Worker's Compensation Claims Examiner remote jobs - 249 jobs
Senior Workers Compensation Claims Adjuster - California
Arthur J Gallagher & Co 3.9
Remote job
Introduction
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it's our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people's lives. It takes empathy, precision, and a strong sense of partnership-and that's exactly what you'll find here. We're a team of fast-paced fixers, empathetic experts, and outcomes drivers - people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you'll play a vital role in helping businesses and individuals move forward with confidence. Here, you'll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you're here, you're part of something bigger. You're part of a team that shows up, stands together, and leads with purpose.
Overview
Jurisdictions: California
Licenses: An active CA Designation is required (up to date on CE hours). SIP optional.
Location: This role is eligible for fully remote work.
How you'll make an impact
Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims.
Interact extensively with various parties involved in the claim process to ensure effective communication and resolution.
Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process.
Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements.
Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file.
About You
Claims Background: Minimum of 3-5 years of hands on workerscompensation adjusting experience including handling a lost time/indemnity desk plus litigation.
Jurisdictional Experience: California WorkersCompensation
Active Adjusters' licenses: CA Designation required. SIP optional.
As a key member of our experienced Claims Adjuster team, you will:
Investigate, evaluate, and resolve complex workerscompensationclaims applying your analytical skills to make informed decisions and bring claims to resolution.
Work in partnership with our clients to deliver innovative solutions and enhance the claims management process
Think critically, solve problems, plan, and prioritize tasks to optimally serve clients and claimants
REQUIRED QUALIFICATIONS:
High School Diploma.
Minimum of 5 years related claims experience.
Appropriately licensed and/or certified in all states in which claims are being handled.
Knowledge of accepted industry standards and practices.
Computer experience with related claims and business software.
DESIRED:
* Bachelor's Degree
#LI-HS1
#LI-Remote
Compensation and benefits
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you'll get, depending on your job level these benefits may improve:
Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Other benefits include:
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program
And more...
The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.
We value inclusion and diversity
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&D) is a core part of our business, and it's embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees' diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as "protected characteristics") by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
$56k-76k yearly est. 2d ago
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Workers Compensation Indemnity Adjuster
Optech 4.6
Remote job
Why work with the OpTech family of companies?
We are woman-owned, value your ideas, encourage your growth, and always have your back! When you work with us, you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today!
Job Title: Workers' Compensation Indemnity Specialist
Terms: Direct Hire, FTE Role (Salaried + Benefits + Bonus)
We are seeking an experienced Indemnity Claims Specialist to manage a complex workers' compensation desk with a strong emphasis on Kentucky, Indiana, Illinois, and Michigan lost-time and litigated claims. This role handles primarily indemnity and complex files, with limited medical-only exposure, and requires collaboration with internal leadership and external stakeholders to ensure high-quality, compliant claim outcomes.
RESPONSIBILITIES:
Manage a caseload of approximately 135 open indemnity and complex workers' compensationclaims, including lost-time files
Handle a desk that is at least 50% litigated, working closely with defense attorneys
Demonstrate strong working knowledge of Kentucky & Indiana Workers' Compensation regulations and practices
Apply Michigan and Illinois jurisdictional knowledge as required by assigned files
Investigate claims, determine compensability, establish reserves, and manage ongoing exposure
Coordinate medical care, wage loss benefits, and return-to-work efforts
Communicate effectively with all stakeholders, including attorneys, injured workers, employers, carriers, and medical providers
Utilize claims management systems to document activity, manage workflows, and meet service expectations
Adhere to quality standards, production benchmarks, and client service level agreements (SLAs)
Participate in internal reviews, audits, and performance evaluations
Performance Measures
Compliance with quality and accuracy standards
Meeting production expectations for claim handling and resolution
Adherence to client service level agreements (SLAs)
Stakeholders
External: Defense attorneys, injured workers, employers, clients, carriers, medical providers
Internal: Supervisor, Manager, Account Manager
QUALIFICATIONS:
Experience & Knowledge
2-3 years of workers' compensationclaims experience, with a strong focus on indemnity and lost-time claims
Extensive Kentucky and Indiana workers' compensation experience required
Illinois claims experience required
Michigan experience preferred and may be eligible for additional consideration
Prior experience handling litigated claims is required
Licenses & Education
Michigan, Indiana, and Kentucky Adjuster's License required
Reciprocal licenses (Florida or Texas) accepted
Illinois Experienced Examiner Certification
Bachelor's degree or equivalent relevant work experience
Technical Skills
Proficiency in Microsoft Office (Teams, Outlook/Email, Word)
Experience using CareMC claims system preferred (not required)
Strong documentation, organization, and time-management skills
OpTech/GTech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
$50k-66k yearly est. 4d ago
Sr DI Claims Examiner
Ameritas 4.7
Remote job
is remote (within the U.S.A.) and does not require regular in-office presence.
What you do:
Evaluates and authorizes disposition of complex claims.
Obtains and analyzes medical records and financial documents.
Initiates and monitors medical reviews, independent medical examinations, surveillance, and financial reviews.
Corresponds with policyholders, attorneys, medical facilities, reinsurers, outside vendors, and insured's employer.
Interacts with and requests formal written opinions from Legal and Medical/Underwriting departments.
Makes decisions on evaluation of claims using judgment, experience, and collaboration with senior associates.
Assists with recoveries from reinsurance carriers.
Performs all claims processing support functions.
What you bring:
Bachelor's degree or equivalent experience is required.
1-3 years of related experience is required.
What we offer:
A meaningful mission. Great benefits. A vibrant culture
Ameritas is an insurance, financial services and employee benefits provider Our purpose is fulfilling life. It means helping all kinds of people, at every age and stage, get more out of life.
At Ameritas, you'll find energizing work challenges. Flexible hybrid work options. Time for family and community. But dig deeper. Benefits at Ameritas cover things you expect -- and things you don't:
Ameritas Benefits
For your money:
• 401(k) Retirement Plan with company match and quarterly contribution.
• Tuition Reimbursement and Assistance.
• Incentive Program Bonuses.
• Competitive Pay.
For your time:
• Flexible Hybrid work.
• Thrive Days - Personal time off.
• Paid time off (PTO).
For your health and well-being:
• Health Benefits: Medical, Dental, Vision.
• Health Savings Account (HSA) with employer contribution.
• Well-being programs with financial rewards.
• Employee assistance program (EAP).
For your professional growth:
• Professional development programs.
• Leadership development programs.
• Employee resource groups.
• StrengthsFinder Program.
For your community:
• Matching donations program.
• Paid volunteer time- 8 hours per month.
For your family:
• Generous paid maternity leave and paternity leave.
• Fertility, surrogacy, and adoption assistance.
• Backup child, elder and pet care support.
An Equal Opportunity Employer
Ameritas has a reputation as a company that cares, and because everyone should feel safe bringing their authentic, whole self to work, we're committed to an inclusive culture and diverse workplace, enriched by our individual differences. We are an Equal Opportunity/Affirmative Action Employer that hires based on qualifications, positive attitude, and exemplary work ethic, regardless of sex, race, color, national origin, religion, age, disability, veteran status, genetic information, marital status, sexual orientation, gender identity or any other characteristic protected by law.
Application Deadline
This position will be open for a minimum of 3 business days or until filled.
This position is not open to individuals who are temporarily authorized to work in the U.S.
$65k-97k yearly est. 2d ago
Commercial Auto & General Liability Claims Examiner III
Tristar Insurance 4.0
Remote job
Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Must work EST core hours. Must pass the NYS Adjuster license exam within 60 days of hire.
Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an efficient claimexamination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.
DUTIES AND RESPONSIBILITIES:
Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto, Auto Med Pay, and/or General Liability Casualty Claims.
Oversee and direct outside investigative service providers and work closely with the client and client counsel, and investigative services to advance the claim to conclusion.
Maintain an ongoing diary.
Continually assess exposure and evaluate for accurate reserves and settlement recommendations.
Prepare Loss Reports providing a thorough analysis of coverage, liability, and damages.
Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
Document all correspondence, reports, discussions, and decisions in the claim file record.
Provide outstanding service to the client.
Position is remote/working from home.
Qualifications
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required; bachelor's degree in related field (preferred) and two years auto and general liability casualty and or No Fault/PIP related experience; or equivalent combination of advanced education and experience.
Special Requirements:
At least two years of Automobile and General Liability claims experience required.
Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge.
Demonstrated verbal and written communications skills.
Demonstrated advanced analytical, decision-making and negotiation skills.
Computer proficiency.
Preferred Skills:
Ability to communicate effectively and clearly, both orally and in writing.
Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.
Excellent customer service skills.
An understanding of the litigation process and case valuation in multiple jurisdictions.
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
Time management skills, organizational skills, and ability to prioritize issues and tasks.
Ability to effectively operate computer equipment and applications.
Independence, flexibility, and creativity.
Other Qualifications:
Candidate must have adjuster licenses and be willing to obtain the NY license if they do not already have one.
Candidate must be willing to work Pacific Time core hours.
Here are some of the benefits you can enjoy in this role:
Medical, Dental, Vision Insurance.
Life and Disability Insurance.
401(k) Plan
Paid Holidays
Paid Time Off.
Referral bonus.
Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements
MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects
Visual requirements necessary to perform the job:
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
2. PHYSICAL EFFORT (cont.)
FREQUENCY
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
X Kneeling: Bending legs at knee to come to a rest on knee or knees.
X Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
X Reaching: Extending hand(s) and arm(s) in any direction.
X Standing: Particularly for sustained periods of time.
X Walking: Moving about on foot to accomplish tasks, particularly for long distances.
X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm.
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Occasionally
Frequently
Frequently
Occasionally
2. PHYSICAL EFFORT (cont.)
FREQUENCY
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.
Frequently
Frequently
Frequently
3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
WORKING CONDITION
ENVIRONMENTAL
FACTOR
NATURE/REASON
OF EXPOSURE
FREQUENCY
Dirt/Dust
Noise
Temperature extremes
Dampness
Vibrations
Equipment movement hazard
Chemicals/solvents
Electrical shock
Significant work pace/pressure
Odors/Fumes
$50k-76k yearly est. 18d ago
Senior Claims Examiner (remote)
Switch'd
Remote job
*5 years WC experience combined in WC *Remote (Must live in CA) *California License SIP not needed but is a plus *4850 (if not can train) *Bilingual (Not necessarty but a plus) $80-$94k
$80k-94k yearly 60d+ ago
Sr Claims Examiner- MSI
The Baldwin Group 3.9
Remote job
Why MSI? We thrive on solving challenges.
As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers' unique needs.
We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products - from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property - delivered through agents, brokers, wholesalers and other brand partners.
Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle.
Bring on your challenges and let us show you how we build insurance better.
The Sr ClaimsExaminer is considered an expert in managing insurance claims for our policyholders, handling claims with high severity and complexity. The Sr ClaimsExaminer must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position. The Sr ClaimsExaminer must be able to work with little to minimal supervision
PRIMARY RESPONSIBILITIES:
• Analyzes insurance policies and other documents to determine insurance coverage.
• Investigates and analyzes claim information to determine extent of liability.
• Handles claims 1st Party Property Claims with complex to major severity.
• Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
• Sets timely, adequate reserves in compliance with the company's reserving philosophy.
• Engages experts to assist in the evaluation of the claim.
• Monitors vendor performance and controls expense costs.
• Evaluates, negotiates and determines settlement values.
• Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
• Handles all claims in accordance with Best Practices.
• Responsible for monitoring and completing assigned claims inventory.
• Acquire and maintain a state adjuster's license and meet state continuing education requirements.
• Provides Best-In-Class customer service for insureds and agents.
• Develops and maintains relationships with external and internal stakeholders.
• Acts as a mentor for less experienced ClaimsExaminers.
• Updates and maintains the claim file.
• Identifies opportunities for subrogation and ensures recovery interests are protected.
• Identifies fraud indicators and refers files to SIU for further investigation.
• Participates in claims audits, internal and external.
• Provides oversight of TPAs
• Assists with special projects
KNOWLEDGE, SKILLS & ABILITIES:
EDUCATION & EXPERIENCE:
High School/GED
10+ year's experience in claims
Must have Property & Casualty Insurance License
#LI-BM1
#LI-REMOTE
Click here for some insight into our culture!
The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.
$44k-65k yearly est. Auto-Apply 8d ago
Sr USDA Claims Recovery & Analysis Loss Specialist
Carrington Mortgage 4.5
Remote job
Come join our amazing team and work remote from home!
The Sr Claims &Recovery Analysis Loss Specialist is responsible for ensuring the proper incurred losses were identified and the financial reconciliation is accurately completed on all liquidated loans. Key reviewer of loss analysis decisions which include validating the determined responsibility and root cause for avoidable losses, ensuring they meet quality expectations and reflect proper decision rationale and supporting evidence and identify any bill back opportunities. Perform all duties in accordance with the company's policies and procedures, all US state and federal laws and regulations, wherein the company operates. The target pay for this position is $23.00/hr - $26.50/hr.
What you'll do:
Review reconciliation of all loan advances once the GSE or Government Mortgage Insured “expense” claim has been paid.
Confirm all prior tasking in LoanServ has been completed as well as update approval tasks as required per job aid upon the date the action occurs.
Issue corrections identified during the Quality Review Process, communicating findings to Loss Specialist for remediation. Ensure Loss Specialist provides corrections as needed.
Responsible for learning new skills and expand job knowledge to better perform assigned duties.
Maintain monthly performance in alignment with quality expectations.
Analyze multiple data elements in order to confirm the proper decision rationale and approve evidentiary support is included and written summaries are accurate.
Validate research on incurred losses, using analytical skills and subject matter knowledge to confirm responsibility and bill back opportunities.
Responsible for staying abreast of relevant changes to GSE or Government Mortgage Insured guidelines, industry standards and client expectations.
Ensure timely completion of projects and tasks when assigned. If unable to meet a deadline, the deadline must be renegotiated prior to the initial deadline date.
Look for opportunities to improve the department's processes and procedures, to reduce costs and eliminate non-essential and manual processes and activities.
Keep Team Lead and Supervisor informed of all trends and problems including, but not limited to, exceptions identified in review of Loss Analysis processes.
Moderate working knowledge of all Default Servicing processes up to and including Loss Mitigation, Bankruptcy, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines.
Moderate background in financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered.
Moderate ability to conduct quality assurance reviews.
Preferred Accounting Background--Must possess the ability to complete financial reconciliations.
Moderate computer skills with MS Word, Excel.
Strong attention to details and excellent time management and organizational skills.
Comprehensive writing skills, including proper punctuation and grammar, organization, and formatting.
Ability to work under general direction to accomplish department goals and reduce/mitigate financial loss to CMS and its Clients.
Ability to substantiate facts and properly document them.
Ability to work effectively and develop rapport with all levels of staff, management, Investors/Insurers and 3rd parties.
Ability to make decisions that have moderate impact to immediate work unit.
Ability to identify urgent matters requiring immediate action and properly escalating them.
Ability to handle multiple tasks under pressure and changing priorities.
What you'll need:
High School diploma required; Associate/Bachelor Degree in accounting or other related field preferred.
Two (2) or more years' quality assurance experience.
Three (3) or more years' Loan Servicing platform experience for all default related activities such as Foreclosure, Bankruptcy, Default MI Claims, Loss Mitigation, etc.
Previous FHA, VA, USDA and PMI claims experience preferred
Our Company:
Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you'll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: ***************************
What We Offer:
Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed.
Access to several fitness, restaurant, retail (and more!) discounts through our employee portal.
Customized training programs to help you advance your career.
Employee referral bonuses so you'll get paid to help Carrington and Vylla grow.
Educational Reimbursement.
Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org.
Notice to all applicants: Carrington does not do interviews or make offers via text or chat.
#LI-SY1
About the Role
At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859.
Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) ClaimsExaminer 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.
What You'll Be Doing
· Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
· Communication via telephone, email, and text with employees, employers, attorneys, and others
· Review and interpret medical records, utilizing resources as appropriate
· Complete financial calculations
· Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
· Apply contract/policy provisions to ensure accurate eligibility and liability decisions
· Demonstrate and apply analytical and critical thinking skills
· Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
· Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
· Leverage a broad spectrum of resources, materials, and tools to render claims decisions
· Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
· Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
· Work independently as well as within a team structure
· Deliver refresher trainings as appropriate to the claim team
· Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
· Prepare reports for management on claim outcomes and performance metrics.
· Assist in training and mentoring junior claimexaminers on best practices, improving their decision-making skills.
· Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits\: Equitable Total Rewards Program
What You Will Bring
· Bachelor's degree or equivalent work experience
· 3+ disability claims administration experience
· Prior leadership experience as a team lead or manager
· Exceptional customer service skills
· Maintains positive and effective interaction with challenging customers
· Strong knowledge of disability and leave laws and regulations
· Ability to handle sensitive information with confidentiality and professionalism
· Group Disability Claims experience
· Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
· Experience working with the Fineos Claim Management System
· Exceptional written and oral communication skills demonstrated in previous work experience
· Excellent organizational and time management skills with ability to multitask and prioritize deadlines
· Ability to manage multiple and changing priorities
· Detail oriented; able to analyze and research contract information
· Demonstrated ability to operate with a sense of urgency
· Experience in effectively meeting/ exceeding individual professional expectations and team goals
· Demonstrated analytical and math skills
· Ability to exercise critical thinking skills, risk management skills and sound judgment
· Ability to adapt, problem solve quickly and communicate effective solutions
· High level of flexibility to adapt to the changing needs of the organization
· Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
· Continuous improvement mindset
· A commitment to support a work environment that fosters diversity and inclusion.
· Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
**********
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE\: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
About the Role At Equitable, we help clients secure their financial well-being so they can pursue long and fulfilling lives- a mission we've honed since 1859. Equitable is looking for an experienced Sr. Disability & Leave Management (Group Insurance) ClaimsExaminer 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.
What You'll Be Doing
* Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
* Communication via telephone, email, and text with employees, employers, attorneys, and others
* Review and interpret medical records, utilizing resources as appropriate
* Complete financial calculations
* Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
* Apply contract/policy provisions to ensure accurate eligibility and liability decisions
* Demonstrate and apply analytical and critical thinking skills
* Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
* Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
* Leverage a broad spectrum of resources, materials, and tools to render claims decisions
* Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
* Work within a fast-paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
* Work independently as well as within a team structure
* Deliver refresher trainings as appropriate to the claim team
* Identify areas for improvement in claims processing, including workflow changes or improving procedure based on trends or challenges observed in claim review.
* Prepare reports for management on claim outcomes and performance metrics.
* Assist in training and mentoring junior claimexaminers on best practices, improving their decision-making skills.
* Oversee the ongoing management of complex, high-priority or escalated cases and callers.
Remote - This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours. Periodic office visits may be requested based on business needs.
The base salary range for this position is $60,000 to $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.
For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
What You Will Bring
* Bachelor's degree or equivalent work experience
* 3 disability claims administration experience
* Prior leadership experience as a team lead or manager
* Exceptional customer service skills
* Maintains positive and effective interaction with challenging customers
* Strong knowledge of disability and leave laws and regulations
* Ability to handle sensitive information with confidentiality and professionalism
* Group Disability Claims experience
* Prior experience managing Paid Family Leave for multiple state
Preferred Qualifications
* Experience working with the Fineos Claim Management System
* Exceptional written and oral communication skills demonstrated in previous work experience
* Excellent organizational and time management skills with ability to multitask and prioritize deadlines
* Ability to manage multiple and changing priorities
* Detail oriented; able to analyze and research contract information
* Demonstrated ability to operate with a sense of urgency
* Experience in effectively meeting/ exceeding individual professional expectations and team goals
* Demonstrated analytical and math skills
* Ability to exercise critical thinking skills, risk management skills and sound judgment
* Ability to adapt, problem solve quickly and communicate effective solutions
* High level of flexibility to adapt to the changing needs of the organization
* Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
* Continuous improvement mindset
* A commitment to support a work environment that fosters diversity and inclusion.
* Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Skills
Analytical Thinking: Knowledge of techniques and tools that promote effective analysis; ability to determine the root cause of organizational problems and create alternative solutions that resolve these problems.
Customer Support Operations: Knowledge of customer support techniques, tools, technologies, and best practices; ability to utilize all aspects of customer support operations to manage a call center.
Customer Support Systems: Knowledge of principles and techniques used in customer support and ability to use applications, hardware, software, networking, and the applications environment used for customer support.
Managing Multiple Priorities: Knowledge of effective self-management practices; ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation.
Problem Solving: Knowledge of approaches, tools, techniques for recognizing, anticipating, and resolving organizational, operational or process problems; ability to apply knowledge of problem solving appropriately to diverse situations.
About Equitable
At Equitable, we're a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.
We turn challenges into opportunities by thinking, working, and leading differently - where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.
We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.
We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose. Click Careers at Equitable to learn more.
Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
NOTE: Equitable participates in the E-Verify program.
If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at ************** or email us at *******************************.
$60k-65k yearly 60d+ ago
Senior Workers Compensation Examiner (Iowa)
Canon Recruiting Group 3.3
Remote job
Workers' CompensationClaimsExaminer - Iowa (Single-Jurisdiction)
Employment Type: Direct Hire
Work Arrangement: Fully Remote
We are seeking an experienced Workers' CompensationClaimsExaminer to manage a single-jurisdiction Iowa workers' compensation desk. This role is responsible for end-to-end claims handling, including investigation, compensability decisions, medical management, litigation oversight, and resolution. The ideal candidate has strong knowledge of Iowa workers' compensation statutes, rules, timelines, and best practices, along with excellent communication and customer-service skills.
This is a direct-hire, fully remote position offering long-term stability and significant autonomy.
Key Responsibilities
Maintain detailed, timely claim file documentation to meet compliance and audit standards.
Ensure adherence to Iowa statutory timelines and reporting requirements.
Negotiate settlements within authority and recommend settlements above authority as needed.
Collaborate with internal teams on risk reduction, claim strategy, and best practices.
Required Qualifications
2-5+ years of workers' compensationclaims handling experience (Iowa experience required).
Strong knowledge of Iowa workers' compensation statutes and administrative rules.
Demonstrated ability to manage a full claim inventory independently.
Experience handling litigated claims and working with defense counsel.
Proficiency with claims management systems and standard office software.
Excellent verbal and written communication skills.
Strong analytical, organizational, and time-management abilities.
Ability to succeed in a fully remote, self-directed environment.
Preferred Qualifications
Multi-state experience (optional but beneficial).
Industry certifications (e.g., AIC, WCCP, WCP, SCLA).
Experience with return-to-work programs and medical management strategies.
Compensation & Benefits
Competitive salary (DOE).
Comprehensive benefits package (medical, dental, vision, 401(k), etc.).
Paid time off and company holidays.
Remote work equipment support (if applicable).
Opportunities for professional development and certification support.
Here at Canon Recruiting, People are our priority, and we are committed to Include Diversity in every segment of who we are. It is only through our Diversity; we are made a stronger organization and increase our ability to provide top tier candidates that our clients have come to know Canon for. We have an inclusive environment all employees are celebrated for their unique differences. The different perspectives and experiences of our workforce give us the competitive advantage that is essential for success in an ever-changing market. By promoting inclusion with the same enthusiasm, we devote to quality and competency and using the experience from a diverse assortment of backgrounds and experiences, Canon can improve the services and value we deliver to clients, employees, and customers. At Canon, Diversification and Inclusiveness are much more than a corporate ambition; they are a critical component in our daily corporate life. Canon Recruiting is committed to a diverse and inclusive workplace. Canon Recruiting is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. The pay range for this position is listed above. Base pay information is based on market location. We will consider for employment qualified applicants with arrest and conviction records. Our range of benefits may include health care and 401(k) savings plans. For individuals with disabilities who would like to request an accommodation, please email hr@canonrecruiting.com
$41k-66k yearly est. 48d ago
Workers' Compensation Claims Adjuster - REMOTE
Aegis Security Insurance 4.2
Remote job
Midwestern Insurance Alliance (MIA) is seeking a full-time Remote Claims Adjuster to join its worker'scompensationclaims processing team.
MIA is a national workers' compensation program administrator offering custom-tailored worker'scompensation 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'scompensationclaims 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 3 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.
$54k-74k yearly est. Auto-Apply 57d ago
(Remote) Senior Claims Examiner
Efinancial 4.7
Remote job
Who We Are Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The Senior ClaimsExaminer works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior ClaimsExaminer is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
* Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
* Review newly reported claims and log them on the pending claims log.
* Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
* Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
* Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
* On claims within the Senior ClaimsExaminer's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
* Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
* Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
* Handle and log specific State and NAIC policy locator searches.
* Mentor and support third-party claims administration staff.
* Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
* Work on special projects and other duties as assigned by the Claims Manager.
* Perform quarterly claim audits focusing on third-party claim handling.
* Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
* Handle Department of Insurance claim complaints or requests in a timely and professional manner.
* Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
* Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
* Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
* Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
* Support M&A activity, if applicable
Qualifications:
* 5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
* Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
* Ability to meet deadlines while performing multiple functions.
* Proficient in MS Office applications and the Internet.
* Ability to proactively analyze and resolve problems.
* Attention to detail.
* Flexibility and willingness to adapt to changing responsibilities.
* Excellent written communication, interpersonal and verbal skills.
* Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
* Proactive and outside-the-box thinker.
* Independent and organized work style.
* Ability to maintain strong performance while working remotely and independently, if applicable.
* Strong judgment and discretion when handling highly confidential business, employee, and customer information.
* Team player and creative, critical thinker highly desired.
Licenses + Certifications:
* Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
* Legal or Paralegal Certifications optional but useful
Essential Functions:
* This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
* Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
* Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
* Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
* When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
* Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
* Salary Range: $70,720 - $91,520
* Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
* Dental Insurance: Coverage for preventive, basic, and major dental services.
* Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
* Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
* Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
* 401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
* PTO and Sick Time accrue each pay period: Take time off when you need it
* Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 52d ago
(Remote) Senior Claims Examiner
Your Journey Starts Here
Remote job
Who We Are
Fidelity Life has been protecting middle-market families since 1896 and continues to lead the industry through innovation, patented products, and data-driven underwriting. We were among the first life insurers to use predictive analytics to dramatically speed policy issuance while maintaining strong risk management and compliance standards.
In partnership with eFinancial, a digital and call-center-based insurance agency, we serve thousands of consumers daily through proprietary technology and licensed agents. Together, as part of iA Financial Group, we are making life insurance more accessible, affordable, and customer-focused.
About Fidelity Life & eFinancial
Fidelity Life is a leading provider of financial security for middle-market consumers. With a history of innovation dating back to 1896, the company continues to redefine the life insurance industry through patented products and processes. Fidelity Life pioneered the use of predictive analytics to streamline the new business process, significantly accelerating the speed at which policies are issued.
In partnership with Fidelity Life, eFinancial is a digital and call-center-based insurance agency with a proven direct-to-consumer life insurance model. Using a proprietary, patented sales technology platform, eFinancial's licensed agents help thousands of consumers each day with their unique life insurance needs, often in a single phone call. The company has also expanded to offer a fully digital purchase experience to meet evolving customer preferences.
Together, Fidelity Life and eFinancial are part of iA Financial Group and are transforming the life insurance industry to make protection more accessible and affordable for everyday Americans. With integrated marketing, product development, and controlled distribution, we are uniquely positioned for continued growth.
Job Summary
The Senior ClaimsExaminer works in conjunction with Fidelity Life's third-party administrator and the Claims Manager to analyze, evaluate, and settle incontestable life, contestable life and accidental death benefit (ADB) claims. The Senior ClaimsExaminer is expected to review and adjudicate claims in accordance with established departmental and statutory guidelines.
Key Responsibilities:
Communicate effectively and respectfully with customers, attorneys, and co-workers via phone, e-mail, online chat, and in person.
Review newly reported claims and log them on the pending claims log.
Document each claim file thoroughly in accordance with departmental procedures, including notes on claim review, information obtained, and final decisions.
Review and interpret insurance policy provisions to ensure accurate and timely claim decisions.
Review any adverse decisions, and decisions outside authority limit, with the Claims Manager. Consult with the Legal Department as needed.
On claims within the Senior ClaimsExaminer's authority limit (500,000), confirm benefits and statutory interest are calculated correctly.
Respond to inquiries from customers and attorneys regarding claim matters, consulting with the Claim Director and/or Legal Department as needed.
Work with Fidelity Life's Underwriting Department on contestable claim referrals and other complex claims as needed.
Handle and log specific State and NAIC policy locator searches.
Mentor and support third-party claims administration staff.
Monitor trends in claims experience, escalate issues to management, and recommend or implement corrective actions. Keep management abreast of any trends in claims experience, unfavorable or otherwise.
Work on special projects and other duties as assigned by the Claims Manager.
Perform quarterly claim audits focusing on third-party claim handling.
Assist FLA Sarbanes-Oxley audit team, internal audit team, external reinsurance representatives and external state regulators with claim audits or market conduct exams.
Handle Department of Insurance claim complaints or requests in a timely and professional manner.
Stay current on all laws, regulations, and industry updates that impact claim handling and compliance
Support FLA actuarial or Finance teams in reserve setting, claims trend analyses or other requests.
Participate in continuous improvement initiatives and suggest proactive changes to operations based on data-driven insights
Help track and analyze claim durations, denial rates, appeal outcomes, and financial impact
Support M&A activity, if applicable
Qualifications:
5+ years of life claims experience, with proven proficiency in adjudicating contestable and/or accidental death benefit claims (preferred).
Skills:
Demonstrate knowledge of medical terminology, regulatory compliance including but not limited to unfair claims practices, and privacy requirements.
Ability to meet deadlines while performing multiple functions.
Proficient in MS Office applications and the Internet.
Ability to proactively analyze and resolve problems.
Attention to detail.
Flexibility and willingness to adapt to changing responsibilities.
Excellent written communication, interpersonal and verbal skills.
Ability to perform basic mathematical calculations including addition, subtraction, multiplication, division and percentages.
Proactive and outside-the-box thinker.
Independent and organized work style.
Ability to maintain strong performance while working remotely and independently, if applicable.
Strong judgment and discretion when handling highly confidential business, employee, and customer information.
Team player and creative, critical thinker highly desired.
Licenses + Certifications:
Completion of LOMA courses and/or courses offered by the ICA Claims Education program is preferred but not required.
Legal or Paralegal Certifications optional but useful
Essential Functions:
This position primarily involves remote desk work, requiring the ability to remain in a stationary position (e.g., sitting at a computer) for extended periods of time.
Regular use of standard office equipment such as a computer, keyboard, mouse, and video conferencing tools is essential.
Must be able to communicate effectively in both virtual and in-person settings, including the ability to participate in video calls, phone calls, and written correspondence.
Occasional travel (estimated at 1-3 times per year) is required for in-person meetings, conferences, or vendor visits. Travel may involve transportation by air, train, or car, and may require overnight stays.
When traveling or attending events, the employee may need to navigate various environments, including office buildings, hotels, or convention centers.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Our Culture
We combine the stability of a long-standing insurer with the mindset of a modern, technology-driven organization. Our teams value integrity, thoughtful decision-making, collaboration, and continuous improvement. Employees are trusted to work independently while staying connected through strong cross-functional partnerships.
Compensation & Benefits:
We believe in taking care of our employees and their families. We offer a comprehensive benefits package designed to support your health, well-being, and financial future. Here's a look at what we provide:
Salary Range: $70,720 - $91,520
Medical Insurance: Choose from a variety of plans to fit your healthcare needs.
Dental Insurance: Coverage for preventive, basic, and major dental services.
Employer-Paid Vision: Comprehensive eye care coverage at no cost to you.
Employer-Paid Basic Life and AD&D Insurance: Peace of mind and additional protection.
Employer-Paid Short-Term and Long-Term Disability Insurance: Financial support in case of illness or injury.
401(k) Plan: Save for your future with a company match to help you grow your retirement savings.
PTO and Sick Time accrue each pay period: Take time off when you need it
Annual Bonus Program: Performance-based bonus to reward your hard work.
EEOC/Other: eFinancial/Fidelity Life Association is an equal opportunity employer and supports a diverse workplace. As an eFinancial/Fidelity Life employee, you will be eligible for Medical and Dental Insurance, Health Savings Accounts, Flexible Spending Accounts (Health, Dependent Care & Transit), Vision Care, 401(K), Short-term and Long-term Disability, Life and AD&D coverages.
Remote work is not available in the following States:
California, Colorado, Connecticut, and New York.
#FidelityLifeAssociation #hiring #LI-Remote #IND-Corporate
$70.7k-91.5k yearly 50d ago
Technical Claims Spec, Workers Compensation
Liberty Mutual 4.5
Remote job
Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex WorkersCompensation cases of high exposure and severity. Applies established medical management strategies on high dollar complex claims. Has developed high level knowledge of WorkersCompensationclaims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry trends and claim handling techniques Uses available data to track claims trends and other claim related metrics.
This is a remote position. Candidates residing within 50 miles of Weatogue, CT office are required to report onsite twice a month. Please note this policy is subject to change.
Responsibilities:
Investigates claims to determine whether coverage is provided, establish compensability and verify exposure.
Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority.
Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management.
Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols.
Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely.
Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
Establishes and maintains accurate reserves on all assigned files.
Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority.
Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds.
Demonstrates the ability to understand new and unique exposures and coverages. Demonstrates the ability to understand key data elements and claims related data analysis.
Confers directly with policyholders on coverage and resolution strategy issues.
Coordinates and participates in training sessions for less experienced staff, including both Complex non-Complex staff.
Qualifications
A Bachelors degree or equivalent business experience is required.
In addition, the candidate will generally posses 5-7 years of related claims experience with 1-2 years of experience in complex claims.
Demonstrated proficiency in Excel, PowerPoint as well as excellent written and verbal. communication skill required.
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in
every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive
benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
$86k-127k yearly est. Auto-Apply 39d ago
Senior Claims Specialist - Short Term Disability
Pacific Life 4.5
Remote job
Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead - our policyholders count on us to be there when it matters most. It's a big ask, but it's one that we have the power to deliver when we work together. We collaborate and innovate - pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it's the right thing to do. Pacific Life is more than a job, it's a career with purpose. It's a career where you have the support, balance, and resources to make a positive impact on the future - including your own.
We're actively seeking a talented Senior Claims Specialist - Short Term Disability join our Workforce Benefits Team in Omaha, NE or (remote) in Chattanooga, TN.
As a Senior Claims Specialist - Short Term Disability, you'll move Pacific Life, and your career, forward by leading the end-to-end adjudication of complex Short Term Disability claims, partnering closely with clinical and vocational resources to support claim decision-making and help employees in their return-to-work (RTW) journey. You will play an instrumental part in developing and refining claims processes, ensuring compliance with evolving regulations, and helping deliver a best-in-class, empathetic claims experience. You will fill an existing role that sits on a team in the Workforce Benefits Division.
You'll play an instrumental part in developing and refining claims processes, ensuring compliance with evolving regulations, and helping deliver a best-in-class, empathetic claims experience. This position combines hands-on case management with leadership and mentorship responsibilities. As a trusted resource and role model, you'll elevate team performance, ensure consistency in service delivery, and uphold Pacific Life's core values of integrity, innovation, and accountability.
How you'll help move us forward:
Manage a diverse and often complex caseload of STD (Short Term Disability) claims from initial intake through resolution, ensuring timely, fair, and accurate decisions using sound judgment and adherence to policy provisions.
Collaborate with clinical and vocational partners to develop effective RTW strategies and determine appropriate benefit eligibility and durations.
Serve as a subject matter expert on STD claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements.
Leverage a deep understanding of disability contract provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements (e.g., FMLA, ERISA, HIPAA).
Ensure detailed and accurate documentation of all decisions and interactions, and communicate clearly with claimants, employers, and internal stakeholders.
Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team.
Collaborate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to deliver a coordinated and compliant claims experience.
Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives.
Demonstrate agility in adapting to changing priorities, business needs, and regulatory requirements.
Maintain a high level of confidentiality, professionalism, and integrity in all claim-related activities.
The experience you bring:
College degree or equivalent experience preferred.
Minimum 5 years of experience handling Short Term Disability claims
Strong understanding of Short term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically.
Demonstrated problem-solving and analytical skills with a customer-first mindset.
Highly organized and detail-oriented with the ability to manage competing priorities.
Proven ability to mentor peers and support a collaborative team environment.
Proficiency with claims administration platforms and workflow/documentation tools.
Demonstrated ability to work independently and exercise sound judgment.
Growth mindset with a commitment to continuous learning and improvement.
Strong time management and the ability to thrive in a fast-paced, evolving environment.
Experience supporting cross-functional or enterprise initiatives and change management efforts.
What makes you stand out:
• Experience with Long Term Disability and/or absence management
#LI-KB1
You can be who you are.
People come first here. We're committed to an inclusive workforce. Learn more about how we create a welcoming work environment at ******************** What's life like at Pacific Life? Visit Instagram.com/lifeatpacificlife.
Base Pay Range:
The base pay range noted represents the company's good faith minimum and maximum range for this role at the time of posting. The actual compensation offered to a candidate will be dependent upon several factors, including but not limited to experience, qualifications and geographic location. Also, most employees are eligible for additional incentive pay.
$66,960.00 - $81,840.00
Your Benefits Start Day 1
Your wellbeing is important to Pacific Life, and we're committed to providing you with flexible benefits that you can tailor to meet your needs. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we've got you covered.
Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
Paid Parental Leave as well as an Adoption Assistance Program
Competitive 401k savings plan with company match and an additional contribution regardless of participation
You Can Be Who You Are
We are committed to a culture of diversity and inclusion that embraces the authenticity of all employees, partners and communities. We support all employees to thrive and achieve their fullest potential.
What's life like at Pacific Life? Visit Instagram.com/lifeatpacificlife
EEO Statement:
Pacific Life Insurance Company is an Equal Opportunity /Affirmative Action Employer, M/F/D/V. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Pacific Life Insurance Company.
$67k-81.8k yearly Auto-Apply 3d ago
Senior Claims Specialist-Product
Allied Benefit Systems 4.2
Remote job
Use independent judgment and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical, vision, and dental claims, based upon specific knowledge and application of the client's customized plan. Assist with specific claim related tasks as needed and assigned by the Management Team and support of Claims Team.
ESSENTIAL FUNCTIONS:
Read, analyze, understand, and ensure compliance with clients' customized plans. (A plan may be hundreds of pages or more.)
Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
Request, review and analyze any physician notes, hospital records or police reports.
Interview claimants, physicians, hospitals and other third parties for additional information.
Consult with other professionals such as attorneys, nurses, physicians and auditors who can offer additional evaluation of a claim.
Independently review, analyze, and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physicians and hospitals; and 3) fraud.
Process claims in the QicLink System.
Review, analyze and add applicable notes to the QicLink System.
Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.
Review billed procedure and diagnosis codes on claims for billing irregularities.
Review and analyze specific procedure and diagnosis codes for medical necessity.
Determine whether claimant's plan covers the claim submitted and how much money, if any, should be paid.
Authorize payment, partial payment or denial of claim based upon individual investigation and analysis. (On a yearly basis, responsible for determining claims payments totaling millions of dollars on behalf of Allied's clients.)
Review Workflow Manager daily to document and release pended claims.
Review Pended Claim Reports and close out pended claims for which no response has been received.
Review Suspended Claim Reports and follow up on open issues.
Process Adjustment Claims when necessary due to corrected claims as well as applying refunds in the QL system.
Assist and support Assistant Claims Specialists and Claims Specialists as needed and when requested.
Attend continuing education classes as required, including but not limited to HIPAA training.
Performs other related duties as assigned
EDUCATION
High School diploma or equivalent required.
College degree preferred.
EXPERIENCE AND SKILLS:
5 years of medical claims analysis, processing and adjudication experience (including dental and vision claims analysis) required.
Applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-10 coding terminology.
Applicants must demonstrate the desire to assist the Team with exceeding all established goals.
Prior experience in Adjustment Processing is preferred.
POSITION COMPETENCIES:
Job Knowledge
Time Management
Accountability
Communication
Initiative
Customer Focus
PHYSICAL DEMANDS:
Office setting and ability to sit for long periods of time.
WORK ENVIRONMENT:
Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
WorkersCompensationClaims Adjuster (Southeast Jurisdictions)
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 workerscompensation 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 workerscompensationclaims on behalf of our clients. The ideal candidate will have excellent communication and negotiation skills, be detail-oriented, and possess a strong understanding of workerscompensation 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 workerscompensationclaims adjuster.
License/state experience in the Southeast states.
Demonstrated knowledge of workerscompensation 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 (CBCS)
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' CompensationClaim 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. Applicants without hands-on adjusting experience will not be considered.
Build Your Career With Purpose at CCMSI
At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success.
We don't just process claims-we support people. As the largest privately owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.
Job Summary
We are seeking a Workers' CompensationClaim 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
When we hire adjusters at CCMSI, we look for professionals who understand that every claim represents a real person's livelihood, take ownership of outcomes, and see challenges as opportunities to solve problems.
Conduct basic workers' compensationclaim 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' compensationclaims (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.
Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required.
Work Environment & Travel
Remote role reporting to Irvine, CA.
Occasional travel to the office may be required for file reviews.
Why You'll Love Working Here
4 weeks PTO + 10 paid holidays in your first year
Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance
Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP)
Career growth: Internal training and advancement opportunities
Culture: A supportive, team-based work environment
How We Measure Success
At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:
Quality claim handling - thorough investigations, strong documentation, well-supported decisions
• Compliance & audit performance - adherence to jurisdictional and client standards
• Timeliness & accuracy - purposeful file movement and dependable execution
• Client partnership - proactive communication and strong follow-through
• Professional judgment - owning outcomes and solving problems with integrity
• Cultural alignment - believing every claim represents a real person and acting accordingly
This is where we shine, and we hire adjusters who want to shine with us.
Compensation & Compliance
The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity.
Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.
Our Core Values
At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who:
Lead with transparency We build trust by being open and listening intently in every interaction.
Perform with integrity We choose the right path, even when it is hard.
Chase excellence We set the bar high and measure our success. What gets measured gets done.
Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
Win together Our greatest victories come when our clients succeed.
We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you.
#EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #WorkersCompJobs #CaliforniaAdjuster #RemoteJobs #PEOIndustry #StaffingIndustry #ClaimsConsultant #InsuranceCareers #AdjusterLife #NowHiring #ClaimsProfessionals #WorkCompAdjuster #LI-Remote
Our client is seeking to add a Senior Commercial Auto Litigation ClaimsExaminer to their team. This individual will be responsible for overseeing complex commercial auto claims, with a strong focus on litigated matters and severe casualty exposures. The role requires managing the claim process from initial intake through final resolution, including evaluating coverage, directing litigation strategy, and negotiating settlements across multiple jurisdictions. This position offers the ability to work fully remote. Key Responsibilities:
Investigate, evaluate, and resolve litigated Commercial Auto claims from inception through closure.
Analyze liability, damages, and legal exposure to determine appropriate resolution strategies.
Establish timely and appropriate reserves based on investigation and litigation progression.
Partner with defense counsel, insureds, and other experts to effectively manage claims and litigation costs.
Conduct coverage analysis and issue detailed coverage position letters when necessary.
Prepare reports and updates for senior leadership, clients, and other stakeholders.
Maintain consistent communication with policyholders, attorneys, and internal teams throughout the claim lifecycle.
Ensure timely file documentation in compliance with company, client, and regulatory standards.
Negotiate settlements in line with company/client authority and jurisdictional requirements.
Stay current on evolving laws, regulations, and litigation trends impacting commercial auto liability.
Requirements:
10+ years of Commercial Auto / Trucking Bodily Injury Litigation claims handling experience.
Must have 4+ years of Commercial Trucking experience.
Strong knowledge in MCS 90 is strongly desired.
Active Adjuster's License required.
Proven experience managing litigated claims and working directly with defense counsel.
Strong negotiation, litigation management, and analytical skills.
Excellent written and verbal communication skills, including drafting detailed coverage letters and litigation reports.
Highly organized, self-motivated, and able to independently manage a remote workload.
Proficient in Microsoft Office and claims management systems.
Salary & Benefits:
$90,000 - $120,000+ annually (depending on experience)
Comprehensive Medical, Dental, and Vision coverage
401(k) with company match
Paid Time Off and holiday benefits
Professional development and career advancement opportunities
$37k-48k yearly est. 60d+ ago
Worker Compensation Claims Adjuster 2
Enlyte
Remote job
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' Compensationclaims 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' compensationclaims.
* Completion of Workers' Compensation training courses internally and/or externally in all significant areas affecting Workers' Compensationclaims 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.
$21-24 hourly 60d+ ago
Learn more about worker's compensation claims examiner jobs
Work from home and remote worker's compensation claims examiner jobs
Nowadays, it seems that many people would prefer to work from home over going into the office every day. With remote work becoming a more viable option, especially for workers's compensation claims examiner, we decided to look into what the best options are based on salary and industry. In addition, we scoured over millions of job listings to find all the best remote jobs for a worker's compensation claims examiner so that you can skip the commute and stay home with Fido.
We also looked into what type of skills might be useful for you to have in order to get that job offer. We found that worker's compensation claims examiner remote jobs require these skills:
Rehabilitation
Social security
Litigation
Medical management
Workers compensation claims
We didn't just stop at finding the best skills. We also found the best remote employers that you're going to want to apply to. The best remote employers for a worker's compensation claims examiner include:
ICONMA
Sedgwick LLP
W3Global
Since you're already searching for a remote job, you might as well find jobs that pay well because you should never have to settle. We found the industries that will pay you the most as a worker's compensation claims examiner:
Finance
Insurance
Government
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