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claims adjuster,tpa oversight Jobs in Atlanta

claims adjuster,tpa oversight

claims analyst

claims analytics manager

claims manager

Rialtic, Inc.

<div><h3 class="jobSectionHeader"><b>Role Overview</b></h3>
<h4 class="jobSectionHeader"><b>The Senior Manager, Claims Analytics, leads the claims analytics function within the Implementation organization. This role is responsible for overseeing complex reimbursement and payment accuracy analyses, managing analysts, setting analytical standards, and partnering cross-functionally with GTM, Customer Success, Product, and Engineering teams to ensure successful client implementations.</b></h4>
<h4 class="jobSectionHeader"><b>This role combines deep healthcare claims expertise with people leadership, strategic thinking, and operational execution to scale analytics capabilities and drive measurable financial outcomes for clients.</b></h4>
<h3 class="jobSectionHeader"><b>Key Responsibilities</b></h3>
<h4 class="jobSectionHeader"><b>Leadership &amp; Strategy</b></h4>
<ul><li><h4 class="jobSectionHeader"><b>Lead and mentor a team of Implementation Claims Analysts, setting priorities, performance expectations, and development plans. Define and standardize analytical methodologies, reporting frameworks, and best practices for claims and reimbursement analysis.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Partner with Implementation leadership to align analytics deliverables with client goals, timelines, and success metrics.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Act as a subject-matter expert in claims analytics for complex or high-visibility client implementations.</b></h4>
</li></ul><h4 class="jobSectionHeader"><b>Analytics &amp; Execution</b></h4>
<ul><li><h4 class="jobSectionHeader"><b>Oversee large-scale analysis of claims data related to charge capture, reimbursement, underpayment, overpayment, and payment accuracy.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Ensure the delivery of exception-driven, actionable insights that clearly identify systemic versus isolated issues.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Review and validate analytical outputs, ensuring accuracy, consistency, and clarity in reporting and client-facing deliverables.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Guide analyses related to:</b><br>
</h4>
</li><li><ul><li><h4 class="jobSectionHeader"><b>Payor reimbursement behavior and trends</b></h4>
</li><li><h4 class="jobSectionHeader"><b>RVU productivity and payment alignment</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Revenue cycle optimization opportunities</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Financial performance to benchmarks, goals, and norms</b><br>
</h4>
</li></ul></li></ul><h4 class="jobSectionHeader"><b>Cross-Functional Collaboration</b></h4>
<ul><li><h4 class="jobSectionHeader"><b>Partner with GTM and Customer Success teams to support implementations, renewals, and expansion opportunities through analytics insights.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Collaborate with Product and Engineering teams to influence roadmap priorities based on claims analysis findings and client needs.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Serve as a senior analytics representative in client-facing discussions, executive readouts, and strategic reviews.</b><br>
</h4>
</li></ul><h4 class="jobSectionHeader"><b>Technical Oversight</b></h4>
<ul><li><h4 class="jobSectionHeader"><b>Guide data ingestion and processing pipelines using SQL*Loader, Oracle, shell scripting, and cloud-based tools.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Oversee advanced analytics leveraging </b><b>SQL, PL/SQL, Python, Scala, Spark, and AWS</b><b>.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Ensure scalable, repeatable approaches to analyzing </b><b>billions of claims records</b><b> across clients.</b><br>
</h4>
</li></ul><h4 class="jobSectionHeader"><b>Required Qualifications</b></h4>
<ul><li><h4 class="jobSectionHeader"><b>8+ years of experience in healthcare claims analytics, payment accuracy, or reimbursement analysis.</b></h4>
</li><li><h4 class="jobSectionHeader"><b>Prior experience working with claims editing or payment accuracy vendors.</b></h4><b>
</b></li><li><h4 class="jobSectionHeader"><b>Strong expertise in medical coding, billing guidelines, and reimbursement methodologies.</b></h4><b>
</b></li><li><h4 class="jobSectionHeader"><b>Proven people leadership experience managing and developing analytics teams.</b></h4><b>
</b></li><li><h4 class="jobSectionHeader"><b>Advanced proficiency in SQL and experience working with large healthcare datasets.</b></h4><b>
</b></li><li><h4 class="jobSectionHeader"><b>Strong executive communication and presentation skills.\</b></h4></li></ul></div><p></p>

Claims Analytics Manager

Reserv

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

Claims Team Lead Litigation

AIG Claims, Inc.

<div><p>At AIG, we are reimagining the way we help customers to manage risk. Join us as a <b>Complex Claims Liability Director, TPA Oversight</b> to play your part in that transformation. It&rsquo;s an opportunity to grow your skills and experience as a valued member of the team.</p><p></p><p><b>
Make your mark in Claims</b></p><p>
Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical excellence and showcasing our service differentiation to create an unparalleled global claims handling experience. Through a robust stakeholder feedback loop and supported by consistent processes and leadership, we take pride in delivering responsive, fair and professional service with empathy and efficiency.</p><p></p><p><b>
How you will create an impact</b></p><p>
As Complex Claims Director &ndash; TPA Oversight, you will analyze and process bodily injury and third-party property damage claims by investigating and gathering information to determine the exposure on the claim; ensure proactive claims handling aimed at the prompt and cost-effective resolution of claims through well-developed action plans. You will determine need for and direct independent adjusters to gather information to determine exposure on the claim and control their costs.</p><ul><li><p>
Identify and evaluate coverage issues; prepare comprehensive coverage letters with supervisory review and analysis; retain and provide direction to coverage counsel when necessary.</p></li><li><p>
Assess liability and resolve claim within established evaluation. Maintain diaries and complete tasks within required timeframes as set forth by department guidelines; ensure claim files are timely and properly documented with clear and concise analysis on coverage, damages, reserves, and liability including an action plan for resolution. Process and pay invoices within a timely manner.</p></li><li><p>
Coordinate vendor referrals for additional investigation and/or litigation management. Calculate and assign timely and appropriate reserves; monitor reserve accuracy throughout the life of the claim.</p></li><li><p>
Refer case as appropriate to supervisor and management. Respond to requests or directions in a professional and timely manner.</p></li><li><p>
Attend arbitrations, mediations, settlement conference and trials.</p></li><li><p>
Successfully complete required State licensing examinations and continuing education requirement.</p></li><li><p>
Communicate with all internal business partners including underwriters to make sure underwriting is aware of large losses and industry trends.</p></li><li><p>
Partner with TPA Governance and Relationship Management to help TPA&rsquo;s and Insureds comply with claim handling and reporting guidelines.</p></li><li><p>
Work with TPA Claims Financial to check the accuracy of TPA financials ensuring alignment with TTPO financials.</p></li></ul><p></p><p><b>
What you will need to succeed</b></p><ul><li><p>
7 plus years of General Liability/Auto claims experience.</p></li><li><p>
Experience with complex and high exposure General Liability Bodily Injury and Property Damage claims.</p></li><li><p>
Excellent communication skills (verbal/written) and strong negotiation skills.</p></li><li><p>
Advanced experience and capabilities in litigation claims management, including ADR and mediation processes, involving auto/GL exposures.</p></li><li><p>
Strong technical expertise interpreting insurance contracts.</p></li><li><p>
In depth knowledge of claim handling procedures, claims performance strategies, and claim best practices.</p></li><li><p>
Advanced analytical and problem solving skills.</p></li><li><p>
Should also have a demonstrated ability to initiate and champion change initiatives that leverage technology and improve skills in benchmarking.</p></li><li><p>
Creativity in resolving challenging business problems, as well as ability to achieve business goals and objectives is essential.</p></li></ul><p></p><p>
Ready to accelerate your career? We would love to hear from you.</p><p></p><p>
Compensation for this position includes base salary and eligibility for a bonus in accordance with the terms of the applicable incentive plan. In addition, we&rsquo;re proud to offer a range of competitive benefits, a summary of which can be viewed here: US Benefits.</p><p></p><p>
#LI-AIG #claimsprofessionals #InsuranceJobs #legalcareers #paralegaljobs #claimsexaminer #claimsadjuster #InsuranceCareers #insuranceTPA
</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>

Complex Claims Liability Director, TPA Oversight

<div><p>Payment Accuracy Manager, Outpatient Facility</p>
<p><b>
Overview</b></p>
<p>
As a Payment Accuracy Policy Manager, you will serve as a critical bridge between healthcare payment expertise in our facility capability. This role combines deep subject matter knowledge with strategic influence&mdash;driving the development of payment integrity policies that protect our clients while advancing Rialtic's platform capabilities.</p>
<p>
You'll lead the research, evaluation, and implementation of new policies based on CMS guidelines, Medicaid requirements, industry standards, and emerging medical cost trends in the facility space of our offering. Working closely with client management, product, engineering, and content leadership teams, you'll translate complex payment policy concepts into actionable strategies that deliver measurable value. This is an opportunity to shape how health plans approach payment integrity and to build the content foundation that powers our enterprise platform.</p>
<p><b>
Responsibilities</b></p>
<ul>
<li>Serve as the SME for outpatient facility editing policy development, leading the research, scoping, and creation of new claims editing policies for the facility capability</li>
<li>Source, interpret, and scope new payment integrity policies to expand Rialtic's claims editing content library from outpatient facility claims</li>
<li>Prioritize policy updates based on savings potential, client impact, and strategic alignment with platform goals</li>
<li>Leverage CMS, Medicaid, clinical guidelines, and industry trends to identify opportunities for new content development for facility claims</li>
</ul><ul><li>Quantify and communicate policy value through data-driven analysis and clear financial impact assessments in the facility space</li>
</ul><ul><li>Work closely with product and engineering teams to ensure client needs inform platform development, building out our facility capability</li>
<li>Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library</li>
<li>Perform investigation of current facility policy defects and unexpected claim outcomes, performing root cause analysis and policy research to identify corrective actions and improve policy accuracy and performance</li>
<li>Serve as the facility payment accuracy SME in client discussions, presenting policy concepts and addressing facility-related questions when needed</li>
</ul>
<p><b>Qualifications</b></p>
<p><b>
Required</b></p>
<ul>
<li>5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization with focus in outpatient facility claims editing and reimbursement methodologies</li>
<li>Active coding certification (COC, CPC, CCS, or equivalent specialty certification) &mdash; <i>required for this position</i></li>
<li>Proven expertise in:</li>
<li><ul><li>Interpreting medical and payment policies</li>
<li>Applying CMS and Medicaid reimbursement guidelines</li>
<li>Professional and outpatient coding standards</li>
<li>Common claims payment error identification and resolution</li>
</ul></li><li>Demonstrated ability to advise clients and explain complex payment accuracy concepts in clear, accessible terms</li>
<li>Strong analytical skills with experience quantifying policy impact and ROI</li>
<li>Track record of managing claims editing implementations or similar client-facing initiatives</li>
<li>Intermediate Excel skills (i.e., formulas, v-lookups, pivot tables, etc)</li>
</ul>
<p><b>Preferred</b></p>
<ul>
<li>Expertise across both professional and institutional claims environments</li>
<li>Advanced proficiency with Google Suite or similar collaboration tools</li>
<li>Experience working cross-functionally with product and engineering teams in a SaaS or health tech environment</li>
<li>Exceptional written and verbal communication skills with the ability to influence stakeholders at all levels</li></ul></div><p></p>

Payment Accuracy Manager, Outpatient Facility

MAG Mutual Insurance Company

<div>The Claims Analyst is responsible for investigating and managing primary litigation claims as assigned. This role involves developing a litigation plan and strategy with defense counsel, recommending defense or settlement strategies, and presenting cases to trial and settlement committees. This position assists management in the training of claims personnel and is responsible for completing special projects assigned by management. The Claims Analyst abides by MPL Analyst Guidelines.<div>
SPECIFIC DUTIES:</div><ul><li>
Establish and verify insurance coverage for MagMutual insured.</li><li>
Investigate claims against MagMutual insureds.</li><li>
Proper reserving and coding to accurately reflect exposure of MagMutual/insured.</li><li>
Assign a Medical Advisor when required.</li><li>
Thoroughly, accurately, and timely document case files</li><li>
Manage and control LAE expenses incurred on each assigned claim file.</li><li>
Determine the appropriate case plan - settlement or defense.</li><li>
Become knowledgeable and proficient in all claim management related technologies</li><li>
Timely close files</li><li>
Provide recommendations for continued use or termination of defense counsel/firms</li><li>
Handle specialty cases as needed.</li><li>
Lead committees as assigned by management.</li><li>
Assist with reports and communications with reinsurers.</li><li>
Assist with departmental and strategic projects.</li><li>
Become knowledgeable of all companies under the MagMutual Group and assists those companies in their growth when necessary.</li><li>
Attend continuing education seminars/courses to enhance medical/legal knowledge.</li></ul><div></div><div>
QUALIFICATIONS, EXPERIENCE REQUIRED:</div><ul><li>
College undergraduate degree</li><li>
Minimum four years of prior casualty claims experience with emphasis on medical malpractice claims.</li><li>
Experience handling high exposure cases including negotiations/resolution.</li><li>
Excellent communication, interpersonal, analytical, and negotiation skills.</li><li>
Ability to project a professional demeanor.</li><li>
Ability to properly handle confidential information.</li><li>
Flexibility to travel as the position requires.</li></ul><div></div><div>
JOB REPORTS TO:</div><ul><li>
Claims Team Lead</li></ul><div>
Location:</div><div></div>
Atlanta Office</div>

Claims Analyst

<div><p><b>About Reserv</b></p><ul><li>
Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike.<br>
<br>
We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can&rsquo;t wait to meet you.</li></ul><p></p><p><b><br>
About the role</b></p><ul><li>
We are seeking highly organized and customer-focused Resolution Specialists to join our team. The successful candidate will be responsible for communicating with customers on the phone, educating and helping the customer work through their claim to the best possible outcome. This role will also be responsible for handling an inventory of claims, triaging critical claims, and delivering service to all constituents of the claim. The claims you will handle will be transportation-related.<br>
<br>
The ideal candidate has a willingness to work through and design process that supports the quickest claim resolution with the best outcome. In addition, they will collaborate closely with our product and engineering teams to give feedback and identify technology and process improvements.<br>
<br>
<b>Resolution Specialists are:</b></li><li>
Highly motivated and growth-oriented. Excited by the prospect of building a tech-driven claims org.</li><li>
Passionate specialists who care about the customer and their experience.</li><li>
Empathetic. Exercises empathy and patience towards everyone interacted with.</li><li>
Sense of urgency - AT ALL TIMES. That does not mean working at all hours.</li><li>
Creative. Finding the right exit ramp (pun intended) for the resolution of the claim that is in the client&rsquo;s best interest.</li><li>
Conflict-enjoyer. Conflict does not have to be adversarial, but it HAS to be conversational. Working toward a win/win claim resolution.</li><li>
Curious. Wanting to know the whole story so the right decisions are made early and take action to prompt a quick resolution.</li><li>
Anti-status quo. Not just <i>wishing</i> things were done differently but taking the appropriate <i>actions</i> to ensure it.</li><li>
Communicative. Professional written and oral communication with all parties to a claim.</li><li>
And did we mention a sense of humor? Claims are hard enough as it is.</li></ul><p></p><p><b><br>
What you'll do</b></p><ul><li>
Provide prompt, courteous and high-quality customer service to all policyholders and claimants by answering customer calls, filing claims, and resolving customer requests</li><li>
Manage an inventory of litigated and non-litigated cases</li><li>
Analyze and review auto insurance claims to identify areas of dispute, investigating and gathering all necessary information and documentation related to the claim, evaluating liability and damages related to the claim, and negotiating and settling claims with opposing parties or their insurance providers</li><li>
Ensure compliance with specific state regulations, policy provisions, and standard operating procedures</li><li>
Manage both non-litigation and litigation cases related to auto claims disputes, communicate with involved parties, attending mediations, arbitrations, and court hearings as necessary, and communicating regularly with clients, claims adjusters, attorneys, and other stakeholders</li><li>
Collaborate with defense counsel, claims counsel, and litigation claims management for strategic planning, including developing and maintaining positive working relationships with approved defense firms and other vendors in the industry</li><li>
Review legal documents and ensuring compliance with initial suit-handling plan of action</li><li>
Serve as corporate representative for discovery review and depositions, and appearing as Corporate Representative at depositions and trials when needed</li><li>
Analyze policy language and reaching appropriate coverage decisions, drafting frequent and complex coverage correspondence, and proactively managing non-litigated and litigated claim files from inception to closure</li><li>
Direct and control the activities and costs of numerous outside vendors including defense counsel and coverage counsel, experts and independent adjusters</li><li>
Maintain adjuster licenses and continuing education requirements</li></ul><p><b>
Requirements</b></p><ul><li>
Active insurance adjuster&rsquo;s license by way of a designated home state, or home state</li><li>
Bachelor's degree (lack of one should not stop you from applying if you possess all the other qualifications)</li><li>
Minimum of 3 years of experience on point and concentrated in transportation claims adjusting, ideally with:</li><li><div><ul><li>
Third-party PD</li><li>
Third-party bodily injury, including catastrophic losses</li><li>
UM/UIM bodily injury</li><li>
Litigation experience</li><li>
PIP a plus, but not required</li></ul></div></li><li>
Willing to obtain all licenses within 60 days, including completing state-required testing.</li><li>
Knowledge of state regulations, policy provisions, and standard operating procedures.</li><li>
Willingness to travel for clients and claims need</li></ul><p><b>
Benefits</b></p><ul><li>
Generous health-insurance package with nationwide coverage, vision, &amp; dental</li><li>
401(k) retirement plan with employer matching</li><li>
Competitive PTO policy &ndash; we want our employees fresh, healthy, happy, and energized!</li><li>
Generous family leave policy</li><li>
Work from anywhere to facilitate your work-life balance</li><li>
Apple laptop, large second monitor, and other quality-of-life equipment that might be needed. Technology is something that should make your life easier, not harder!</li></ul><p><b>
Additionally, we will</b></p><ul><li>
Provide a manageable pending to deliver the service in a way always wanted from a dedicated account.</li><li>
Listen to the Resolution Specialist's feedback to enhance and improve upon the long-standing challenges.</li><li>
Work toward reducing and eliminating all the administrative work from a Resolution Specialist.</li><li>
Foster a culture of empathy, transparency, and empowerment in a remote-first environment.</li></ul><p></p><p><br>
At Reserv, we value diversity and believe that a variety of perspectives leads to innovation and success. We are actively seeking candidates who will bring unique perspectives and experiences to our team and welcome applicants from all backgrounds.</p></div>

Bodily Injury Claims Adjuster

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

Pipeline General Liability Construction Defect

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