claims adjudicator

Blue Cross Blue Shield of Wyoming

<div><h1 class="jobSectionHeader"><b>Deep Roots. Solid Growth. Caring People.
</b></h1><p></p><p><b>Rooted in Wyoming!</b> We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming.
</p><p></p><p><b>Our Vision:</b> We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve.</p><p></p><p><b>
Our Mission:</b> provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home.</p><p></p><p><b>
If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill:</b></p><p></p><p>
Claims Specialist</p><p></p><p>
If you are a passionate and detail-oriented professional looking to make a difference in the community, apply to be a BCBSWY Claims Specialist today.</p><p></p><p>
As a claims adjudicator you will be responsible for reviewing, assessing, and processing health plan claims to ensure accuracy, compliance with regulations, and adherence to company policies.</p><p></p><p>
In this role, you will key, review, evaluate, and process health plan claims received electronically and via mail. You&rsquo;ll collaborate with the Claims Management Team to ensure adjudication accuracy when needed. Our team approach requires interacting with other departments to solve problems and achieve common goals.</p><p></p><p>
To be successful, you must be able to navigate between multiple systems at the same time and communicate effectively in writing and verbally. You will also need to be well organized and detail oriented.</p><p></p><p>
Requirements include a high school, or equivalent, education and a willingness to help others.</p><p></p><h1 class="jobSectionHeader"><b>
BCBSWY Employees Enjoy</b><b>:
</b></h1><p><b>Best-In-Class Health Insurance</b> at minimal to no-cost for BCBSWY employees! <b>PLUS</b> many other benefits along with highly competitive compensation!</p><p></p><p>
Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions.</p><p></p><p>
At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of <b><i>&quot;Dress for Your Day!&quot;</i></b> which can mean jeans every day <i>(depending on your role)</i>.</p><p></p><h1 class="jobSectionHeader"><b>
Serving Those Who Call Wyoming Home</b><b>.</b></h1><p>
Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility <i>(for those positions that are offered limited WFH, there will be a </i><b><i>required</i></b><i> number of In-Office days per week/month depending on department). </i><b>Executive level employees are required to reside full-time in Wyoming.</b></p><p></p><h1 class="jobSectionHeader"><b>
Our Selection Process</b><b>:
</b></h1><p>Typically includes the following <i>(NOTE: process steps may differ depending on role applied for)</i></p><div><div><div><div><ul><li>
Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment.</li><li>
Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.</li><li>
Recruiter Phone Screen.</li><li>
Possible Self-Assessment and/or Questionnaire.</li><li>
Initial interview with Hiring Manager.</li><li>
Possible 2nd Interview with Hiring Manager and/or additional Team members.</li><li>
Comprehensive Background Check.</li></ul><p></p><p>
BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors.</p><p></p><p>
We use E-Verify to confirm employment eligibility; we <b>DO NOT</b> sponsor applicants for work visas.</p></div></div></div></div><p></p><p>
BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: <i>HR@BCBSWY.com</i></p></div><p></p>

Claims Specialist 1

Trinity Health

<b>Employment Type:</b><br>
Full time
<br><br>
<b>Shift:</b><br>
Day Shift
<br><br>
<b>Description:</b><br>
Position located in Westmont, Illinois - remote eligible. Benefit eligible (medical/dental) from the first day of employment.
<br><br>
Perform Quality Auditing of Claim Adjudicators and Customer Service Representatives. Audit capitation deductions, preparing summary of findings and disputes to the various HMOs. Review and respond to Stat Fax/Past Due Claim (PDC) inquiries from the HMOs.
<br><br>
<ul>
<li>Review claims for accuracy of information into the claims processing system and ensure Standard Operating procedures (SOPs) have been followed. Provide feedback to staff as errors are identified, including where procedures can be found on correct handling when appropriate.</li>
<li>Work closely with Operations Manager to identify areas requiring additional training, either on an individual basis or overall.</li>
<li>Review authorization/claim history to determine handling and appropriateness of deductions. Enter disputed deductions into Excel or Access, depending on the health plan. Review outstanding deductions and follow up with the health plan as needed. Update CHS files upon receipt of health plan’s response to indicate whether or not a credit was received.</li>
<li>Research, document and respond to HMO inquiries within appropriate time frames to avoid future capitation deductions. Responsible for contacting HMO for copies of claims that are not in claims processing system and require entry/adjudication. Responsible for contacting providers when claims have been processed to verify status of accounts.</li>
<li>Enhance department productivity by recommending improvements to the work flow processes and organizational structure. Contribute to team effort by accomplishing related results as determined by management. Attend meetings as necessary either internally or with the HMOs</li>
</ul>
<b>Position Requirements:</b><br>
<b>Minimum Education:</b><br>
<b>Required:</b> Associate Degree or 5-10 years of claims auditing and/or Managed care experience
<br><b>Preferred:</b> Bachelor Degree
<br><b>Specify Degree(s):</b> AAPC certification
<br><b>Residency:</b> N/A
<br><br>
<b>Minimum Experience:</b><br>
<b>Required:</b> 3-5 years of previous job-related experience
<br><b>Preferred:</b> 6-10 years of previous job-related experience
<br><b>Details:</b> Previous job related experience in a managed care environment, claims processing, claims auditing, analysis of claims errors. Familiarity with managed care products. Able to track errors and provide training if needed.
<br><br>
<b>Licensure/Certifications:</b><br>
<b>Preferred:</b> Certified Professional Coder (AAPC)
<br><b>Other:</b> RHIA, RHIT and AAPC
<br><br>
<b>Required Skills:</b><br>
Ability to plan, coordinate and develop multiple projects
<br><br>
<b>Compensation:</b><br>
<b>Pay Range:</b> $21.02 - 32.59 per hour
<br>Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.
<br>Trinity Health Benefits Summary
<br><br>
Our Commitment
<br><br>
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

CLAIMS AUDITOR

Tata Consultancy Services (TCS)

<div></div><div><div><div><div><div>Responsibilities:</div><br>
<div><br>
</div><div>To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
</div><div>Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
</div><div>Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
</div><div>Approval or denial on FMLA claims as per Insurance carrier, and employer&rsquo;s guidelines
</div><div>Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
</div><div>Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
</div><div>Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
</div><div>Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
</div><div>Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
</div><div>Refers cases as appropriate to team lead and clinical case management
</div><div>Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
</div><div>Provide ideas to management on continuous improvement and service level management
</div><div>Performs other duties or participates in special projects as assigned</div><br>
<div><br>
</div><div>Requirements:</div><br>
<div><br>
</div><div>1+ year of Disability/FMLA/PFL claims or insurance claims experience
</div><div>Experience working with FINEOS
</div><div>Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
</div><div>Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
</div><div>Excellent oral and written communication, including presentation skills
</div><div>Strong Analytical, decision making, problem solving, and people management skills
</div><div>Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
</div><div>Willingness to embrace change in a fast paced work environment
</div><div>A strong desire to continuously learn and improve
</div><div>Identify escalated cases and work with Team Leader to develop a plan to address key issues.</div><div><br>
</div>
<div></div><br>
<div>TCS Employee Benefits Summary:
</div><ul><li> Discretionary Annual Incentive.
</li></ul><ul><li> Comprehensive Medical Coverage: Medical &amp; Health, Dental &amp; Vision, Disability Planning &amp; Insurance, Pet Insurance Plans.
</li></ul><ul><li> Family Support: Maternal &amp; Parental Leaves.
</li></ul><ul><li> Insurance Options: Auto &amp; Home Insurance, Identity Theft Protection.
</li></ul><ul><li> Convenience &amp; Professional Growth: Commuter Benefits &amp; Certification &amp; Training Reimbursement.
</li></ul><ul><li> Time Off: Vacation, Time Off, Sick Leave &amp; Holidays.
</li></ul><ul><li> Legal &amp; Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.</li></ul><br>
<div><br>
</div><div>Salary Range: $40,000 - $48,000 per year
</div></div></div></div><div><div><div><b>Location</b></div>
<div>Charlotte, NC</div>
</div><div><div><b>Job Function</b></div>
<div>BUSINESS PROCESS SERVICES</div>
</div><div><div><b>Role</b></div>
<div>Workflow Specialist</div>
</div><div><div><b>Job Id</b></div>
<div>406184</div>
</div><div><div><b>Desired Skills</b></div>
<div>Insurance</div>
</div><div><div><b>Salary Range</b></div>
<div>$40,000-$48,000 a year</div>
</div></div><p>Desired Candidate Profile
</p><div><div><b>Qualifications</b> : Diploma</div></div></div><div></div>

Claims Specialist

Benecard Services Inc.

<p></p><div><div><div><div><div><div>The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</div><div></div><div><br>
This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week and is a Union position.</div><div></div><div><b><br>
Key Responsibilities</b></div><ul><li>
Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li>
Process complex or high-dollar claims requiring supervisory overrides</li><li>
Distribute daily claim workloads and support operational workflow efficiency</li><li>
Prepare and maintain documentation for internal and external audits</li><li>
Ensure compliance with prompt pay regulations and timely filing requirements</li><li>
Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li>
Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li>
Support monthly claims reporting and departmental performance tracking</li><li>
Collaborate with leadership to meet monthly productivity and accuracy goals</li><li>
Respond promptly and professionally to internal and external communications</li><li>
Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><div></div><div><b><br>
Required Qualifications:</b></div><ul><li>
5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li>
Strong knowledge of Medicaid and Medicare claim processing</li><li>
Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li>
Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li>
Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li>
In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li>
Familiarity with appeals and reconsideration processes for government payers</li><li>
Experience researching and resolving claim denials and timely filing issues</li><li>
Working knowledge of AS400 or similar claims processing systems</li><li>
Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li>
Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><div></div><div><b><br>
Preferred Qualifications:</b></div><ul><li>
Previous leadership experience would be preferred</li><li>
Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li>
Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li>
Experience supporting or participating in claims audits or compliance reviews</li></ul><div></div><div><b><br>
Why Join Us?</b></div><ul><li>
Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li>
Opportunity to specialize in eye care and vision insurance claims</li><li>
Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul><p></p><p><br>
National Vision Administrators</p><p>
For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.</p><p>
Website: http://www.e-nva.com</p><p>
We are an equal opportunity employer</p></div></div></div></div><br>
Monday - Friday 8:30am - 5:00pm</div>

Claims Examiner

National Security Agency

<div><div><p>Security and Counterintelligence is responsible for the protection of NSA/CSS information, people and facilities worldwide. In support of this mission, Adjudicators are responsible for ensuring a trusted workforce by providing timely and efficient decisions to determine an individual's eligibility for initial or continued access to NSA classified information, to include evaluating candidates sponsored by the military or external agencies for access to NSA operational areas. Adjudicators work in a myriad of offices within Security and Counterintelligence and their responsibilities include, but are not limited to:
- Conducting security adjudicative administrative processes
- Conducting the security adjudicative analytic and risk mitigation process
- Coordinating the security clearance process, including vetting, approval, denial, and access control
- Making security clearance determinations in accordance with DOD, IC, and NSA/CSS personnel security regulations, principles, and processes
- Evaluating reports of investigations, interpreting, and applying adjudicative guidelines to formulate a recommended course of action consistent with relevant Executive Orders, OPM, Department of Justice, and NSA related to security/suitability determinations
- Corroborating or mitigating serious derogatory information
- Reviewing case files of all relevant materials pertaining to a case including all paperwork, any other source materials, and the opinions of other relevant/investigative personnel
- Reviewing investigative documents to identify discrepancies, inconsistencies, and areas potentially requiring clarification or additional investigation
- Reviewing internal records to determine if there are any open internal cases which may be related to affiliate's background investigation
- Determining if additional inquiries are necessary to resolve discrepant, negative, or contradictory information
- Retrieving data from credit bureaus, requesting Local Agency checks, reviewing reports to determine criminal records or traffic violations
- Reviewing adjudicative determinations of other personnel security professionals (e.g., polygraphers, security information specialists, counterintelligence investigators)
- Reviewing and verifying information submitted on applications/Personnel Security Questionnaires</p></div><div><p>
Job Summary</p><p>
Adjudicators ensure a trusted workforce by providing timely and efficient decisions to determine an individual's eligibility for initial or continued access to NSA classified information. Decisions are based on information developed through Reports of Polygraph Examination, Reports of Investigation, continuous evaluation programs and various other investigative/analytical resources per the criteria established in Intelligence Community Directive 704 (ICD 704).</p></div><div><p>
Qualifications</p><p>
The qualifications listed are the minimum acceptable to be considered for the position.
Degree in any field is acceptable.
Relevant experience must be in one or more of the following: adjudication, personnel security, physical security, counterintelligence, anti-terrorism force protection, analysis, investigation, or auditing.
ENTRY/DEVELOPMENTAL
Entry is with a high school diploma or GED plus 4 years of relevant experience, or an Associate's degree plus 2 years of relevant experience, or a Bachelor's degree and no experience.
FULL PERFORMANCE
Entry is with a high school diploma or GED plus 7 years of relevant experience, or an Associate's degree plus 5 years of relevant experience, or a Bachelor's degree plus 3 years of relevant experience, or a Master's degree plus 1 year of relevant experience, or a Doctoral degree and no experience.</p></div><div><p>
Competencies</p><p>
The ideal candidate has a desire for continual learning with excellent problem-solving, analytic, and interpersonal skills who is:
- A strong written and oral communicator
- Able to work as an individual and in team environment
- Capable of making independent decisions or recommendations
- Well-organized, able to handle multiple assignments and prioritize work
- Focused on customer needs
- Able to use basic office tools and functions, such as Microsoft Products (Word, Excel, Outlook)
- Able to lift 20lbs
- Preference is given to applicants with a DoD Adjudicator Professional Certification (APC)</p></div><div><p>
Pay, Benefits, &amp; Work Schedule</p><p>
Pay: Salary offers are based on candidates' education level and years of experience relevant to the position and also take into account information provided by the hiring manager/organization regarding the work level for the position.
Salary Range: $57,736 - $133,142 (Entry/Developmental, Full Performance)
Salary range varies by location, work level, and relevant experience to the position.
Training will be provided based on the selectee's needs and experience.
Benefits: NSA offers a comprehensive benefits package.
Work Schedule: This is a full-time position, Monday - Friday, with basic 8hr/day work requirement between 6:00 a.m. and 6:00 p.m. (flexible). Core hours are 10:00 a.m. to 2:00 p.m..
DCIPS Trial Period:
If selected for this position, you will be required to serve a two-year DCIPS trial period, unless you are a veterans' preference-eligible employee, in which case you are required to serve a one-year trial period. This trial period runs concurrently with your commitment to the position, if applicable. Before finalizing your appointment at the conclusion of your trial period, NSA will determine whether your continued employment advances the public interest. This decision will be based on factors such as your performance and conduct; the Agency's needs and interests; whether your continued employment would advance the Agency's organizational goals; and whether your continued employment would advance the efficiency of the Federal service.
Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
If you do not receive certification for continued employment, you should receive written notice prior to the end of your trial period that your employment will be terminated and the effective date of such termination.</p></div><div><p>
How to apply</p><p>
Apply soonest, as job postings can close earlier than stated end dates due to changes in requirements. It is important to review and note the minimum qualifications, as only those applicants who meet the required qualifications will be contacted to continue the employment process. Please populate the resume tool to showcase any relevant work experience and education related to the position and answer any applicable screening questions. Information collected will be used to determine eligibility, and failure to provide accurate information may result in disqualification for this position.
A confirmation email will be sent after submission of the first application and also after any future updates to submitted applications. **Due to time sensitive communications regarding applications, please ensure your spam filters are configured to accept email from noreply@intelligencecareers.gov. For job vacancies that include stated testing requirements, also include the following: @uwe.nsa.gov, @nsa.gov, and @pearson.com**
U.S. Citizenship is required for all applicants. NSA is an equal opportunity employer and abides by applicable employment laws and regulations. All applicants and employees are subject to random drug testing in accordance with Executive Order 12564. Employment is contingent upon successful completion of a security background investigation and polygraph. NSA is committed to providing reasonable accommodations to qualified applicants with disabilities during the application and hiring process.<br>
The following four narrative questions provide an opportunity for you to highlight your dedication to public service for the hiring manager and agency leadership (or designee(s)). While your responses are not required and will not be scored, we encourage you to thoughtfully address each question. Please provide a response of 200 words or less to each question. You will be asked to certify that you are using your own words and did not use a consultant or artificial intelligence (AI) such as a large language model (LLM) like ChatGPT or Copilot. (Please attach in application)
1. How has your commitment to the Constitution and the founding principles of the United States inspired you to pursue this role within the Federal government? Provide a concrete example from professional, academic, or personal experience.
2. In this role, how would you use your skills and experience to improve government efficiency and effectiveness? Provide specific examples where you improved processes, reduced costs, or improved outcomes.
3. How would you help advance the President's Executive Orders and policy priorities in this role? Identify one or two relevant Executive Orders or policy initiatives that are significant to you, and explain how you would help implement them if hired.
4. How has a strong work ethic contributed to your professional, academic or personal achievements? Provide one or two specific examples, and explain how those qualities would enable you to serve effectively in this position.</p></div><div><p>
DCIPS Disclaimer</p><p>
**VETERANS AND TRANSITIONING SERVICE MEMBERS**
Thank you for your service! The National Security Agency (NSA) is part of the Defense Civilian Intelligence Personnel System (DCIPS). All positions at NSA are in the Excepted Service under Title 10, United States Codes (U.S.C.), Section 1601 appointment authority.
Veterans' Preference
In accordance with the procedures provided in DoD Instruction 1400.25, Volume 2005, &quot;DoD Civilian Personnel Management System: Defense Civilian Intelligence Personnel System Employment and Placement,&quot; NSA applies veterans' preference, as defined by Section 2108 of Title 5, U.S.C., to eligible candidates. If you are claiming veterans' preference, you are required to provide acceptable documentation of your preference eligibility upon application.
Acceptable documentation includes:
- DD-214: &quot;Certificate of Release or Discharge from Active Duty,&quot; which shows dates of service and discharge under honorable conditions (Copy 4); OR
- Certification of Service:
A written document on letterhead from the appropriate branch of the armed forces that certifies the service member is expected to be discharged or released from active duty service in the armed forces under honorable conditions not later than 120 days after the date the certification is signed. The certification should include the military service dates, including the expected discharge or release date; AND
- Standard Form 15 (SF-15)
Application for 10-point Veteran Preference (http://www.opm.gov/forms/pdf_fill/sf15.pdf).
If you are claiming a service-connected disability of 30 percent or more, the documentation you provide must specifically demonstrate this level of disability; AND
- VA Letter of Disability (for 10pt and Sole Survivorship rating)
You may obtain a letter from the Department of Veterans Affairs reflecting your level of disability for preference eligibility by visiting a VA Regional Office, contacting a VA call center, or online (https://www.ebenefits.va.gov/).
**Failure to provide sufficient documentation of veterans' preference eligibility may preclude NSA from identifying you as a preference eligible candidate during the hiring selection process.</p></div></div><div></div>

Adjudicator

Harbor Claims LLC

<div>Description: <b>Job Overview</b><p>
Our Claims Analyst I&rsquo;s are our entry-level team members who are selected for, participate in and earn the opportunity to graduate from our Harbor Claims College. During Claims College, they are considered students and learn how to handle basic claims the Harbor Claims way in both a classroom and hands-on environment. After successful completion of Harbor Claims College, our Claims Analysts I initially focus their attention on providing constant, top-quality and highly-responsive service to our customers in order to successfully handle first notice of loss (FNOL) communications and or routine claims inquiries and/or issues from policyholders, agents and other Company team members. Concurrently, in order to expose the Claims Analyst I&rsquo;s to the &ldquo;nuts and bolts&rdquo; of the Harbor Claims way, our Claims Analyst I&rsquo;s provide other administrative and technical assistance in support of their team. Eventually, as their knowledge base expands, our Claims Analyst I&rsquo;s are tasked with handling routine claims files within minimum levels of authority and then receive increased exposure to more challenging files as they demonstrate mastery and ability. Our Claims Analyst I&rsquo;s have varied backgrounds, but all come to the job ready, willing and able to quickly and thoroughly learn the &ldquo;ins and outs&rdquo; of Cabrillo claims handling from their team leaders and specialists.</p><b>
Job Responsibilities</b><p>
Under close supervision, provides outstanding service to Harbor Claims external and internal customers; utilizes tact, diplomacy and professional communication skills to positively represent Harbor Claims in telephone and email contacts; per Company claims guidelines, Company quality and time standards and governmental regulations, appropriately and correctly responds via telephone and email interactions to claimants&rsquo;, agents&rsquo; and third party representatives&rsquo; routine claims, policy and other related inquiries and issues; handles first notice of loss communication and/or communicates with customers on assigned pending claims files on an ongoing basis.</p><p>
Within minimum levels of authority and required time frames and with close supervision, assigns applicable claims to independent and/or Harbor Claims field adjusters; provides professional and responsive assistance on pending claims to independent and/or Harbor Claims field adjusters; develops and maintains effective working partnerships with independent and field adjusters to ensure prompt and appropriate claims&rsquo; actions.</p><p>
Within minimum authority levels and time frames, with close supervision, and adeptly utilizing assigned tools, analyzes claims information to determine appropriate settlement; communicates with claimant regarding settlement; settles claim and closes files; when outside scope of authority, clearly communicates pertinent information regarding files and works with other assigned analysts and/or leaders to ensure prompt resolution of claims.</p><p>
Maintains claims files in compliance with governmental regulations and Company standards; efficiently and effectively utilizes multiple Carrier and Harbor Claims Information Systems/Programs to accurately maintain Claims files and file diaries.</p><p>
As requested by leaders and/or other analysts, assists in review of designated files for subrogation potential; as warranted, identifies potential subrogation opportunities; clearly communicates findings to leaders, other analysts and/or subrogation specialist and provides follow-up assistance and support, as necessary.</p><p>
Actively contributes as a member of the Harbor Claims Team by providing assistance and support to assigned claims, underwriting, customer support, product, sales and/or other team members; as requested.</p><p>
Participates in and/or assists with &ldquo;special&rdquo; Company projects, including CAT planning, organization, and preparation as directed.</p><p>
Dynamically enhances Company&rsquo;s success by taking advantage of learning and development opportunities and personally integrating positive actions to improve individual performance.</p><b>
Job Family Overview</b><p>
Our Harbor Claims team provides direct, prompt, courteous and professional service to our policyholders, their agents, legal counsel and/or other third party representatives in the unfortunate event that the policyholders&rsquo; residential property is damaged or lost due to a covered event. To that end, our claims team members apply their technical know-how on a daily basis to review, investigate, evaluate and settle claims in a timely and equitable manner while also successfully and responsively handling claims inquiries and/or issues from many different people, including policyholders, agents, claimants&rsquo; third party representatives, as well as internal customers or carrier representatives, as assigned.</p><p>
Most of our employees on our Harbor Claims team are in positions that are included in our claims analyst progressive job series, comprised of Claims Analyst I, II and III. By utilizing a progressive job series, our claims analysts are able to learn and consequently earn advancement on the claims team and in the Company. We provide clear criteria that defines what represents demonstrated mastery at each level. Once an incumbent has mastered that position in the progressive job series, he/she, with his/her claims team leader&rsquo;s active input and agreement, is eligible to advance to the next level in the series, increasing his/her responsibility, authority and pay levels as a result. At Harbor Claims, along with our claims analysts&rsquo; progressive job series, we also have a field adjusters&rsquo; job series. A claims analyst is differentiated from a field adjuster in that the claims analyst is our internal &ldquo;desk&rdquo; adjuster located at our headquarters office who might, depending on the type, severity and/or location of claim, request a field adjuster or an independent adjuster go out and investigate a claim on the Company&rsquo;s behalf while the field adjuster is out in the field on a day-to-day basis examining claims.</p><p>
The other positions on our claims team include our claims team leaders and claims team specialists. These positions, respectively, are the supervisory and expert level positions on the team. Both types of positions require incumbents who are exceedingly well-versed in - and passionate about - their chosen profession of claims and additionally require incumbents with a remarkable understanding of, deep appreciation and respect for and ability to flourish in the Company&rsquo;s unique culture and work environment. Our claims team leaders serve a vital role in our Company&rsquo;s success by utilizing their demonstrated and dynamic leadership strengths to provide front-line day-to-day coaching, supervising &amp; leading of assigned claims analysts and/or field adjusters, while also continuing to carry out their respective day-to-day claims handling duties as working claims analysts. Comparable to our claims team leaders, our claims team specialists are also expected to carry out their assigned day-to-day claims handling or field adjusting duties as working claims analysts, while also continually demonstrating an exceptional depth and/or breadth of technical knowledge and claims expertise. Due to the breadth of their knowledge, they serve as the Go-To for the claims and customer support teams in those niche areas. Furthermore, as a result of the breadth of their knowledge, they are the team members who, at a moment&rsquo;s notice due to fluctuating business needs, can also be open, flexible, willing and adroitly able to take on additional pending and/or new claims files as needed. Our team specialists are expected to train team members on a recurring basis by teaching new hires how to do things our way (aka, the right way the first time), training current team members about new information and/or tasks and/or teaching multiple team members on a large-scale, even Company-wide, basis about a discipline in which the incumbent demonstrates proven expertise and knowledge. Finally, both our team leaders and specialists may spearhead a myriad of special projects producing important results and positive impact for the Company.</p>
Requirements: <b>Skills and Expertise</b><p><b>
Qualities:</b> quality- oriented; detail-oriented; self-starter; team player; multi-tasker; adaptability; flexibility; strong work ethic; positive &ldquo;can do&rdquo; attitude; collaborator; financially-oriented; service-oriented; coachable; dependable.</p><p><b>
Strong skill sets in the following areas: </b>effective decision-making; time management/working under tight deadlines; information and financial review and analyses; organization; problem analyses/solving; active listening; asking good questions to learn about claims handling; oral and written communication; interpersonal communication.</p><p><b>
Strong knowledge of:</b> business writing, grammar and punctuation rules; telephone and email business etiquette rules; desktop computer operations; standard business software and web-based engine operations (e.g., Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet Explorer). MS Access and MS PowerPoint a plus.</p><b>
Licenses, Education and/or Experience</b><p>
Bachelor&rsquo;s Degree or equivalent work experience. Insurance-related degree or residential property claims customer service experience is highly desirable. A current 6-20 adjuster license, other applicable states&rsquo; adjuster license/s and/or required obtainment of specified license/s within three months of hire, specific to the job opening, is required.</p></div>

Claims Analyst I/II (Residential Property)

<div>Description: <b>Job Overview</b><p>
Our Claims Analyst III&rsquo;s are highly-seasoned residential property (1st party) and/or liability (3rd party) claims professionals who are dedicated to doing an outstanding job of accurately and effectively handling a heavy claims file load of the full range of routine to complex claims for the Company. Additionally, our Claims Analyst III&rsquo;s provide constant, top-quality and highly-responsive service to successfully handle even the most advanced claims inquiries and/or issues from policyholders, agents, third party representatives and other Company team members.</p><b>
Job Responsibilities</b><p><i><br>
In the spirit of our Company&rsquo;s mission, values and culture, the duties listed below serve as illustrations of the various types of work that may be performed by our Claims Analyst II&rsquo;s. We may also expect our Claims Analyst II&rsquo;s to carry out other responsibilities that are similar, related or a logical assignment to this job class.</i></p><ul><li>
With minimal supervision, provides outstanding service to Harbor Claims external and internal customers; utilizes tact, diplomacy and professional communication skills to positively represent Harbor Claims in telephone and email contacts; per Company claims guidelines, Company quality and time standards and governmental regulations and with minimal supervision, appropriately and correctly responds via telephone and email interactions to a wide range of routine to complex claimants&rsquo;, agents&rsquo; and third party representatives&rsquo; claims, policy and other related inquiries and issues.</li><li>
Within designated levels of authority and required time frames and with minimal supervision, assigns applicable claims to independent and/or Harbor Claims field adjusters; provides professional and responsive assistance on pending claims to independent and/or Harbor Claims field adjusters; develops and maintains effective working partnerships with independent and field adjusters to ensure prompt and appropriate claims&rsquo; actions; correctly reviews, assesses and applies independent and/or field adjusters&rsquo; findings in order to appropriately handle the respective claims.</li><li>
Within designated authority levels and time frames, with minimal supervision and adeptly utilizing assigned tools, analyzes claims information to determine appropriate settlement; as required, requests, obtains, reviews and evaluates outside experts&rsquo; (including engineers, architects, construction contractors and attorneys) opinions and/or information and confers with experts; communicates with claimant regarding settlement and effectively negotiates, when necessary; as required, interviews and records statements of claimants and witnesses to gather pertinent information; communicates with claimant regarding settlement and effectively negotiates, as necessary; settles claim and closes a wide spectrum of files including those with increased complexity, severity and/or exposure and/or which may be attorney- or third-party-represented; when claim is outside scope of authority or is attorney or third-party represented, actively and professionally works the file while maintaining clear communication and ongoing interaction with management, internal legal counsel and/or outside legal counsel, as appropriate, to ensure prompt timely and fair resolution of claims; may participate in mediation and/or court proceedings.</li><li>
Maintains exceptionally thorough, accurate claims files in compliance with governmental regulations and Company standards; efficiently and effectively utilizes multiple Carrier and Harbor Claims Information Systems/Programs to accurately maintain Claims files and file diaries.</li><li>
Reviews assigned files for subrogation potential; as warranted, identifies potential subrogation opportunities; clearly communicates findings to subrogation specialist and provides follow-up assistance and support, as necessary.</li><li>
Actively contributes as a member of the Harbor Claims Team by providing assistance and support to assigned claims, underwriting, customer support, product, sales and/or other team members; as requested, researches routine to more difficult policy, coverage and eligibility provisions; develops and communicates provision findings, analyses and/or recommendations to appropriate internal and/or external contacts .</li><li>
Participates in and/or actively assists with &ldquo;special&rdquo; Company projects, including CAT planning, organization, and preparation, vendor management or others, as directed.</li><li>
Dynamically enhances Company&rsquo;s success by taking advantage of learning and development opportunities and personally integrating positive actions to improve individual performance.</li></ul>
Requirements: <b>Skills and Expertise</b><br>
<b>Qualities: </b>quality- oriented; detail-oriented; self-starter; team player; multi-tasker; adaptability; flexibility; strong work ethic; positive &ldquo;can do&rdquo; attitude; collaborator; financially-oriented; service-oriented; coachable; dependable.<p><b>
Strong skill sets in the following areas: </b>effective decision-making; time management/working under tight deadlines; information and financial review and analyses; organization; problem analyses/solving; active listening; asking productive questions with an ability to apply learned information to a variety of related or similar situations; oral and written communication; interpersonal communication.</p><p><b>
Strong knowledge of</b>: advanced understanding of personal lines products, including residential homeowners and personal umbrella products; depending on area of focus, advanced understanding of property-related (1st party) and/or liability-related (3rd party) principles, practices, processes and terminology; business writing, grammar and punctuation rules; telephone and email business etiquette rules; desktop computer operations; standard business software and web-based engine operations (e.g., Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet Explorer). MS Access, MS PowerPoint a plus. Thorough knowledge of Xactimate required.</p><b>
Licenses, Education and/or Experience</b><p><b><br>
For external candidates applying to a Claims Analyst III position:</b> Bachelor&rsquo;s Degree and five or more years residential property (1st party) or liability (3rd party) experience or equivalent. Must hold a current 6-20 Claims Adjuster or equivalent (for other applicable states) license, as required by job opening.</p></div>

Claims Analyst III (Residential Property and/or Liability)

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