anchorage Lending CA, LLC a finance lender licensed by the California Department of Financial Protection and Innovation, License No. 60DBO-11976, or Anchorage Digital Singapore Pte Ltd, a Singapore private limited company, all wholly-owned subsidiaries of Anchor Labs, Inc., a Delaware corporation. Protecting your privacy rights is important to Anchorage Digital, and we work to maintain the trust and confidence of our clients when handling personal or financial information. Please see our privacy policy notices here.
    $56k-84k yearly est. Auto-Apply 3d ago
  • Financial Examiner

    Rsm 4.4company rating

    Remote senior examiner job

    We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM. The Financial Examiner will primarily perform financial examinations and regulatory consulting services for state insurance departments. This position has significant opportunity for advancement as well as personal and professional growth. Responsibilities (Responsibilities vary depending on seniority level) Perform risk focused financial examinations to determine solvency and compliance to statutes on behalf of Risk & Regulatory Consulting LLC insurance clients. Perform reviews of examination work papers and evaluate insurance company operations. Ensure the integrity of the regulatory system. Assist with the preparation of reports, exhibits, and other supporting schedules that detail a company's solvency, condition and compliance with laws and regulations, and recommend solutions to questionable financial conditions. Responsible for timely submission of draft reports for review. Recommend/document actions to ensure compliance with laws and regulations, or to protect solvency of the company. Provide knowledge and guidance of insurance laws, rules, and regulations. Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to interpret their meaning and determine impact to the company. Analyze financial operating statements, reports, and records relating to specific and overall operations of insurance companies; prepare and supervise writing of clear, complete, concise, and informative reports of financial conditions of insurance companies and health care organizations. Consistently enhance knowledge of: principles, practices, techniques, and methods of accounting and auditing; insurance examination and regulation; insurance laws and Insurance Commissioner's rulings; and related Attorney General opinions and court decisions; insurance company practices; statistical sampling procedures; basic actuarial mathematics; principles and practice of effective supervision, insurance companies and health care organizations. Qualifications Bachelor's Degree in Accounting or Finance; MBA and/or professional certification/s preferred Minimum 5+ years experience as an accountant, auditor or examiner with a state insurance department or a public accounting firm or as an accountant, internal or external auditor or examiner of insurance companies. Insurance industry experience is a must. Certified Financial Examiner (CFE) or CFE Candidate, CPA or CPA candidate, and/or Certified Internal Auditor (CIA) or CIA Candidate a plus PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point) Strong interpersonal, presentation, analytical and examination/audit skills Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills Strong written and verbal communication skills are required Dynamic/flexible demeanor with exceptional client service skills Must be self-motivated, work well independently and possess a sense of urgency Skilled in team building and team development Work from home with flexibility to travel Ability to demonstrate ethical and professional standards as outlined by the Firm At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at ************************************************** All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at ************ or send us an email at *****************. RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate. RSM will consider for employment qualified applicants with arrest or conviction records. For those living in California or applying to a position in California, please click here for additional information. At RSM, an employee's pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range. Compensation Range: $69,800 - $132,000 Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance.
    $69.8k-132k yearly Auto-Apply 31d ago
  • Sr Claim Examiner- WC

    Crawford 4.7company rating

    Remote senior examiner job

    📢 We're Hiring: Senior Claims Examiner - Workers Compensation 💻 Work From Home 🧘 Excellent Crawford Benefits that Empower Financial, Physical, and Mental wellness 🎯 Great Bonus Opportunity 🤝 Generous Employee Referral Bonus program 🛍️ Access to Multiple Employee Discounts 💼 We're looking for a Senior Claims Examiner - WC with a passion for claims management to join our team! 📘 Licensing is required 🏅 Proven experience managing Multi‑jurisdictions Workers Compensation claims! What You'll Do: 🔍 Investigate and settle advanced, large-loss, and complex claims promptly and equitably under minimal supervision, while managing moderate-to-difficult claims within established authority. 📄 Review coverages, determine liability and compensability, gather essential information, arrange property damage appraisals, and settle claims using best practices. 📊 Evaluate and set reserves, assist with litigation preparation, and contribute to team success by conducting training and mentoring new hires. 🌍 This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise. Bachelor's degree or equivalent experience required. Industry designations preferred but not required (IIA, AIC, AEI and/or CPCU).. Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization. Ability to work independently while assimilating various technical subjects.. Strong written and oral communication, negotiation and presentation skills. Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects. Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients. Workers Compensation (WC) Adjuster License required according to jurisdictional requirements #LI-EM3 Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted. Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. Analyzes claims activity and prepares reports for clients/carriers and management. Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements. Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. Develops subrogation and third party recovery potential and follows reclaim procedures. Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
    $40k-59k yearly est. Auto-Apply 9d ago
  • Financial Clearance - Remote

    Conifer Health Solutions 4.7company rating

    Remote senior examiner job

    The Patient Service Center Representative II is responsible for creating a positive patient experience by accurately and efficiently handling the day-to-day operations relating to both Financial Clearance and Scheduling of a patient. This includes adherence to department policies and procedures related to verification of eligibility/benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties in addition to full scheduling duties. Upon occasion, the PSC REP II may be only assigned to complex pre-registration. The PSC REP II is expected to develop a thorough understanding of assigned function(s). ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Completes both scheduling functions and registration functions with the patient for an upcoming visit during one call: Scheduling: Responsible for timely scheduling, provide callers with important information related to their appointment (i.e. Prep information for test, directions, order management etc.) Financial Clearance: up to and including verifying patient demographic, insurance information and securing payment of patients financial liability/performing collection efforts If assigned to Order Management: verifies order is complete and matches scheduled procedure. Includes indexing and exporting physicians orders to correct account number. If assigned to complex Pre-Reg: Collect and verify required patient demographic and financial data elements, including determining a patient's financial responsibility and securing pre-payment for future services/performing collection efforts Create a complete pre-registration account for an upcoming inpatient/surgical admission Completes all pre-certification requirements by obtaining authorization from insurer and/or healthcare facility Other duties as assigned based on departmental needs KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to work in a production driven call-center environment Familiarity with working with dual computer monitors (may be required to use dual monitors) Must have basic typing ability Must have working knowledge of Windows based computer environment Ability to multitask in multiple systems (financial clearance and scheduling) simultaneously Extensive multitasking ability Strong written and verbal communication skills Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. Required: High school diploma or GED Preferred: Two plus years of college (two years in a professional, customer service-driven environment may substitute for two years of college), completion of related medical certification program Preferred: Telephone/call center experience Preferred: Pre-registration and/or scheduling experience Preferred: 2-3 years of customer service experience PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work in sitting position, use computer and answer telephone Ability to travel WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office Work Environment Hospital Work Environment TRAVEL Approximately 0% travel may be required As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.
    $15.8-23.7 hourly Auto-Apply 6d ago
  • (Remote) Senior Claims Examiner

    Efinancial 4.7company rating

    Remote senior examiner job

    The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: * Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. * Review newly reported claims and log them on the pending claims log. * Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. * Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. * Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. * On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. * Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. * Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. * Handle and log specific State and NAIC policy locator searches. * Mentor and support third-party claims administration staff. * Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. * Work on special projects and other duties as assigned by the Claims Manager. * Perform quarterly claim audits focusing on third-party claim handling. * Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. * Handle Department of Insurance claim complaints or requests in a timely and professional manner. * Stay current on all laws, regulations, and industry updates that impact claim handling and compliance * Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. * Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights * Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact * Support M&A activity, if applicable Qualifications: * 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: * Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. * Ability to meet deadlines while performing multiple functions. * Proficient in MS Office applications and the Internet. * Ability to proactively analyze and resolve problems. * Attention to detail. * Flexibility and willingness to adapt to changing responsibilities. * Excellent written communication, interpersonal and verbal skills. * Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. * Proactive and outside-the-box thinker. * Independent and organized work style. * Ability to maintain strong performance while working remotely and independently, if applicable. * Strong judgment and discretion when handling highly confidential business, employee, and customer information. * Team player and creative, critical thinker highly desired. Licenses + Certifications: * Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. * Legal or Paralegal Certifications optional but useful Essential Functions: * This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. * Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. * Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. * Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. * When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. * Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: * Salary Range: $70,720 - $91,520 * Medical Insurance: Choose from a variety of plans to fit your healthcare needs. * Dental Insurance: Coverage for preventive, basic, and major dental services. * Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. * Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. * Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. * 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. * PTO and Sick Time accrue each pay period: Take time off when you need it * Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
    $70.7k-91.5k yearly 38d ago
  • (Remote) Senior Claims Examiner

    Your Journey Starts Here

    Remote senior examiner job

    The Senior Claims Examiner works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior Claims Examiner is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines. Key Responsibilities: Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person. Review newly reported claims and log them on the pending claims log. Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions. Review and interpret insurance policy provisions to ensure accurate and timely claim decisions. Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed. On claims within the Senior Claims Examiner's authority limit (500,000), confirm benefits and statutory interest are calculated correctly. Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed. Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed. Handle and log specific State and NAIC policy locator searches. Mentor and support third-party claims administration staff. Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise. Work on special projects and other duties as assigned by the Claims Manager. Perform quarterly claim audits focusing on third-party claim handling. Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams. Handle Department of Insurance claim complaints or requests in a timely and professional manner. Stay current on all laws, regulations, and industry updates that impact claim handling and compliance Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests. Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact Support M&A activity, if applicable Qualifications: 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred). Skills: Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements. Ability to meet deadlines while performing multiple functions. Proficient in MS Office applications and the Internet. Ability to proactively analyze and resolve problems. Attention to detail. Flexibility and willingness to adapt to changing responsibilities. Excellent written communication, interpersonal and verbal skills. Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages. Proactive and outside-the-box thinker. Independent and organized work style. Ability to maintain strong performance while working remotely and independently, if applicable. Strong judgment and discretion when handling highly confidential business, employee, and customer information. Team player and creative, critical thinker highly desired. Licenses + Certifications: Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required. Legal or Paralegal Certifications optional but useful Essential Functions: This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time. Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential. Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence. Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays. When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Compensation & Benefits: We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide: Salary Range: $70,720 - $91,520 Medical Insurance: Choose from a variety of plans to fit your healthcare needs. Dental Insurance: Coverage for preventive, basic, and major dental services. Employer-Paid Vision: Comprehensive eye care coverage at no cost to you. Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection. Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury. 401(k) Plan: Save for your future with a company match to help you grow your retirement savings. PTO and Sick Time accrue each pay period: Take time off when you need it Annual Bonus Program: Performance-based bonus to reward your hard work. EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages. Remote work is not available in the following States: California, Colorado, Connecticut, and New York. #FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
    $70.7k-91.5k yearly 36d ago
  • Senior Claims Examiner (remote)

    Switch'd

    Remote senior examiner job

    *5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
    $80k-94k yearly 60d+ ago
  • Sr Claims Examiner II

    Penn Mutual 4.8company rating

    Remote senior examiner job

    The Sr Claims Examiner II is a subject matter expert responsible for handling highly complex and sensitive claims within Life, Annuity, RPS, or a combination of all three, including escalated cases, requiring advanced judgment and interpretation. This role provides leadership in process improvements, mentors junior examiners, and serves as a key resource for technical guidance. The position requires deep expertise, strong analytical skills, and the ability to manage risk effectively. Responsibilities Independently adjudicate highly complex life, annuity, and/or RPS death claims, ensuring compliance with all regulatory and contractual requirements. Exercise sound judgement and utilize appropriate medical and risk resources, adhering to referral policies, and transferring claims to appropriate risk level in timely manner. Demonstrate strong relationship building, customer service and communication when interacting with customers and business partners. Serve as an escalation point for unusual or disputed cases, providing expert analysis and resolution. Lead investigations into complex claims and collaborate with legal, compliance, and other departments as needed. Mentor and provide technical guidance to Sr Claims Examiner I and other team members. Identify and implement process improvements to enhance efficiency and accuracy. Represent the claims function in cross-functional projects and initiatives. Adheres to Service Level Agreements (SLAs) and individual/team metrics. Ability to work core business hours between 8:30 AM to 6:00 PM EST. Knowledge, Skills, and Abilities Expert knowledge of life insurance products, claims processes, and regulatory requirements. Advanced analytical and decision-making skills with ability to interpret complex contracts. Ability to multitask and adapt to a changing environment. Detail oriented, organized and accurate. Strong leadership and mentoring capabilities. Excellent communication and relationship building skills with a customer service mindset. Proficiency in claims systems and advanced digital tools. Ability to manage risk and drive continuous improvement initiatives. Proven experience implementing AI tools to automate or improve work processes. Education Bachelor's degree required Master's degree preferred Experience Minimum 5-7 years of experience in life, annuity, and/or RPS (combined) claims required 10+ years preferred for complex case handling Certifications Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) strongly preferred. Base Salary Range - $65,000 - $75,000 For over 175 years, Penn Mutual has empowered individuals, families and businesses on the journey to achieve their financial goals. Through our partnership with Financial Professionals across the U.S., we help instill the confidence and reliability that comes from a stronger financial future. Penn Mutual and its affiliates offer a comprehensive suite of competitive products and services to meet the unique needs of Financial Professionals and their clients, including life insurance, annuities, wealth management and institutional asset management. To learn more, including current financial strength ratings, visit ******************* Penn Mutual is committed to Equal Employment Opportunity (EEO). We provide employment and advancement opportunities to all qualified applicants and associates, according to applicable laws. This is reflected in our practices for hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment, compensation, selection or training, and all other terms and conditions of employment. All employment-related decisions and practices are free from unlawful discrimination. This includes: race, creed, color, national origin, ancestry, citizenship age, gender (including pregnancy), sexual orientation, gender identity or expression, domestic partnership or civil union status, marital status, genetic information, disability, religious observance or practice, liability, veteran status or any other classification protected under applicable law.
    $65k-75k yearly Auto-Apply 4d ago
  • Sr Claims Examiner, Liability - MSI

    MSI 4.7company rating

    Remote senior examiner 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. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Sr. Claims Examiner. The Sr Claims Examiner is considered an expert in managing insurance claims and will be handling claims with high severity and complexity, both pre-suit and in suit. The Sr Claims Examiner must have the experience and technical knowledge needed to manage a complex case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party claims involving complex and severe bodily injury or property damage from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 10+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with a willingness to expand licenses as needed. #LI-BM1 #LI-REMOTE Click here for some insight into our culture!
    $43k-62k yearly est. Auto-Apply 8d ago
  • Sr Claims Examiner, Liability - MSI

    The Baldwin Group 3.9company rating

    Remote senior examiner 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. MSI handles third-party claims involving bodily injury and property damage under various homeowner's insurance policies and renter's insurance policies nationwide. We are looking for an experienced individual to join our Liability Claims Team as a Sr. Claims Examiner. The Sr Claims Examiner is considered an expert in managing insurance claims and will be handling claims with high severity and complexity, both pre-suit and in suit. The Sr Claims Examiner must have the experience and technical knowledge needed to manage a complex case load from inception to resolution while providing our customers and business partners superior service at all times. The ability to develop relationships and effectively communicate with others is a key factor to succeeding in this role. Having a strategic vision coupled with tactical execution to achieve results, in accordance with goals and objectives, is also critical to the overall success of this position. The Sr Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party claims involving complex and severe bodily injury or property damage from initial assignment through to resolution of claim, including negotiating settlements. Evaluates and analyzes insurance policies in order to make coverage determinations. Drafts Reservation of Rights letters and coverage disclaimers as warranted. Makes prompt contact with policy holders, claimants and other appropriate parties to gather information, take recorded statements, and conduct thorough investigations. Investigates claims to determine validity and the potential for liability against insureds. Evaluates damages (both bodily injuries and property damages) to determine potential exposures and sets appropriate reserves. Works a claim load efficiently and independently with little to no supervision. Sets timely file reserves in compliance with company's reserving philosophy and continues to evaluate pending reserves throughout the life of the claim. Manage defense counsel which includes assisting in claim strategy, evaluating potential exposure, reviewing invoices, and attending mediations and settlement conferences as necessary. Engages experts, as needed, to assist in the evaluation of the claim and monitors experts and vendors' performance while controlling expense costs. Drafts reports for large losses and reports to Leadership as required. Evaluates, negotiates and determines settlement values in settlement of claims. Communicates with all interested parties throughout the life of the claim including proactively discussing coverage decisions, the need for additional information, and settlement amounts with interested parties. Establishes and maintains an organized diary system to ensure all claims are appropriately handled in a timely manner. Adheres to all state/local regulations including the NJ/PA Unfair Claims Practices and Guidelines. Handles all claims in accordance with Best Practices and provides Best-In-Class customer service to insureds, agents, claimants, and business partners. Responsible for monitoring and completing assigned claims inventory. Acquires and maintains multiple state adjuster's licenses and maintains continuing education requirements. Develops and maintains relationships with external and internal stakeholders. Identifies questionable risks, red flags and fraud indicators and alerts the Special Investigation Unit when applicable. Identifies opportunities for subrogation and ensures recovery interests are protected. Acts as a mentor for less experienced Claims Examiners. Updates and maintains well drafted claim file notes with proper documentation throughout the life of the file. Assists with special projects when required. KNOWLEDGE, SKILLS & ABILITIES: Ability to communicate clearly, professionally, and provide superior customer service over the phone and through written correspondence. Strong organizational and time management skills. Strong writing skills. Excellent analytical, investigative, and negotiation skills. Proficient with Microsoft Office, Teams, Word, Excel and various other computer skills with the ability to learn and utilize new computer systems and other technologies. EDUCATION & EXPERIENCE: Bachelor's degree or equivalent work experience 10+ years of casualty claims adjusting experience First-Party Property experience is a plus Insurance designations preferred Must have a State Adjuster License(s) (California, Florida licenses are desirable) with a willingness to expand licenses as needed. #LI-BM1 #LI-REMOTE Click here for some insight into our culture! The 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.
    $44k-65k yearly est. Auto-Apply 8d ago
  • Experienced ABL Field Examiner

    LCG Advisors 4.2company rating

    Remote senior examiner job

    LCG Advisors is looking for an Experienced ABL Field Examiner to work closely with our clients, including large money-center banks such as JP Morgan Chase, Bank of America, Goldman Sachs, and Regions Bank. Our client base includes private equity firms, financial intermediaries, family offices, and accredited investors. Finance jobs in Tampa with LCG offer a wide variety of benefits through a gratifying and rapidly evolving career. Primary Responsibilities: Conduct due diligence services, including audit engagements, portfolio reviews, and acquisition due diligence for a wide variety of clients Perform on-site or remote engagements as contracted by a bank or lender for clients needing lines of credit ranging from under one million dollars or as much as one billion dollars Conduct audits focused on the company's collateral - typically accounts receivable and inventory - by understanding complex concepts or information Input examination findings into excel templates and produce a comprehensive written report for lenders describing the results and listing findings or exceptions Perform professional interaction with clients, including calls and meetings Qualifications: Strong analytical skills with a willingness to learn new things Naturally inquisitive on all topics relating to transactions Excellent verbal and written communication skills Attention to detail Ability to meet strict deadlines Advanced proficiency in Microsoft Office Excel and Word, Monarch, or other data extraction programs Flexibility for occasional travel 2-4 years of relevant work experience preferred ABL experience is desired but not required Competencies: Verbal Skills: Communicates with a vast vocabulary in a variety of settings and can understand the sophisticated language Numeric Ability: Proficient with basic numerical equations and is comfortable with complex calculations resulting in accurate and sophisticated conclusions Fast-Paced: Very active and results-driven with the ability to juggle the demands of several tasks at once Assertiveness: Enjoys influencing others but is still willing to follow directions from someone else when necessary Sociability: Comfortable working alone, but willing to collaborate as part of a team when necessary Decisiveness: Balances timeliness and deliberation but is comfortable making quick decisions when required Independence: Autonomous yet can accept necessary guidance and instruction Judgment: Balances objective information and instincts to make decisions Education: Bachelor's Degree in Accounting or Finance; Masters preferred Company Benefits: Competitive Medical Benefits 401(k) plan with employer contributions Unlimited Paid Time Off Flexibility to work from home Paid Family Care Leave Annual Holiday Retreat Professional Development
    $55k-80k yearly est. 60d+ ago
  • Sr. Commercial Trucking Litigation Claims Examiner | Remote

    King's Insurance Staffing 3.4company rating

    Remote senior examiner job

    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
  • Remote Plans Examiner

    Tew & Taylor 4.1company rating

    Remote senior examiner job

    Job DescriptionBenefits: 401(k) Health insurance Paid time off About Us: Tew & Taylor has been a trusted name in building code inspections and plan review services since 2008. Our mission is to provide expert services with a strong emphasis on accuracy, timeliness, and exceptional customer service. With an expanding presence across Florida, our St. Petersburg office is seeking a skilled and dedicated Plan Reviewer to join our team. Position Summary: As a Plan Reviewer at Tew & Taylor, you will play a critical role in ensuring compliance with Florida Building Code and local regulations by reviewing construction plans and documents. You will collaborate with clients, contractors, and local authorities to facilitate efficient permitting and construction processes. Key Responsibilities: Conduct detailed reviews of architectural, structural, mechanical, electrical, and plumbing plans for compliance with Florida Building Code and local ordinances. Provide clear and concise feedback to clients regarding required corrections or clarifications. Ensure plan reviews are completed within specified timeframes to meet same-day or next-day service commitments. Communicate effectively with contractors, design professionals, and permitting officials to address questions or resolve issues. Stay up-to-date with changes in building codes and regulations and apply them to your reviews. Maintain accurate records of reviews, correspondence, and project progress. Collaborate with the inspection team to ensure a seamless process from plan review to project completion. Qualifications: A minimum of 5 years of experience in building code plan review or a related field. Certification as a Plans Examiner or the ability to obtain certification within six months of employment (preferred: ICC or Florida Board of Building Code Administrators). Strong knowledge of Florida Building Code, including structural, mechanical, electrical, plumbing, and energy provisions. Proficiency in reading and interpreting construction documents, including blueprints and specifications. Excellent communication and interpersonal skills for client-facing interactions. High attention to detail and the ability to manage multiple projects simultaneously. Proficiency in Microsoft Office Suite and permitting software (preferred). This is a remote position.
    $41k-63k yearly est. 5d ago
  • Commercial Plans Examiner

    Licking County 3.6company rating

    Senior examiner job in Newark, OH

    Hours: Full Time, 7:00AM to 4:00PM Salary: $87,360.00 - $95,680.00 Performs commercial code plan reviews in a way that assures safe construction of buildings. Ensures County is in compliance with all state and local laws pertaining to Building Codes. Identifies areas of improvement and recommends changes to the Building Code Administrator. Duties : Demonstrates regular and predictable attendance. Promotes and maintains positive and effective working relationships and promotes good public relationships as a representative of Licking County Government. Performs commercial plan examinations. Reviews building plans, specifications and checks calculations of buildings to ensure compliance with currently adopted codes; approves building permit applications prior to permit issuance; calculates building permit fees. Responds to questions regarding adopted codes from property owners, developers, contractors, engineers and architects. Researches code-related questions. Investigates and resolves code-related issues. Interprets and explains code during plan review process. Performs field inspections to assist in the resolution of code related issues. Prepares and maintains records of plans, plan reviews or inspections used in connection with all building permits. Performs a variety of administrative functions to ensure efficient operation of department; formulates/recommends, implements and administers new and revised policies and procedures; prepares reports. Meets all job safety requirements and all applicable OSHA safety standards that pertain to the essential functions of the position and all agency safety procedures. Remains informed of current developments and procedures pertinent to duties; may be required to attend seminars/training. Qualifications Minimum Qualifications: Bachelor's degree or equivalent from four-year college or university; and four (4) to six (6) years related experience and/or training; or equivalent combination of education and experience. Additional Qualifications (Agency/Dept. Qualifications): Possess excellent: Interpersonal Skills and Conflict Resolution Skills Demonstrated knowledge of Ohio Building Code and related Codes. Ability to operate engineering and analysis software. Ability to detect hazards and violations. Ability to enforce regulations with firm, tact and impartiality. Ability to read and interpret plans and specifications and compare them with construction in progress. Ability to meet the state minimum requirements for required certifications. Ability to be covered under the county fleet vehicle liability insurance policy. Valid Ohio Driver's License Possess registration as an Ohio-licensed Architect or Engineer Master Plans Examiner Certification* *May be acquired after hire and obtained within one (1) year of employment. Additional Information Application Procedures: Submit completed application, resume and cover letter to the Licking County Human Resources Department, 20 South Second Street, 3rd Floor, Newark, Ohio 43055. Applications can be obtained in person in the Human Resources Department between 8:00 a.m. and 4:30 p.m. daily or printed from the web site at ********************** Applications may also be submitted online or e-mailed or faxed to ************. Successful candidates will be subject to Licking County's pre-employment drug screen and background check. Licking County is an Equal Opportunity Employer.
    $87.4k-95.7k yearly 3d ago
  • Remote Master Plans Examiner On Call

    Safebuilt 3.9company rating

    Remote senior examiner job

    Remote Master Plans Examiner - On Call *This position has flexible hours* SAFEbuilt has the technical expertise to provide Community Development services, but the reason for our success is our people. Over 1600 experts make up our team from across the country, with experience in a full range of professional services and skills. Each Team member values integrity, improvement, service, teamwork, and respect. These Core Values are the foundation of positive relationships among coworkers, our clients, residents, and anyone invested in the continued success of their community. We are currently seeking a talented and experienced Master Plans Examiner to join our team of professionals. This position offers great opportunities for dynamic, motivated self-starters to work on a variety of work assignments. You'll be a member of our highly respected team of professionals with a full complement of resources to support you and exciting projects to keep you challenged. JOB REQUIREMENTS: Reviews all plans and specifications for commercial, industrial, and residential projects to ensure compliance with city, state, and federal laws and regulations. Initiates preconstruction conferences with contractors and/or developers and associated staff members. Provides technical direction and assistance to inspection personnel relating to field problems. Assess and resolve complaints received from clients, applicants, public, designers, and contractors. Regularly interacts directly with municipal clients and their staff. May be required to perform inspections on as needed basis, providing interpretation of codes in the field. Oversight and quality control of Building Plans Examiner's plan reviews. Attends meetings, educational seminars, and functions relating to building codes. SKILLS/KNOWLEDGE: Extensive knowledge of local building codes and current construction procedures/technology. Must possess the ability to positively interact with other staff members, the general public, contractors, governmental agencies, and other clientele. Excellent verbal and written communication. Good time management, organization, and attention to detail. Demonstrated ability to exercise initiative and a considerable amount of independent judgment. Ability to prepare written plan review correspondence and update information into software programs. Candidate must be able to handle multiple projects in a fast-paced atmosphere. Candidate must stay familiar and up to date with different editions of the Ohio Building Codes. Strong computer skills including Microsoft Office. EDUCATION/CERTIFICATION/EXPERIENCE: Combination Plans Examiner (CE) (Lvl 4) (previously Master Plans Examiner) Certification as issued by the Ohio Board of Building Standards required. Additional state or ICC certifications are a plus. COMPENSATION & BENEFITS: SAFEbuilt pays competitive wages and has a 401K with matching. More About SAFEbuilt: ********************* Our employees are our greatest asset, with exceptionally certified individuals in all departments, including Planning & Zoning, Code Enforcement, Fire Prevention, and Engineering, as well as full-service and supplemental Building Department services. SAFEbuilt invests in developing our employees, exploring innovative technology, and giving back to our communities. In partnership with over 1200 communities, our talented experts make a difference in the cities and towns where we live and work. Through quality people and consistent service, SAFEbuilt plays an important role in continually improving lives by developing safe, thriving communities. SAFEbuilt is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, gender identity, gender expression, age, disability, veteran status or any other protected factor. If you need assistance or an accommodation due to a disability, please contact us at ****************** or you may call us directly on ************.
    $36k-48k yearly est. 40d ago
  • Commercial Plans Examiner

    Nova Engineering and Environmental 4.2company rating

    Remote senior examiner job

    NOVA Engineering is currently seeking a multi-disciplined Plans Examiner in the Lawrenceville, GA area. This person can work remotely a few days a week. Primary duties will include performing plans review (building mechanical, electrical, plumbing, and fire - as licensed) on residential and commercial buildings, as well as managing specific projects related to these types of code inspections. The Plans Examiner will be interacting with staff, contractors and the public. Some travel may be required for inspections and/or managing projects in the assigned area. The inspector positions are predominately field located but may occasionally include office assignments, whereas the Plan Examiners positions are primarily office-based. Essential Functions: Building Code Review and/or Quality Control Inspections Prepare written and electronic reports, and issue notices of correction Explain and interpret code and/or quality control regulations or requirements Recognize, evaluate and properly resolve unique problems or situations Maintain effective customer service relationship with clients and the public Assist the inspection management team with business development Perform other related duties as assigned by the Manager Minimum Qualifications, Experience and Education Required ICC Plans Examiner licenses in two (2+) or more of the following disciplines: Building (Structural), Mechanical, Electrical, Plumbing, and or Fire 5+ years' experience performing plan review and/or inspections High School diploma or equivalent education; Associates or Bachelors degree preferred Valid State Driver's license with clean driving record In addition to our welcoming company culture and competitive compensation packages, our employees enjoy the below benefits: Use of take-home Company Vehicle and fuel card for daily travel to work sites Comprehensive group medical insurance, including health, dental and vision Opportunity for professional growth and advancement Certification reimbursement and incentive program with pay increases Paid time off Company-observed paid holidays Company paid life insurance for employee, spouse and children Company paid short term disability coverage Other supplemental benefit offerings including long-term disability, critical illness, accident and identity theft protection 401K retirement with company matching of 50% on the first 6% of employee contributions Wellness program with incentives Employee Assistance Program NOVA is an Equal Opportunity Employer. All qualified candidates are encouraged to apply. NOVA does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, ancestry, marital status, veteran status or any other characteristic protected by law. #LI-JT
    $48k-63k yearly est. 60d+ ago
  • Financial Examiner

    Rsm 4.4company rating

    Remote senior examiner job

    We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM. The Financial Examiner will primarily perform financial examinations and regulatory consulting services for state insurance departments. This position has significant opportunity for advancement as well as personal and professional growth. Responsibilities (Responsibilities vary depending on seniority level) Perform risk focused financial examinations to determine solvency and compliance to statutes on behalf of Risk & Regulatory Consulting LLC insurance clients. Perform reviews of examination work papers and evaluate insurance company operations. Ensure the integrity of the regulatory system. Assist with the preparation of reports, exhibits, and other supporting schedules that detail a company's solvency, condition and compliance with laws and regulations, and recommend solutions to questionable financial conditions. Responsible for timely submission of draft reports for review. Recommend/document actions to ensure compliance with laws and regulations, or to protect solvency of the company. Provide knowledge and guidance of insurance laws, rules, and regulations. Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to interpret their meaning and determine impact to the company. Analyze financial operating statements, reports, and records relating to specific and overall operations of insurance companies; prepare and supervise writing of clear, complete, concise, and informative reports of financial conditions of insurance companies and health care organizations. Consistently enhance knowledge of: principles, practices, techniques, and methods of accounting and auditing; insurance examination and regulation; insurance laws and Insurance Commissioner's rulings; and related Attorney General opinions and court decisions; insurance company practices; statistical sampling procedures; basic actuarial mathematics; principles and practice of effective supervision, insurance companies and health care organizations. Qualifications Bachelor's Degree in Accounting or Finance; MBA and/or professional certification/s preferred Minimum 5+ years experience as an accountant, auditor or examiner with a state insurance department or a public accounting firm or as an accountant, internal or external auditor or examiner of insurance companies. Insurance industry experience is a must. Certified Financial Examiner (CFE) or CFE Candidate, CPA or CPA candidate, and/or Certified Internal Auditor (CIA) or CIA Candidate a plus PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point) Strong interpersonal, presentation, analytical and examination/audit skills Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills Strong written and verbal communication skills are required Dynamic/flexible demeanor with exceptional client service skills Must be self-motivated, work well independently and possess a sense of urgency Skilled in team building and team development Work from home with flexibility to travel Ability to demonstrate ethical and professional standards as outlined by the Firm Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed. RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients. Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients. RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES. At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at ************************************************** All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law. Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at ************ or send us an email at *****************. RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate. RSM will consider for employment qualified applicants with arrest or conviction records. For those living in California or applying to a position in California, please click here for additional information. At RSM, an employee's pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range. Compensation Range: $67,000 - $126,500 Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance.
    $67k-126.5k yearly Auto-Apply 28d ago
  • Sr Claims Examiner I

    Penn Mutual 4.8company rating

    Remote senior examiner job

    The Sr Claims Examiner I is an independent and self-sufficient professional who handles death claims with moderate complexity. This may include processing claims within Life, Annuity, RPS, or a combination of the three. This role ensures accurate processing in accordance with contract provisions, policies, and regulatory guidelines. While capable of handling routine and moderately complex cases independently, highly complex or unusual cases are escalated for review. This position serves as a developmental senior role, building expertise and judgment for future advancement. Responsibilities Review and adjudicate standard and moderately complex life and annuity claims in compliance with policies and regulations. Adjudicates and pays claims within established service level agreements (SLAs) up to $1M. Validate beneficiary designations and process payments accurately within documented procedures and team SLAs. Applies established procedures and regulatory guidelines to determine if requests are in “good order.” Identify and escalate highly complex or unusual cases to senior team members or management. Maintain accurate records and documentation for all claims handled. Communicate effectively with beneficiaries, agents, and internal stakeholders to resolve inquiries and champion strong relationship building and customer service. Navigate multiple administrative systems, workflows, and imaging tools simultaneously with a high level of organization and attention according to standard operating procedures (SOPs). Participate in training and development activities to enhance technical knowledge and skills. Adheres to Service Level Agreements (SLAs) and individual/team metrics. Ability to work core business hours between 8:30 AM to 6:00 PM EST. Knowledge, Skills, and Abilities Strong attention to detail and organizational skills. Ability to work independently and manage assigned workload efficiently. Foundational knowledge of life insurance products and claims processes. Strong customer service mindset with demonstrated professionalism, empathy, accountability and ownership. Strong analytical mindset with proven problem-solving abilities and math skills. Effective written and verbal communication skills. Proficiency with digital tools and claims systems. Demonstrated accuracy, organization skills, and ability to work to meet deadlines and SLAs. Ability to learn and adapt to changing procedures and regulations. Ability to work with others in a collaborative team environment. Demonstrated ability to learn and apply new digital tools, including AI applications such as Microsoft CoPilot. Education Bachelor's degree preferred or equivalent work experience. Experience 3-5 years of experience in life, annuity, or RPS claims or related field. Certifications Industry certifications (e.g., ALHC, FLMI, Series 6 or 26, HIAA, etc.) are a plus but not required. Salary Range - $55,000- $65,000 For over 175 years, Penn Mutual has empowered individuals, families and businesses on the journey to achieve their financial goals. Through our partnership with Financial Professionals across the U.S., we help instill the confidence and reliability that comes from a stronger financial future. Penn Mutual and its affiliates offer a comprehensive suite of competitive products and services to meet the unique needs of Financial Professionals and their clients, including life insurance, annuities, wealth management and institutional asset management. To learn more, including current financial strength ratings, visit ******************* Penn Mutual is committed to Equal Employment Opportunity (EEO). We provide employment and advancement opportunities to all qualified applicants and associates, according to applicable laws. This is reflected in our practices for hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment, compensation, selection or training, and all other terms and conditions of employment. All employment-related decisions and practices are free from unlawful discrimination. This includes: race, creed, color, national origin, ancestry, citizenship age, gender (including pregnancy), sexual orientation, gender identity or expression, domestic partnership or civil union status, marital status, genetic information, disability, religious observance or practice, liability, veteran status or any other classification protected under applicable law.
    $55k-65k yearly Auto-Apply 7d ago
  • Experienced ABL Field Examiner

    LCG Advisors 4.2company rating

    Remote senior examiner job

    Job DescriptionSalary: LCG Advisors is looking for an Experienced ABL Field Examiner to work closely with our clients, including large money-center banks such as JP Morgan Chase, Bank of America, Goldman Sachs, and Regions Bank. Our client base includes private equity firms, financial intermediaries, family offices, and accredited investors. Finance jobs in Tampa with LCG offer a wide variety of benefits through a gratifying and rapidly evolving career. Primary Responsibilities: Conduct due diligence services, including audit engagements, portfolio reviews, and acquisition due diligence for a wide variety of clients Perform on-site or remote engagements as contracted by a bank or lender for clients needing lines of credit ranging from under one million dollars or as much as one billion dollars Conduct audits focused on the companys collateral typically accounts receivable and inventory - by understanding complex concepts or information Input examination findings into excel templates and produce a comprehensive written report for lenders describing the results and listing findings or exceptions Perform professional interaction with clients, including calls and meetings Qualifications: Strong analytical skills with a willingness to learn new things Naturally inquisitive on all topics relating to transactions Excellent verbal and written communication skills Attention to detail Ability to meet strict deadlines Advanced proficiency in Microsoft Office Excel and Word, Monarch, or other data extraction programs Flexibility for occasional travel 2-4 years of relevant work experience preferred ABL experience is desired but not required Competencies: Verbal Skills: Communicates with a vast vocabulary in a variety of settings and can understand the sophisticated language Numeric Ability: Proficient with basic numerical equations and is comfortable with complex calculations resulting in accurate and sophisticated conclusions Fast-Paced: Very active and results-driven with the ability to juggle the demands of several tasks at once Assertiveness: Enjoys influencing others but is still willing to follow directions from someone else when necessary Sociability: Comfortable working alone, but willing to collaborate as part of a team when necessary Decisiveness: Balances timeliness and deliberation but is comfortable making quick decisions when required Independence: Autonomous yet can accept necessary guidance and instruction Judgment: Balances objective information and instincts to make decisions Education: Bachelors Degree in Accounting or Finance; Masters preferred Company Benefits: Competitive Medical Benefits 401(k) plan with employer contributions Unlimited Paid Time Off Flexibility to work from home Paid Family Care Leave Annual Holiday Retreat Professional Development
    $55k-80k yearly est. 9d ago

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