Worker's Compensation Claims Examiner remote jobs

*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.

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 *******************************.

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.

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

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

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

Job DescriptionJob Profile Job Title: Claims ExaminerLocation: Rancho Cucamonga, CA -must live in CAHire Type: Contingent Pay Range: $50Work Model: Remote Work Shift: Monday-Friday 8 am - 4:30 pm Recruiter Contact: Sean Craft I sean@marykraft.com I 443-345-3305 Nature & Scope:Positional OverviewWe are seeking a skilled Claims Examiner with experience handling complex or technically challenging Workers' Compensation claims. The Claims Examiner will investigate, analyze, and manage high-exposure cases, including litigated and rehabilitation claims, ensuring accurate benefit determination and adherence to industry's best practices. This role will work remotely but must reside within the state of California.Role & Responsibility:Tasks That Will Lead to Your Success Analyze and process complex workers' compensation claims, determining claim exposure through detailed investigation. Develop and execute action plans to ensure timely and appropriate claim resolution. Evaluate, calculate, and maintain accurate reserves across the life of each claim. Approve and process benefits, payments, and adjustments in accordance with authority levels. Prepare and submit all required state filings within statutory timeframes. Manage litigation activities and collaborate with legal partners to ensure cost-effective outcomes. Coordinate vendor referrals for investigations, medical reviews, or litigation support. Utilize cost-containment strategies, including partnerships with approved vendors, to minimize overall claim expenses. Manage recovery opportunities such as subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets. Report applicable claims to excess carriers and respond promptly to direction requests. Maintain ongoing communication with claimants and clients, fostering strong professional relationships. Ensure claim documentation is complete, accurate, and compliant with coding standards. Escalate cases to supervisors or management when necessary. . Skills & ExperienceQualifications That Will Help You Thrive High School Diploma or GED required. Bachelor's degree preferred. Professional certifications related to workers' compensation or claims management preferred. Minimum 5 years of claims management experience, or an equivalent combination of experience and education. In-depth understanding of workers' compensation laws, insurance principles, recovery practices, and cost containment strategies. Strong analytical, investigative, and interpretive abilities. Excellent written and verbal communication skills, including presentation ability. High proficiency with Microsoft Office and claims management systems. Strong negotiation skills and ability to resolve disputes effectively. Organized, detail-oriented, and capable of managing multiple cases simultaneously. Team-oriented with strong interpersonal skills. Ability to meet or exceed service expectations consistently.

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

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.

* This is a continuous recruitment* * Qualified candidates are encouraged to apply immediately* Bargaining Unit: Local 21 - Non-Supervisory Management Contra Costa County is seeking two (2) Workers' Compensation Claims Adjuster II to join our Risk Management team. The County Workers' Compensation Program is unique as it is not only self-insured, but also self-administers the claims and provision of benefits to industrially injured employees of the County. Where other public agencies rely on third-party administrators to administer their claims, the County believes our self-administered approach is one that prioritizes the quality of service to our internal departments and their injured employees. The Workers' Compensation Claims Adjuster II may report to the Senior Workers' Compensation Claims Adjuster or the Workers' Compensation Claims Supervisor. Why join our team? The County believes staff is its greatest asset. We strive to provide a workplace that is inclusive of all people, cultures, and backgrounds. At Contra Costa County, we see every day as a chance to create a positive impact on the individuals we serve. We lead through our values, integrity, community, and our employees are dedicated and provide excellent service. The Workers' Compensation Unit in particular is a small and dedicated unit within the Risk Management team. Each team member has a unique opportunity to support each other, make an immediate impact on the program, and to share their experience and knowledge with the rest of the team. Our Adjusters have the opportunity to work on a wide variety of claims which ensures you are always learning something new and continuing to grow in your skillset and career path. We are looking for someone who is: * An effective communicator who possesses strong verbal, written, and listening skills * Productive under pressure, while maintaining deadlines and administering timely Workers' Compensation benefits * Capable of maintaining working relationships with multiple parties including claimants, employer contacts, medical providers, and legal counsel * Able to apply technical knowledge and accurately make mathematical calculations * Able to interpret and use Workers' Compensation rules and regulations What you will typically be responsible for: * Investigating compensability of on-the-job injury claims filed by County employees * Administering timely Workers' Compensation benefits to include provision of medical treatment, as well as, temporary disability benefits, permanent disability benefits, and Supplemental Job Displacement Benefits * Working closely with legal counsel for case development and claim resolution * Working on negotiation and settlement of claims by Stipulations and Compromise and Release * Reviewing and documenting diaries, reserves, and pertinent claim materials in a timely manner * Maintaining timely reporting with the excess insurance carrier, when appropriate A few reasons you might love this job: * You will be part of a dynamic team * We offer a hybrid remote work schedule * You will have access to a generous benefits package including retirement, health plan options and other benefits listed here: Employee Benefits | Contra Costa County, CA Official Website A few challenges you might face in this job: * You will work in a fast-paced environment * You will be expected to manage multiple assignments with competing deadlines * You may interact with clients that are upset and/or confused The eligible list for this recruitment may remain active for 6 months. Please view the job description here License Required: Possession of a valid California Motor Vehicle Operator's License. Out of state Motor Vehicle Operator's License may be accepted during the application process. Certification: The incumbent must be a current "certified claims adjuster" in the state of California pursuant to Title 10 of CCR2592, or possess the self-insurance certificate issued by the State of California. Education: Completion of 60 semester or 90 quarter units from an accredited college or university which included at least six semester or nine quarter units in business or public administration, insurance, physical science, finance or a closely related field. Experience: Three (3) years of full-time or its equivalent performing as a Workers' Compensation Claims Adjuster I or in an equivalent classification as a professional claims adjuster with an insurance carrier or third party claims administrator whose primary responsibility was the adjustment of workers' compensation indemnity claims. Substitution for Education: Additional experience of the type noted above may be substituted for the required education on a year-for-year basis up to a maximum of two (2) years. * Application Filing and Evaluation: Applicants will be required to complete a supplemental questionnaire at the time of application, applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process. * Training and Experience Questionnaire: Candidates will be required to complete a training and experience questionnaire at the time of filing. The responses to the training and experience questions on the supplemental questionnaire will be used to evaluate candidates relevant education, training and/or experience as it relates to the Workers' Compensation Claims Adjuster II Classification. (Weighted 100%) The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices. For recruitment specific questions, please contact Lashun Fuller at *****************************. For any technical issues, please contact the GovernmentJobs' applicant support team for assistance at ***************. CONVICTION HISTORY After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment. DISASTER SERVICE WORKER All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency. EQUAL EMPLOYMENT OPPORTUNITY It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the 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

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

We are currently seeking the right candidate who will bring added value to all key stakeholders by assisting and educating employers with managing their Workers' Compensation claims. The Advocate must also engage with claims examiners to ensure best practices for the most optimal results. Responsibilities include analyzing loss runs and claim handler status reports, then strategizing and negotiating to move cases to resolution. Documenting results, trends and outcomes is a critical component of the deliverables. Proficiency in Excel, Word, and Power Point is a requirement to create professional deliverables. Job duties also include analysis of Experience Rating Forms, calculating X-Mod forecasts and knowledge of the basis for WCIRB recalculation opportunities. A strong network of defense attorneys, Workers' Comp vendors and doctors is needed to recommend and advise on managing these aspects of claims. Duties include daily interaction with multiple employers, claim examiners and insurance brokers. In addition, the Advocate must have strict organizational ability to set and adhere to tight diaries following up on activities that achieve the desired results. The job includes consistent follow up and report scheduling, leading and facilitating in-person or telephonic claims reviews for productive, informative exchange of information and ensuring accountability to agreed-upon action plans. It also requires the ability to learn many different carrier/TPA on line claim systems, in addition to our internal programs and processes. The Advocate is responsible for interpreting and summarizing data to provide the employer with information that allows them to make the best financial, legal and ethical decisions about managing their Workers' Compensation claims. The ESM Claims Advocate is a consistent and persistent advocate for employers and a service partner with insurance brokers. Responsibilities: This job requires professionalism and a broad technical knowledge of claims, California Labor Code, case law, California Experience Rating, insurance policy terms and employment issues. The right candidate is adept at analysis of claims, identifying the key outstanding issues, and recommending appropriate actions to ensure timely, and cost saving resolution. We are searching for a Workers' Compensation Claims Advocate who understands the risks that employers face and can develop relationships with all stakeholders, serving as a trusted advisor. Analytical ability and an excellent memory for details are a requirement. Building relationships with multiple employers, brokers, and claims handlers is needed to ensure success. The job requires dogged perseverance, flexibility, ability to think globally and recommend detailed actions. The right person is compassionate and empathetic, yet firm and confident in making recommendations to employers and claims handlers. Excellent communication skills are imperative. These include creating presentations with Power Point and Excel, composing newsletter articles or blogs to educate employers and brokers, excellent writing ability to succinctly summarize claims action items and target dates, and verbal speaking ability via GoToMeeting webinars. Experience: We are conducting a search for the best candidate - one who has years of working within the Workers' Compensation claims arena. The ideal candidate understands the complexities of X-mods, has broker relationships, understands the role of Claims Advocate and advocacy for employers and has had claim handler experience. Assisting an employer with managing their Workers' Compensation risk requires basic understanding of types of policies, Captives, PEOs and Carve Outs. ESM is a small business looking for an entrepreneurial minded individual who can think strategically and understands the technicalities of Workers' Compensation claims management to help enhance our services and deliverables. Requirements: The candidate must have 5+ years of Workers' Compensation claims advocacy experience. Certificates of WCCA, WCCP, ARM, Self-Insurance certificate, CPDM or other certification. Prior brokerage experience or carrier/ TPA claim examiner position. Must be a critical thinker and a problem solver. Excellent organizational and time management skills. Must be able to set priorities and manage their time and budgets accordingly. Excellent computer skills (MSFT Word, Excel, Power Point, Outlook) is a requirement. Must be able to clearly communicate verbally and in writing and have an ability to summarize data in a succinct manner. Must be able to confidently recommend, persuade, negotiate, and achieve results. A desire to help our company succeed by making a positive contribution to employers and the communities that we serve. Occasional travel to client is required Confidentiality is a must

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 Accounts: PEO, Staffing, National Accounts 🚨 Please Note This is not an HR, risk management, or consulting role. This is a hands-on Workers' Compensation adjusting position that requires active investigation, evaluation, and management of California WC claims. Build Your Career With Purpose at CCMSI At CCMSI, we don't just adjust claims-we support people. As one of the nation's largest employee-owned Third Party Administrators and a certified Great Place to Work , we provide meaningful work, manageable caseloads, long-term stability, and an ownership mindset that empowers our employees to grow. When you join CCMSI, you're joining a team that values collaboration, integrity, continuous learning, and service excellence. Job Summary We are seeking a Workers' Compensation Claim Consultant to handle California jurisdiction claims supporting a mix of PEO, Staffing, and National Account business. This is a fully remote role (reporting to our Irvine, CA branch) with structured training, ongoing mentoring, and strong leadership support. This position is ideal for an adjuster with foundational California WC experience who is ready to grow while contributing to a fast-paced, client-focused environment. Responsibilities Conduct basic workers' compensation claim investigation and day-to-day adjusting responsibilities. Complete timely 3-point contact per CCMSI best practices. Evaluate, manage, and resolve claims consistent with corporate standards and CA WC laws. Establish and maintain appropriate reserves. Administer indemnity benefits in accordance with CA requirements. Maintain a current diary and meet all deadlines. Participate in client file reviews and provide status updates as needed. Effectively communicate with claimants, employers, providers, and attorneys. Document file activity thoroughly and accurately per best practice standards. Qualifications Qualifications - Required Experience handling California workers' compensation claims (basic adjusting experience acceptable). Strong communication, organization, and documentation skills. Ability to work PST hours (M-F, 8:00 AM-4:30 PM). Proficient in Microsoft Office (Word, Excel, Outlook). Preferred / Nice to Have Prior CA WC adjusting experience. SIP certification preferred but not required. Experience supporting PEO or staffing accounts is helpful but not mandatory. Training & Development Training continues until the individual is fully comfortable on their desk. Structured onboarding with one-on-one support. Ongoing access to a dedicated mentor even after transitioning to independent desk responsibilities. Work Environment & Travel Remote role reporting to Irvine, CA. Occasional travel to the office may be required for file reviews. Performance Metrics Your performance will be evaluated on: Compliance with CCMSI Best Practices Closing ratio Timely and appropriate settlements File documentation and communication standards What We Offer Employee Ownership: As an Employee-Owned Company (ESOP), every employee has a stake in our success. Time Off: 4 weeks of paid time off in your first year, plus 10 paid holidays. Comprehensive Benefits: Medical, Dental, Vision, Life, Short- and Long-Term Disability, Critical Illness, and 401(k). Career Growth: Robust internal training and professional development opportunities. Supportive Culture: We believe in manageable caseloads, collaboration, and maintaining a healthy work-life balance. 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 #WorkersCompJobs #CaliforniaAdjuster #RemoteJobs #PEOIndustry #StaffingIndustry #ClaimsConsultant #InsuranceCareers #AdjusterLife #NowHiring #ClaimsProfessionals #WorkCompAdjuster We can recommend jobs specifically for you! Click here to get started.

The Company At Utica National Insurance Group, our 1,300 employees nationwide live our corporate promise every day: to make people feel secure, appreciated, and respected. We are an "A" rated, $1.7B award-winning, nationally recognized property & casualty insurance carrier. Headquartered in Central New York, we operate across the Eastern half of the United States, with major office locations in New Hartford, New York and Charlotte, and regional offices in Boston, New York City, Atlanta, Dallas, Columbus, Richmond, and Chicago. For candidates in MA or CT, remote work may be considered. What You Will Do In this role, you'll use your customer service experience, investigative skills, and detail orientation to handle more serious and complex claims in jurisdictions including: CT, MA, RI, and NH. Communicating with our insureds, attorneys, and other relevant parties will be required in this role. With technical claims knowledge, you'll also use your decision making skills to settle claims within your assigned authority. Key Responsibilities * Include performing all duties and responsibilities as outlined for Claims Specialist. * Investigating and handling primarily New England Workers' Compensation claims of a complex and serious nature, and other jurisdictions as needed. * Performing special claims investigation and handling matters requiring broad technical claims knowledge. * Operating on an independent basis with little supervision. * Settling claims within assigned authority. * Numerous contact with attorneys concerning serious claim matters. * Reviewing court decisions, law and coverage interpretations. Broad knowledge and understanding of the law and claim practices. * May assume duties of the Claims Supervisor in the Supervisor's absence. What You Need * 4-year degree in business administration or equivalent experience. * 1-2 years as Claims Specialist or 3-4 years adjusting experience. * Experience with New England jurisdictions strongly preferred (MA, CT, RI, NH). Licensing Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment. Salary range: $73,000-$95,000 The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications. Benefits We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following: * Medical and Prescription Drug Benefit * Dental Benefit * Vision Benefit * Life Insurance and Disability Benefits * 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results) * Health Savings Account (HSA) * Flexible Spending Accounts * Tuition Assistance, Training, and Professional Designations * Company-Paid Family Leave * Adoption/Surrogacy Assistance Benefit * Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance * Student Loan Refinancing Services * Care.com Membership with Back-up Care, Senior Solutions * Business Travel Accident Insurance * Matching Gifts program * Paid Volunteer Day * Employee Referral Award Program * Wellness programs Additional Information This position is a full time salaried, exempt (non overtime eligible) position. Utica National is an Equal Opportunity Employer. Apply now and find out what it's like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy. #LI-HL1

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