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business unit ci sustainability leader - claim operations Jobs in New York

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claim analyst iii

claims adjustment specialist i Jobs in New York

claims adjustment specialist i

claims examiner

Jones Jones LLC

<div><p>Jones Jones LLC is a trusted leader in workers&rsquo; compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. Our firm values growth, integrity, and excellence across every level of our organization.</p><p>
We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow within a premier workers&rsquo; compensation firm.</p><p>
The Firm is located at 5 Hanover Square, New York, NY and this is a hybrid position.</p><p></p><p><b><br>
Essential Functions</b></p><p></p><p><br>
1. Claims Adjusting Work (NYTIC / Emerald):</p><ul><li>
Perform intake and coverage verification via WCB employer coverage search</li><li>
Initiate three-point contact (employer/clamant/provider) within 24 hours</li><li>
Conduct compensability analysis and develop action plans</li><li>
Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement</li><li>
Calculate AWW and benefit rates; set and review reserves at key milestones</li><li>
Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections</li><li>
Route medical bills to bill review and ensure fee schedule compliance</li><li>
Prepare for hearings and maintain eCase updates</li><li>
Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices</li></ul><p></p><p><br>
2. Licensing &amp; Compliance (Jones Jones):</p><ul><li>
Collaborate with the Compliance team on licensing forms and regulatory filings</li><li>
Review TPA scorecards and ensure compliance with WCB standards</li><li>
Track and invoice licensing fees and renewals</li><li>
Support examiner training and respond to licensing-related inquiries</li></ul><p></p><p><br>
3. ADR (MRM):</p><ul><li>
Manage intake, eligibility, and notices under the collectively bargained ADR program</li><li>
Coordinate and schedule mediations</li><li>
Draft case summaries and settlement proposals</li><li>
Ensure adherence to Medical Network protocols and document variances</li><li>
Prepare and route settlement paperwork, including Section 32 agreements</li><li>
Maintain dashboards of ADR cycle times and outcomes for annual reporting</li><li>
Obtain loss runs from wrap-up sponsors</li></ul><p></p><p><br>
4. MMG</p><div><ul><li>
Evaluate Independent Medical Examination (IME) reports for accuracy and compliance</li></ul></div><ul><li>
Assist with administrative tasks such as schedule coordination and provider panel management</li></ul><p></p><p><b><br>
Competencies</b></p><ul><li>
Excellent and professional verbal and written communication skills</li><li>
Strong understanding of workers&rsquo; compensation best practices</li><li>
Exceptional organizational skills and attention to detail</li><li>
Excellent time management skills with a proven ability to meet deadlines</li><li>
Strong analytical and problem-solving skills</li><li>
Ability to perform well in a fast-paced, dynamic environment</li><li>
Ability to maintain confidentiality and exercise discretion and sound judgment</li><li>
Proficient with Microsoft Office Suite or related software</li></ul><p></p><p><b><br>
Qualifications</b></p><ul><li>
Bachelor&rsquo;s degree in business administration or related field</li><li>
Active Independent Adjuster License (required)</li><li>
 2- 5 years of claims management experience</li></ul><p></p><p><br>
Apply today to join a firm with over a century of success and a future focused on innovation. Jones Jones LLC is an equal employment opportunity employer.</p></div>

Claims Examiner

Markel Corporation

<div><div>What part will you play? If you&rsquo;re looking for a place where you can make a meaningful difference, you&rsquo;ve found it.</div>
The work we do at Markel gives people the confidence to move forward and seize opportunities, and you&rsquo;ll find your fit amongst our global community of optimists and problem-solvers. We&rsquo;re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
What part will you play? If you&rsquo;re looking for a place where you can make a meaningful difference, you&rsquo;ve found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you&rsquo;ll find your fit amongst our global community of optimists and problem-solvers. We&rsquo;re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.<br>
<br>
Join us and play your part in something special!<br>
<br>
This position will be the acknowledged technical expert and be responsible for the resolution of high complexity and high exposure claims. The position will have significant responsibility for decision making and work autonomously within their authority.<div></div><div>
Responsibilities:</div><ul><li>
Investigate, negotiate and settle primary and excess policy cyber, privacy liability and technology errors &amp; omissions claims.</li><li>
Investigate and evaluate coverage for complex primary and excess cyber and technology errors &amp; omissions policies; make coverage determinations; draft complex coverage correspondence; effectively communicate coverage positions to policyholders and other stakeholders; manage complex claims involving coverage litigation.</li><li>
Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist Company claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues.</li><li>
Contribute and assist in the implementation of a wide range of initiatives, claims exposure reports and action plans brought forth by the team&rsquo;s Director.</li><li>
Communicate with underwriting as needed to manage claims and to alert of any significant developments.</li><li>
Promptly communicate with management on adverse claim developments and provide information on pertinent issues affecting cyber and technology errors &amp; omissions product lines.</li><li>
Proven ability to work in a collaborative team environment. Analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form.</li><li>
Maintain and adhere to Markel&rsquo;s guidelines and procedures.</li><li>
Ensure proper adherence to internal reporting requirements.</li><li>
Participate in agent related functions and meetings as required.</li><li>
Actively participate in the ongoing training and development of the claims examiners.</li></ul><div></div><div>
Requirements:</div><ul><li>
5-10+ years of handling cyber and/or technology errors &amp; omissions policies required. Excess liability (quota share, first layer and high layer) claims experience a plus.</li><li>
College degree and/or professional designation required, JD preferred.</li><li>
Excellent written and oral communication skills.</li><li>
Sound comprehension of insurance coverage posed by cyber and technology errors &amp; omissions and excess liability policies.</li><li>
Ability to analyze and convey summations of complex issues both verbally and in writing; recognize alternative approaches and develop action plans.</li><li>
Experience in determining contractual obligations, insurance coverage analyses, and investigations. Insurance coverage litigation experience a plus.</li><li>
Ability to manage complex litigation, set loss and expense reserves and evaluate settlement values.</li><li>
Work collaboratively and as team player willing to assist within the Unit and Professional Liability Division as needed.</li><li>
Ability to proactively self-manage a caseload.</li><li>
Travel required as necessary (approximately 20%).</li></ul><div></div><div>
US Work Authorization</div><div></div><div>
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.</div><div></div><div>
Pay information:</div><div>
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The national average salary for the Executive Claims Examiner, Cyber and Technology E&amp;O Clams is $97,520 - $134,090 with 25% bonus potential.</div><div></div><div><div><div>
Who we are:</div></div><div></div><div><div>
Markel Group (NYSE &ndash; MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.</div></div><div></div><div><div><br>
We&rsquo;re all about people | We win together | We strive for better</div></div><div></div><div><div><br>
We enjoy the everyday | We think further</div></div><div></div><div><div><br>
What&rsquo;s in it for you:</div></div><div></div><div><div>
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.</div></div><div><ul><li><div>
We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees&rsquo; needs at all stages of life.</div></li></ul></div><div><ul><li><div>
All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&amp;D insurance.</div></li></ul></div><div><ul><li><div>
We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.</div></li></ul></div><div></div><div><div><br>
Are you ready to play your part?</div></div><div></div><div><div>
Choose &lsquo;Apply Now&rsquo; to fill out our short application, so that we can find out more about you.</div></div></div><div></div><div><div><div><br>
Caution: Employment scams</div></div><div></div><div><div>
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These &quot;job offers&quot; include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:</div></div><div><ul><li><div>
All legitimate job postings with Markel will be posted on <div>Markel Careers</div>. No other URL should be trusted for job postings.</div></li></ul></div><div><ul><li><div>
All legitimate communications with Markel recruiters will come from Markel.com email addresses.</div></li></ul></div><div></div><div><div><br>
We would also ask that you please report any job employment scams related to Markel to <div>rarecruiting@markel.com</div>.</div></div><div></div><div><div><br>
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.</div><div></div><div><br>
Should you require any accommodation through the application process, please send an e-mail to the <div>rarecruiting@markel.com</div>.</div><div></div><div>
No agencies please.</div></div></div></div>

Executive Claims Examiner, Cyber and Technology E&O Claims

AIG Claims, Inc.

<div><p><b>Claims Analyst III</b></p><p></p><p>
As a Claim Analyst III, you will be responsible for handling all aspects of third-party EPL/Professional Liability/D&amp;O claims from inception through conclusion brought against insureds.</p><p></p><p><b>
How you will create an impact</b></p><ul><li><p>
Focused on Employment Practices Liability, this role is an ideal opportunity to develop your expertise in handling and investigating complex claims. The aim is deal with genuine claims through a proactive, best practice approach, in line with AIGs quality standards &ndash; you will actively promote and demonstrate the principles of &lsquo;Treating Customers Fairly&rsquo; in claims handling.</p></li><li><p>
You will also proactively identify and review suspect/fraudulent claims on a consistent basis &ndash; dealing with such claims in line with our clear guidelines.</p></li><li><p>
Your work will involve regular contact with internal stakeholders and brokers, (medical) experts, clients&rsquo; lawyers, victims or their legal representatives. We want you to build effective relationships with internal and external customers, while acting as a point of referral.</p></li><li><p>
You will have the opportunity to grow your experience by providing support to Team Managers and deputizing in their absence. For example, you will assist with monitoring market/industry practices in claims handling.</p></li><li><p>
In addition, you can use the claims experience you gain to help improve our products in collaboration with colleagues in underwriting.</p></li></ul><p></p><p><b>
What you&rsquo;ll need to succeed</b></p><ul><li><p>
Bachelor&rsquo;s Degree or equivalent required. Multi-state adjuster licenses and/or JD preferred.</p></li><li><p>
Strong knowledge of legal / regulatory and litigation / procedural requirements for Financial Lines.</p></li><li><p>
Specialist knowledge of Employment Practices Liability technical claims topics.</p></li><li><p>
At least some experience in negotiation, mediation, and arbitration.</p></li><li><p>
Policy language skills enabling accurate and consistent policy wording interpretation.</p></li><li><p>
Lateral thinking and the ability to problem solve and develop new ideas to improve working practices.</p></li><li><p>
Strong communication, time management, administrative and report-writing skills.</p></li></ul><p></p><p>
For positions based in Massachusetts, the base salary range is $76,000-$90,000. For positions based in New York, the base salary range is $68,000-$91,000. For positions based in New Jersey, the base salary range is $56,000-89,000. In addition, 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:<b> </b>2026 Benefits Overview<b>.</b></p><p></p><p>
Ready to accelerate your career? We would love to hear from you.</p><p></p><p><b><i>
#claims #claimsmanagement #arbitration #litigation #negotiation #complexclaims #financiallines #investigations</i></b></p><p></p><p>
#LI-NH1</p><p></p><p>
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.</p><p></p><p><b>
Enjoy benefits that take care of what matters</b></p><p>
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.</p><p></p><p><b>
Reimagining insurance to make a bigger difference to the world</b></p><p>
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.</p><p></p><p><b>
Welcome to a culture of </b><b>inclusion</b></p><p>
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.</p><p></p><p><i>
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.</i></p><p></p><p>
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.
</p><p></p><div><div><div><div><div><div><div><p>Functional Area:</p></div></div></div></div></div></div></div>
CL - Claims<p></p>
AIG Claims, Inc.</div><p></p>

Claim Analyst III

MetroPlusHealth

<div>
 <strong>
  Empower. Unite. Care.
  <br/>
  <br/>
 </strong>
 <strong>
  MetroPlusHealth
 </strong>
 is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
 <br/>
 <br/>
 <strong>
  About NYC Health + Hospitals
  <br/>
  <br/>
 </strong>
 MetroPlus
 <strong>
  Health
 </strong>
 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
 <strong>
  Health
 </strong>
 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus
 <strong>
  Health
 </strong>
 has been committed to building strong relationships with its members and providers.
 <br/>
 <br/>
 <strong>
  Position Overview
  <br/>
  <br/>
 </strong>
 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
 <br/>
 <br/>
 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.
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  Work Shifts
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  9:00 A.M &ndash; 5:00 P.M
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  Duties &amp; Responsibilities
  <br/>
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 </strong>
 <ul>
  <li>
   Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed using multiple systems and platforms.
  </li>
  <li>
   Ensure that the proper payment guidelines are applied to each claim by using the appropriate tools, processes, and procedures (e.g., claims processing P&amp;P&rsquo;s, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plans, etc.)
  </li>
  <li>
   Research claims that may have paid incorrectly and communicate findings for adjustment; Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts etc.) ensuring that all relevant information is considered.
  </li>
  <li>
   Advise business partners of findings outcome if their input is needed to help fix the issue.
  </li>
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   Communicate through correspondence with providers regarding claim payment or additional required information in a clear and concise manner.
  </li>
  <li>
   Process the adjustment of claims in a timely manner, according to established timelines.
  </li>
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   Remain current with changes/updates in claims processing, as well as updates to coding systems.
  </li>
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   Maintain accurate records of all claims processed, including notes on actions taken.
  </li>
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   Generate reports on claim activity as requested.
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   Respond to audits of claims processed.
  </li>
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   Able to work independently and exercise good judgment
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  </li>
 </ul>
 <strong>
  Minimum Qualifications
  <br/>
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 </strong>
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   High School Degree or evidence of having passed a High School Equivalency Program required. Associate degree preferred.
  </li>
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   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>
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   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>
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   Data Entry of Provider Claim/Billing information
  </li>
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   Experience handling or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.
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  </li>
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  Professional Competencies
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   Integrity and Trust
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   Customer Focus
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   Functional/Technical skills
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   Written/Oral Communication
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   Strong Analytical Skills
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   Knowledgeable in MS Word and Excel
   <br/>
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  </li>
 </ul>
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  Benefits
  <br/>
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 NYC Health and Hospitals offers a competitive benefits package that includes:
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   Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
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   Retirement Savings and Pension Plans
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   Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
  </li>
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   Loan Forgiveness Programs for eligible employees
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   College tuition discounts and professional development opportunities
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   College Savings Program
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   Union Benefits for eligible titles
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   Multiple employee discounts programs
  </li>
  <li>
   Commuter Benefits Programs
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  </li>
 </ul>
 #MHP50
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</div>


Claims Adjustment Specialist I

Axis

<div><p>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.</p><p>
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.</p><p>
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 &ndash; NJ, Red Bank &ndash; NJ, Princeton &ndash; NJ, Alpharetta, Kansas City, or Chicago.</p><ul><li>
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.</li><li>
Set accurate and timely claim reserves and make referrals to senior members of the team where necessary.</li><li>
Obtain relevant policies, review policy wordings to validate coverage for claims and escalate any issues arising.</li><li>
Prepare coverage positions to be reviewed and approved by Claim Manager.</li><li>
Work closely with Insureds, Claimants, attorneys and brokers ensuring a premier and best practices claim service is maintained, escalating issues as appropriate.</li><li>
Documents claim file notes, stores electronic documents, documents claim details in an effective and timely manner.</li><li>
Develop a working knowledge of the legal frameworks and claims handling practices relevant to the jurisdictions in which the claims arise.</li><li>
Monitor and investigate assigned claims and develop resolution strategy.</li><li>
Attend mediation, arbitration and other claim meetings as needed.</li><li>
Participate in presentations and discussions with Underwriters.</li><li>
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.</li><li>
Ensure file set up accurately with proper coding, LOB, Danger Signal and CAT Codes.</li></ul><p>
REQUIRED EDUCATION/TRAINING &amp; EXPERIENCE:</p><ul><li>
Bachelor&rsquo;s degree or equivalent; JD a plus.</li><li>
Claims adjuster license required; valid adjusting licenses in required states and additional states as needed</li><li>
Minimum of 2-5 years claim adjusting experience required.</li><li>
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.</li><li>
Attain expert comfort level in remote and work from home virtual working practices and platforms</li><li>
Excellent written and verbal communication skills, to liaise with numerous customers, both internal and external</li><li>
Solid understanding of individual and group performance metrics and KPIs</li><li>
Experience with Excel, Word, PowerPoint, OneNote and SharePoint a plus</li><li>
Availability for occasional travel</li><li>
Team player who has a positive outlook, flexible, organized, efficient and timely</li></ul><p>
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 Exempt for FLSA purposes.</i></p></div><p></p>

Cyber / Media Claims Specialist

Nationwide Mutual Insurance Company

<div>If you&rsquo;re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide&rsquo;s Property and Casualty team could be the place for you! At Nationwide&reg;, &ldquo;on your side&rdquo; goes beyond just words. Our customers and partners are at the center of everything we do and we&rsquo;re looking for associates who are passionate about delivering extraordinary care.<p></p><p>
We are looking for a motivated and talented individual to join our growing cyber claims team. As a Senior Claims Consultant, you will be handling complex and high exposure primary and excess cyber and data privacy claims from inception to conclusion. Your role will include investigating, evaluating and negotiating first-party and third-party cyber and data privacy claims.</p><p></p><p><b>
Job Description Summary</b></p>
If you can put your keen legal mind to work analyzing, managing and resolving insurance coverage and claims, we want to know more about you! Working on our team offers the opportunity to be involved in settling litigated claims of the highest level of complexity and severity in terms of exposure and coverage.<br>
<br>
As a Senior Claims Consultant, you'll investigate, evaluate and negotiate claims to a successful resolution. This role supports management liability and specialty lines of business including surety liability, error and omissions, directors and officers and employment practices liability, among others. Claim files will include litigated accounts of the highest complexity and severity, and of significant value to the organization. We will count on you to collaborate and provide insight to our business partners on claims and policy wording questions and maintain, develop and influence relationships with customers and business partners. You'll have opportunities to be a subject matter authority and collaborate with internal business partners to develop and implement claims strategies.<p></p><p><b>
Job Description</b></p><h2 class="jobSectionHeader"><b>
Key Responsibilities:</b></h2><ul><li><p>
Investigates and evaluates coverage, liability and damages to set an appropriate claim strategy, settlement and file reserves for the most serious and complex claims within approved claims authority.</p></li><li><p>
Provides timely and appropriate evaluation of claims to identify and manage reserves in compliance with company standards.</p></li><li><p>
Delivers outstanding customer service and satisfaction through effective interactions with insured, agents and legal counsel.</p></li><li><p>
Develops, coaches, trains and mentors individual team members. Acts as top level subject matter authority in specialty line claims. Identifies and develops training plans and strategies for the division.</p></li><li><p>
Maintains current knowledge of multiple coverage lines, venue-specific court decisions which may impact the claim function, current guidelines, and policy changes and modifications.</p></li><li><p>
Provide feedback on claim trends and development. Provide input to underwriters on review of potential and existing insured&rsquo;s claim experience.</p></li><li><p>
Contributes to a collaborative environment by consistently demonstrating teamwork, motivation, positive behavior and effort to achieve goals and objectives.</p></li><li><p>
Provides top level consultation/direction to claims leadership, peers and other business partners about severe specialty claims issues, coverage, or risks.</p></li><li><p>
Recommends changes to business leadership. Provides implementation strategies and coordinates execution processes in product development and management for specialty lines of business. Provides claim handling expertise to new product development.</p></li><li><p>
Provides standardized processes for claims handling related to new products. Assists in developing business plans to ensure claims quality results.</p></li><li><p>
Provides associate performance management, salary planning and administration, training and development, workflow and organizational planning, hiring and placement and disciplinary actions of contributing staff.</p></li></ul><p>
May perform other responsibilities as assigned.</p><p></p><p><b>
Reporting Relationships:</b> Reports to Claims Director or Associate Vice President</p><p></p><h2 class="jobSectionHeader"><b>
Typical Skills and Experiences:</b></h2><p></p><p><b>
Education: </b>College degree preferred. Juris Doctorate desired</p><p></p><p><b>
License/Certification/Designation:</b> Associates must acquire the required federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to obtain required licenses/registrations within the designated time period, the associate will be ineligible to continue in the position. Completion of insurance courses such as IIA, AEI, or CPCU preferred.</p><p></p><p><b>
Experience:</b> Ten years of prior insurance experience preferred. Proven experience investigating and resolving severe complex litigated claims. Confirmed experience analyzing and handling sophisticated coverage issues. Specific experience in a particular line of business may be required by the hiring business unit.</p><p></p><p><b>
Knowledge, Abilities and Skills:</b> Proven knowledge of the best claims practices used to resolve severe claims. Top level specialist in a particular line of business. Additional education may be required by the business unit. Extensive knowledge and expertise relating to insurance contracts, coverage issues, contingent or extra-contractual liability against insurers and litigation management, both foreign and domestic.</p><p></p><p>
Demonstrated analytical skills to make independent decisions and resolve conflict in application of coverage to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Validated ability to coordinate defense counsel in the handling of cases involving serious and complex liability and damage issues from inception through trial. Excellent verbal and written communication skills for use in communicating with policyholders, claimants, attorneys and all levels of management. Confirmed organizational skills to effectively establish work priorities in conformity with objectives and standards. Demonstrated personal computer skill, including the ability to operate claims and business software.</p><p></p><p>
Other criteria, including leadership skills, competencies and experiences may take precedence.</p><p></p><p>
Staffing exceptions to the above must be approved by the Vice President and HR Business Partner.</p><p></p><p><b>
Values:</b> Regularly and consistently demonstrates the Nationwide Values.</p><p></p><h2 class="jobSectionHeader"><b>
Job Conditions:</b></h2><p></p><p><b>
Overtime Eligibility:</b> Not Eligible (Exempt)</p><p></p><p><b>
Working Conditions:</b> Normal office environment. Travel as required.</p><p></p><p><b>
ADA:</b> The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.</p><p></p><p><b>
Credit/Background Check:</b> Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.</p><p></p><p><b>
Benefits</b></p><p>
We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer.</p><p></p><p>
Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.</p><p></p>
#claims<br>
<p></p>
For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf<p></p><p><b>
NOTE TO EMPLOYMENT AGENCIES:</b></p><p></p><p>
We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.</p><p></p>
Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.<p></p>
The national salary range for Sr Consultant, Claims - Management Liability &amp; Specialty Lines : $122,000.00-$214,000.00<p></p>
The expected starting salary range for Sr Consultant, Claims - Management Liability &amp; Specialty Lines : $122,000.00 - $182,000.00</div><p></p>

Sr Consultant, Claims - Management Liability & Specialty Lines

<div><p><b>Job Ref: </b>TE0088<br>
<b>Category: </b>Claims<br>
<b>Department: </b>CLAIMS<br>
<b>Location: </b>50 Water Street, 7th Floor, New York, NY 10004
<br>
<b>Job Type: </b>Temporary<br>
<b>Employment Type: </b>Full-Time<br>
<b>Work Arrangement: </b>Hybrid<br>
<b>Salary Range: </b>$21.00 - $26.00<br>
</p><p></p><p><b>Empower. Unite. Care.</b></p>
<p>MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.</p>
<p><b>About NYC Health + Hospitals</b></p>
<p>MetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.</p>
<p><b>Position Overview</b></p>
<p>The Payment Integrity Intern will be responsible for reviewing and analyzing claims to ensure that they meet specific criteria for reimbursement. This includes but not limited to checking for proper documentation and verifying patient eligibility. The ideal candidate will have strong analytical skills and capable to analyze data related to claims and payments to identify trends, discrepancies, or areas for improvement. This involves using software tools to assess large datasets and make meaningful recommendations. Strong communication skills are required, as Payment Integrity requires working closely with other departments, including Claims Operations, Provider Network Relations, Core Configuration and Compliance.</p>
<p>Duties &amp; Responsibilities</p>
<ul><li>Assist in reviewing and analyzing healthcare claims to ensure accuracy and compliance with policies and regulations.</li>
<li>Identify and report discrepancies or anomalies in claims data that may indicate billing errors.</li>
<li>Collaborate with cross-functional teams to resolve payment issues.</li>
<li>Support the development and implementation of Payment Integrity initiatives aimed at enhancing efficiency.</li>
<li>Conduct data analysis using software tools to identify trends in claims submissions and payment patterns.</li>
<li>Prepare detailed reports summarizing findings related to claims accuracy and payment integrity.</li>
<li>Assist in developing and maintaining payment integrity policies and procedures.</li>
</ul>
<p><b>Work Shifts</b></p>
<p>9:00 AM- 5:00 PM</p>
<p><b>Minimum Qualifications</b></p>
<ul><li>Currently enrolled in a degree program related to healthcare administration, health information management, finance, business administration, data analytics, or related field.</li>
<li>Students pursuing a bachelor&rsquo;s degree or higher.</li>
<li>Strong academic performance, with a focus on analytical and critical thinking skills.</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>
</ul>
<p>#LI-Hybrid</p></div><p></p>

Summer Intern - Payment Integrity

Explore 67+ Claims examiner in New York this March. Find roles across top companies and apply now to boost your career.