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claims adjustment specialist i

NYC Health + Hospitals

<div><div><div><h2 class="jobSectionHeader"><b>About NYC Health + Hospitals</b></h2><div><br>
<div><div>
</div><p>MetroPlus<b>Health</b> provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus<b>Health</b>'s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus<b>Health</b> has been committed to building strong relationships with its members and providers.</p><p><b>
Position Overview</b></p><p>
As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post-paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position will be responsible for responding to inquiries from providers whose claims may be paid incorrectly and performing accurate data entry and maintenance accurate records and files.</p><br>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Work Shifts</b></h2><div><br>
<div><div>
</div><p><b>9:00 A.M &ndash; 5:00 P.M</b></p><br>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Duties &amp; Responsibilities</b></h2>
<div>
<div></div><div><ul><li>High School Degree or evidence of having passed a High School Equivalency Program required. Associate degree preferred.</li><li>
Minimum 2 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required.</li><li>
Experience using a PC and claim adjudication system(s)</li><li>
Experience using Customer Relationship Management (CRM) software; Salesforce is a plus.</li><li>
Experience working with large data and spreadsheets.</li><li>
Knowledge of medical terminology, CPT, ICD-10, and Revenue Codes</li><li>
Processing of Medical Claim Forms (HCFA, UB04)</li><li>
Knowledge of Medical Terminology</li><li>
Knowledge of HIPPA Guidelines regarding Protected Health Information</li><li>
Data Entry of Provider Claim/Billing information</li><li>
Experience handling or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.</li></ul><p><b>
Professional Competencies</b></p><ul><li>
Integrity and Trust</li><li>
Customer Focus</li><li>
Functional/Technical skills</li><li>
Written/Oral Communication</li><li>
Strong Analytical Skills</li><li>
Knowledgeable in MS Word and Excel</li></ul>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>Benefits</b></h2><div><br>
<div><div>
</div><p>NYC Health and Hospitals offers a competitive benefits package that includes:</p><ul><li>
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week</li><li>
Retirement Savings and Pension Plans</li><li>
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts</li><li>
Loan Forgiveness Programs for eligible employees</li><li>
College tuition discounts and professional development opportunities</li><li>
College Savings Program</li><li>
Union Benefits for eligible titles</li><li>
Multiple employee discounts programs</li><li>
Commuter Benefits Programs</li></ul></div></div></div></div></div>

Claims Adjustment Specialist I

AXIS Capital

<div><div>This is your opportunity to join AXIS Capital &ndash; a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.</div><div></div><div>
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.</div><div></div><div>
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.</div><div></div><div>
Cyber/Media Claims Specialist &ndash; Salary Grade I<br>
<br>
This is your opportunity to join AXIS Capital &ndash; a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.<br>
<br>
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.<br>
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.<br>
<br>
'Please note this role requires hybrid work, with in office attendance 3 days a week. The role can be based in any of these Axis office locations: NYC, Short Hills - NJ, Red Bank &ndash; NJ, Princeton &ndash; NJ, Alpharetta, Kansas City, or Chicago.<br>
<br>
Exercises critical thinking, proper judgment and decision making in a best practices claim environment to promptly analyze the claim exposure, determine the proper course of action, and pursue claims to conclusion.<br>
<br>
Set accurate and timely claim reserves and make referrals to senior members of the team where necessary.<br>
<br>
Obtain relevant policies, review policy wordings to validate coverage for claims and escalate any issues arising.<br>
<br>
Prepare coverage positions to be reviewed and approved by Claim Manager.<br>
<br>
Work closely with Insureds, Claimants, attorneys and brokers ensuring a premier and best practices claim service is maintained, escalating issues as appropriate.<br>
<br>
Documents claim file notes, stores electronic documents, documents claim details in an effective and timely manner.<br>
<br>
Develop a working knowledge of the legal frameworks and claims handling practices relevant to the jurisdictions in which the claims arise.<br>
<br>
Monitor and investigate assigned claims and develop resolution strategy.<br>
<br>
Attend mediation, arbitration and other claim meetings as needed.<br>
<br>
Participate in presentations and discussions with Underwriters.<br>
<br>
Additional responsibilities for this role include validation of indemnity and fee payments, ensuring these are processed accurately and promptly, including monitoring and processing of claims bordereaux and ISO searches and reporting.<br>
<br>
Ensure file set up accurately with proper coding, LOB, Danger Signal and CAT Codes.<br>
<br>
REQUIRED EDUCATION/TRAINING &amp; EXPERIENCE:<br>
Bachelor&rsquo;s degree or equivalent; JD a plus.<br>
Claims adjuster license required; valid adjusting licenses in required states and additional states as needed<br>
Minimum of 2-5 years claim adjusting experience required.<br>
Experience handling cyber primary and excess claims, including first party and third-party privacy liability claims, and media liability claims. Experience handling technology errors and omissions is a plus.<br>
Attain expert comfort level in remote and work from home virtual working practices and platforms<br>
Excellent written and verbal communication skills, to liaise with numerous customers, both internal and external<br>
Solid understanding of individual and group performance metrics and KPIs<br>
Experience with Excel, Word, PowerPoint, OneNote and SharePoint a plus<br>
Availability for occasional travel<br>
Team player who has a positive outlook, flexible, organized, efficient and timely<br>
For this position, we currently expect to offer a base salary in the range of $87K-115K. The specific salary offer will be based on an assessment of a variety of factors including the experience of the successful candidate and their work location. <i>Where this role is based in the United States of America, this role is</i><i> </i><i>Exempt</i><i> </i><i>for FLSA purposes.</i></div></div><div></div>

Cyber/Media Claims Specialist

Argo Group

<div><p><b>Company
</b></p>Argo Group
<p></p><p>Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.<br>
</p><p><br>
<b>Job Description
</b></p><p></p><div><div><p><b>Business Title(s): </b>Senior Technical New York Labor Law Claims Specialist
</p></div><div><p><b>Employment Type: </b>Full-Time
</p></div><div><p><b>FLSA Status: </b>Exempt
</p></div><div><p><b>Location: </b>In-Office
 </p></div><div><p>____________________________________________________________________________
</p></div><div><p><b>Summary:
</b></p></div><div><p>Due to continued growth, we are looking for a highly capable Senior Technical New York Labor Law Claims Specialist to join our team and work from our New York City office. We work together in the office five days a week in order to strengthen our culture, build team connections, and drive profitability. This role will be adjudicating claims of general liability, third party property damage, and third party bodily injury with a focus on New York Labor Law.<br>
<br>
</p></div><div><p>This is a 100% in -office position. Candidates must be able to work on-site at a designated company office during standard business hours.<br>
<br>
</p></div><div><p><b>Essential Responsibilities </b><b>:
</b></p></div><div><ul><li><p>Working under limited oversight under broad management direction, adjudicate New York Labor Law claims at the highest authority limits on assignments reflecting the highest degree of technical complexity, potentially with major impact on departmental results.
</p></li></ul></div><div><ul><li><p>Conducting detailed information gathering, analysis and investigation to find solutions to issues that are numerous and undefined.
</p></li></ul></div><div><ul><li><p>Reporting to senior management and underwriters on claims trends and developments.
</p></li></ul></div><div><ul><li><p>Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.
</p></li></ul></div><div><ul><li><p>Investigating claims promptly and thoroughly, including interviewing all involved parties.
</p></li></ul></div><div><ul><li><p>Managing claims in litigation
</p></li></ul></div><div><ul><li><p>Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
</p></li></ul></div><div><ul><li><p>Properly setting claim reserves, taking into account how different policy wordings impact the claims reserving process.
</p></li></ul></div><div><ul><li><p>Identifying loss drivers and claims trends to reduce claims frequency and severity through data analysis and improved claim management.
</p></li></ul></div><div><ul><li><p>Identifying , assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution.
</p></li></ul></div></div><div><div><ul><li><p>Preparing reports for file documentation
</p></li></ul></div><div><ul><li><p>Applying creative solutions which result in the best financial outcome.
</p></li></ul></div><div><ul><li><p>Negotiating highly complex settlement packages within scope of authority in order to settle claims in most cost effective manner.
</p></li></ul></div><div><ul><li><p>Processing mail and prioritizing workload.
</p></li></ul></div><div><ul><li><p>Responsible for telephone calls and written correspondence to/from various parties (insured, claimant, etc.).
</p></li></ul></div><div><ul><li><p>Having an appreciation and passion for strong claim management.<br>
<br>
</p></li></ul></div><div><p><b>Qualifications / Experience Required:
</b></p></div><div><ul><li><p>A deep knowledge of adjudicating New York Labor Law claims, as well as exceptional customer service focus, typically achieved through a minimum of:
</p></li></ul></div><div><ul><li><p>Seven years&rsquo; experience adjudicating commercial general liability claims with a focus on New York Labor Law.
</p></li></ul></div><div><ul><li><p>Bachelor&rsquo;s degree from an accredited university required . Juris Doctor from an accredited law school is strongly preferred . Two or more insurance designations or four additional years of related experience adjudicating environmental claims beyond the minimum experience required above may be substituted in lieu of a degree.
</p></li></ul></div><div><ul><li><p>Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers&rsquo; ability to be profitable).
</p></li></ul></div><div><ul><li><p>Ability to regularly exercise discretion and independent judgment with respect to matters of significance.
</p></li></ul></div><div><ul><li><p>A strong focus on execution in getting things done right . Proven ability to consistently produce and deliver expected results to all stakeholders by:
</p></li></ul></div><div><ul><li><p>Finding a way to achieve success through adversity.
</p></li></ul></div><div><ul><li><p>Being solution (not problem) focused
</p></li></ul></div><div><ul><li><p>Thinking with a global mindset first.
</p></li></ul></div><div><ul><li><p>Must have excellent communication skills and the ability to build lasting relationships.
</p></li></ul></div><div><ul><li><p>Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
</p></li></ul></div><div><ul><li><p>Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast-paced environment that is evolving constantly.
</p></li></ul></div><div><ul><li><p>Excellent evaluation and strategic skills required .
</p></li></ul></div></div><div><div><ul><li><p>Strong claim negotiation skills a must .
</p></li></ul></div><div><ul><li><p>Knows how claims reserving techniques are used and how to assess whether a claim reserve is accurate .
</p></li></ul></div><div><ul><li><p>Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information.
</p></li></ul></div><div><ul><li><p>Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
</p></li></ul></div><div><ul><li><p>Demonstrates innovative thinking and regularly shares ideas to help the team whenever possible
</p></li></ul></div><div><ul><li><p>Intellectual curiosity . Consistently considers all options and is not governed by conventional thinking.
</p></li></ul></div><div><ul><li><p>Client focus &ndash; the ability to effectively determine specific client needs and to provide value added solutions.
</p></li></ul></div><div><ul><li><p>Ability to articulate the financial value of your work at multiple responsibility levels inside our clients&rsquo; business which may include CEO.
</p></li></ul></div><div><ul><li><p>Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis .
</p></li></ul></div><div><ul><li><p>Proficient in MS Office Suite and other business-related software.
</p></li></ul></div><div><ul><li><p>Polished and professional written and verbal communication skills in order to present information accurately and effectively.
</p></li></ul></div><div><ul><li><p>The ability to read and write English fluently is required .
</p></li></ul></div><div><ul><li><p>Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.
</p></li></ul></div><div><ul><li><p>Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days<br>
<br>
</p></li></ul></div><div><p>The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary, all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package.
</p></div><div><ul><li><p><b>New York City Pay Range: </b>$165,000 - $227,500<br>
</p></li></ul></div><p></p><div><p><b>About Working in Claims at Argo Group
</b></p></div><div><p>Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful.<br>
<br>
</p></div><div><p>Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.<br>
<br>
</p></div></div><div><p>We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses.<br>
<br>
</p></div><div><p>Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.<br>
<br>
</p></div><div><p>We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
</p></div><p></p><div><p><b><i>PLEASE NOTE:
</i></b></p><p>Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.
</p><p></p><p>If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at 210-321-8400.
</p><p></p><p><b>Notice to Recruitment Agencies:
</b><br>
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.
</p><p></p><p>We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
</p><p></p><p>The collection of your personal information is subject to our HR Privacy Notice
</p><p></p><p><b>Benefits and Compensation
</b></p><p>We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program&mdash;including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.</p></div></div><p></p>

Senior Technical New York Labor Law Claims Specialist

Gallagher

<div><b>Introduction</b><br>
<div>
At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they&rsquo;re free to grow, lead, and innovate. You&rsquo;ll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you&rsquo;re not just improving clients' risk profiles, you&rsquo;re building trust. You&rsquo;ll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you&rsquo;re ready to bring your unique perspective to a place where your work truly matters; think of Gallagher.</div><div><br>
</div><br>
<b>Overview</b><div><br>
The Gallagher National Risk Control Team is now the Gallagher Claims and Risk Consulting Team. This new team is equipped with experts, processes and solutions to help you meet the evolving nature of risk. As risk evolves, so has Gallagher with tools and programs to help you proactively meet these challenges now and in the future. Gallagher's Claims and Risk Consulting team includes more than 100 safety and risk control professionals across the country with in-depth knowledge of current and emerging regulations, safety and health management, and operational exposures. The position is full-time remote.</div><br>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Consult on appropriate claims strategy with brokers and clients</li><li>
Analyze claims and policies for reporting claims to insurers</li><li>
Report claims in timely and appropriate manner</li><li>
Manage communications between clients, insurers and brokers to move the claims process forward</li><li>
Advocate for clients to maximize results</li><li>
Negotiate with insurers to ensure proper defense counsel arrangements, granting of consents to settlement and otherwise, and timely issuance of coverage letters
</li><li>Exercise judgment in escalating complicated or high-exposure claims
</li><li>Engage proactively to drive the claims process in a timely and appropriate manner</li><li>
Provide insight and claims information during claims reviews and sales pitches</li><li>
Assist the broker team with questions on claims, policy language reviews, and presentations to current and prospective clients</li><li>
Maintain claims information and documentation in approved diary system and databases</li></ul>
<br>
<b>About You</b><br>
<ul><li>
3 years of relevant claims experience, with adjuster experience preferred</li><li>
Advanced proficiency with Microsoft Word, Outlook, Excel, and PowerPoint</li><li>
Exceptional verbal, written and interpersonal communication skills, including responsiveness</li><li>
Excellent analytical, time management, and organizational skills, including ability to multi-task, prioritize, and manage large volumes of information</li></ul><div>
#LI-MS1</div><br>
<br>
<b>Compensation and benefits</b><p><br>
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.
</p><p>Below are the <b>minimum core benefits</b> you&rsquo;ll get, depending on your job level these benefits may improve:
</p><ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div><b>
Other benefits include:</b></div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div><i>
**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.</i></div><div></div><div><b><br>
We value inclusion and diversity</b></div><p>
Click Here to review our U.S. Eligibility Requirements</p><p>
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;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.
</p><p>Gallagher embraces our employees&rsquo; 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.</p><p>
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 &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
</p><p>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.</p></div>

Advocate

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><p><b>
Position Summary</b></p><p>
The <b>Claim Audit Quality Specialist </b>will audit pre- and post-payment claims for accuracy and eligibility transactions. They will also be responsible for identifying errors, necessary corrective measures, and may participate in special audit assignments.</p><p></p><p><b>
In this role, you will:</b></p><ul><li><p>
Work consistently out of a production queue, auditing any assigned claims.</p></li><li><p>
Oversee the completion several reviews a day, utilizing plan documents as a primary source.</p></li><li><p>
Utilize DG system to complete all reviews.</p></li><li><p>
Complete various tasks as assigned by team leads, and attend internal meetings as needed.</p></li><li><p>
Collaborate with internal account representatives and/or claims examiners as needed.</p></li></ul><p></p><p><b>
Required Qualifications</b></p><ul><li><p>
1+ year of experience working in a health care setting.</p></li><li><p>
At least 6 months of experience with interpreting and understanding of plan documents.</p></li><li><p>
Demonstrated knowledge of Microsoft Excel.</p></li></ul><p><b><br>
Preferred Qualifications</b></p><ul><li><p>
1-2 years of claims processing experience.</p></li><li><p>
1-2 years of auditing experience.</p></li><li><p>
Ability to succeed in a production driven environment, managing multiple tasks while shifting priorities and maintaining a high work volume.</p></li><li><p>
Excellent verbal and written communication skills, with the ability to interact effectively and courteously.</p></li><li><p>
Ability to work with minimal guidance while delivering accurate and timely results.</p></li><li><p>
Strong time management, attention to detail, and organizational skills.</p></li><li><p>
Team-oriented personality.</p></li></ul><p><b><br>
Education</b></p><ul><li><p>
High school diploma or GED.</p></li></ul><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$17.00 - $34.15<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:</p><ul><li><p><b>
Affordable medical plan options,</b> a <b>401(k) plan </b>(including matching company contributions), and an <b>employee stock purchase plan</b>.</p></li><li><p><b>
No-cost programs for all colleagues </b>including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</p></li><li><p><b>
Benefit solutions that address the different needs and preferences of our colleagues</b> including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</p></li></ul><p></p><p>
For more information, visit https://jobs.cvshealth.com/us/en/benefits</p><p></p>
We anticipate the application window for this opening will close on: 03/04/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Claim Audit Quality Specialist

<div></div><div><div>Primary Details</div>
Time Type: Full time<div></div>
Worker Type: Employee<div></div><div>
Senior Claims Specialist Construction Liability</div><div></div><ul><li><div>
Location: USA &ndash;New York NY, Atlanta GA, Boston MA and Chicago, ILL</div></li><li><div>
Work Arrangement: Hybrid</div></li><li><div>
The salary range for this role is: $ 112,000-210,000</div></li></ul><div></div><div>
The Opportunity</div><div></div><div>
Manages the complete investigation, evaluation and resolution of assigned portfolio of claims emanating from Construction Auto Liability and General Liability claims, including high‑severity bodily injury, catastrophic loss, and multi‑party construction defect matters. Engages, directs and manages external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants across highly complex portfolio of matters.</div><div></div><div>
Primary Responsibilities<br>
<br>
Manage a diverse portfolio exclusively of high severity claims which includes conducting fact, liability and loss investigations and interpreting insurance contracts in an effective and efficient manner<br>
<ul><li>Evaluate and negotiate the resolution of assigned claims in a timely manner, within appropriate authority and in accordance with applicable laws, regulations, statutes, best practices and Department of Insurance (DOI) compliance</li><li>Drive the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to deliver superior claim outcomes</li><li>Collaborate with outside representative counsel to formulate litigation strategy ensuring achievement of desired outcome and effective litigation management strategies</li><li>Directs and manage external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants.</li><li>Oversee projects and planning surrounding departmental initiatives to achieve strategic objectives</li><li>Analyze, develop and determine appropriate case reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy</li><li>Advise on specific Construction areas of specialization and coordinates efforts to disseminate information and guide learning and thought leadership in those areas; serve as the subject matter expert</li><li>Represent QBE by participating in and attending industry seminars or authoring articles pertaining to Construction subjects</li><li>Collaborate with Underwriters to identify, understand and address novel or complex risks to appropriately price and negotiate terms including participation in sales calls and requests for proposals (RFPs)</li><li>Manage relationships with external vendors to deliver accurate, timely, and cost effective solutions.</li><li>Take ownership for personal development and career planning, and development of required skills, tools, techniques, and technology to continually add value to the organization.</li><li>Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility</li></ul><br>
Required Education<br>
<br>
<ul><li>Bachelor's Degree or equivalent combination of education and work experience</li></ul><br>
Required Experience<br>
<br>
<ul><li>8 years relevant experience</li></ul><br>
Preferred Competencies/Skills<br>
<br>
Generate original, innovative solutions to difficult or unusual situations<br>
<ul><li>Identify and locate information and facts which are necessary and relevant for the purposes of evaluating a claim</li><li>Financial and business acumen and awareness of financial responsibility</li><li>Quickly change direction when working on multiple projects or issues</li><li>Properly document investigation findings and preserve evidence in accordance with internal and external laws and procedures</li><li>Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems</li><li>Assume a methodical approach to a given situation and develop a systematic procedure as a response</li><li>Develop effective negotiation strategies and prepare a plan of action</li><li>Build and capitalize on beneficial internal and external relationships including competitors</li><li>Actively contributes towards continuously improving performance and mentor team with feedback, on-the-job skill enhancement opportunities and career advice</li><li>Build and establish constructive and cooperative working relationships and open lines of communication</li><li>Utilize effective communication skills to influence and persuade decision makers</li><li>Manage a diverse and extensive portfolio of Construction liability claims with varying levels of complexity and activity.</li><li>Collaborate with internal resources to resolve difficult claims situations and drive resolution opportunities with internal and external stakeholders</li></ul><br>
Preferred Education<br>
<br>
<ul><li>Juris Doctorate</li></ul><br>
Preferred Experience<br>
<br>
<ul><li>Experience handling Construction liability matters including Auto Liability, General Liability and Construction Defect claims.</li></ul><br>
Preferred Knowledge</div><div>
Advanced working knowledge of current and possible future Construction products, policies, practices, trends, technology and information affecting the business and organization; knows how the business works<br>
<ul><li>Advanced working knowledge of relevant Construction claims legal and technical knowledge for all US jurisdictions</li><li>Advanced working knowledge of insurance policy and contract language</li><li>Advanced working knowledge of business and management principles involved in strategic planning, resource allocation, leadership technique and coordination of people and resources</li><li>Advanced working knowledge of experts in field of concentration, including attorneys, mediators, judges and experts</li></ul></div><div></div><div>
Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate&rsquo;s professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE&rsquo;s annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.</div><div></div><div>
QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:</div><ul><li><div>
Hybrid Working &ndash; a mix of working from home and in the office</div></li></ul><ul><li><div>
22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis</div></li></ul><ul><li><div>
Competitive 401(k) program with company match up to 8%</div></li></ul><ul><li><div>
Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice</div></li></ul><ul><li><div>
Tuition Reimbursement for professional certifications, and continuing education</div></li></ul><ul><li><div>
Employee Network and Community &ndash; QBE actively supports six Employee Networks, and many ways to give back to your community</div></li></ul><div></div><div>
To learn more, click here: <div>Benefits | QBE US</div>.</div><div></div><div>
Why QBE? What if you could have a positive impact &ndash; at work and in the world?</div><div>
At QBE, we&rsquo;re enabling a more resilient future &ndash; for our customers, communities, environment, and for our people. We&rsquo;re building momentum to achieve something significant and know our people are at the center of our success.</div><div>
Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you&rsquo;ll get to spend every day working with people who are passionate, talented and kind. And our international scale means we&rsquo;re big enough for your ambitions, yet small enough for you to make a real impact.</div><div>
Join us now, so you can be part of our success &ndash; and we can be part of yours!</div><div><div>
https://www.linkedin.com/company/qbe-north-america/</div></div><div></div><div><br>
QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.</div><div></div><div><br>
Equal Employment Opportunity:</div><div>
QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status.</div><div></div><div>
This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship.</div><div></div><div><div><br>
Supplementary information</div></div><div></div><div>
Global Disclaimer:</div><div></div><div>
The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee&rsquo;s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.</div><div></div><div>
US Only Disclaimer:</div><div></div><div>
To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.</div><div></div><div>
US Only - Travel Frequency:</div><div></div><div>
Infrequent (approximately 1-4 trips annually)</div><div></div><div>
US Only - Physical Demands:</div><div></div><div>
General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs.</div><div></div><div>
Skills:</div>
Adaptability, Claims Settlement, Commercial Acumen, Conflict Resolution, Critical Thinking, Customer Value Management, Insurance Claims Processing, Intentional collaboration, Managing performance, Mentorship, Personal Initiative, Project Delivery, Regulatory Compliance, Risk Management, Team Development<div></div><div>
How to Apply:</div><div>
To submit your application, click &quot;Apply&quot; and follow the step by step process.</div><div></div><div>
Equal Employment Opportunity:</div><div>
QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.</div></div>

Senior Claims Specialist Construction Liability

Peachy

<div><div><p>Peachy's mission is to clear care barriers and make wrinkle treatment more accessible than it's ever been through Preventative Botox, Prescription Retinoids, and Daily Use Sunscreen. Our approach? Transparent pricing, unmatched quality of care and solutions backed by science. Plain and simple.
</p></div><p><b>Job Title: </b>Front Desk Coordinator (Studio Experience Specialist)</p>
<p><b>
Location: </b>New York, NY - Peachy Manhattan West</p>
<p>
The <b>Front Desk Coordinator</b> role at Peachy, known internally as a<b> </b><b><i>Studio Experience Specialist</i></b>, works closely with our Studio Manager and Clinical Providers to ensure a positive and educational experience for every client, every time. This role is a client journey expert, passionate about wrinkle prevention and knowledgeable about Peachy products and services. Learn more about this role below and apply today!</p>
<p><b>
What You'll Do:</b></p>
<ul>
<li>Greet clients and ensure a seamless check-in and check-out process</li>
<li>Collaborate with team members and support Clinical Providers to deliver a best-in-class studio experience for our clients</li>
<li>Provide consistent, high-quality service and hospitality to clients, answer questions about Peachy treatment options and promote Peachy after care products</li>
<li>Communicate with remote Customer Service team to maintain client schedule, including new client and rescheduled client appointments</li>
<li>Demonstrate Peachy company Core Values and foster an inclusive culture with both team members and clients</li>
<li>Complete studio opening and closing tasks</li>
<li>Maintain studio appearance, replenishing products, maintaining stock room, cleaning common areas</li>
<li>Adhere to infection control standards including, but not limited to hand hygiene, use of PPE, and equipment disinfection/sterilization. Strong commitment to HIPAA privacy practices</li>
</ul>
<p><b>Who You Are:</b></p>
<ul>
<li>Communicates Effectively - Delivers messages in a clear and concise manner; Attentively listens to others; Effective in a variety of settings: one-on-one, small and large groups, and among diverse position levels.</li>
<li>Collaborates - Works cooperatively with others across the organization to achieve shared objectives; Partners with others to get work done.</li>
<li>Tech Savvy - Readily learns and adopts new technologies.</li>
<li>Situational Adaptability - Seamlessly adapts in a fast paced, quickly changing environment effectively utilizing available resources; Picks up on situational cues and adjusts in the moment; Understands that different situations may call for different approaches depending on the circumstances.</li>
<li>Embodies our Core Values of Providing the Positive, Continually Raising the Bar, Earning &amp; Keeping Trust, Being Client Obsessed, and Reveling in the Constraints.
</li></ul><p><b>What You Have:</b></p>
<ul>
<li>Experience in a customer service, hospitality, high-end retail or wellness services role.</li>
<li>Flexible to work in multiple studio locations within a reasonable distance to your home studio</li>
<li>Full-day availability is required on Mondays and Tuesdays on a rotating basis, as well as on either Saturday or Sunday each weekend. Some holiday availability is also required.</li>
<li>Minimum of 18 years old and eligible to work in the United States without sponsorship</li>
</ul>
<p><b>Physical Requirements:</b></p>
<ul>
<li>Frequently required to kneel, bend, sit and stand for long periods of time</li>
<li>Ability to lift/transport items weighing up to 30 lbs</li>
<li>Operate standard office equipment and technology</li>
</ul>
<p><b>Pay &amp; Perks:</b></p>
<ul>
<li>Competitive Compensation + Performance Based Bonus</li>
<li>Complimentary quarterly wrinkle treatment + retinoid</li>
<li>Employee discount for Peachy services and products</li>
<li>Exclusive optional discounts through LifeMart</li>
</ul>
<p>The target base pay for the Studio Experience Specialist role in New York, NY is $19.00/hour USD. This rate may be modified in the future.</p><br>
<p></p>
<p>
This position requires additional responsibilities not listed here and may change throughout employment.</p>
<p>
By applying for this job, I agree to receive text (SMS) messages, including via autodialer, related to my application and, if I am hired, related to my employment and Peachy's business. Standard messaging and data rates may apply. Text &quot;STOP&quot; at any time to cancel. I have read and agree to be bound by Peachy's Privacy Policy, which can be found here: https://peachystudio.com/pages/privacy-policy</p>
<p>
#LI-Onsite</p><div><p><i>
Peachy is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, genetic information, age, or military or veteran status in accordance with federal law. In addition, the Company complies with applicable state and local laws governing non discrimination in employment in every jurisdiction in which it maintains facilities. The Company also provides reasonable accommodation to qualified individuals with disabilities, pregnant individuals, and individuals with sincerely held religious beliefs, in accordance with applicable laws.</i></p>
<p><i>
Alert: We are aware of a scam whereby imposters are posing as employees from Peachy. Be aware of anyone requesting financial or personal information. At Peachy, we take pride in creating a best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver's license, or bank information, etc.) from you via text or email. If you are suspicious of a job posting or job related communication mentioning Peachy, let us know by contacting us at </i><i>jobs@peachystudio.com</i><i>.</i></p>
<p><i>
Information for Recruiters: Peachy only accepts resumes directly from candidates. Peachy does not accept unsolicited resumes from staffing vendors, including recruitment agencies and/or search firms, and does not pay fees to any such vendors for any unsolicited resumes.</i></p>
<p><i>
Pursuance to the Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.</i></p></div></div><p></p>

Front Desk Coordinator

Explore 238+ Claims adjustment specialist i in New York United States this March. Find roles across top companies and apply now to boost your career.