Senior Complex Claims Specialist, Major Case Unit (OPEN TO REMOTE)
Claim specialist job at The Jonus Group
Senior Complex Claims Specialist
Seeking an experienced Senior Complex Claims Specialist to oversee large exposure and complex general liability, auto liability, and trucking claims. This role focuses on managing claims handled by third-party administrators (TPAs) while supporting internal stakeholders and ensuring effective resolution strategies. The position does not include direct staff management but requires oversight of the claims process and TPA performance.
Responsibilities
Provide technical oversight on high-exposure and complex claims, ensuring timely resolution and superior outcomes.
Collaborate with TPA staff, Claim Account Managers, underwriters, legal teams, and internal stakeholders to execute claim strategies.
Communicate effectively with insureds and brokers, delivering exceptional customer service.
Conduct coverage analysis, investigations, liability and damage evaluations, and reserve setting within granted authority.
Manage litigation, vendors, settlement negotiations (including structured settlements), and overall claim resolution.
Maintain accurate claim file documentation, coding, and diary management.
Partner with defense and coverage counsel to develop litigation strategies, manage budgets, and review legal invoices.
Prepare timely claim reporting and updates for management and business stakeholders.
Participate in mediations, trials, and related proceedings.
Ensure compliance with state adjuster licensing requirements.
Support TPA oversight, including staff training, best practice sharing, claim audits, file reviews, and regular meetings.
Qualifications/Requirements
Juris Doctorate degree required.
Minimum of 10 years of commercial general/auto liability claims experience, including complex and large-exposure files, or equivalent law firm insurance defense/coverage experience.
Experience with trucking, construction, or emergency services/medical professional liability claims preferred.
Prior TPA management or oversight experience preferred.
Strong negotiation, analytical, and problem-solving skills.
Excellent written and verbal communication, collaboration, and interpersonal abilities.
Proven ability to manage complex information, distill key issues, and present concise recommendations.
Skilled in leading strategic discussions and making cost-effective decisions.
Highly adaptable, independent, and team-oriented.
Proficiency with Microsoft Excel, PowerPoint, and Word.
Willingness & ability to travel up to 10% of the time.
Compensation Package
Compensation: Between $145K-$165K (based on experience).
Competitive benefits package, paid time off, professional development opportunities, etc.
Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.
#LI-MW1
WC Claims Representative - CA
Claim specialist job at The Jonus Group
Workers' Compensation Claims Representative - CA
Seeking a highly skilled and experienced Workers' Compensation Claims Representative to join a team. This is a fully remote position, allowing you to work from anywhere within the continental United States. The ideal candidate will have a strong background in handling workers' compensation claims, particularly in California, and possess the necessary certifications and licenses to excel in this role. If you are detail-oriented, organized, and have a passion for delivering exceptional service, encourage you to apply.
Compensation Package
Salary Range: $90,000 - $105,000 per year
Employment Type: Permanent, Full-Time
Remote Work: 100% remote
Responsibilities
Determine compensability and/or coverage issues for lost-time workers' compensation claims.
Effectively manage a caseload of lost-time claims across multiple jurisdictions.
Negotiate and direct settlements under management's review.
Gather medical and factual evidence to assess compensability.
Direct outside investigations and manage litigation files within assigned authority.
Maintain regular communication with claimants, attorneys, investigators, rehabilitation personnel, insureds, account liaisons, and medical providers.
Qualifications/Requirements
Education: Bachelor's degree required.
Licensing: Active Adjuster License, including confirmation of home state license.
Experience: Minimum of 3 years of workers' compensation claims desk experience, with jurisdictional expertise in California.
Certification: SIP Certification required.
Preferred Skills:
Bilingual (Spanish) candidates are highly preferred.
Carrier experience is a plus.
Familiarity with medical terminology.
Strong organizational, problem-solving, negotiation, and conflict resolution skills.
Excellent verbal and written communication abilities.
#LI-BC1
Claims Supervisor (Bodily Injury)
Richardson, TX jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage:
complex investigations
coverage determinations
liability assessments
bodily injury claim resolutions-through both settlement and litigation.
This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims.
If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors:
Ownership: You take responsibility for outcomes in all scenarios.
Adaptability: You navigate dynamic environments with creativity and resilience.
Leading People: You empower individuals and teams to achieve their best.
Collaboration: You build and strengthen partnerships across organizational lines.
Driving Value: You use data-driven insights to align actions with strategic goals.
What You'll Do:
Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust.
Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims.
Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority
Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations.
Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention.
Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service.
Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence.
Collaborate with leadership and cross-functional teams to identify and implement process improvements.
Serve as a resource for team members on insurance-related questions
providing mentorship and training to build their industry knowledge.
What We're Looking For:
Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases.
Active Adjuster license (required)
Expertise in Casualty claims, including knowledge of industry regulations and best practices
Strong ability to assess needs and guide associates in negotiating claim settlements as needed
Experienced in the use of various claims tools with ability to assist associates
Strong adherence to compliance and regulatory requirements
Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment
Strong results orientation, with a history of meeting or exceeding performance goals
Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations
Ability to analyze data and metrics to inform decision-making and improve customer outcomes
Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence
Why Join GEICO?
Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction.
Inclusive Culture: Join a company that values diversity, collaboration, and innovation.
Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit.
Professional Growth: Access GEICO's industry-leading training programs and development opportunities:
Licensing and continuing education at no cost to you.
Leadership development programs and hundreds of eLearning courses to enhance your skills.
Increased Earnings Potential:
Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually.
Incentives and Recognition:
Corporate wide bonus programs are in place to reward top performers.
Beware of scams! As a recruiter, I will only contact you through a @geico.com email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ***********************.
keywords: litigation, auto liability, liability claims#geico300#LI-AL2
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Auto-ApplyPersonal Injury Examiner
Melville, NY jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Personal Injury Protection Claims Examiner - Melville, NY
Salary: talk to your recruiter for more details
What sets GEICO apart from our competition? One key factor is our ability to provide outstanding customer service during the insurance claims process. We are looking for Personal Injury Protection (PIP) Claims Examiners in our Melville, NY office to deliver our promise to be there and assist our customers throughout the often complicated medical aspects of auto insurance claims. We're seeking outstanding associates who want to kickstart a fulfilling career with one of the fastest-growing auto insurers in the U.S.
As a PIP Claims Examiner, you will investigate medical necessity and determine casualty. You will consult with involved parties, secure medical information and review insurance contracts, associated reports and billing documentation. We will rely on you to evaluate the validity of personal injury insurance claims and monitor case files over the course of treatment.
This job is a great fit for people who are continuous life learners, as PIP Claims Examiners are consistently challenged to learn more and increase their knowledge of our industry and company. Plus, GEICO encourages a promote-from-within culture, so there is plenty of room to grow your career and be rewarded for your hard work and determination.
Bring your passion for helping others and a desire to make impact and start a rewarding career with GEICO today!
Qualifications & Skills:
Bachelor's degree
Prior insurance claims experience preferred, but not required
Personal injury, bodily injury or workers' compensation experience preferred
Solid analytical, customer service and multi-tasking skills
Strong attention to detail, time management and decision-making skills
#geico500
Annual Salary
$29.00 - $45.28
The above annual salary range is a general guideline. Multiple factors are taken into consideration to arrive at the final hourly rate/ annual salary to be offered to the selected candidate. Factors include, but are not limited to, the scope and responsibilities of the role, the selected candidate's work experience, education and training, the work location as well as market and business considerations.
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Auto-ApplySubstance Abuse Specialist
New York, NY jobs
Licensed Behavioral Health Clinicians provide supportive counseling, advocacy, education, and care management to help patients and their families navigate mental illness, access community resources, and manage symptoms to help them remain safely in the community This is a senior, master's level, licensed social services role that provides direct care as part of a team. Join us in building on our 130-year history and become a part of the Future of Care that is strengthening communities with high quality, integrated behavioral health programs. VNS Health Behavioral Health team members provide vital client-centered behavioral health care to New Yorkers most in need, across all stages of life and mental well-being. We deliver care wherever our clients are, including outpatient clinics, clients' homes, and the community. Our short- and long-term service models include acute, transitional, and intensive care management programs that impact the most vulnerable populations, from children, to adolescents, to aging adults. As part of our fast-growing Behavioral Health team, you'll have an opportunity to develop and advance your skills, whether you're early in your career or an experienced professional.
What We Provide
Attractive sign-on bonus and referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, CEU credits, and advancement opportunities
Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals
What You Will Do
Utilizes approved assessments to identify clients/members needs and family needs; develops initial and ongoing clinical plan of care. Updates plan at specified intervals, and as needed based on changes in client/member condition or circumstances
Performs and maintains effective care management for assigned caseload of clients/members. Leads the care coordination for complex psychiatric clinical cases. Tracks and monitors progress; maintains detailed, accurate and timely progress notes and other documentation
Provides supportive counseling and/or supportive therapy as well as ongoing mental health services
Collaborates and refers to appropriate agencies as required. Addresses any client/member concerns to ensure satisfaction with overall services provided and uses motivational interviewing techniques to foster behavioral changes
Develops inventory of resources that meet the clients/members needs as identified in the assessment
Provides linkage, coordination with, referral to and follow-up with appropriate service providers and managed care plans. Facilitates periodic case record reviews and case conferences with all providers serving the clients/members
Provides information and assistance through advocacy and education to clients/members and family on availability and eligibility of entitlements and community services. Arranges transportation and accompanies clients/members to appointments as necessary
Assists clients/members and/or families in the development of a sustainable network of community-based supports, utilizing identified strengths and tools designed to prevent future participant crises and/or reduce the negative impact if a crisis does occur
Participates in initial and ongoing trainings as necessary to maintain and enhance clinical and professional skills
Maintains updated case records in program EMR. Maintains case records in accordance with program policies/procedures, VNS Health standards and regulatory requirements
Participates and consults with team supervisor in case conferences, staff meetings, utilization review and discharge planning meetings to determine if client/member requires an alternate level of care or is appropriate for discharge
Participates in 24/7 on-call coverage schedule and performs on-call duties, as required
Acts as liaison with other community agencies
Provides short term counseling (coping skills, trauma informed, decision making) and Risk Health Assessment/Safety Planning
Collects and reports data, as required while adhering to productivity standards
Leads and participates in βNetwork Meetingsβ with client, client/ member's personal support network and other team members using the Open Dialogue Model
Qualifications
Master's Degree in Social Work, Psychology, Mental Health Counseling, Family Therapy or related degree
Minimum of two years of mental health work experience providing direct services to clients/members with Serious Mental Illness (SMI), developmental disabilities, substance use disorders and/or chronic medical conditions required
Effective oral/written/interpersonal communication skills required
Bilingual skills may be required as determined by operational needs
License and current registration to practice as a Mental Health Counselor, Marriage and Family Therapist , Social Worker, Clinical Social Worker or related license in New York State
Valid NYS ID or NYS driver's license may be required as determined by operational needs.
Pay Range
USD $63,800.00 - USD $79,800.00 /Yr.
About Us
VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us - we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 βneighborsβ who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
Auto-ApplyPrincipal Claims Representative - Subrogation
Stevens Point, WI jobs
Evaluate and resolve complex subrogation claims in an efficient and accurate manner, developing strategies to prove subrogation theories and negotiate settlements.
This position will be located in our Stevens Point, WI - Division Street office under our hybrid work model.
What You'll Do:
Drive strategic subrogation initiatives for complex and high-exposure property and workers' compensation losses, identifying all potential avenues for recovery, including non-traditional sources.
Handle severe and complex litigation while working with manager, staff counsel, or subrogation counsel. Attend mediation settlement conferences, and trials to provide subrogation expertise and support resolutions.
Evaluate and investigate complex claims involving workers' compensation injuries, damages to property, or motor vehicle accidents to determine if liability and recovery exists. Hire experts as needed and make decisions on recovery opportunities and payments in accordance with assigned authority limit.
Act as a strategic partner for frontline adjusters, litigation teams, and risk professionals to proactively identify subrogation opportunities early in the claim lifecycle.
Stay ahead of emerging trends in subrogation law, recovery technologies, and industry litigation that may impact strategy.
Obtain and maintain state adjusters licenses as required.
What it Takes:
Bachelor's degree or equivalent experience
Advanced training in insurance law, contracts, or liability analysis; Juris Doctor Degree preferred
7+ years of related work experience
Demonstrated expertise in technical claims with ability to understand and manage litigated claims
Extensive claims knowledge with ability to understand and manage litigated claims
Ability to review and analyze complex documents, insurance policies, coverages, medial reports, and insurance regulations
Ability to make appropriate claim decisions, prioritize, and manage workload
Strong negotiation skills with the ability to influence and drive resolution in adversarial or ambiguous situations
Advanced writing, communication, and presentation skills
Technology aptitude
Ability to handle multiple lines of business
What You'll Receive:
At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive.
Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you'll work in office.
As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office.
Meal Subsidy available for associates who report to an office.
401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future.
Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program
Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off
Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle.
Well-being and Employee Assistance programs
Sentry Foundation gift matching program to encourage charitable giving.
About Sentry:
We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction.
Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States. We're rated A+ by A.M. Best, the industry's leading rating authority.
Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth.
Get ready to own your future at Sentry. Opportunities await!
Joe Larsen
Talent Acquisition Specialist
...@sentry.com
Equal Employment Opportunity
Sentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.
Insurance Specialist I - Corporate Patient AR Mgmt - Full Time
Towanda, PA jobs
Responsible for nonβcomplex electronic and paper claim submissions to insurance payers. Coordinates required information for filing secondary and tertiary claims reviews and analyzes claims for accuracy, i.e. diagnosis and procedure codes are compatible and accurate. Makes charge corrections or follows up with appropriate parties as needed to ensure billing invoice is correct. Follows up with payers on unresponded claims. Works denied claims by following correct coding and payer guidelines resulting in appeal or charge correction. Teams with Insurance Billing Specialist II and Denial Resolution staff to work projects, request guidance on more complex billing issues and cross training for other payers and tasks. Responds to a variety of questions from insurance companies, government agencies and all Guthrie Medical Group offices. Partners with CRC and other Guthrie departments to field billing inquiries. Answers all correspondence from insurance carriers including requests for supportive documentation.
Education, License & Cert:
High school diploma required; CPC, CCA, RHIA, RHIT certification in medical billing and coding or Associates degree preferred.
Experience:
Strong organizational and customer service skills a must. Experience with office software such as Word and Excel required. Previous experience performing in a high volume and fast paced environment.
Essential Functions:
1. Works preβAR edits, paper claims, reports and work queues as assigned to ensure accurate and timely claim submission to individual payers. Reports possible payer or submission issues.
2. Works closely with a Denial Resolution Specialist or Billing Specialist II mentor to cross train on various payers and tasks to expand insurance billing knowledge and skills.
3. Follows up on rejected and/or nonβresponded claims as assigned. Utilizes internal rejection protocols, coding knowledge, reimbursement policies, payer guidelines and other sources in order to research rejections to secure appropriate payment.
4. Provides back up to Central Charge Entry and Cash Applications. Manually enters charges, posts and distributes insurance and patient payments.
5. Promptly reports payer, system or billing issues.
6. Utilizes Epic system functions accurately to perform assigned tasks. Ex: charge corrections, invoice inquiry, billing edits, insurance eligibility.
7. Exports and prepares spreadsheets, manipulating data fields for project work.
8. Identifies and provides appropriate follow up for claims that require correction or appeal.
9. Provides timely resolution of credit balance as identified and/or assigned. 10. Requests adjustments on invoices that have been thoroughly researched and/or were unable to reach payment resolution. Documents support on request forms and performs adjustments within policy guidelines.
Other Duties:
1. Provides feedback related to workflow processes in order to promote efficiency.
2. Answers phone calls and correspondence providing request information. Documents action taken and provides appropriate follow up.
3. Acquires and maintains knowledge of and performs within the compliance of the Guthrie Clinic's Corporate Revenue Cycle policies and insurance payer regulations and guidelines.
4. Demonstrates excellent customer service skills for both internal and external customers.
5. Maintains strict confidentiality related to patient health information in accordance with HIPAA regulations.
6. Assists with and completes projects and other duties as assigned.
Claims Supervisor (Bodily Injury)
Dallas, TX jobs
At GEICO, we offer a rewarding career where your ambitions are met with endless possibilities.
Every day we honor our iconic brand by offering quality coverage to millions of customers and being there when they need us most. We thrive through relentless innovation to exceed our customers' expectations while making a real impact for our company through our shared purpose.
When you join our company, we want you to feel valued, supported and proud to work here. That's why we offer The GEICO Pledge: Great Company, Great Culture, Great Rewards and Great Careers.
Join a team where your expertise truly matters!Our Casualty Claims department is seeking a highly motivated and experienced Claims Supervisor (Bodily Injury). As a key leader within our Casualty organization, you will be responsible for empowering a team that handles attorney-represented automotive liability claims. Your team will manage:
complex investigations
coverage determinations
liability assessments
bodily injury claim resolutions-through both settlement and litigation.
This role requires advanced knowledge of litigation processes and the ability to strategically support litigated and attorney-represented claims.
If you're passionate about developing talent, driving results, and making an impact in the automotive liability space, we'd love to hear from you.Success in this role is built on the foundation of GEICO's core leadership behaviors:
Ownership: You take responsibility for outcomes in all scenarios.
Adaptability: You navigate dynamic environments with creativity and resilience.
Leading People: You empower individuals and teams to achieve their best.
Collaboration: You build and strengthen partnerships across organizational lines.
Driving Value: You use data-driven insights to align actions with strategic goals.
What You'll Do:
Lead, mentor, and inspire a team of associates to deliver exceptional customer service while building trust.
Leverage your property and casualty insurance expertise to guide team members in resolving complex customer inquiries and claims.
Provide authority on evaluations that exceed your adjusters personal, assigned authority and work with others on claims that exceed your authority
Personalize your leadership approach to develop team members' skills, fostering their growth and ensuring they consistently exceed customer expectations.
Monitor and evaluate team performance using key performance indicators (KPIs) to enhance efficiency, customer satisfaction, and retention.
Hold your team accountable for achieving results, maintaining compliance with insurance regulations, and delivering outstanding service.
Address escalated customer concerns with professionalism and empathy, modeling GEICO's dedication to service excellence.
Collaborate with leadership and cross-functional teams to identify and implement process improvements.
Serve as a resource for team members on insurance-related questions
providing mentorship and training to build their industry knowledge.
What We're Looking For:
Minimum of 2 years of leadership experience in Bodily Injury claims, including direct oversight of litigated cases.
Active Adjuster license (required)
Expertise in Casualty claims, including knowledge of industry regulations and best practices
Strong ability to assess needs and guide associates in negotiating claim settlements as needed
Experienced in the use of various claims tools with ability to assist associates
Strong adherence to compliance and regulatory requirements
Proven ability to motivate, inspire, and develop high-performing teams in a customer-centric environment
Strong results orientation, with a history of meeting or exceeding performance goals
Excellent interpersonal and communication skills, with the ability to adapt leadership styles to diverse individuals and situations
Ability to analyze data and metrics to inform decision-making and improve customer outcomes
Collaborative mindset with a commitment to fostering a culture of inclusivity and excellence
Why Join GEICO?
Meaningful Impact: Make a real difference by resolving issues and enhancing customer satisfaction.
Inclusive Culture: Join a company that values diversity, collaboration, and innovation.
Workplace Flexibility: This is a M-F, 8:00am - 4:30pm position offering a Hybrid work model based in Richardson, TX. GEICO reserves the right to adjust in-office requirements as needed to support the needs of the business unit.
Professional Growth: Access GEICO's industry-leading training programs and development opportunities:
Licensing and continuing education at no cost to you.
Leadership development programs and hundreds of eLearning courses to enhance your skills.
Increased Earnings Potential:
Pay Transparency: The starting salary for this position is between $97,735 annually and $151,700 annually.
Incentives and Recognition:
Corporate wide bonus programs are in place to reward top performers.
Beware of scams! As a recruiter, I will only contact you through ************ email address and will never ask you for financial information during the hiring process. If you think you are being scammed or suspect suspicious activity during the hiring process, please contact us at ...@geico.com.
keywords: litigation, auto liability, liability claims#geico300#LI-AL2
At this time, GEICO will not sponsor a new applicant for employment authorization for this position.
The GEICO Pledge:
Great Company: At GEICO, we help our customers through life's twists and turns. Our mission is to protect people when they need it most and we're constantly evolving to stay ahead of their needs.
We're an iconic brand that thrives on innovation, exceeding our customers' expectations and enabling our collective success. From day one, you'll take on exciting challenges that help you grow and collaborate with dynamic teams who want to make a positive impact on people's lives.
Great Careers: We offer a career where you can learn, grow, and thrive through personalized development programs, created with your career - and your potential - in mind. You'll have access to industry leading training, certification assistance, career mentorship and coaching with supportive leaders at all levels.
Great Culture: We foster an inclusive culture of shared success, rooted in integrity, a bias for action and a winning mindset. Grounded by our core values, we have an an established culture of caring, inclusion, and belonging, that values different perspectives. Our teams are led by dynamic, multi-faceted teams led by supportive leaders, driven by performance excellence and unified under a shared purpose.
As part of our culture, we also offer employee engagement and recognition programs that reward the positive impact our work makes on the lives of our customers.
Great Rewards: We offer compensation and benefits built to enhance your physical well-being, mental and emotional health and financial future.
Comprehensive Total Rewards program that offers personalized coverage tailor-made for you and your family's overall well-being.
Financial benefits including market-competitive compensation; a 401K savings plan vested from day one that offers a 6% match; performance and recognition-based incentives; and tuition assistance.
Access to additional benefits like mental healthcare as well as fertility and adoption assistance.
Supports flexibility- We provide workplace flexibility as well as our GEICO Flex program, which offers the ability to work from anywhere in the US for up to four weeks per year.
The equal employment opportunity policy of the GEICO Companies provides for a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religious creed, national origin, ancestry, age, gender, pregnancy, sexual orientation, gender identity, marital status, familial status, disability or genetic information, in compliance with applicable federal, state and local law. GEICO hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
GEICO reasonably accommodates qualified individuals with disabilities to enable them to receive equal employment opportunity and/or perform the essential functions of the job, unless the accommodation would impose an undue hardship to the Company. This applies to all applicants and associates. GEICO also provides a work environment in which each associate is able to be productive and work to the best of their ability. We do not condone or tolerate an atmosphere of intimidation or harassment. We expect and require the cooperation of all associates in maintaining an atmosphere free from discrimination and harassment with mutual respect by and for all associates and applicants.
Oracle Specialist
Vienna, VA jobs
The final salary or hourly wage, as applicable, paid to each candidate/applicant for this position is ultimately dependent on a variety of factors, including, but not limited to, the candidate's/applicant's qualifications, skills, and level of experience as well as the geographical location of the position.
Applicants must be legally authorized to work in the United States. Sponsorship not available.
Our client is seeking a BSA, Oracle ERP Fusion Security in Vienna, VA.
Skills & Requirements
We are seeking a skilled contractor to join our Finance Technology Security and Controls team. This team is responsible for security and risk monitoring across the Oracle ERP Fusion ecosystem, leveraging the Risk Management Cloud (RMC) module to ensure compliance and mitigate risk.
Key Responsibilities
β’ Perform user access reviews and manage privileged access across Oracle ERP Fusion.
β’ Monitor and resolve RMC alerts related to security and compliance.
β’ Collaborate with internal and external auditors to support ICFR (Internal Controls over Financial Reporting) requirements.
β’ Work closely with cross-functional teams across Procurement, Finance, and HR to ensure security best practices.
β’ Act as a Business Systems Analyst (BSA):
o Gather and document requirements.
o Analyze processes and recommend improvements.
o Support testing and validation of security configurations.
o Assist in risk assessment and remediation activities.
o Maintain strong documentation for audit and compliance purposes.
Required Skills & Experience
o Oracle ERP Fusion Security expertise (roles, privileges, data access).
o Hands-on experience with Risk Management Cloud (RMC).
o Strong understanding of ICFR and compliance frameworks.
o Experience in user access management, privileged access controls, and risk monitoring.
o Ability to work across multiple ERP modules (Finance, Procurement, HR).
o Excellent communication and collaboration skills.
o Strong Oracle background (functional and/or technical).
Preferred Qualifications
o Prior experience in audit support and risk management (ICFR)
o Familiarity with OTBI reporting for security and compliance.
o Knowledge of segregation of duties.
Benefits/Other Compensation
This position is a contract/temporary role where Hays offers you the opportunity to enroll in full medical benefits, dental benefits, vision benefits, 401K and Life Insurance ($20,000 benefit).
Why Hays?
You will be working with a professional recruiter who has intimate knowledge of the industry and market trends. Your Hays recruiter will lead you through a thorough screening process in order to understand your skills, experience, needs, and drivers. You will also get support on resume writing, interview tips, and career planning, so when there's a position you really want, you're fully prepared to get it.
Nervous about an upcoming interview? Unsure how to write a new resume?
Visit the Hays Career Advice section to learn top tips to help you stand out from the crowd when job hunting.
Hays is committed to building a thriving culture of diversity that embraces people with different backgrounds, perspectives, and experiences. We believe that the more inclusive we are, the better we serve our candidates, clients, and employees. We are an equal employment opportunity employer, and we comply with all applicable laws prohibiting discrimination based on race, color, creed, sex (including pregnancy, sexual orientation, or gender identity), age, national origin or ancestry, physical or mental disability, veteran status, marital status, genetic information, HIV-positive status, as well as any other characteristic protected by federal, state, or local law. One of Hays' guiding principles is βdo the right thing'. We also believe that actions speak louder than words. In that regard, we train our staff on ensuring inclusivity throughout the entire recruitment process and counsel our clients on these principles. If you have any questions about Hays or any of our processes, please contact us.
In accordance with applicable federal, state, and local law protecting qualified individuals with known disabilities, Hays will attempt to reasonably accommodate those individuals unless doing so would create an undue hardship on the company. Any qualified applicant or consultant with a disability who requires an accommodation in order to perform the essential functions of the job should call or text ************.
Drug testing may be required; please contact a recruiter for more information.
Claims Process Specialist (Remote)
Los Angeles, CA jobs
The Claims Process Specialist is responsible for overseeing and managing the end-to-end claims process for homeowners and commercial property claims. The role involves designing, implementing, monitoring, and continuously improving claims processes to ensure efficiency, effectiveness, and compliance with organizational standards. Key responsibilities include defining process workflows, establishing performance metrics, identifying areas for improvement, and maintaining process documentation. Process Owners also facilitate communication and training related to their processes and may lead initiatives to optimize workflows and implement best practices.
This role will serve as the process steward for Claims and its touchpoints with Policy/Underwriting and Finance, as well as reporting for business stakeholders.
PRINCIPAL DUTIES & RESPONSIBILITIES
Review, develop, implement, and continuously improve the claims process to ensure efficiency, accuracy, and compliance.
Recommend, standardize, and implement procedures and workflows related to claims handling.
Monitor the end-to-end claims process, ensuring timely and accurate claims handling.
Address problems or bottlenecks within the claims process promptly and effectively.
Ensure all established claims processes comply with company policies, industry standards, and federal and state regulatory requirements.
Maintain up-to-date knowledge of relevant laws and regulations affecting claims processing. Aligning with California DOI requirements, retention/legal hold, and audit traceability.
Champion cross-module coherence (Policy/UW β Claims β Finance) and Single Source of Truth (SSOT) alignment for data and definitions.
Oversee the use and maintenance of claims management systems.
Identify, recommend, implement, and monitor technological improvements to streamline claims operations.
Develop and update claims policies, procedures, and guidelines.
Ensure policies are communicated and, in collaboration with the Quality Assurance team, adhered to across the claims team.
Prepare and present reports on process performance, issues, and improvement initiatives to management.
Any other duties needed to help fulfill the Association's Mission, abide by the Association's Values, and fulfill the Association's Strategic Objectives.
EDUCATION & EXPERIENCE
Bachelor's degree or equivalent preferred.
Experience with homeowners' catastrophe claims-specifically wind and fire preferred.
Proven experience in process management, ideally within homeowners' insurance.
Advanced knowledge and application of relevant tools and methodologies (such as Lean, Six Sigma, or BPM), as well as industry standards.
Experience with Duck Creek claims platform preferred.
Advanced knowledge of computer software, i.e., Microsoft Word, Excel, and Outlook.
Strong analytical and problem-solving skills, with attention to detail and accuracy.
Excellent internal and external customer service, as well as strong oral and written communication skills.
Experienced CA WC Adjuster - Remote - Multi-Industry (Trucking, Staffing, Valet)
Irvine, CA jobs
Overview Workers' Compensation Claim Consultant (CA Jurisdiction Only) - Remote
Salary: $77,000-$87,000 annually Schedule: Monday-Friday, 8:00 AM-4:30 PM PST Experience Required: 5+ Years (Litigated & Some Complex Claims)
π¨ Please Note
This is not an HR, risk management, or consulting position. This is an experienced California Workers' Compensation adjusting role requiring hands-on claim investigation, evaluation, negotiation, and settlement. Candidates must have direct experience investigating, evaluating, reserving, negotiating, and resolving claims as an adjuster or adjuster supervisor within a carrier, TPA, or similar claims environment. Applicants without hands-on adjusting experience will not be considered.
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We're seeking an experienced Workers' Compensation Claim Consultant to handle California jurisdiction claims for a multi-account desk supporting clients in the trucking & warehouse, valet/shuttle services, and staffing agency industries.
This fully remote position requires strong litigated claim handling experience, the ability to independently manage complex files, and a commitment to CCMSI's best practice standards. You'll join a collaborative team of four other consultants, working together to deliver high-quality, timely, and accurate claim service to our clients.
Responsibilities
When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems.
Conduct timely 3-point contact per CCMSI best practices.
Investigate, evaluate, and adjust California workers' compensation claims with independence and sound judgment.
Establish, maintain, and justify detailed reserve levels.
Administer indemnity and award payments in accordance with CA jurisdictional requirements.
Negotiate settlements consistent with corporate standards, client instructions, and state law.
Maintain a current and thorough diary, ensuring all deadlines and statutory requirements are met.
Pursue subrogation recovery as applicable.
Prepare claim status reports, reserve analyses, and updates for client meetings.
Conduct claim reviews with clients and participate in discussions as needed.
Communicate effectively with injured workers, employers, providers, and attorneys throughout the claim lifecycle.
Ensure all documentation meets CCMSI best practice requirements.
Qualifications Qualifications - Required
5+ years of California WC adjusting experience, including litigated files and some complex exposure.
Adjuster designation required.
Strong working knowledge of California WC laws, timelines, benefits, and litigation processes.
Proficiency with Microsoft Office (Word, Excel, Outlook).
Excellent written and verbal communication skills, critical thinking, and decision-making ability.
Nice to Have
SIP certification preferred.
Strong documentation habits per CCMSI best practices.
Experience presenting or conducting client reviews.
Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Work Environment & Travel
Remote role reporting to the Irvine, CA branch.
Occasional travel to the office may be required for rare mandatory in-office meetings.
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
Quality claim handling - thorough investigations, strong documentation, well-supported decisions
β’ Compliance & audit performance - adherence to jurisdictional and client standards
β’ Timeliness & accuracy - purposeful file movement and dependable execution
β’ Client partnership - proactive communication and strong follow-through
β’ Professional judgment - owning outcomes and solving problems with integrity
β’ Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #WorkersCompJobs #CaliforniaAdjuster #RemoteJobs #ClaimsConsultant #InsuranceCareers #AdjusterLife #NowHiring #LI-Remote
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Auto-Apply1099 Adjuster Apply Here!
Remote
Requirements
2+ years handling property insurance claims required
Candidate must have an active Xactimate account
Can handle partial and full assignments
Commercial and personal lines experience preferred
A qualified candidate must have their own transportation, equipment and software
Good writing and technology skills
1099 Adjuster Apply Here!
Virginia Beach, VA jobs
Job DescriptionDescription:
Capstone ISG is one of the nation's fastest growing Independent Adjustment firms. As we continue to grow our business, we look for people who offer inspiration and innovation, as well as have an internal drive for results. Our team members are focused on customer service and are dedicated to making Capstone a fun and rewarding place to work. We are currently accepting applications for independent (1099) property adjusters in the locations below. Other locations may be considered.
Louisville, KYPIttsburgh, PAEastern Shore, MDMinneapolis, MNMemphis, TNNorthern New JerseyFlorence, SC
This is a contract (1099) position.
Β· Conducts prompt, thorough and fair investigations by obtaining relevant facts to determine coverage, origin, and extent of loss.
Β· Documents damage and prepares written estimates using Xactimate software.
Β· Keeps the client and the insured informed about the claim status with clear, timely and accurate written/oral communication.
Requirements:
2+ years handling property insurance claims required
Candidate must have an active Xactimate account
Can handle partial and full assignments
Commercial and personal lines experience preferred
A qualified candidate must have their own transportation, equipment and software
Good writing and technology skills
Adjuster II - LA
Los Angeles, CA jobs
Marketing Statement:
TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan's oldest insurer and one of the largest insurance groups in the world. Tokio marine has offices in 38 countries staffed by more than 15000 employees outside of Japan.
($34.00 to $47.00 hourly)
Job Summary:
Adjust Marine and Inland Marine claims, which includes surveyor appointment, reserve notification, and file maintenance. Understand claims relative to loss history and application of special claims procedures as may be required for individual accounts. Responsible for pursuing recovery against liable carriers.
Essential Job Functions:
Process and adjust ocean and inland marine claims.
Determine liability and/or necessity of surveyor with availability for occasional travel to loss sites.
Review survey reports or supporting documentation for determining loss.
Determine whether coverage exists for loss.
Prepare necessary correspondence with assured/claimant/broker inclusive of loss control and damage prevention reporting.
Handle tasks that require a high level of organization and attention to detail.
Conclude all settlement agreements.
Responsible for protecting all rights against third parties and/or responsible parties which may be liable.
Such responsibility may include direct recovery handling.
Comply with MCD business plan by conducting self audits, meet expectations of TMM/TMNF audits, and follow SLR procedures.
Participate in training seminars and additional technical training courses.
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.
Qualifications:
College degree preferred
Strong PC skills, including Word and Excel
Strong written and oral communication skills
Auto industry experience preferred
Minimum 3 years claims handling experience.
Ability to work as part of a team
EEO Statement:
Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Auto-ApplyDesk Adjuster
Jacksonville, FL jobs
Job: Desk Adjuster
Reports To: Claims Manager
Summary/Objective
This position is an operational role and desk adjusters are expected to investigate insurance claims to ascertain the extent of liability on behalf of an insurance company. He/she will need to coordinate assignment of inspections of homes, commercial buildings, agricultural equipment, farmland, and automobiles with field adjusters and/or engineers, review written report/estimate of damages, and prepare decision letter, issuing payments when applicable. Desk Adjusters will operate under leadership and direction from the Claims Manager and assure that all work product is in line with carrier directives and GRS file standards. The Desk Adjuster will be required to understand and explain written repair estimates and understand application of insurance policy coverage to the documented loss.
Essential Functions
1. Make and maintain contact with insured to provide timely service for the insured's claim.
2. Review property damage or personal injury claim written report and/or estimate.
3. Prepare reports and document the claim file as required via carrier.
4. Review reports from specialists such as public adjusters, lawyers, engineers, contractors, vehicle technicians and health care staff.
5. Ability to communicate effectively both orally and in writing.
6. Ability to operate multiple computer applications and programs, including but not limited to word processing and spreadsheets. Ability to quickly learn proprietary client claims systems.
7. Must have professional communication and customer service skills.
8. Strong product identification skills required with a general knowledge of home/commercial building/ auto construction.
9. Ability to effectively prioritize and complete multiple tasks within established timeframes.
10. Ability to travel throughout the United States and Canada (for in-office assignments) or ability to work at home office (for remote assignments).
11. Performs other related duties as assigned.
Competencies
1. Leadership - Exhibit's confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.
2. Strong Communicator - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings; Writes clearly and informatively.
3. Decision Making - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
4. Teamwork Orientation - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
5. Technical Capacity - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
6. Learning Orientation - Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
7. Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
8. Results Orientation - Anticipate, identify, and effectively deal with problems and risks; plan for contingencies to deal with unexpected challenges. Remains open to others' ideas and tries new things.
9. Diversity - Demonstrates knowledge of company EEO policy; Shows respect and sensitivity for cultural differences; Recognize the value of diversity; Promotes a harassment-free environment; Appreciates a diverse workforce.
10. Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
11. Adaptability - Adapts to changes in the work environment; Manages competing demands; Change's approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Supervisory Responsibility
This position will have the responsibility of complete claim file investigation and handling, including issuing payment or communication coverage decision.
Work Environment
Work location to be determined and may be in office or remote at the discretion of management or based on department needs.
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.
This is largely a sedentary role and requires operating a computer and telephone for extended periods of time. The person in this role needs to be in good physical shape with no restrictions.
Position Type/Expected Hours of Work
This is a seasonal position: Workdays will typically be Monday-Friday during client business hours, but additional days and time may be needed and will be based on volume of work.
Travel
This position typically requires up to 100% travel (in office assignments), or 0% travel (remote assignments), but can be more in CAT situations based on department need.
Preferred Education and Experience
1. Designated Home State Adjuster's License
2. State Specific Adjuster's license
3. 2 + years' experience in a claim handling environment.
4. Must be able to partner effectively with management.
5. Experience with customer service.
6. Smart and engaging leader with ability to work alone or in a team environment to accomplish performance goals. Possess excellent analytical and problem-solving skills.
7. Strong problem-solving skills.
8. Adaptable to changing work requirements.
9. Ability to function well in a high paced and at times stressful environment.
Auto-ApplyTotal Loss Adjuster, Personal Lines
Dallas, TX jobs
The Total Loss Adjuster will handle first and third party total loss claims for all vehicle types including private passenger autos, trailers, RV's, motorcycles, boats, farm equipment, construction equipment, commercial vehicles and commercial trucking. The Total Loss Adjuster makes and maintains a connection with the customer by understanding and meeting their needs; exhibits empathy and proactively follows up with the customer. Researches and responds to a variety of customer communications, concerns, or issues ranging from simple to complex. Documents the claim file with notes, evaluations and decision making process. Evaluates, validates and negotiates simple to complex total losses.
Key Responsibilities:
Investigating, evaluating, and negotiating claims, in order to reach a fair and equitable settlement
Negotiates settlement of claims with insureds, claimants and attorneys while following established, authorized settlement authority.
Uses compassionate communication and persuasive negotiation to ensure a positive customer experience
Reviews claim details, coverage limits, the estimate and all associated charges to confirm Total Loss Evaluation
Handles all claims within the guidelines of the states' Fair Claims Practices Acts and other Regulations. Will act as specialist in knowledge of Salvage and Title laws of the various states to facilitate legal transfer of title and claim resolution
Communicates with Lien Holders, Body shops, tow facilities and other vendors to secure information needed to bring claim to a conclusion
Controls associated claims for Rental/Loss of Use and storage
Ensure timeliness and KPI's are being met
Work closely with the MD appraisers to ensure accurate and timely evaluations
Ensure claim files are properly documents and all documents are attached
Request documents needed to process titles and salvage of vehicles
Monitor Copart website for receipt of title documents
Maintains an up-to-date dairy
Identifies subrogation and SIU opportunities and follows Company procedures to notify the appropriate company personnel of same
Ensure compliance with Hallmark Best Practices
Adjusts reserves to accurately reflect the exposure
Issue payments to the appropriate parties
Other Responsibilities:
Attend and participate in team meetings
Attends and successfully completes all assigned training in a timely manner
Complete continuing education and maintain state licensing for states which require a license
Qualifications:
Decisive and purposeful
Strong moral character and work ethic
Independent and self starting
Strong verbal communication skills
Shows initiative, exhibits a βcan doβ attitude, and provide ideas while working within a team environment
Able to work in a high volume, collaborative, fast paced environment while managing multiple priorities
Highly organized
Detail oriented with strong analytical skills and sound judgement
Excellent time management skills to meet deadlines and prioritize
Problem solver
Adaptive and flexible
Strong negotiation skills
Education, Experience, Knowledge and Skills:
Excellent verbal and written communication skills.
Strong interpersonal skills
Demonstrated proficiency of technology including, Microsoft Suite Software (Word, Excel, Power Point, Outlook), Total Loss Manager, ACD, vendor databases and other required web-enabled applications
Ability to operate business technology
Superior telephone skills
Excellent math skills
Ability to draft business correspondence, using correct punctuation, spelling and grammar
Experience investigating, evaluating, negotiating and settling simple to complex Auto claims strongly preferred
Knowledgeable of laws and regulations as it applies to auto insurance industry
Bilingual preferred
Hallmark Financial Services is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Auto-ApplyClaims Processing Expert
Phoenix, AZ jobs
Join Our Team as a Claims Processing Expert!
Are you a data-driven marketer who thrives on turning insights into impactful strategies? We are looking for a Claims Processing Expert to analyze key performance metrics, optimize marketing campaigns, and drive data-backed decision-making.
Why You'll Love This Role:
π Data-Driven Impact - Play a critical role in shaping marketing strategies through analytics.
π Career Growth - Access professional development and leadership opportunities.
β° Work-Life Balance - Enjoy a flexible schedule with full-time opportunities.
π° Competitive Compensation - Earn a stable income with performance-based incentives.
Your Responsibilities:
Analyze marketing campaign performance, customer behavior, and market trends.
Develop and track key performance indicators (KPIs) to measure marketing effectiveness.
Provide data-driven insights and recommendations to optimize marketing strategies.
Work with cross-functional teams to ensure data accuracy and consistency.
Utilize analytics tools (Google Analytics, Tableau, etc.) to generate reports and dashboards.
A/B test campaigns and refine strategies based on data insights.
What We're Looking For:
Proven experience in marketing analytics, data analysis, or a related field.
Proficiency in analytics tools such as Google Analytics, Tableau, or SQL.
Strong analytical and problem-solving skills.
Ability to translate complex data into actionable marketing strategies.
Experience with digital marketing metrics, reporting, and performance optimization.
Perks & Benefits:
Professional development and continuous learning opportunities.
Health insurance and retirement plans.
Performance-based bonuses and recognition programs.
Leadership growth and career advancement opportunities.
π Ready to Turn Data into Growth?
If you're passionate about leveraging data to drive marketing success, apply today! Join us and help shape data-driven marketing strategies that make an impact.
Your journey as a Claims Processing Expert starts here-let's optimize for success together!
Auto-ApplyClaims Processing Expert
Raleigh, NC jobs
Join Our Dynamic Insurance Team - Unlock Your Potential!
Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential.
NOW HIRING:
β
Licensed Life & Health Agents
β
Unlicensed Individuals (We'll guide you through the licensing process!)
We're looking for our next leaders-those who want to build a career or an impactful part-time income stream.
Is This You?
β Willing to work hard and commit for long-term success?
β Ready to invest in yourself and your business?
β Self-motivated and disciplined, even when no one is watching?
β Coachable and eager to learn?
β Interested in a business that is both recession- and pandemic-proof?
If you answered YES to any of these, keep reading!
Why Choose Us?
πΌ Work from anywhere - full-time or part-time, set your own schedule.
π° Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month.
π No cold calling - You'll only assist individuals who have already requested help.
β No sales quotas, no pressure, no pushy tactics.
π§ π« World-class training & mentorship - Learn directly from top agents.
π― Daily pay from the insurance carriers you work with.
π Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary
π Ownership opportunities - Build your own agency (if desired).
π₯ Health insurance available for qualified agents.
π This is your chance to take back control, build a rewarding career, and create real financial freedom.
π Apply today and start your journey in financial services!
(
Results may vary. Your success depends on effort, skill, and commitment to training and sales systems.
)
Auto-Apply2nd Shift Converting Adjuster
White Bluff, TN jobs
Job Details WHITE BLUFF, TN Full Time 2nd ShiftDescription
Job Summary: Sets up bag machine for bag operator based on job order and customer's specifications. Trouble shoots machine either for mechanical or quality problems.
Job Responsibilities:
Sets up bag machine to the specifications of the job.
Troubleshoots machine problems and quality issues.
Responsible for minor maintenance on machinery.
Responsible for maintaining floor shop information accurately.
General Housekeeping
Responsibilities are not inclusive.
Responsible for compliance with all regulatory, facility food safety, and quality policies and procedures including product safety (GMPs) policies and procedures.
Qualifications
Essential Functions:
Must have reading skills necessary to read orders and must be able to use a ruler to verify specifications.
Must be able to comprehend and follow detailed instruction without constant supervision.
Must be able to lift 30 - 75 pound boxes and must be able to manipulate 200-1,000 pounds with the assistance of mechanical devices.
Must be able to follow safety rules.
Must be able to tolerate standing for long periods of time.
Reflexes must be in excellent condition for quick response time on moving machinery. Employee must be able to react to rapidly moving parts in order to avoid serious injury to him/her. Employee must be completely alert at all times to operate machinery in proper manner.
Must be able to distinguish subtle shades of color accurately in order to match samples and color designations on orders.
FNOL Adjuster
Deerfield Beach, FL jobs
The FNOL Adjuster is responsible for taking inbound calls and recording First Notice of Loss. The position provides excellent customer service to all internal and external PTIC customers by utilizing excellent, in-depth knowledge of company products and programs. 620 license required. ESSENTIAL DUTIES AND RESPONSIBILITIES
Provide timely and accurate information to incoming customer requests.
Take First Notice of Loss (FNOL).
Resolve customer concerns and answer question on existing claims.
Receives, investigates, and then responds to customer complaints.
Works under general supervision performing a variety of complicated tasks requiring a wide degree of latitude and creativity.
Must be knowledgeable of concepts, practices, and procedures within a particular field.
Performs other duties as assigned.
REQUIRED SKILLS 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.
Problem Solving: identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem-solving situations; uses reason even when dealing with emotional topics.
Teamwork: contributes to building a positive team spirit.
Oral / Written Communication: speaks and writes clearly and persuasively in positive and negative situations; listens and gets clarification.
Attendance/Punctuality is consistently at work and on time; ensures work responsibilities are covered when absent.
Analytical: understands situations by breaking them down into component parts and looking for interdependence; weigh options and proposals critically and thoroughly through the use of a variety of information sources and tools; provides rationale for and results of analysis to others.
Interpersonal Skills: refer to the measure of a person's ability to operate within business organizations through social communication and interactions. Interpersonal skills are how people relate to one another.
Creativity: ability to identify radical alternatives to current thinking. Ability to develop innovative solutions to problems.
QUALIFICATIONS
High school diploma or general education degree GED); at least three years (3 plus) related experience and/or training; or equivalent combination of education and experience
State of Florida 5-20 or 6-20 Insurance Adjusters license
Intermediate to advanced computer skills: Microsoft Office, Outlook