appeals specialist - hospital billing, underpayments

appeals specialist - hospital billing, underpayments Jobs in Atlanta United States

ar representative Jobs in Atlanta United States

ar representative

billing administrator Jobs in Atlanta United States

billing administrator

claims adjuster,tpa oversight Jobs in Atlanta United States

claims adjuster,tpa oversight

claims team lead apd Jobs in Atlanta United States

claims team lead apd

claims adjustertpa oversight

Reserv

<div><p><b>About Reserv</b></p><p>
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.</p><p>
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you.</p><p></p><p><b><br>
About the role</b></p><ul><li>
We&rsquo;re hiring an Business Analyst, Capacity Planning to be the primary owner of forecasting customer claim volume and corresponding headcount needs across our rapidly scaling organization. In this role, you will steward our workforce capacity planning process, maintain and iterate on our claims forecasting model, and partner cross-functionally with our finance, operations, and account management teams to inform critical workforce decisions.<br>
<br>
You will ensure forecast inputs are accurate and auditable, surface meaningful insights, and support leadership decision-making to directly influence staffing strategy for hundreds of employees. This is a high-impact role at the center of how we plan, scale, and invest in our operational capacity and rigor.</li></ul><p><b>
What you'll do</b></p><ul><li>
Be the principal owner of capacity planning and operational volume forecasting to ensure that we are sufficiently staffed for customer programs while meeting internal productivity and efficiency targets</li><li>
Maintain and evolve our claim volume and headcount model (currently Excel-based) to reflect changing business requirements, new initiatives, and company growth.</li><li>
Gather, coordinate, and consolidate data from multiple sources and internal teams on a regular basis.</li><li>
Prepare forecast outputs and scenario analyses to support regular workforce planning discussions.</li><li>
Identify and report discrepancies between projected and actual results and provide insights on utilization, capacity constraints, and risk signals.</li><li>
Communicate forecasting results and recommendations to stakeholders, including senior leaders and functional directors, to drive actionable insights and support decision-making.</li><li>
Partner with finance to align headcount needs with budgeting and planning cycles.</li><li>
Troubleshoot complex spreadsheets and resolve breaks or formula issues quickly and with precision.</li><li>
Maintain clear documentation, versioning, and training materials for the forecasting process.</li><li>
Train other team members on model functionality and ensure shared understanding of assumptions and outputs</li></ul><p><b>
Qualifications</b></p><ul><li>
5+ years of experience in claims forecasting, capacity planning, analytics, finance, operations, and/or business intelligence in the insurance and claims space.</li><li>
Advanced Excel proficiency with experience in complex formulas (e.g., INDEX/MATCH), pivot tables, and data integrity checks.</li><li>
Demonstrated ability to own a complex forecasting model, maintain it, and troubleshoot issues with minimal oversight.</li><li>
Strong analytical skills with experience working with large and complex datasets or incomplete datasets and making defensible assumptions.</li><li>
Strong attention to detail with a bias toward high-quality, reliable outputs.</li><li>
Excellent written and verbal communication skills, including the ability to explain technical concepts to non-technical audiences.</li><li>
Strong organizational and project management skills, with the ability to manage deadlines across recurring workflows and coordinate with cross-functional partners.</li><li>
Preferred experience using SQL to extract, validate, and analyze operational datasets.</li><li>
Preferred exposure to actuarial concepts or actuarial experience, particularly in environments involving claims forecasting, loss trends, or insurance-related operations.</li></ul><p><b>
Benefits</b></p><ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul><p></p><p><b><br>
Additionally, we will</b></p><ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul><p><br>
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</p></div><p></p>

Operations Analyst, Capacity Planning & Forecasting

Midway Insurance Management International

<p>Midway Insurance Management International, Inc. provides Claims Management and Adjusting Services.</p><p>We understand the insurance industry operates in a world where only the fittest will survive. It follows that our success is inherently linked to the success of our insurance partners. We understand that it takes creativity, resourcefulness and honest hard work to become a successful adjusting company.</p><p>We provide the solutions to the ever increasing demands of the insured, agents and brokers:</p><ul><li>Casualty</li><li>Transportation</li><li>Auto</li><li>Litigation Management</li><li>Program Management</li><li>Individual Claims Assignments</li><li>Consulting Services</li><li>Administration</li></ul><p><b>Liability Adjuster Position:</b></p><p><b>Job Summary:</b></p><p>The Liability Claims Adjuster will be responsible for investigating, evaluating, and resolving liability claims related to commercial trucking incidents. This role requires strong analytical and negotiation skills, along with a deep understanding of insurance policies, claims handling procedures, and regulatory compliance. The ideal candidate will have experience in handling complex claims, working with insured parties, claimants, attorneys, and other stakeholders to ensure fair and efficient settlements.</p><p><b>Key Responsibilities:</b></p><ul><li>Investigate and analyze liability claims, including reviewing accident reports, witness statements, and other relevant documentation.</li><li>Determine coverage, assess damages, and evaluate liability exposure.</li><li>Communicate with insureds, claimants, attorneys, and other involved parties to gather information and negotiate settlements.</li><li>Collaborate with internal teams, including underwriting and risk management, to assess claim impact.</li><li>Manage claims from initial report through resolution, ensuring timely and accurate processing.</li><li>Maintain detailed and organized claim files in compliance with company policies and industry regulations.</li><li>Work with external experts, such as investigators and medical professionals, when needed.</li><li>Prepare detailed reports and recommendations for claims resolution.</li><li>Stay up to date with industry trends, legal developments, and regulatory changes affecting liability claims.</li></ul><p>Job Type: Full-time</p><p>Pay: $55,000.00 - $75,000.00 per year</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: Hybrid remote in Atlanta, GA 30326</p>

Liability Claims Adjuster

<div><p><b>About Reserv</b></p><p>
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.</p><p>
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you.</p><p></p><p><b><br>
About the role</b></p><ul><li>
As a Team Lead at Reserv, you will be a working leader providing support to a Claims manager with leadership and claim technical responsibilities. Leadership responsibilities will include overseeing work done within the Commercial Auto Claims adjusting staff. We want your background and experience to deliver operational effectiveness, particularly in leveraging technology and analytics to drive better efficiencies and performance. You will serve a critical role with the team, the customers, and the client. This role will balance management responsibilities and individual contributor responsibilities when volume dictates the need for assistance with a claim.</li></ul><h3 class="jobSectionHeader"><b>
Who you are</b></h3><ul><li>
Highly motivated and growth-oriented, impactful and influential</li><li>
Claims professional - you are knowledgeable and have a track record of success in commercial auto claims adjudication.</li><li>
Strong leader - through formal management experience or a proven track record of peer and project leadership, you have demonstrated the ability to motivate, support, and teach a team to help them excel in their roles.</li><li>
Tech-oriented - You are excited by the prospect of building a tech-driven claims organization while delivering an excellent service and have proven results leveraging technology and analytics.</li><li>
Passionate - Claims professional who cares about their team, the customer, and their experience</li><li>
Empathetic leader - You exercise empathy and patience towards everyone you interact with</li><li>
Sense of urgency - at all times. That does not mean working at all hours</li><li>
Creative - You challenge existing assumptions and find ways of leveraging technology and the talents of your team to address problems</li><li>
Curious - You want to know the whole story so you can make the right decisions early and be decisive when it counts.</li><li>
Problem solver - You have the ability to take a &lsquo;deep dive&rsquo; into the details of the business while staying focused on the big picture.</li><li>
Anti-status quo - You don&rsquo;t just wish things were done differently; you act on it</li><li>
Communicative - You are comfortable with and understand the importance of phone communications throughout the claims process.</li><li>
And did we mention a sense of humor? Claims are hard enough as it is!</li></ul><h3 class="jobSectionHeader"><b>
 What we need</b></h3><p>
We need you to do all the things typical to the role:</p><ul><li>
Flexibility - you will need to be able to switch from claims handling to coaching and feedback</li><li>
Agility- you must have an agile mindset and the ability to pivot from focus to focus in a moment&rsquo;s notice</li><li>
Be consistently dependable in achieving or exceeding goals and overcoming obstacles</li><li>
Implement and maintain best practices for claims handling, including claim intake, investigation, evaluation, settlement, and recovery</li><li>
Align team with client and customer expectations of the claims process</li><li>
Serve as a resource for escalated claims</li><li>
Foster a positive work environment, promote teamwork, and encourage professional growth and development</li><li>
Attract, hire, retain, and provide a high level of training with the support of the rest of the leadership team</li><li>
Prepare and present comprehensive claims reports, metrics, and analyses to clients and customers; advise clients on claim trends and loss mitigation</li></ul><p>
Job Duties:</p><ul><li>
Serve as backup/leader when the Manager is out of office</li><li>
Responsible for having direct reports</li><li>
Responsible for initial onboarding tasks / access and new hire cultural immersion</li><li>
SME for first-line questions, escalations, roundtable discussions</li><li>
Increased reserve and payment authority with the ability to assist with moderate reviews</li><li>
Identify topics and trends to discuss in team Huddles and Elevated Claims Experience Workshops lead/ co-lead by Team Leads, Managers, and other Reserv employees</li><li>
Customer Obsession Champions - Active advocates who help leadership cultivate a customer-centric mindset</li></ul><h2 class="jobSectionHeader"><b>
Requirements</b></h2><ul><li>
5+ years of insurance claims experience in multiple lines of business, preference for an auto with some bodily injury experience</li><li>
3+ years of leadership experience with a preference for experience managing in a remote environment</li><li>
Comfortable with technology and the ability to evolve the claims systems and processes to drive better efficiencies and outcomes</li><li>
Demonstrated commitment to quality, accuracy, and attention to detail</li><li>
Integrity, ethics, and a strong sense of accountability in handling confidential and sensitive information</li><li>
Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license</li></ul><p><b>
Benefits</b></p><ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul><p></p><p><b><br>
Additionally, we will</b></p><ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul><p><br>
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</p></div><p></p>

Claims Team Lead APD

<div><p><b>About Reserv</b></p><p>
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.</p><p>
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you.</p><p></p><p><b><br>
About the role</b></p><ul><li>
Come join an amazing and collaborative team! We are seeking a highly organized and customer-focused General Liability Adjuster with <b>construction defect experience</b> to join our team. The successful candidate will be responsible for speaking to customers on the phone, educating and helping the customer work through their claim to the best possible outcome. Your role will also be responsible for handling an inventory of claims, triaging critical claims, and delivering service to all constituents of the claim.<br>
<br>
The ideal candidate has a willingness to work through a design process that supports the quickest claim resolution with the best outcome. In addition, you will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements.</li></ul><p>
**While this position may not be open just yet, we are looking ahead. Submit your application to stay on our radar for future roles as we are growing quickly!<br>
<br>
<b>What you'll do</b></p><ul><li>
Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests</li><li>
Gather necessary information from customers to initiate the claim and explain policy, coverage, and appropriate course of action</li><li>
Manage an inventory of claims, analyze coverage and identify any potential coverage issues.</li><li>
Establish initial reserves for all potential exposures, and adjust as appropriate throughout the claim</li><li>
Ability to handle all aspects of construction defect claims</li><li>
Ability to handle all aspects of general liability claims including but not limited to Slip and Falls, Habitational, Risk Transfer, Construction, and New York Labor Law</li><li>
Ensure compliance with specific state regulations, policy provisions, and standard operating procedures</li><li>
Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority</li><li>
Provide input for continuous development of claims guidelines, best practices, and process improvements</li><li>
Oversee and direct outside investigative service providers, client counsel and investigative services to resolve the claim while closely with the client.</li><li>
Engage in learning opportunities to build knowledge of personal lines claims, court decisions impacting the claims function, current guidelines in claims function, and policy changes and modifications</li></ul><p></p><p><b><br>
Who you are</b></p><ul><li>
Highly motivated and growth-oriented. You're excited by the prospect of building a tech-driven claims org.</li><li>
Passionate adjuster who cares about the customer and their experience.</li><li>
Empathetic. You exercise empathy and patience towards everyone you interact with.</li><li>
Sense of urgency - at all times. That does not mean working at all hours.</li><li>
Creative. You can find the right exit ramp (pun intended) for the resolution of the claim that is in the insured&rsquo;s best interest.</li><li>
Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational.</li><li>
Curious. You have to want to know the whole story so you can make the right decisions early and action them to a prompt resolution.</li><li>
Anti-status quo. You don&rsquo;t just <i>wish</i> things were done differently, you <i>action</i> on it.</li><li>
Communicative. (we'd love to know what this means to you)</li><li>
And did we mention, you have a sense of humor. Claims are hard enough as it is.</li><li>
You are collaborative and a team player.</li></ul><p><b><br>
Requirements</b></p><ul><li>
Bachelor's degree. JD, Professional insurance designations strongly preferred.</li><li>
Active adjuster license required: resident state license if available, otherwise a Designated Home State (DHS) license</li><li>
Minimum of 5 years of experience ideally with;</li><li><div><ul><li>
General Liability (Premise, Habitational, Auto, Garagekeepers, BOP&rsquo;s, Dwelling)</li><li>
Construction Liability is required.</li><li>
Employers Liability.</li><li>
Liquor Liability/Dram Shop.</li><li>
Complex claims involving litigation.</li><li>
Policy interpretation. Drafting Reservation of Rights letters, coverage declinations.</li><li>
Third-party bodily injury.</li><li>
Third-party litigated bodily injury/property damage.</li></ul></div></li><li>
Willing to obtain all licenses within 45 days, including completing state required testing</li><li>
Knowledge of state regulations, policy provisions, and standard operating procedures</li><li>
Ability to analyze and evaluate complex data and make sound decisions based on established guidelines, policies, and procedures</li><li>
Curious and motivated by problem solving and questioning the status quo</li><li>
Desire to engage in learning opportunities and continuous professional development</li><li>
Ability to collaborate with colleagues within and outside your department</li><li>
Willingness to travel for client and claims needs</li></ul><p><b><br>
Benefits</b></p><ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul><p></p><p><b><br>
Additionally, we will</b></p><ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul><p><br>
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</p></div><p></p>

Pipeline General Liability Construction Defect

Hiscox

<div><div>Job Type:</div>
Permanent<div></div><div>
Build a brilliant future with Hiscox</div><div><br>
The Complex Claims Specialist is a senior level individual contributor position. This person adjudicates assigned claims within given authority and provides operational support to the claims team.</div><div></div><div>
This Person Will Also:</div><ul><li><div>
Strategize and maximize early settlement opportunities for Construction Defect and 3rd Party Property Damage Claims</div></li><li><div>
Demonstrates proficient knowledge regarding coverage triggers and time on risk allocation</div></li><li><div>
Draft and Review coverage analyses</div></li><li><div>
Manage/Partner with local defense counsel while monitoring litigation</div></li><li><div>
Drives litigation best practices to manage deployment and utilization of defense counsel</div></li><li><div>
Continually assess exposures and adequacy of claim reserves</div></li><li><div>
Demonstrates proficient knowledge regarding theories of liability and State specific negligence standards</div></li><li><div>
Accurately document claim files with all relevant correspondence, documentation, and file notes</div></li><li><div>
Demonstrates proficient knowledge of ACV vs RCV property damage assessments</div></li><li><div>
Attend mediations and/or settlement conferences where appropriate</div></li><li><div>
Identifies suspected fraudulent claims and tracks with special investigations unit</div></li><li><div>
Actively participate in the Claims/UW/Actuarial feedback loop</div></li><li><div>
Keep senior claims management adequately and appropriately informed of key issues</div></li><li><div>
Liaising directly on daily basis with insureds and brokers</div></li></ul><div></div><div>
The Team:</div><div>
The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox&rsquo;s strong brand built on a long history of outstanding claims handling.</div><div></div><div>
Requirements:</div><ul><li><div>
10+ years of claims handling experience within General Liability &amp; Bodily Injury</div></li><li><div>
A JD from an ABA accredited law school may be considered as a supplement to claims handling experience</div></li><li><div>
Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation</div></li><li><div>
Expert knowledge of coverage within the team&rsquo;s specialty or focus</div></li><li><div>
Expert knowledge of litigation process and negotiation skills</div></li><li><div>
Proven track record of mentoring others</div></li><li><div>
Excellent verbal and written communication skills</div></li><li><div>
Advanced analytical skills</div></li><li><div>
B.A./B.S degree from an accredited College or University preferred</div></li></ul><div></div><div>
Hiscox Values:</div><div>
At Hiscox our spirit is in Challenging Convention and everything we do is guided by our Values.</div><ul><li><div>
Courage: Dare to take a risk</div></li><li><div>
Ownership: Passionate, commercial and accountable</div></li><li><div>
Integrity: Do the right thing, however hard</div></li><li><div>
Connected: Together, build something better</div></li><li><div>
Human: Clear, fair and inclusive</div></li></ul><div></div><div>
What Hiscox USA Offers:</div><ul><li><div>
Competitive salary and bonus (based on personal &amp; company performance)</div></li><li><div>
401(k) with competitive company matching</div></li><li><div>
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)</div></li><li><div>
Company paid group term life, short- term disability and long-term disability coverage</div></li><li><div>
24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days</div></li><li><div>
Paid parental leave</div></li><li><div>
4 week paid sabbatical after every 5 years of service</div></li><li><div>
Financial Adoption Assistance and Medical Travel Reimbursement Programs</div></li><li><div>
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program</div></li><li><div>
Company paid subscription to Headspace to support employees&rsquo; mental health and wellbeing</div></li><li><div>
Recipient of 2024 Cigna&rsquo;s Well-Being Award for having a best-in-class health and wellness program</div></li><li><div>
Dynamic, creative and values-driven culture</div></li><li><div>
Modern and open office spaces, complimentary drinks</div></li></ul><div></div><div>
**Please note that this position is hybrid and requires two (2) days in our office weekly**</div><div></div><div>
Salary range: $115-$130k</div><div><i>
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.</i></div><div></div><div>
About Hiscox:</div><div>
As an international specialist insurer, we are far removed from the world of mass market insurance products. Instead we are selective and focus on our key areas of expertise and strength - all of which is underpinned by a culture that encourages us to challenge convention and always look for a better way of doing things.</div><div></div><div>
We insure the unique and the interesting. And we search for the same when it comes to talented people. Hiscox is full of smart, reliable human beings that look out for customers and each other. We believe in doing the right thing, making good and rebuilding when things go wrong. Everyone is encouraged to think creatively, challenge the status quo and look for solutions.</div><div></div><div>
Scratch beneath the surface and you will find a business that is solid, but slightly contrary. We like to do things differently and constantly seek to evolve. We might have been around for a long time (our roots go back to 1901), but we are young in many ways, ambitious and going places.</div><div>
Some people might say insurance is dull, but life at Hiscox is anything but. If that sounds good to you, get in touch.</div><div></div><div>
About Hiscox USA:</div><div>
Hiscox USA was established in 2006 to focus on the needs underserved and specialty commercial clients via both the regional broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group.</div><div></div><div>
Today, Hiscox USA has a talent force of about 400 employees mostly operating out of 6 major cities - New York, Atlanta, Dallas, Chicago, Los Angeles and San Francisco. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber &amp; data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap &amp; ransom, commercial property and terrorism.</div><div></div><div>
You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance)</div><div></div><div>
#LI-RM1</div><div><i><br>
Work with amazing people and be part of a unique culture</i></div></div>

Complex Claims Specialist - General Liability

<div><p><b>About Reserv</b></p><p>
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.</p><p>
We have ambitious (but attainable!) goals and need people who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you.</p><p></p><p><b><br>
About the role</b></p><p>
We are seeking a highly organized, detail-oriented, and customer-focused Non-Standard Claims Adjuster to support our deposit replacement and surety programs. In this role, you will manage first-party claims involving non-standard policy language and complex contractual agreements. Success requires strong analytical skills and the ability to interpret policy forms, lease agreements, financial ledgers, and supporting addenda with accuracy and confidence.</p><p>
You will work directly with property managers, policyholders, and internal stakeholders to drive fair, thorough, and timely claim outcomes. This role requires clear communication, sound judgment, and the ability to navigate nuanced coverage positions while maintaining a high level of professionalism and empathy.</p><p>
This position is ideal for an adjuster who thrives in a fast-paced, evolving environment and enjoys working within specialty programs. The right candidate is adaptable, solutions-oriented, and comfortable balancing high claim volume with exceptional service delivery and compliance standards.</p><p></p><p><b><br>
Who You Are:</b></p><ul><li>
Highly motivated and growth-oriented. You&rsquo;re excited about building a tech-driven claims organization.</li><li>
Passionate adjuster. You care deeply about the customer experience and delivering fair, timely resolutions.</li><li>
Empathetic. You exercise patience and understanding in every interaction.</li><li>
Urgent but balanced. You work with a sense of urgency but understand that doesn&rsquo;t mean working at all hours.</li><li>
Creative problem-solver. You find innovative ways to resolve claims efficiently while keeping the insured&rsquo;s best interests in mind.</li><li>
Comfortable with conflict. You see conflict as a conversation, not a confrontation&mdash;an opportunity to collaborate and resolve issues.</li><li>
Curious. You want to know the whole story to make informed decisions early and drive prompt resolutions.</li><li>
Anti-status quo. You don&rsquo;t just wish things were different&mdash;you take action to improve processes and outcomes.</li><li>
Communicative. You can break down complex topics, actively listen, and ensure clarity in every interaction. <i>(What does this mean to you? We&rsquo;d love to know!)</i></li><li>
Sense of humor. Claims are challenging&mdash;you know how to keep things light when needed.</li></ul><p></p><p><b><br>
What you'll do</b></p><ul><li>
Provide prompt, courteous, and high-quality customer service.</li><li>
Manage a high volume of low-complexity claims; set and adjust reserves appropriately.</li><li>
Gather necessary information and documentation to initiate the claims process, explain coverage, and outline the next steps.</li><li>
Analyze contracts, financial ledgers, lease agreements, and addenda to determine claim validity and obligations.</li><li>
Ensure compliance with state regulations, policy provisions, and internal procedures.</li><li>
Communicate with all involved parties and issue payments within the set authority.</li><li>
Contribute to the continuous improvement of claims guidelines, best practices, and workflows.</li><li>
Oversee and direct investigative service providers, working closely with clients, counsel, and other stakeholders.</li><li>
Stay informed on industry trends, legal decisions, and policy changes affecting claims handling.</li></ul><p></p><p><b><br>
Qualifications</b></p><ul><li>
Bachelor&rsquo;s degree preferred (but if you meet the other qualifications, don&rsquo;t let that stop you from applying!).</li><li>
3 years of experience in general claims handling or related insurance roles.</li><li>
Ability to interpret non-standard policy language, contract terms, and lease agreements.</li><li>
Have active adjuster license(s) and be willing to obtain all required licenses within 60 days, including completing state-required testing</li></ul><ul><li>
Familiarity with state regulations, policy provisions, and claims procedures.</li><li>
Strong analytical skills&mdash;able to evaluate complex data and make sound decisions.</li><li>
Curious, proactive, and always looking for better ways to do things.</li><li>
The desire for continuous learning and professional growth.</li><li>
Willingness to travel for client and claim needs.</li><li>
Excellent verbal and written communication skills with strong attention to detail.</li><li>
Superior organizational skills&mdash;able to prioritize and manage workload efficiently.</li><li>
Comfortable with an Apple laptop, Google Docs, Sheets, and other relevant software.</li></ul><p><b>
Benefits</b></p><ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy after 8 months of continuous work</li><li>
Work from anywhere to facilitate your work life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment you may want. Technology is something that should make your life easier, not harder!</li></ul><p></p><p><b><br>
Additionally, we will</b></p><ul><li>
Listen to your feedback to enhance and improve upon the long-standing challenges of an adjuster and the claims role</li><li>
Work toward reducing and eliminating all the administrative work from an adjuster role</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment</li></ul><p><br>
At Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!</p></div><p></p>

Specialty Risk/Non-Standard Claims Resolution Specialist

<div>
 At AIG, we are reimagining the way we help customers to manage risk. Join us as a Claims Adjuster TTPO Claims to play your part in that transformation. It&rsquo;s an opportunity to grow your skills and experience as a valued member of the team.
 <br/>
 <br/>
 <strong>
  Make your mark in TPA Claims
  <br/>
  <br/>
 </strong>
 Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.
 <br/>
 <br/>
 <strong>
  How You Will Create An Impact
  <br/>
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Analyze and process bodily injury and third-party property damage claims by investigating and gathering information to determine the exposure on the claim; ensure proactive claims handling aimed at the prompt and cost-effective resolution of claims through well-developed action plans. Determine need for and direct independent adjusters to gather information to determine exposure on the claim and control their costs.
  </li>
  <li>
   Identify and evaluate coverage issues; prepare comprehensive coverage letters with supervisory review and analysis; retain and provide direction to coverage counsel when necessary.
  </li>
  <li>
   Assess liability and resolve claim within established evaluation. Maintain diaries and complete tasks within required timeframes as set forth by department guidelines; ensure claim files are timely and properly documented with clear and concise analysis on coverage, damages, reserves, and liability including an action plan for resolution. Process and pay invoices within a timely manner.
  </li>
  <li>
   Coordinate vendor referrals for additional investigation and/or litigation management. Calculate and assign timely and appropriate reserves; monitor reserve accuracy throughout the life of the claim.
  </li>
  <li>
   Refer case as appropriate to supervisor and management. Respond to requests or directions in a professional and timely manner.
  </li>
  <li>
   Attend arbitrations, mediations, settlement conference and trials.
  </li>
  <li>
   Successfully complete required State licensing examinations and continuing education requirement.
  </li>
  <li>
   Communicate with all internal business partners including underwriters to make sure underwriting is aware of large losses and industry trends.
  </li>
  <li>
   Partner with TPA Governance and Relationship Management to help TPA&rsquo;s and Insureds comply with claim handling and reporting guidelines.
  </li>
  <li>
   Work with TPA Claims Financial to check the accuracy of TPA financials ensuring alignment with TTPO financials.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Need To Succeed
  <br/>
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   4 plus years of General Liability/Auto claims experience.
  </li>
  <li>
   Experience with complex and high exposure General Liability Bodily Injury and Property damage claims
  </li>
  <li>
   Excellent communication skills (verbal/written) and strong negotiation skills
  </li>
  <li>
   Advanced experience and capabilities in litigation claims management, including ADR and mediation processes, involving auto/GL exposures.
  </li>
  <li>
   Strong technical expertise interpreting insurance contracts.
  </li>
  <li>
   In depth knowledge of claim handling procedures, claims performance strategies, and claim best practices.
  </li>
  <li>
   Advanced analytical and problem solving skills.
  </li>
  <li>
   Should also have a demonstrated ability to initiate and champion change initiatives that leverage technology and improve skills in benchmarking.
  </li>
  <li>
   Creativity in resolving challenging business problems, as well as ability to achieve business goals and objectives is essential.
   <br/>
   <br/>
  </li>
 </ul>
 Ready to take your career to the next level? We would love to hear from you.
 <br/>
 <br/>
 The position is eligible for a bonus in accordance with the terms of the applicable incentive plan. In addition, we&rsquo;re proud to offer a range of competitive benefits, a summary of which can be viewed here: US Benefits Overview.
 <br/>
 <br/>
 #TPA #Claims
 <br/>
 <br/>
 At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike.
 <br/>
 <br/>
 <strong>
  Enjoy Benefits That Take Care Of What Matters
  <br/>
  <br/>
 </strong>
 At AIG, our people are our greatest asset. We know how important it is to protect and invest in what&rsquo;s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security&mdash;as well as your professional development&mdash;to bring peace of mind to you and your family.
 <br/>
 <br/>
 <strong>
  Reimagining insurance to make a bigger difference to the world
  <br/>
  <br/>
 </strong>
 American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world&rsquo;s most far-reaching property casualty networks. It is an exciting time to join us &mdash; across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.
 <br/>
 <br/>
 <strong>
  Welcome to a culture of inclusion
  <br/>
  <br/>
 </strong>
 We&rsquo;re committed to creating a culture that truly respects and celebrates each other&rsquo;s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG&rsquo;s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.
 <br/>
 <br/>
 <em>
  AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.
  <br/>
  <br/>
 </em>
 AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to candidatecare@aig.com.
 <br/>
 <br/>
 <strong>
  Functional Area
  <br/>
  <br/>
 </strong>
 CL - Claims
 <br/>
 <br/>
 AIG Claims, Inc.
 <br/>
 <br/>
</div>


Claims Adjuster,TPA Oversight

Explore 88+ Claims adjustertpa oversight in Atlanta United States this March. Find roles across top companies and apply now to boost your career.