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claims specialist ii

Mercury Insurance Company

<div>Overview:

Join an amazing team that is consistently recognized for our achievements and culture, including our most recent Forbes award of being one of America's Best Midsize Employers for 2024! 
Training consists of 8 weeks of paid training. Monday through Friday from 8:00am-4:45pm PST. After training we offer a fixed schedule of 40 hours per week Monday through Friday from 8:00am-4:45pm PST.
Geo-Salary Information:
<div>
An in-person interview may be required during the hiring process</div><div></div><div> 
State specific pay scales for this role are as follows:</div>
$29.33 per hour (CA, NJ, NY, WA, HI, AK, MD, CT, RI, and MA)
$26.92 per hour (NV, OR, AZ, CO, WY, TX, ND, MN, MO, IL, WI, FL, GA, MI, OH, VA, PA, DE, VT, NH, and ME).
$24.52 per hour (UT, ID, MT, NM, SD, NE, KS, OK, IA, AR, LA, MS, AL, TN, KY, IN, SC, NC, and WV)<div> 
This position is a work from home position that requires a dedicated workspace, free from distractions</div>
Responsibilities:

Position Overview
If you&rsquo;re passionate about helping people restore their lives when the unexpected happens, and providing high-quality customer experiences, then our Mercury Insurance Claims team could be the place for you! We offer dynamic and challenging opportunities to those who want to make a meaningful impact. 
With ongoing guidance and support, the Claims Specialist II takes the lead in guiding customers through the claims process. You will investigate and process claims for damage to vehicles and other property as well as moderate bodily injury claims. You will focus on accurate and efficient claims to prevent unnecessary expense to the Company and policyholders. You will provide excellent customer service to ensure our customers have a positive experience and feel valued and supported. 
At Mercury, we believe in nurturing growth, making time to have fun, and working together to make great things happen. 
Key Responsibilities:
Customer Interaction and Claims Process Management: Review and explain coverage details and the claims process to customers. Set reserves for anticipated expenses and arrange vehicle inspections and rental authorizations. Address customer inquiries and concerns throughout the claim process to ensure satisfaction and retention. 
Investigation and Evidence Gathering: Utilize various communication methods (phone calls, emails, texts, letters) to obtain information from involved parties, including witnesses. Review law enforcement reports and seek out additional evidence (dash cam, surveillance video) to assess the facts of loss and determine liability. 
Risk Assessment and File Management: Identify and escalate high-risk files with significant indemnity exposure or suspected fraud to supervisors for further review or investigation. 
Bodily Injury Claims Management: Analyze medical records to evaluate, negotiate, and settle moderate bodily injury claims with legal counsel for represented claimants and unrepresented parties. 
Cross-Department Collaboration: Serve as the primary point of contact for customers, coordinating with other departments to ensure a smooth claims experience and complete customer satisfaction. 
Team Collaboration: Collaborate with a team to address the needs of shared customers when necessary. 

Qualifications:
<ul><li>High school diploma or equivalent, Bachelor&rsquo;s degree preferred</li><li>
6 months&rsquo; customer service experience in a high-volume work environment or equivalent combination of education and experience</li><li>
6-12 months&rsquo; claims adjusting experience, preferred</li><li>
Prior experience working in a remote environment is a plus</li></ul>
Physical Requirements:
<div>
Continuously (66%-100%): 
<ul><li>Must be able to maintain a sedentary position for extended periods.</li><li>Must be able to communicate (electronically and telephonically) with team members, customers, and external parties.</li><li>Must be able to operate and type on a computer, laptop, and/or other Company-issued electronic device for extended periods of time.</li><li>Must be able to access and operate Company computer system, including preparing documents, entering data into computer system, and reading documents from a computer database or email system.</li></ul>
Occasionally (Up to 33%): 
<ul><li>Must be able to bend, stoop, reach, climb, and/or stand to access files, documents, and other equipment.</li><li>Must be able to grasp, open, and close drawers, filing cabinets, and other equipment.</li></ul></div>
About the Company:

Why choose a career at Mercury?
At Mercury, we have been guided by our purpose to help people reduce risk and overcome unexpected events for more than 60 years. We are one team with a common goal to help others. Everyone needs insurance and we can&rsquo;t imagine a world without it.
Our team will encourage you to grow, make time to have fun, and work together to make great things happen. We embrace the strengths and values of each team member. We believe in having diverse perspectives where everyone is included, to serve customers from all walks of life.
We care about our people, and we mean it. We reward our talented professionals with a competitive salary, bonus potential, and a variety of benefits to help our team members reach their health, retirement, and professional goals.
Learn more about us here: https://www.mercuryinsurance.com/about/careers
Mercury Insurance 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, status as a protected veteran, or any other characteristic protected by federal, state, or local law.
Perks and Benefits:

At Mercury, we seek a better way to serve our customers, own every interaction, do the right thing in every situation, and move quickly to deliver exceptional results. Join our team and make an impact today!
We offer many great benefits, including:<ul><li>Competitive compensation</li><li>Flexibility to work from anywhere in the United States for most positions</li><li>Paid time off (vacation time, sick time, paid Company holidays, volunteer hours)</li><li>Incentive bonus programs (potential for holiday bonus, referral bonus, and performance-based bonus)</li><li>Medical, dental, vision, life, and pet insurance</li><li>401 (k) retirement savings plan with company match</li><li>Engaging work environment</li><li>Promotional opportunities</li><li>Education assistance</li><li>Professional and personal development opportunities</li><li>Company recognition program</li><li>Health and wellbeing resources, including free mental wellbeing therapy/coaching sessions, child and eldercare resources, and more.</li></ul>
Pay Range: USD $44,466.00 - USD $77,881.00 /Yr.</div>

Claims Specialist II

California Fair Plan Association

<div>POSITION SUMMARY 
The Claims Operations Manager supports the Claims teams through robust training, accurate data reporting, and efficient processes. This role is also responsible for evaluating and analyzing the Claims department&rsquo;s policies and procedures to recommend streamlining, developing, or eliminating processes, and ensuring efficient claims handling.<div> 
PRINCIPAL DUTIES &amp; RESPONSIBILITIES 
<ul><li>Continually evaluate Claims processes for efficiency and regulatory compliance.</li><li>Lead and coach staff to elevate performance, foster development, and ensure accountability.</li><li>Monitor, measure, and report on process improvements and training effectiveness.</li><li>Coordinate legal review of training material and document approvals in compliance records.</li><li>Guide and oversee the Claims Business Process Analyst, ensuring efficient collaboration with business partners.</li><li>Oversee the claims data reporting process, ensuring timely, accurate data reporting. Monitor new regulations and industry practices for CFP policy updates.</li><li>Ensure all Department of Insurance compliance training materials are up to date, keeping pace with regulatory changes and other market developments.</li><li>Oversee the creation of Claims unit training materials, delivery methods, and employee development programs to align with unit and company strategy and standards.</li><li>Implement policies to ensure compliance with claim-handling guidelines and to ensure good-faith handling of claims.</li><li>Collaborate with Claims Managers to provide relevant content for training materials.</li><li>Identify and recommend specific training programs to help employees maintain or improve job skills.</li><li>Recommend process modifications to improve quality, workflow, and policies and procedures.</li><li>Develop and manage the Claims training schedule for new hires, current team members, and vendors.</li><li>Report implementation progress and training completion to Claims management.</li><li>Serve as the liaison to the California Earthquake Authority, representing the organization with professionalism and integrity.</li><li>Any other duties needed to fulfill the Association's Mission, Values, and Strategic Objectives.</li></ul></div><div> 
EDUCATION &amp; EXPERIENCE 
<ul><li>Bachelor&rsquo;s degree in Business or related field</li><li>10+ years property claims experience, with 2+ years in management</li><li>Claims training and auditing experience preferred.</li><li>Demonstrated communication skills, both written and verbal</li><li>Proven decision-making skills and attention to detail</li><li>Advanced skills in Microsoft Office Suite of products</li><li>Advanced skills in Xactimate and Xactanalysis</li><li>Comprehensive understanding of policy contract/statutes and claims processes</li><li>Experienced handling, producing, and presenting claims data to stakeholders preferred</li><li>Duck Creek experience preferred</li><li>Certified in CEA and Fair Claims Settlement Practices preferred</li></ul></div></div>

Property Claims Operations Manager (Remote)

Otsuka

Official job title: <ul><li>Neuroscience Specialist, CNS</li></ul>Territory: <ul><li>Bakersfield CA (Los Angeles CA, Bakersfield CA, Lancaster CA)</li></ul>Job Summary In its evolved customer engagement model, a Neuroscience Specialist engages healthcare providers (HCPs) using in-person, virtual, and digital tools, offering expertise on products and their approved conditions. This model enhances patient, caregiver, and HCP experiences by focusing on local care delivery, aiming to improve patient care and provide a superior experience. The Neuroscience Specialist will report directly to the respective Area Business Lead, coordinating with cross-functional colleagues in Medical (MSLs), Market Access, and Patient Support under appropriate guidelines. This individual will serve as the primary point of contact for HCP customers and should possess a broad range of expertise, capable of addressing complex on-label information based on approved content. This position is designed to enhance customer engagement, thought leadership, and business planning within the organization. The role involves proactive outreach to healthcare professionals (HCPs), facilitating discussions, and elevating insights to inform strategic decisions. Key Responsibilities: <ul><li>Personally engage customers through various virtual or digital tools.</li><li>Direct customers to other colleagues, such as Customer Service Specialists (CSS), as needed.</li><li>Ensure customer requests are met and solicit feedback on the quality of engagement.</li><li>Facilitate speaker programs to share knowledge and insights.</li><li>Organize local provider groups for discussions on experiences and outcomes with local/regional leaders.</li><li>Elevate opportunities and feedback to the Area Business Lead, including local market insights.</li><li>Collaborate compliantly with the ecosystem team to adjust targeting and call point plans.</li><li>Action on insights collected from customer-facing roles to inform local strategy and business goals.</li><li>Conduct proactive outreach to HCPs on topics such as product access, on-label information, and established patient care guidance.</li><li>Engage customers through various virtual or digital tools and direct them to other colleagues (e.g., CSS) as needed.</li><li>Facilitate speaker programs and organize local provider groups for discussions on experiences and outcomes with local/regional leaders.</li><li>Elevate opportunities and feedback to the Area Business Lead, including local market insights to inform local strategy and business goals.</li></ul>Experience &amp; Qualifications <ul><li>A minimum of 2 years of pharmaceutical or medical device sales experience.</li><li>Prior experience in CNS, psychiatry, or ADHD preferred.</li><li>Experience launching a new product or new indication preferred.</li><li>Must reside within a commutable distance of 50 miles from the primary city in the sales territory.</li><li>Previous cross-functional industry experience in commercial life sciences or related industry.</li><li>4 or more years of experience working in a sales role with HCPs, ideally representing multiple products.</li><li>Ability to work in an ambiguous environment undergoing transformation.</li><li>Proven track record in coaching, training, and mentoring peers or others.</li><li>Demonstrates a commitment to ethical business practices, an understanding of regulatory standards, and the ability to execute business activities in compliance with Company policies and guidance.</li><li>Ability to assimilate and communicate complex clinical and product information.</li><li>Valid U.S. driver&rsquo;s license and acceptable driving record.</li><li>Overnight travel may be required depending on territory geography.</li></ul>Key Sales Capabilities Territory Analysis / Business Planning <ul><li>Uses competitive data and business reports to track progress and uncover opportunities, including sales data and promotional budget</li><li>Displays knowledge of territory and business conditions that impact sales results to establish near term priorities for his/her territory business plan</li><li>Responds compliantly to competitive threats and opportunities</li><li>Educates office staff on payer guidelines and reimbursement procedures to increase pull through</li><li>Effectively utilizes promotional materials</li></ul>Selling Skills, Engagement &amp; Account Pull Through <ul><li>Maintains ongoing awareness of internal support team resources available throughout the ecosystem and utilizes appropriately</li><li>Applies market and industry knowledge to overcome objections and influence prescribing habits during the total office call</li><li>Identifies territory professional groups to network and ensure access/exposure to potential key opinion leaders</li><li>Builds strong relationships with all key office/practice personnel and focuses on patient health in conversations with all staff members. Takes personal responsibility for follow-through and providing value to the accounts by providing accurate information in response to their needs</li><li>Delivers effective and balanced office calls and sales presentations utilizing the appropriate approved marketing materials and technical references (e.g. studies, package inserts, etc.) with clarity and confidence to help HCPs enhance patient outcomes; demonstrates competent product knowledge of own product and competition</li></ul>Competencies <ul><li>Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.</li><li>Strategic Thinking &amp; Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business.</li><li>Patient &amp; Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.</li><li>Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.</li><li>Respectful Collaboration - Seek and value others&rsquo; perspectives and strive for diverse partnerships to enhance work toward common goals.</li><li>Empowered Development - Play an active role in professional development as a business imperative.</li></ul>Pay: <ul><li>Base Pay: Minimum $107,362.00 - Maximum $166,750.00, </li><li>plus incentive opportunity</li><li>The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate&rsquo;s job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.</li></ul>Company benefits: <ul><li>Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death &amp; dismemberment, short-term and long-term disability insurance,</li><li>tuition reimbursement, student loan assistance,</li><li>a generous 401(k) match,</li><li>flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.</li></ul>About Otsuka: Otsuka America Pharmaceutical Inc. is a global healthcare company with the corporate philosophy: &ldquo;Otsuka-people creating new products for better health worldwide.&rdquo; Otsuka researches, develops, manufactures and markets innovative products, with a focus on pharmaceutical products to meet unmet medical needs and nutraceutical products for the maintenance of everyday health. Application Deadline: This will be posted for a minimum of 5 business days. Disclaimer: This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary. Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting Accommodation Request . Statement Regarding Job Recruiting Fraud Scams At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf. Please understand, Otsuka will never ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment. Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters. To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External . Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka&rsquo;s call center at: 800-363-5670. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: https://www.ic3.gov , or your local authorities. Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development &amp; Commercialization, Inc., and Otsuka Precision Health, Inc. (&ldquo;Otsuka&rdquo;) does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka&rsquo;s application portal without a valid written search agreement in place for the position will be considered Otsuka&rsquo;s sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails. Benefits: <ul><li>401(k)</li><li>Dental insurance</li><li>Disability insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Tuition reimbursement</li><li>Vision insurance</li></ul>Work Location: In person

Neuroscience Sales Specialist

<div>POSITION SUMMARY 
The Claims Quality Assurance Supervisor leads a team of Quality Assurance Representatives or Quality Analysts. This role is responsible for reviewing claim files for accuracy, compliance with policies and procedures, as well as CA Department of Insurance guidelines. This role will also include managing communications with the Department of Insurance as well as assisting with coverage analysis for Claims Examiners.<div> 

PRINCIPAL DUTIES &amp; RESPONSIBILITIES 
<ul><li>Assist the Claims Quality Assurance Manager in managing and leading the Quality Assurance Department.</li><li>Collaborate with and support Claims Quality Analysts and QA Representative teams to maintain the daily workflow across the Quality Assurance Department.</li><li>Hire, train, and coach Quality Assurance Representatives and Claims Quality Analysts.</li><li>Provide file data for file reviews and maintain the audit platform.</li><li>Direct and oversee file reviews and Department of Insurance complaint responses.</li><li>Provide feedback/results/trends to Claims Examiners, Supervisor, Managers, and Claims Quality Manager based on review results and findings and make recommendations for training or improvement</li><li>Review, analyze, and provide suggestions for claim handling practices handled by Desk Examiners and Independent Adjusters.</li></ul>
Review repair estimates for technical accuracy and adherence to industry/CFP guidelines/standards, as well as client requirements. 
<ul><li>Compile estimate revision requests and coordinate with network contractors to obtain estimate corrections.</li><li>Verify file documentation is included for completion of the review process.</li><li>Create and maintain workbooks, questionnaires, processes, and training materials to promote accuracy and consistency.</li><li>Take lead on various projects, including but not limited to QA software and report implementation.</li><li>Manage CEA Liaisons and support CEA training and reporting.</li><li>Adhere to Federal and State laws and regulation.</li><li>Any other duties needed to help fulfill the Associations Mission, abide by the Association&rsquo;s Values, and fulfill the Association&rsquo;s Strategic Objectives.</li></ul></div><div> 

EDUCATION &amp; EXPERIENCE 
<ul><li>Bachelor&rsquo;s degree or equivalent preferred.</li><li>Strong knowledge of property claims. Minimum of 5-10 years&rsquo; property insurance claims experience, 2+ years of Quality Assurance experience and 1 year of supervisory experience.</li><li>Strong organizational, file management and time management skills.</li><li>Attention to detail; ability to prioritize and strong decision-making skills.</li><li>Excellent written and oral communication skills.</li><li>Adaptability and demonstrated ability to manage change.</li><li>Working experience with MS-Office (especially Word and Excel) is required.</li><li>Proficient in the Xactimate estimating program.</li><li>Certified in CEA and Fair Claims Settlement Practices.</li></ul></div></div>

Property Claims Quality Assurance Supervisor (Remote)

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 LA)
<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></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 LA)

AAA Auto Club Enterprises

Job Summary
 
The Claims Casualty Adjuster handles low to moderate-complexity claims involving material damage, property, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation and negotiation of low to moderate-complexity claims in compliance with established company technical and customer service Best Practices. Under moderate supervision, works within specific limits of authority to resolve claims with well-defined procedures.
 
Job Duties
 
Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address common coverage issues.
 
Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses.
 
Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
 
Negotiate within settlement authority with insureds and claimants to resolve their first and third party claims.
 
Handle administrative functions, update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
 
Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
 
Independently resolve claim exposures within level of authority.
 
Respond quickly to customer needs and problems.
 
Qualifications
 
Bachelors Equivalent combination of education and experience Preferred
 
4-6 years Prior claims handling experience. Required
 
4-6 years Property or Casualty claims administration experience. Preferred
 
Working knowledge of claims best practices and procedures.
 
Moderate understanding of building and vehicle repair practices.
 
General knowledge of insurance, fault assessment, negligence and subrogation principles.
 
Working knowledge of Microsoft Office suite, general computer software and claims software.
 
Advanced organization and planning recognition skills required.
 
Advanced oral and written communication skills required.
 
Advanced interpersonal skills required.
 
Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
 
Associate in Claims - Insurance Institute of America Preferred
 
An insurance/claims adjuster license may be required for claims administration in specific states. Preferred
 
The starting pay range for this position is: 
$33.43 - $44.53
 Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.
 .
 
Remarkable benefits: 
<ul>
<li>Health coverage for medical, dental, vision</li>
<li>401(K) saving plans with company match AND Pension</li>
<li>Tuition assistance</li>
<li>Floating holidays and PTO for community volunteer programs</li>
<li>Paid parental leave</li>
<li>Wellness programs</li>
<li>Employee discounts (membership, insurance,</li>
</ul>
travel, entertainment, services and more!)
 
Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
 
“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
 
AAA is an Equal Opportunity Employer
 
Our organization participates in E-Verify
 
The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

Claims Casualty Adjuster

AmTrust Financial

<div>Overview:
<div>
Works independently to manage Workers' Compensation cases, including complex and catastrophic claims.</div><div></div><div> 
Note commercial Workers' Compensation experience in California is required.</div>
Responsibilities:

.<div>
DISTINGUISHING CHARACTERISTICS:</div>
Administers complex non-litigated and litigated workers&rsquo; compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits. Provides technical guidance, mentoring and support to claims assistants and clerical staff.<div> 
ESSENTIAL DUTIES AND RESPONSIBILITIES:</div><div>
To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions. Reasonable accommodation may be made for individuals with disabilities.</div><div></div><div> 
The functions of this job include but are not limited to;
</div><ul><li>Set up claims and make timely three point contacts</li><li>
Ensure the privacy and security of Protected Health Information (PHI)</li><li>
Analyze claim, investigate and estimate proper reserves</li><li>
Develop and maintain relevant plan of action</li><li>
Set up and maintain timely benefit payments (Includes wage statement calculation and diary management)</li><li>
Identification and pursuit of subrogation</li><li>
Timely review and maintenance of incoming mail</li><li>
Timely response to Request for Authorization or referral for Utilization Review</li><li>
Consistent communication and claim reviews with all parties, including our Claims Services Account Manager in relation to brokers and policy holders.</li><li>
The agricultural accounts are generally higher volume policies, fast-paced and seasonal, and special handling is oftentimes required.</li><li>
Timely evaluation of reserve adequacy</li><li>
Proactively maintaining current status of claims</li><li>
Identify, rate and reserve for possible permanent disability</li><li>
Evaluate claim for settlement purposes</li><li>
Timely excess Carrier Reporting</li><li>
Close cases in a timely and expedient manner</li><li>
Other duties as may be assigned</li><li>
Must be able to work at least 40 hours per week, Monday thru Friday and be available to work extended hours as situations arise.</li></ul>
Qualifications:
<ul><li>Requires 3 to 5 years of commercial Workers&rsquo; Compensation experience</li><li>
Any combination equivalent High School graduation and/or two year community college or experience in business or closely related field.</li><li>
Litigated and non-litigated claims experience required.</li><li>
Basic mathematical skills required for calculations and ratings.</li><li>
Knowledge and understanding of workers&rsquo; compensation claims administration required.</li><li>
Through knowledge of Self-Insurance regulations, Case Law, Labor Code.</li><li>
Must possess strong time management, organization and problem solving skills.</li><li>
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents.</li><li>
Ability to write letters, memos and reports that conform to prescribed style, format and grammatical correctness.</li><li>
Ability to effectively present information to top management.</li><li>
Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.</li><li>
Must be able to negotiate.</li><li>
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.</li><li>
Ability to define problems, collect data, establish facts, and draw valid conclusions.</li><li>
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.</li><li>
Must be Current on Worker&rsquo;s Compensation education training hours.</li></ul><div></div><div> 
Your employer reserves the right to modify the description of the duties and the requirements of this job at any time upon reasonable notice.</div><div></div><div> 
The expected salary range for this role is $87,600-$100,000.00.</div><div></div><div> 
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.</div></div>

Claims Adjuster III, Agriculture

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