Worker's compensation claims examiner jobs near me

The Workers' Compensation Claims TPA Liaison provides direct oversight of Third-Party Administrator (TPA) claim administration and facilitates communication between the TPA, policyholders, legal, and other internal departments. The WC TPA Liaison's mission is to provide superior customer service and ensure TPA claim outcomes are within best practices by utilizing technical claims expertise and providing guidance to the TPA. This position reports to the Workers' Compensation Claims Manager. Location: This is a full-time remote position. This position may require occasional travel to attend mediations, trainings, trials and/or other related department meetings. Job Responsibilities Direct management of TPA handled claims, including oversight of investigation, reserving, medical and disability management, coverage decisions, compensability determinations, and settlements Provide strategic direction to TPA adjuster/defense counsel to formulate proactive litigation strategies Monitor TPA's compliance with claim handling procedures, including nurse case management, return to work, legal, settlement, and reserving Alert Underwriting to relevant information and safety concerns Contact policyholders as needed during the investigation phase to clarify and/or gather additional information required to process claims and/or resolve inquiries Consult legal to clarify coverage questions and provide guidance to TPA Resolve routine and complex TPA claim and coverage questions with a goal of providing claim direction to TPA Resolve date of loss discrepancies identified on the DOL Mismatch report Extend reserve and settlement authority to TPA, alerting management to over-authority requests and complex claims Monitor TPA claims to identify files that exceed medical/disability guidelines or treatment parameters. Recommend TPA engage medical resources as appropriate. Participate in conference calls with TPA and defense counsel on complex claims with significant exposure Generate TPA inventory reports and monitor aging claims and/or claims with significant exposure Provide guidance to TPA to ensure claims are proactively managed to resolution Respond to daily emails from the TPA requiring assistance Perform TPA audits to evaluate quality of work and claim outcomes Ensure appropriate resources (NCM, FNCM, subrogation, legal, etc) are timely assigned to TPA claims Monitor claim assignment workflow to ensure claims are assigned to TPA efficiently Partner with Claims Technician to resolve TPA system data errors Assist with process improvement in the development of enhanced TPA workflows and methods Prepare ad hoc TPA reports Handle escalated TPA issues and projects as assigned Assist Claims Manager with day-to-day TPA operations, including TPA funding requests Other tasks and special projects as assigned Qualifications Active adjuster license 3-5 years experience adjusting workers' compensation claims (multi-jurisdictional knowledge a plus) Technical understanding of workers' compensation claims investigation techniques, compensability, insurance coverages, and negotiation skills Large loss injury litigation experience Self-motivated with the ability to work independently to meet deadlines Excellent verbal and written communication skills Ability to multi-task and work in a fast-paced, collaborative, virtual office environment Strong analytical, organizational, and time management skills Proficiency with MS Word, Excel and internet applications Highly attentive to details Able to work under pressure and execute good judgment in sensitive situations Strong interpersonal skills Excellent written and verbal communication skills Strong organizational and computer skills Strong negotiation skills Education: BA/BS degree required AIC, SCLA, CPCU or other industry designation a plus About Us bi Berk is where commercial insurance buyers can obtain coverage for their businesses from insurers of the Berkshire Hathaway group of Insurance Companies, one of the best capitalized insurance groups in the world. Our ultimate parent, Berkshire Hathaway Inc. (berkshirehathaway.com) is a holding company with diversified interests in a host of industries, including insurance, energy, transportation and manufacturing. Most policies issued through bi Berk.com will be underwritten by Berkshire Hathaway Direct Insurance Company ("BHDIC"), which is an AM Best rated A++ insurer. BHDIC is domiciled in Omaha, Nebraska. BHDIC and the team at bi Berk are focused on helping small business owners quickly and easily buy affordable insurance directly from a financially strong insurance company they can trust. BHDIC is excited to announce our comprehensive benefits package with some new and enhanced features for 2026 that include: Medical (PPO/HDHP), vision, disability, and life insurance. Enhanced dental plan with orthodontia coverage in addition to a standard plan. Generous PTO plan for all benefit-time eligible employees. Paid company holidays and 4 floating holidays. Paid parental leave. Employee Retirement Savings Plan/401(k) with company match and immediate vesting. Education Assistance Program that offers 100% upfront tuition reimbursement after 6 months of service for approved degree programs. Service Recognition Program that provides a monetary award to be used toward a vacation every 5 years of employment. Wellness Initiatives that include Fitness Center and Weight Watchers Reimbursement programs. Voluntary benefits that include accident, critical illness, and hospital indemnity. Employee discount and rewards program on travel, tickets, electronics, home, and more. In accordance with pay transparency laws and regulations, the following good faith compensation range estimate is being provided. The salary range for this position is $75,000-$90,000 per year. Final compensation will be based on candidate qualifications, geographic location, and other considerations permitted by law.

Workers Compensation Claims Adjuster (Texas Jurisdiction) Who says you can't have it all? Cottingham & Butler Claims Services (CBCS) is offering the opportunity to work in a fast-paced and exciting position with NO commute! You will be working from home so previous workers compensation adjusting experience is required (i.e. taking statements, paying lost wage benefits, filing state forms, denying claims, subrogation, litigation, etc.). As a Work Comp Adjuster, you will be responsible for investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients. The ideal candidate will have excellent communication and negotiation skills, be detail-oriented, and possess a strong understanding of workers compensation laws and regulations. You will be communicating with a wide variety of individuals, to include CEO's, claimants, providers offices, and attorneys. Experience handling claims in multiple jurisdictions is vital for success in this role. Qualifications: Minimum of 1 year experience as a workers compensation claims adjuster. License/state experience. Demonstrated knowledge of workers compensation laws and regulations. Strong analytical and problem-solving skills. Excellent communication and negotiation skills. Ability to work independently and in a team environment. Strong organizational and time-management skills. Proficiency in computer programs, including Microsoft Office and claims management software. If you are looking for a position that will allow you to stay in claims, continue to grow in your career, and also have the flexibility that working from home allows, this is the position for you. We will provide your office equipment and IT support, as well as training and support from our home office. If this sounds like a good fit to your career and life goals, we'd love to talk! Pay & Benefits Salary - Flexible based on your experience level. Most Benefits start Day 1 Medical, Dental, Vision Insurance Flex Spending or HSA 401(k) with company match Profit-Sharing/ Defined Contribution (1-year waiting period) PTO/ Paid Holidays Company-paid ST and LT Disability Maternity Leave/ Parental Leave Company-paid Term Life/ Accidental Death Insurance Cottingham & Butler Claims Services At CBCS, we sell a promise to help our clients through life's toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday - that's who we are and what we believe in. As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day. Want to learn more? Follow us on ****************** | LinkedIn

Overview Workers' Compensation Claim Specialist - Remote (CA Jurisdiction Only) Reporting Location: Concord, CA Branch Schedule: Monday-Friday, 8:00 a.m. - 4:30 p.m. PST Compensation: $85,000 - $97,000 annually Work Setting: Remote (must reside in a location that supports CA claim handling) Build Your Career With Purpose At CCMSI, we look for the brightest and most dedicated professionals to join our employee-owned team. As one of the nation's leading Third Party Administrators in self-insurance services, we pride ourselves on providing exceptional service, innovative solutions, and a culture that values every employee's contribution. We are seeking an experienced California Workers' Compensation Claim Specialist to join our remote team supporting the Concord, CA branch. This position manages a multiple-account desk handling California jurisdiction only and requires advanced claim handling knowledge, attention to detail, and the ability to balance multiple priorities in a fast-paced environment. Job Summary The Workers' Compensation Claim Specialist is responsible for investigating, evaluating, and resolving a variety of complex California workers' compensation claims in accordance with CCMSI's best practices, state regulations, and client-specific service standards. This position is ideal for a skilled adjuster seeking a long-term career with an employee-owned company that invests in training, technology, and its people. Important - Please Read Before Applying This is not an HR, benefits, safety, or manufacturing management role. We are seeking an insurance claims professional with proven experience directly investigating, reserving, litigating, and settling complex workers' compensation claims as an adjuster or adjuster supervisor within an insurance carrier, TPA, or similar claims-handling environment. Candidates without this background (for example, those with HR-only, safety, or employer-side risk management experience) will not be considered. Responsibilities Investigate, evaluate, and adjust workers' compensation claims within California jurisdiction in compliance with applicable laws and CCMSI standards. Establish and maintain appropriate reserves; authorize or recommend reserves and payments within assigned authority levels. Review, negotiate, and approve medical, legal, and other invoices as appropriate. Coordinate communication among claimants, clients, attorneys, and medical professionals to ensure timely and effective claim resolution. Attend and participate in hearings, mediations, and legal conferences as required. Prepare and maintain accurate, detailed claim documentation in compliance with corporate and client requirements. Monitor subrogation and excess/reinsurance claims as applicable. Deliver high-quality, client-focused service aligned with CCMSI's commitment to excellence. Qualifications Required: 10+ years of progressively responsible experience adjusting California workers' compensation claims. Demonstrated knowledge of California WC statutes, regulations, and case law. Exceptional written and verbal communication skills. Strong organization, multitasking, and time management abilities. Proficiency in Microsoft Office (Word, Excel, Outlook). Reliable, predictable attendance during client service hours. Preferred: SIP certification and/or California Adjuster Certification. AIC designation or other industry credentials. Prior experience with Third Party Administrator (TPA) claims handling. How We Measure Success Consistent compliance with CCMSI's claim handling standards and state regulations. Supervisor review of claim quality and timeliness. Positive client feedback and adherence to service level expectations. Achievement of key audit and performance goals. What We Offer 4 weeks PTO + 10 paid holidays in your first year • Medical, Dental, Vision, Life, and Disability Insurance • 401(k) and Employee Stock Ownership Plan (ESOP) • Internal training and advancement opportunities • A supportive, team-based work environment 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: • Act with integrity • Deliver service with passion and accountability • Embrace collaboration and change • Seek better ways to serve • Build up others through respect, trust, and communication • Lead by example-no matter their title 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 #WorkersCompensation #ClaimsAdjuster #InsuranceCareers #RemoteAdjusterJobs #CaliforniaJobs #NowHiring #JoinOurTeam #LI-Remote We can recommend jobs specifically for you! Click here to get started.

The Opportunity Are you a skilled claims professional ready to make a meaningful impact in workers' compensation management? As a Workers' Compensation Claims Advisor at M3, you'll serve as a trusted specialist providing expert claims support and consultation to our Property & Casualty Division. This role offers an exciting opportunity to work directly with clients and carriers, developing cost containment strategies while supporting client safety and risk management efforts in a dynamic, multi-state environment. How You Will Make an Impact * Serve as the agency's go-to specialist for workers' compensation claims resolution and scheduled reviews across multiple states * Provide expert claims management assistance and direction to both internal teams and external clients * Lead and participate in Risk Analysis Report discussions with Client Executives, proactively managing performance metrics * Counsel clients and claimants on their responsibilities and options, ensuring clear understanding of the claims process * Facilitate claims review meetings by preparing comprehensive data analysis and maintaining strong carrier relationships * Collaborate on dispute mediation and provide innovative solutions for complex claims situations * Develop cost containment strategies that directly impact client operations and retention * Maintain positive relationships with clients, carriers, and internal staff through exceptional service delivery What You Will Need to Succeed * Bachelor's degree in risk management, business, or related field preferred * Minimum 3 years of workers' compensation claims handling experience in multi-line P&C insurance * Property and Casualty License required or willing to obtain upon hire; valid driver's license required * Insurance designations (CIC, AIC, CPCU, CFPS, CISR) preferred but not required * Exceptional communication skills with ability to present to executives and front-line employees * Strong analytical abilities and proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) * Demonstrated expertise in customer service, problem-solving, and relationship building * Ability to work standard business hours (8am-5pm) Monday through Friday with occasional travel (10%) * Experience with multi-state jurisdictional laws and claims processes preferred Join Us Your role at M3 won't be about the boundaries presented in a job description - it's about the possibilities that you can envision once you walk through the doors on your first day. We're looking for people ready to take control of their career and excited to make a real impact with their position. Who We Are As an insurance broker, M3 helps you manage risk, purchase insurance, and provide benefits to your employees. We partner with clients on everything from property & casualty and employee benefits to personal lines, executive benefits, and employer-sponsored retirement plans. And, we're privately owned and independent which means we're doing what's best for our clients - not what's best for Wall Street or private equity. What Draws People to M3 Autonomy- Being able to work towards a common goal, but how you get there is an open book. Immediate Impact- Every M3er can make an impact, from day one in any role. Powered by Team- Be a part of a close-knit group of team members with whom you build trust and share responsibility. People- Every M3er is unique in their own way, M3 is a collection of unique achievers. At M3 Insurance experience the best of both worlds with our dynamic flexible work environment. Enjoy the flexibility to work remotely periodically while still fostering collaboration and innovation in-person in our office spaces. We prioritize work-life balance and empower our employees to thrive in a supportive and inclusive atmosphere. Benefits as an M3er Joining the M3 team means gaining access to a host of exceptional benefits and perks. Our benefits package is continuously evolving to cater to the needs of our team members. From flexible time-off and paid parental leave to employee appreciation events and volunteering opportunities, we prioritize the well-being and satisfaction of our employees. Additionally, our profit-sharing program ensures that every member of our team shares in the success of our organization. These enticing benefits showcase our commitment to nurturing and retaining top talent within our organization. Diversity, Equity & Inclusion M3 is building a culture focused on learning and progression, where M3ers are empowered by education, inclusive conversations, and real action that supports the future we envision. Equal Employment Opportunity M3 is committed to providing equal employment opportunity for all qualified individuals regardless of their age, sex, color, race, creed, national origin or ancestry, religion, marital status, military status, sexual orientation, disability/handicap, family responsibilities, non-relevant arrest or conviction records, or any other basis protected by law. In addition, we are committed to fully observing all relevant non-discrimination laws, including those regarding veterans' status, and will make reasonable accommodations for otherwise qualified individuals as appropriate. This commitment is reflected in all M3's practices and policies regarding hiring, training, promotions, transfers, rates of pay, and layoff, as well as in all forms of compensation, granting leaves of absence and in any other conditions of employment. All matters relating to employment are based upon ability to perform the job. In the best interests of M3 and all of its employees, every employee is to make every effort to avoid bias or prejudice in the workplace with regard to the above categories.

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

*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

Midwestern Insurance Alliance (MIA) is seeking a full-time Remote Claims Adjuster to join its worker's compensation claims processing team. MIA is a national workers' compensation program administrator offering custom-tailored worker's compensation insurance programs through its carrier partners. MIA focuses on niche segments such as local and long-haul trucking, parcel and mail delivery, and fuel hauling. MIA's acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels. Claims Adjuster responsibilities include, but are not limited to: Thoroughly investigating worker's compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable worker's comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are worker's comp injury-related and in accordance with the treatment plan. Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim. Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Preparing required state filings within statutory limits. Providing information as needed for litigation or settlement negotiations. The ideal Claims Adjuster will have: Bachelor's degree preferred, but not required. At least 33 years' WC claims adjusting experience. Examiner designation or WC Claims Adjuster license. Experience with Georgia and Florida WC claims preferred. Strong verbal and written communication skills. Strong organizational skills with attention to details. Ability to work with little supervision. Ability to manage multiple tasks in a fast-paced environment. Proficiency in MS Word, Excel, and Outlook. Salary: 80-85k US per year, depending on experience. MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week. Learn more about MIA at midwesterninsurance.com and K2 Insurance Services at k2ins.com.

Job DescriptionOur client, a recognized leader in the Workers' Compensation Insurance Industry, is seeking to add (2) New York Workers' Compensation Claims Adjusters to their Northeast team due to continued growth. You will be responsible for managing and resolving New York Workers' Compensation claims from initial report through final settlement. This role requires an experienced claims professional with strong technical expertise in New York Workers' Compensation Law, attention to detail, and the ability to handle a caseload efficiently while maintaining a high standard of quality. This position will allow the candidate to work fully remote! Key Responsibilities: Investigate, evaluate, and manage New York Workers' Compensation claims from start to resolution. Maintain a caseload of approximately 80-100 lost-time claims. Negotiate settlements and authorize payments within delegated authority. Ensure full compliance with state regulations, company policies, and best practices. Communicate effectively with policyholders, employers, medical providers, and attorneys to gather details and resolve claims promptly. Maintain timely and accurate claim documentation, reserve analysis, and file notes. Monitor and update claim diaries on an ongoing basis to ensure proper claim handling and follow-up. Qualifications: 3 - 10+ years of experience handling New York Workers' Compensation claims. Must hold an active New York Adjusters' License. Experience handling New Jersey or Pennsylvania Workers' Compensation claims is a plus but not required. Experience working for an insurance carrier or TPA is required. Prior experience handling Self-Insured or Large Deductible accounts is a plus. Strong organizational and analytical skills with the ability to work independently. Compensation & Benefits: Base Salary: $80,000 - $110,000+ (based on experience) plus annual bonus. 401(k) with employer match. Competitive Medical, Dental, Vision, and Life insurance plans. Employer contribution to HSA. Generous PTO and paid holidays. Long-term incentive programs. Flexible work schedule and the ability to work from home.

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference. This is a full-time remote position that can be located anywhere in the U.S. Must be able to work EST timezone * Investigates, evaluates, and resolves assigned Workers' Compensation claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. * Evaluate claimant eligibility; communicate with attending physician, employer and injured worker. * Work with both the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing treatment and related information. * Work directly with employers to facilitate a return to work, either on a full-time or modified duty basis. * Confirm coverage and applicable insurance policy or coverage document and statutory requirements. * Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate. * Identify potential for disability or pension credits or offsets and apply same where appropriate. * Ensure timely denial or payment of benefits in accordance with jurisdictional requirements. * Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure. * Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws. * Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution. * Where litigation is filed, evaluate exposure and work with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim. * Close all files as appropriate in a timely and complete manner. * Maintain closing ratio as directed by management team. * Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable. * Complete PARs (payment authorization request) when applicable. * Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting. Qualifications * High School diploma required. * Associate's or Bachelor's degree preferred. * 2 years of experience handling workers' compensation claims. * Completion of Workers' Compensation training courses internally and/or externally in all significant areas affecting Workers' Compensation claims handling and practices. * Workers' Compensation licenses, certifications, awards preferred. Benefits We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $20.96 - $24.03 hourly, and will be based on a number of additional factors including skills, experience, and education. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-FP1 #LI-Remote

We are looking to add a Sr. Workers' Compensation Claims Specialist, Supervisor to join our Creative Risk Solutions team. The ideal candidate will have jurisdictional experience in multiple states. This team member will provide high quality claims handling oversight and expertise for all CRS customers on litigated and complex claim situations. This includes assisting staff supervised with investigating, communicating, evaluating, and resolving claims utilizing the CRS Best Practice of Claim Handling. Assisting claim staff with goals, career pathing, and ensuring engagement. Essential Responsibilities: Claims Management: Adjudicate claims during staffing shortages, investigate, and negotiate settlements per “Best Practices for Claims.” Monitor and document claim files, focusing on Coverage, Investigation, Reserves, Plan of Action, Legal, and Medical Management. Recommend adjustments as needed. Research and respond to questions and complaints from insureds, claimants, agency partners, and fronting carriers. Discuss complex claims and coverage issues with clients, addressing any inquiries. Maintain communication with customers and fronting carriers per “CRS Communication Expectations” and “Reportable” file guidelines. Assist staff in managing litigation claims, ensuring timely responses and protecting the interests of insured and carriers. Management Responsibilities: Ensure appropriate staffing, including hiring and terminations. Coach team members on workflow, processes, customer service, and client consulting. Conduct performance reviews, set goals, and hold employees accountable. Foster career development and manage timesheets and compensation decisions Coordinate training and maintain standardized processes for quality service. Facilitate regular team meetings and attend enterprise and leadership training. Additional Responsibilities: Conduct monthly performance meetings and quarterly team meetings. Set and monitor annual goals for staff. Participate in round tables, claim reviews, and Risk Control Workshops. Mediate between insured and insurance company, addressing coverage issues and large loss reporting. Analyze performance data to implement necessary changes. Review all files at least every 90 days. Qualifications: Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. Experience: 5+ years of adjusting property and casualty claims, including litigated claims. Prior agency, loss control or carrier experience preferred. Prior supervisory experience preferred. Licensing: Active state specific Workers Compensation License required or the ability to acquire license within three months of hire. Skills: Extensive knowledge of General and Auto Liability or Workers Compensation coverages and application in job duties, proficient in claims processing procedures, knowledge or ability to learn multiple state insurance regulations; pass state licensing exams. Technical Competencies: An ideal candidate will have a strong grasp of claims principles, practices, and insurance coverage interpretation, contributing to workflows and adhering to compliance requirements. They will prioritize problem-solving, actively foster relationships, and collaborate to deliver impactful solutions and a world-class client experience. Here's a little bit about us: Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members. Benefits: In addition to core benefits like health, dental and vision, also enjoy benefits such as: Paid Parental Leave and supportive New Parent Benefits - We know being a working parent is hard, and we want to support our employees in this journey! Company paid continuing Education & Tuition Reimbursement - We support those who want to develop and grow. 401k Profit Sharing - Each year, Holmes Murphy makes a lump sum contribution to every full-time employee's 401k. This means, even if you're not in a position to set money aside for the future at any point in time, Holmes Murphy will do it on your behalf! We are forward-thinking and want to be sure your future is cared for. Generous time off practices in addition to paid holidays - Yes, we actually encourage employees to use their time off, and they do. After all, you can't be at your best for our clients if you're not at your best for yourself first. Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities that are important to you - Through our Holmes Murphy Foundation, we offer several vehicles where you can make an impact and care for those around you. DE&I programs - Holmes Murphy is committed to celebrating every employee's unique diversity, equity, and inclusion (DE&I) experience with us. Not only do we offer all employees a paid Diversity Day time off option, but we also have a Chief Diversity Officer on hand, as well as a DE&I project team, committee, and interest group. You will have the opportunity to take part in those if you wish! Consistent merit increase and promotion opportunities - Annually, employees are reviewed for merit increases and promotion opportunities because we believe growth is important - not only with your financial wellbeing, but also your career wellbeing. Discretionary bonus opportunity - Yes, there is an annual opportunity to make more money. Who doesn't love that?! The salary range for this role is $65,000- $109,000. Compensation is based on several factors, including, but not limited to, education, work experience and industry certifications. In addition to your salary, Holmes Murphy offers a comprehensive total rewards program including annual bonuses, total wellbeing benefits and support for professional development. #LI-EG1 #Remote

Midwestern Insurance Alliance (MIA) is seeking a full-time Remote Claims Adjuster to join its worker's compensation claims processing team. MIA is a national workers' compensation program administrator offering custom-tailored worker's compensation insurance programs through its carrier partners. MIA focuses on niche segments such as local and long-haul trucking, parcel and mail delivery, and fuel hauling. MIA's acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels. Claims Adjuster responsibilities include, but are not limited to: Thoroughly investigating worker's compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable worker's comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are worker's comp injury-related and in accordance with the treatment plan. Ensuring payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. Calculating and assigning appropriate reserves to claims, and managing reserve adequacy throughout the life of the claim. Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Preparing required state filings within statutory limits. Providing information as needed for litigation or settlement negotiations. The ideal Claims Adjuster will have: Bachelor's degree preferred, but not required. At least 33 years' WC claims adjusting experience. Examiner designation or WC Claims Adjuster license. Experience with Georgia and Florida WC claims preferred. Strong verbal and written communication skills. Strong organizational skills with attention to details. Ability to work with little supervision. Ability to manage multiple tasks in a fast-paced environment. Proficiency in MS Word, Excel, and Outlook. Salary: 80-85k US per year, depending on experience. MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week. Learn more about MIA at midwesterninsurance.com and K2 Insurance Services at k2ins.com.

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is looking for an experienced Claims Specialist supporting Disability and Leave Management claims to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required. Key Job Responsibilities * Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved * Communication via telephone, email, and text with employees, employers, attorneys, and others * Review and interpret medical records, utilizing resources as appropriate * Complete financial calculations * Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication * Apply contract/policy provisions to ensure accurate eligibility and liability decisions * Demonstrate and apply analytical and critical thinking skills * Verify on-going liability and develop strategies for return-to-work opportunities as appropriate * Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication * Leverage a broad spectrum of resources, materials, and tools to render claims decisions * Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards * Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities * Work independently as well as within a team structure * Deliver refresher trainings as appropriate to the claim team * Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review. * Prepare reports for management on claim outcomes and performance metrics. * Assist in training and mentoring junior claim examiners on best practices, improving their decision-making skills. * Oversee the ongoing management of complex, high-priority or escalated cases and callers. The base salary range for this position is $60,000 - $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility. For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below. Equitable Pay and Benefits: Equitable Total Rewards Program Required Qualifications * Bachelor's degree or equivalent work experience * 3 disability claims administration experience * Prior leadership experience as a team lead or manager * Exceptional customer service skills * Maintains positive and effective interaction with challenging customers * Strong knowledge of disability and leave laws and regulations * Ability to handle sensitive information with confidentiality and professionalism * Group Disability Claims experience * Prior experience managing Paid Family Leave for multiple state Preferred Qualifications * Experience working with the Fineos Claim Management System * Exceptional written and oral communication skills demonstrated in previous work experience * Excellent organizational and time management skills with ability to multitask and prioritize deadlines * Ability to manage multiple and changing priorities * Detail oriented; able to analyze and research contract information * Demonstrated ability to operate with a sense of urgency * Experience in effectively meeting/ exceeding individual professional expectations and team goals * Demonstrated analytical and math skills * Ability to exercise critical thinking skills, risk management skills and sound judgment * Ability to adapt, problem solve quickly and communicate effective solutions * High level of flexibility to adapt to the changing needs of the organization * Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment * Continuous improvement mindset * A commitment to support a work environment that fosters diversity and inclusion. * Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word Skills Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems. Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center. Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support. Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations. #LI-Remote ABOUT EQUITABLE At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities. We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork. We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws. NOTE: Equitable participates in the E-Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.

Why MSI? We thrive on solving challenges. As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs. We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners. Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle. Bring on your challenges and let us show you how we build insurance better. 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 Claims Examiner. The Claims Examiner will be managing insurance claims for our policyholders with low to moderate severity and complexity. The Claims Examiner must have the experience and technical knowledge needed to manage a 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 Claims Examiner must be able to work with little to minimal supervision in a fast-paced environment. PRIMARY RESPONSIBILITIES: Directly handles third-party bodily injury and property damage claims involving low to moderate complexity 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 5+ 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 willingness to expand licenses as needed. #LI-BM #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.

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates General Liability claims affecting primary and excess policies in a fast-paced E&S Claim environment. ESSENTIAL DUTIES AND RESPONSIBILITIES Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Independently evaluating information on coverage, liability, and damages to determine the extent of exposure to the insured and all financial partners. 2. Countrywide Litigation Management providing world class claims service to our clients, developing and executing litigation plans, managing legal budgets and lawsuits through resolution. 3. Determine where new loss claims should be reported. 4. Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately. 5. Analyze claim coverage with insurance carriers to ensure claims are paid accurately. 6. Assess eligibility status of denied claims. 7. Providing outstanding customer service and fostering great working relationships with insureds, brokers and underwriters in the handling and adjudication of all claims. 8. Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources. 9. Process all departmental claims in a timely manner according to company policy. 10.Ability to travel to mediations and trials as needed. 11. Perform other duties as assigned. QUALIFICATIONS Required Qualifications: 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. 1. Bachelor's degree with a concentration in business or equivalent work experience 2. Three years of General Liability Claims handling experience and commercial and multi-line knowledge 3. Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations 4. Ability to make independent decisions following CRC guidelines with minimal or no supervision 5. Good organizational, time management, and detail skills 6. Extensive knowledge of insurance and CRC processes 7. Ability to maintain a high level of tact and professionalism 8. Good leadership skills to influence all departmental employees in a positive manner 9. Possess strong interpersonal skills 10. Strong verbal and written communication skills 11. Strong computer and office skills 12. Ability to work extended hours when necessary Preferred Qualifications: 1. Multi-State Resident and Non-Resident adjuster 2. Ability to thrive in a remote team environment 3. Experience in the Construction and E&S Claim Environment with a high degree of specialized and technical competence in interpreting general liability policies and exposures for both property damage and bodily injury claims. General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Serves as a resource for co-worker process questions and concerns. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School Graduate or equivalent. 2. Certified Revenue Cycle Representative (CRCR) Certification from AAHAM or HFMA within 90 days of hire. 3. Completes eight hours of revenue cycle continuing education required annually. EXPERIENCE: 1. Three (3) years medical billing/medical office experience. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. Three (3) years medical billing/medical office experience, preferably related to claims billing and insurance follow-up. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Accesses and utilizes all necessary computer software, applications and equipment to perform job role. 11. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 12. Attends department meetings, teleconferences and webcasts as necessary. 13. Researches and processes mail returns and claims rejected by the payer. 14. Reconciles billing account transactions to ensure accurate account information according to established procedures. 15. Processes billing and follow-up transactions in an accurate and timely manner. 16. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 17. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 18. Maintains work queue volumes and productivity within established guidelines. 19. Provides excellent customer service to patients, visitors and employees. 20. Participates in performance improvement initiatives as requested. 21. Works with supervisor and manager to develop and exceed annual goals. 22. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 23. Communicates problems hindering workflow to management in a timely manner. 24. Serves as a resource for co-worker process questions and concerns. 25. Works with Hospital Billing Trainer to identify training opportunities for staff. 26. Serves as a Super User for Quadax, FISS, and other PFS software applications. 27. Exceeds productivity measures in like work group as demonstrated by Epic dashboards. 28. Assists in the annual review of departmental policies and procedures and provides feedback. PHYSICAL REQUIREMENTS: 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. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 4. Visual acuity must be within normal range. 5. Must be able to communicate effectively. 6. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING 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. 1. Office type environment. SKILLS AND ABILITIES: 1.Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of third party payers required. 5. Knowledge of business math preferred. 6. Knowledge of ICD-10 and CPT coding processes preferred. 7. Excellent customer service and telephone etiquette. 8. Ability to use tact and diplomacy in dealing with others. 9. Maintains current knowledge of third party payer and managed care billing requirements and contracts. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 UHA Patient Financial Services

The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests only; other inquiries won't receive a response). Regular or Temporary: Regular Language Fluency: English (Required) Work Shift: 1st Shift (United States of America) Please review the following job description: Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates General Liability claims affecting primary and excess policies in a fast-paced E&S Claim environment. ESSENTIAL DUTIES AND RESPONSIBILITIES Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Independently evaluating information on coverage, liability, and damages to determine the extent of exposure to the insured and all financial partners. 2. Countrywide Litigation Management providing world class claims service to our clients, developing and executing litigation plans, managing legal budgets and lawsuits through resolution. 3. Determine where new loss claims should be reported. 4. Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately. 5. Analyze claim coverage with insurance carriers to ensure claims are paid accurately. 6. Assess eligibility status of denied claims. 7. Providing outstanding customer service and fostering great working relationships with insureds, brokers and underwriters in the handling and adjudication of all claims. 8. Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources. 9. Process all departmental claims in a timely manner according to company policy. 10.Ability to travel to mediations and trials as needed. 11. Perform other duties as assigned. QUALIFICATIONS Required Qualifications: 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. 1. Bachelor's degree with a concentration in business or equivalent work experience 2. Three years of General Liability Claims handling experience and commercial and multi-line knowledge 3. Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations 4. Ability to make independent decisions following CRC guidelines with minimal or no supervision 5. Good organizational, time management, and detail skills 6. Extensive knowledge of insurance and CRC processes 7. Ability to maintain a high level of tact and professionalism 8. Good leadership skills to influence all departmental employees in a positive manner 9. Possess strong interpersonal skills 10. Strong verbal and written communication skills 11. Strong computer and office skills 12. Ability to work extended hours when necessary Preferred Qualifications: 1. Multi-State Resident and Non-Resident adjuster 2. Ability to thrive in a remote team environment 3. Experience in the Construction and E&S Claim Environment with a high degree of specialized and technical competence in interpreting general liability policies and exposures for both property damage and bodily injury claims. General Description of Available Benefits for Eligible Employees of CRC Group: At CRC Group, we're committed to supporting every aspect of teammates' well-being - physical, emotional, financial, social, and professional. Our best-in-class benefits program is designed to care for the whole you, offering a wide range of coverage and support. Eligible full-time teammates enjoy access to medical, dental, vision, life, disability, and AD&D insurance; tax-advantaged savings accounts; and a 401(k) plan with company match. CRC Group also offers generous paid time off programs, including company holidays, vacation and sick days, new parent leave, and more. Eligible positions may also qualify for restricted stock units and/or a deferred compensation plan. CRC Group supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC Group is a Drug Free Workplace. EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify

Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking a seasoned workers' compensation adjuster to join our Third-Party Administration team. This is a remote role, open to candidates who live in Orange or Los Angeles County. Team meetings and training sessions are held in person at our Long Beach office a few times each year. Job Summary The Workers Compensation Claims Adjuster is responsible for managing all aspects of a workers compensation claim which includes determining compensability, verifying coverage, administering disability and medical benefits, skillfully negotiating claim resolutions, troubleshooting and assisting injured employees, employers and medical/legal professionals with any service needs throughout the lifespan of a claim. Essential Functions * Receives newly reported claims * Maintains and updates claim notes throughout lifespan of claim * Records claim information in electronic database * Interviews claimants, insureds, medical professionals and witnesses to determine claim validity * Communicates claim compensability decisions to claimant, employer and medical provider * Sets appropriate reserves based on nature/extent of injury * Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate * Orders independent medical examination as necessary and prepares all relevant documentation for physician review * Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments * Reviews and processes medical bills through third-party vendor for additional discount opportunities * Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued * Works in partnership with legal counsel to warrant that insured's interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure * Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured * Reviews and approves defense attorney bills within authority * Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses * Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters * Identifies subrogation potential and pursues recovery * Leads claim reviews with clients as requested * Other duties as assigned Requirements * 10 years of experience adjusting Workers Compensation Claims in California required * SIP Certification required * Bilingual (Spanish/English) required * Must be current with CEU's * Proficiency in entire Microsoft Office suite * Knowledge of relevant workers compensation laws * Strong grasp of medical terminology * Familiarity with medical cases and how treatment typically progresses * Excellent oral and written communication abilities * Attention to detail and good organization skills * Ability to negotiate issues and settlements * Strong focus on customer service which includes timely response to requests/inquiries * Ability to adapt to changing technologies and learn functionality of new equipment and systems * Ability to establish and maintain effective working relationships with others Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, life insurance and 401(K) with match. If you are seeking a career where you can achieve great things for great clients in a supportive and collaborative environment, then we may be the place for you. Values At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration. Equal Opportunity Employer Here at Charles Taylor, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex, or sexual orientation. Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive, and diverse culture and environment which we are proud to be a part of at Charles Taylor. About Charles Taylor Charles Taylor is an independent, global provider of claims solutions, insurance management services and technology platforms for all property and casualty markets, including commercial property, workers' compensation, and auto/liability. We offer complex loss adjusting, technical services, third-party administration, and managed care programs with specialization in catastrophic, aviation, energy, and marine claims. With over 100 years of expertise at our core, we offer a comprehensive suite of solutions across all lines of business to help our clients manage risk.

BroadPath is hiring a detail-oriented **Senior Claims Examiner** to train and work from home! Join our team as a Senior Claims Examiner and play a crucial role in ensuring the financial health of our organization while supporting quality patient care. The Senior Claims Examiner's primary function is to ensure the accurate adjudication of all complex claims for SCCIPA contracted plans. Your expertise will be crucial in maintaining our high standards of accuracy and efficiency in claims processing. **Compensation Highlights:** + Base Pay: $18.00 per hour + Pay Frequency **:** Weekly **Schedule Highlights:** + Training Schedule: 5 days, Monday-Friday, 8:00 AM - 5:00 PM PST + Production Schedule: Monday-Friday, 8:00 AM - 5:00 PM PST, no weekends! **Responsibilities** + Adjudicate all types of claims, resolving system edits and audits for hardcopy and electronic submissions + Resolve provider and eligibility issues related to received claims + Generate emergency reports and authorizations for claims that lack prior authorization + Adjudicate third-party liability and coordination of benefit claims in line with policy + Review stop loss reports and identify members approaching reinsurance levels + Identify potential system programming issues and report them to the supervisor + Provide technical support and training for claims processors + Recognize and appropriately route claims for carved-out services based on plan contracts + Process claims using knowledge of plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans, and capitation arrangements + Ensure correct posting of claims information to the appropriate general ledger accounts + Collaborate with Customer Service and Provider Services on large claim projects and adjustments + Assist with benefit and plan interpretation via the cut-log system when necessary + Adjust complex claims and support other examiners with claim resolution + Perform additional duties as assigned **Qualifications** + High school diploma or equivalent required + Two years of experience processing both regular and complex claims + Proficiency in ICD-9, CPT, HCPC, and revenue coding required + Strong communication skills with the ability to collaborate effectively with supervisors, co-workers, and other departments + Ability to analyze and resolve claims issues, troubleshooting complex problems independently + Capable of working in a high-volume, production-oriented environment + Detail-oriented with the ability to maintain focus during extended periods of time + Strong performance under demanding production and quality standards + Technical proficiency with claims processing software + In-depth understanding of complex claims procedures and medical terminology + Knowledge of HEDIS, DOC, HCFA, and NCQA requirements + Ability to act as a resource and trainer for claims processors **Diversity Statement** _At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!_ _Equal Employment Opportunity/Disability/Veterans_ _If you need accommodation due to a disability, please email us at_ _*****************_ _. This information will be held in confidence and used only to determine an appropriate accommodation for the application process._ _BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law._ _Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location._

Come join our amazing team and work remote from home! The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses were identified and the financial reconciliation is accurately completed on all liquidated loans. Key reviewer of loss analysis decisions which include validating the determined responsibility and root cause for avoidable losses, ensuring they meet quality expectations and reflect proper decision rationale and supporting evidence and identify any bill back opportunities. Perform all duties in accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay for this position is $23.00/hr - $26.50/hr. What you'll do: Review reconciliation of all loan advances once the GSE or Government Mortgage Insured “expense” claim has been paid. Confirm all prior tasking in LoanServ has been completed as well as update approval tasks as required per job aid upon the date the action occurs. Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as needed. Responsible for learning new skills and expand job knowledge to better perform assigned duties. Maintain monthly performance in alignment with quality expectations. Analyze multiple data elements in order to confirm the proper decision rationale and approve evidentiary support is included and written summaries are accurate. Validate research on incurred losses, using analytical skills and subject matter knowledge to confirm responsibility and bill back opportunities. Responsible for staying abreast of relevant changes to GSE or Government Mortgage Insured guidelines, industry standards and client expectations. Ensure timely completion of projects and tasks when assigned. If unable to meet a deadline, the deadline must be renegotiated prior to the initial deadline date. Look for opportunities to improve the department's processes and procedures, to reduce costs and eliminate non-essential and manual processes and activities. Keep Team Lead and Supervisor informed of all trends and problems including, but not limited to, exceptions identified in review of Loss Analysis processes. Moderate working knowledge of all Default Servicing processes up to and including Loss Mitigation, Bankruptcy, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines. Moderate background in financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered. Moderate ability to conduct quality assurance reviews. Preferred Accounting Background--Must possess the ability to complete financial reconciliations. Moderate computer skills with MS Word, Excel. Strong attention to details and excellent time management and organizational skills. Comprehensive writing skills, including proper punctuation and grammar, organization, and formatting. Ability to work under general direction to accomplish department goals and reduce/mitigate financial loss to CMS and its Clients. Ability to substantiate facts and properly document them. Ability to work effectively and develop rapport with all levels of staff, management, Investors/Insurers and 3rd parties. Ability to make decisions that have moderate impact to immediate work unit. Ability to identify urgent matters requiring immediate action and properly escalating them. Ability to handle multiple tasks under pressure and changing priorities. What you'll need: High School diploma required; Associate/Bachelor Degree in accounting or other related field preferred. Two (2) or more years' quality assurance experience. Three (3) or more years' Loan Servicing platform experience for all default related activities such as Foreclosure, Bankruptcy, Default MI Claims, Loss Mitigation, etc. Previous FHA, VA, USDA and PMI claims experience preferred Our Company: Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you'll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: *************************** What We Offer: Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed. Access to several fitness, restaurant, retail (and more!) discounts through our employee portal. Customized training programs to help you advance your career. Employee referral bonuses so you'll get paid to help Carrington and Vylla grow. Educational Reimbursement. Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org. Notice to all applicants: Carrington does not do interviews or make offers via text or chat. #LI-SY1