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claim representative

claims examiner - liability (must reside in louisiana) Jobs in Los Angeles

claims manager, medicare advantage plan Jobs in Los Angeles

claims manager, medicare advantage plan

commercial property claims examiner iii Jobs in Los Angeles

commercial property claims examiner iii

claims examiner liability must reside

Sedgwick

<div>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
Certified as a Great Place to Work&reg;
Fortune Best Workplaces in Financial Services &amp; Insurance
Claims Examiner - Liability (MUST RESIDE IN Louisiana)
<div>Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
<ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul>ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
</li><li>Assesses liability and resolves claims within evaluation.
</li><li>Negotiates settlement of claims within designated authority.
</li><li>Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
</li><li>Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
</li></ul>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
<ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li><li>Travels as required.
</li></ul>QUALIFICATIONS
Education &amp; Licensing
Bachelor's degree from an accredited college or university preferred.
Experience :
Five (5) years of Liability claims management experience or equivalent combination of education and experience required.
TAKING CARE OF YOU
<ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul>The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time
</div>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
<h2 class="jobSectionHeader">If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</h2></div>

Claims Examiner - Liability (MUST RESIDE IN Louisiana)

Chubb Insurance

<div>Chubb is currently seeking a Workers&rsquo; Compensation Medical Only Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA office.
Duties &amp; Responsibilities:
<ul><li>Handles all aspects of workers&rsquo; compensation medical only claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
</li><li>Review and assess new medical-only claims to determine eligibility and coverage under workers' compensation policies and complete coverage match where necessary.
</li><li>Conducts initial and ongoing investigations, obtaining facts and takes statements as necessary, with insured, claimant and medical providers.
</li><li>Evaluates the facts gathered through the investigation to determine compensability of the claim or if additional investigation for AOE/COE investigation.
</li><li>Coordinate and authorize appropriate medical treatment for injured workers, ensuring timely and effective care.
</li><li>Sets timely reserves within authority limits for medical and expenses and recommends reserve changes to Team Leader throughout the life of the claim.
</li><li>Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
</li><li>Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
</li><li>Controls and directs vendors, telephonic cases managers, and use all medical cost containment programs.
</li><li>Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
</li><li>Files workers&rsquo; compensation forms and electronic data with states to ensure compliance with statutory regulations.
</li><li>Works with in-house Technical Assistants, Special Investigators, Nurse to exceed customer's expectations for exceptional claims handling service.
</li><li>Always maintains 100%+ closing rate.
</li><li>Timely recommend transfer of claims to lost time status.
</li><li>Maintain detailed and accurate records of all claim activities, including medical reports, correspondence, and payment information.
</li><li>Serve as the primary point of contact for claimants, medical providers, and employers, providing updates and information as needed.
</li><li>Address and resolve any issues or disputes related to medical treatment or claim processing.
</li></ul>Technical Skills &amp; Competencies:
<ul><li>Preference for prior experience as MO Claim Examiner in workers&rsquo; compensation as a lost time examiner, or similar examiner experience in short-term / long-term disability, auto personal injury protection / medical injury, or general liability claims.
</li><li>Requires basic knowledge of workers&rsquo; compensation statutes, regulations, and compliance. Understanding of workers' compensation laws and medical terminology.
</li><li>Exceptional customer service and focus.
</li><li>Ability to openly collaborate with leadership and peers to accomplish goals.
</li><li>Demonstrates a commitment to a career in claims.
</li><li>Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
</li><li>Use analytical skills to find mutually beneficial solutions to claim and customer issues.
</li><li>Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
</li><li>Willing to take ownership and tackle obstacles to meet Chubb's quality
</li><li>standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
</li><li>Superior verbal and written communication skills.
</li><li>High school diploma or equivalent; some positions may require an associate's or bachelor's degree in a related field.
</li></ul>Experience, Education &amp; Requirements:
<ul><li>Experience working in a customer focused, fast-paced, fluid environment
</li><li>Experience utilizing strong communication and telephonic skills
</li><li>Prior experience requiring a high level of organization, follow-up, and accountability
</li><li>Prior workers&rsquo; compensation claim handling experience or other similar type of claim handling experience is preferred (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
</li><li>Proficiency with Microsoft Office Products
</li><li>If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
</li></ul>The pay range for the role is $57,200 to $83,300. The specific offer will depend on an applicant&rsquo;s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website . The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.</div>
 <div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. 
</div><div></div> 
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

Claim Representative

California Fair Plan Association

<div>POSITION SUMMARY 
The Commercial Property Examiner III reviews, evaluates and processes complex commercial insurance claims and makes recommendations for resolution. Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other records to determine insurance coverage, ensuring payment recommendations and settlements have been made correctly.<div> 
PRINCIPAL DUTIES &amp; RESPONSIBILITIES 
<ul><li>Manage a caseload of commercial property claims from assignment through resolution.</li><li>Examine commercial claims investigated by independent adjusters to determine the extent of insurance coverage and validity of the claims.</li><li>Review and adjust commercial loss reserves, correspondence, reports, verify coverage and authorize payments submitted by independent adjusters.</li><li>Collaborate with internal personnel and/or legal counsel on claims involving litigation.</li><li>Investigate, evaluate, and adjust claims, applying technical knowledge and human relations skills to promote fair and prompt settlement of claims.</li><li>Oversee independent adjuster files to ensure they have followed CFP IA Guidelines.</li><li>Verify and analyze data used in settling claims to ensure validity and that settlement is in accordance with company practices and procedures.</li><li>Maintain compliance with the Department of Insurance and Company procedures.</li><li>Identify fraud or illegal activity indicators and follow internal processes to refer the claims to the appropriate personnel for follow up.</li><li>Promptly negotiates settlements ensuring the settlement reflects the insured losses while confirming the insurer is protected from invalid claims.</li></ul></div> 
ADDITIONAL DUTIES &amp; RESPONSIBILITIES 
Commercial Claims Examiner III: The Commercial Claims Examiner III role will focus on Claims over $500,000 but may receive smaller claims as needed.<div> 

KNOWLEDGE &amp; SKILL REQUIREMENTS 
<ul><li>Bachelor&rsquo;s degree or equivalent.</li><li>5+ years of property claims adjusting experience, including 2+ years commercial property claims preferred.</li><li>Excellent oral and written communication skills.</li><li>Working experience with MS-Office (especially Word and Excel).</li><li>Comprehensive understanding of policy contract/statutes and claims processes.</li><li>Certified in CEA and Fair Claims Settlement Practices.</li></ul></div> 

ADDITIONAL REQUIREMENTS (PRIOR EXPERIENCE)

Commercial Claims Examiner III: 4 years Commercial Experience, 2 years claims over $500k</div>

Commercial Property Claims Examiner III

USAA

<div>Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values &ndash; honesty, integrity, loyalty and service &ndash; define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
As a dedicated Property Adjuster Specialist , you will work within established guidelines and framework to investigate, evaluate, negotiate, and settle complex property insurance claims presented by or against our members. You will confirm and analyzes coverage, recognize liability exposure and negotiate equitable settlements in compliance with all state regulatory requirements.
Property Adjuster Specialist focus on using technology and desk adjusting for a virtual first approach to inspections and claims handling. USAA also provides a company vehicle to physically inspect losses within your locally assigned territory. Field Adjusters may travel outside of their local territory to respond to claims in other regions when needed. This is an hourly, non-exempt position with paid overtime available.
This is a field-based role for Irvine, CA. Candidates currently living in this location or willing to self-relocate are encouraged to apply.<h2 class="jobSectionHeader">
What you'll do:</h2><ul><li>
Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability.</li><li>
Partners with vendors and internal business partners to facilitate complex claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance.</li><li>
Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.</li><li>
Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing information involving complex policy terms and contingencies.</li><li>
Determines and negotiates complex claims settlement within authority limits. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes.</li><li>
Maintains accurate, thorough, and current claim file documentation throughout the claims process.</li><li>
Advance knowledge of estimating technology platforms and virtual inspection tools. Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims.</li><li>
Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.</li><li>
May be assigned CAT deployment travel with minimal notice during designated CATs.</li><li>
Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.</li><li>
Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience.</li><li>
Adjusts complex claims with attorney involvement.</li><li>
Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.</li><li>
May require travel to resolve claims, attend training, and conduct in-person inspections.</li><li>
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul><h2 class="jobSectionHeader">
What you have:</h2><ul><li>
High School Diploma or General Equivalency Diploma required.</li><li>
2 years of relevant property claims adjusting experience of moderate complexity losses that includes writing estimates, involving dwelling and structural damages.</li><li>
Advanced knowledge of estimating losses using Xactimate or similar tools and platforms.</li><li>
Proficient knowledge of residential construction.</li><li>
Proficient knowledge of property claims contracts and interpretation of case law and state laws and regulations.</li><li>
Proficient negotiation, investigation, communication, and conflict resolution skills.</li><li>
Proven investigatory, analytical, prioritizing, multi-tasking, and problem-solving skills.</li><li>
Ability to travel 50-75% of the year (local &amp; non-local) and/or work catastrophe duty when needed.</li><li>
Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.</li></ul><h2 class="jobSectionHeader">
What sets you apart:</h2><ul><li>
US military experience through military service or a military spouse/domestic partner</li><li>
5 years of prior field experience handling higher severity/complex losses (i.e. vandalism, malicious mischief, foreclosures, earth movement, collapse, liability, etc.)</li><li>
Prior experience adjusting property claims using virtual technologies</li><li>
Prior property field adjuster experience handling DWG, APS and ALE adjustments</li><li>
Industry designations such as AINS, CPCU, AIC, SCLA (or actively pursuing)</li><li>
Xactimate Level 1 and/or Level 2 certification</li><li>
Prior deployments in support of catastrophes</li><li>
Currently hold an active Adjuster License</li><li>
Currently reside within or have the ability to self-relocate to Irvine, CA</li></ul><h2 class="jobSectionHeader">
Physical Demand Requirements:</h2><ul><li>
May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.</li><li>
May need to meet all USAA safe driving requirements including verification of driving record through MVR &amp; possession of valid driver&rsquo;s license.</li><li>
May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.</li><li>
May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics.</li></ul>
Compensation range: The salary range for this position is: $69,920.00 - $133,620.00.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. 
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. 
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. 
For more details on our outstanding benefits, visit our benefits page on USAAjobs.com
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. 
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.</div>

Property Adjuster Specialist - Field

SimpleCiti Companies

<div>
 Fort Morgan is seeking an experienced Personal Injury Case Manager to oversee pre-litigation files from intake through demand. This role manages insurance communication, liability development, medical coordination, lien handling, and consistent client contact to advance cases efficiently and maximize value.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Contact new clients promptly and confirm case details
 </li>
 <li>
 Review intake materials and obtain missing documentation
 </li>
 <li>
 Open insurance claims and verify coverage
 </li>
 <li>
 Establish and document liability
 </li>
 <li>
 Obtain accident reports and supporting evidence
 </li>
 <li>
 File required government notices
 </li>
 <li>
 Coordinate and monitor medical treatment
 </li>
 <li>
 Retrieve and review medical records and bills
 </li>
 <li>
 Identify and track statutory liens
 </li>
 <li>
 Monitor provider balances
 </li>
 <li>
 Handle property damage and rental claims
 </li>
 <li>
 Provide regular client updates
 </li>
 <li>
 Prepare medical summaries and demand packages
 </li>
 <li>
 Draft demand letters for attorney review
 </li>
 <li>
 Maintain case system updates and track deadlines
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 2+ years of personal injury pre-litigation experience
 </li>
 <li>
 Experience managing cases from intake through demand
 </li>
 <li>
 Knowledge of California insurance and claim procedures
 </li>
 <li>
 Experience communicating with adjusters and providers
 </li>
 <li>
 Familiarity with medical records and lien processes
 </li>
 <li>
 Ability to manage a high-volume caseload
 </li>
 <li>
 Strong organizational and communication skills
 </li>
 </ul>
</div>

Case Manager

JDC Claims

Job Summary Join our dynamic team as an Independent Proper Field Insurance Adjuster, where you will play a vital role in evaluating insurance claims. Work from home. Flexible hours. This position offers the flexibility to operate independently while providing expert assessments that help clients navigate complex claims processes. Your expertise in analyzing damages, detecting potential fraud, and negotiating settlements will ensure fair and efficient resolutions. If you thrive in a fast-paced environment and are passionate about delivering exceptional customer service, this is the perfect opportunity to advance your career in insurance adjusting. Estimating and/or contracting experience needed.Duties<ul><li>Investigate insurance claims by examining property damages and relevant documentation to determine coverage eligibility and liability.</li><li>Conduct thorough analysis of claim details, including medical reports, auto estimates, and financial data using specialized software tools.</li><li>Detect and prevent potential fraud by identifying inconsistencies or suspicious activity during claim assessments.</li><li>Negotiate settlements.</li><li>Maintain organized records of all claim activities, correspondence, and investigation findings for compliance and future reference.</li><li>Collaborate with insurance carriers, legal teams, healthcare providers, and repair specialists to gather necessary information and streamline claims processing.</li></ul>Qualifications<ul><li>Proven experience as an insurance adjuster or in a related role with a focus on property claims.</li><li>Strong analysis skills with the ability to interpret estimates, financial data, and legal documents.</li><li>Excellent negotiation abilities to facilitate fair settlements while maintaining positive relationships with clients and stakeholders.</li><li>Knowledge of fraud prevention and detection techniques specific to insurance claims.</li><li>Familiarity with property estimating software and financial management tools used in claims processing.</li><li>Exceptional organizational skills for managing multiple cases efficiently while ensuring accuracy and compliance.</li><li>Outstanding customer service skills with a professional approach to handling sensitive situations. Embark on a rewarding career where your expertise makes a real difference! We are committed to supporting your professional growth by providing an engaging work environment that values integrity, innovation, and excellence in service delivery.</li></ul>Job Type: ContractPay: $35.83 - $50.00 per hourExpected hours: 15 &ndash; 30 per weekWork Location: Hybrid remote in Los Angeles, CA 90060

Insurance Adjuster - Independent

Law Office of raymond Sarraf

Responsibilities:<ul><li>Schedule doctor appointments for clients</li><li>Open insurance claims</li><li>Maintain Liability</li><li>Open Medi-Cal/Medicare/Private Insurance Liens</li><li>Collect all possible information, evidence and documentation that pertains to the case</li><li>Collect and organize medical records</li><li>Prepare files to submit to demand writers</li><li>Manage medical treatment while providing treatment recommendations</li><li>Client communication</li></ul><ul><li>Qualifications:</li><li>Bilingual English/Spanish</li><li>Client service-oriented</li><li>Ability to multi-task</li><li>Attention to detail and deadline oriented</li></ul>Job Type: Full-timePay: $25.00 - $35.00 per hourBenefits:<ul><li>Dental insurance</li><li>Free parking</li><li>Health insurance</li><li>Paid sick time</li><li>Retirement plan</li><li>Vision insurance</li></ul>Work Location: In person

Personal Injury Case Manager

Explore 317+ Claims examiner liability must reside in Los Angeles this March. Find roles across top companies and apply now to boost your career.