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claims specialist ii

Blue Cross and Blue Shield of Louisiana

<div>We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.<div>
POSITION PURPOSE
Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for the Coordination of Benefits (COB), adjusting previously paid claims and initiating procedures to recover funds on overpaid claims. Analyzing, investigating, and resolving problem cases; executing recovery processes; and completing special projects. Accountable for complying with all laws and regulations that are associated with duties and responsibilities.</div><div>
NATURE AND SCOPE<ul><li>
This role does not manage people</li><li>
This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS</li><li>
Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist II must be in contact with personnel in other Units: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Enrollment and Billing, Administrative Services, and District Offices. Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.</li></ul></div><div>
QUALIFICATIONS 
 
Education<ul><li>
High School Diploma or equivalent required
</li></ul>Work Experience<ul><li>
2 years in medical claims processing required
</li><li>Coordination of Benefits (COB) processing experience preferred
</li></ul>Skills and Abilities<ul><li>
Strong analytical ability, that includes strong logical, systemic, and investigates thinking.
</li><li>Strong oral and written communication skills and human relations skills are necessary.
</li><li>Working knowledge of relevant PC software.
</li><li>Ability to prioritize multiple streams of work effectively.
</li></ul>Licenses and Certifications 
<ul><li>
None Required</li></ul></div><div> 
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS<ul><li>
Reviews, researches, and makes necessary updates to claims that may include the following: recalculation of benefits to previously processed claims, the processing of claims edits, or initiation of refund requests, according to contractual benefits or provider reimbursement rules, ultimately providing a high degree of customer satisfaction.
</li><li>Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes pertaining to all claims (including our coordination with additional coverage plans) in order to process both coordinated and non-coordinated claims correctly. Requesting of medical records may be required.
</li><li>Communicates, both orally and in writing, with internal and external contacts in order to provide necessary and accurate information for the establishment of sound claim records. This may include, but is not limited to, the coordination of benefits (COB), medical record requests, etc.
</li><li>Review quality audits for correction or routing within 48 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing and customer satisfaction.
</li><li>Researches, investigates, and determines the correct order of benefits for payment to be made by the applicable plans and makes necessary corrections to COB records. Communicates to appropriate department(s) when Medicare has determined primacy incorrectly and ensures a letter is generated to notify Medicare. Failure to report discrepancy could result in a daily fine up to $1,000.00.
</li><li>Analyzes, investigates, resolves problem cases (to include COB records, adjusting previously processed claims and requesting refund of overpaid claims). Reviews all previously processed claims to ensure consistency in payments to maximize recovery of overpayments following corporate and departmental guidelines to ensure financial stability.
</li><li>Executes procedures to recover funds from providers, subscribers, or beneficiaries where overpayments have occurred to ensure accuracy of claims processing and financial stability.
</li><li>Steps in and assists in any other capacity as deemed necessary (i.e., training, implementations, and documentation).
</li><li>May complete special projects as assigned by Management due to internal audit findings, multiple provider status changes, and system errors following corporate and departmental guidelines to ensure financial stability and customer satisfaction.
</li></ul>Additional Accountabilities and Essential Functions 
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions<ul><li>
Perform other job-related duties as assigned, within your scope of responsibilities.
</li><li>Job duties are performed in a normal and clean office environment with normal noise levels.
</li><li>Work is predominately done while standing or sitting.
</li><li>The ability to comprehend, document, calculate, visualize, and analyze are required.
</li></ul></div>An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the &quot;My Applications&quot; section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.</div>

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 2026! 
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:
<ul><li>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></li></ul>
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>

U-Haul

<div><h2 class="jobSectionHeader">Computer Support Specialist</h2>
If you are detail-oriented, relish variety, and feel at home around all kinds of technology, consider becoming U-Haul&rsquo;s newest Field Computer Specialist. In this role you will be responsible for all computer and security systems in your area, traveling from place to place to maintain equipment and train users. In exchange U-Haul provides excellent perks and benefits as well as a caring company culture.
U-Haul offers its Field Computer Specialists:<ul><li>
Paid holidays, vacation, and sick days, if eligible</li><li>
Career stability
</li><li>Gym Reimbursement Program, if eligible</li><li>
Opportunities for advancement
</li><li>Valuable on-the-job training</li><li>
Complete Benefit Plan, if eligible</li><li>
RRSP payroll deduction plan
</li><li>Deferred profit-sharing plan, if eligible</li><li>
You Matter Program (EAP)</li><li>
Mindset App Program</li><li>
Wellness Programs</li><li>
Discounts on Apple products, Dell computers, hotels, and more</li></ul>
Field Computer Specialist Primary Responsibilities:<ul><li>
Maintain maximum uptime for computer systems and associated broadband connectivity</li><li>
Implement and maintain field computer systems for all entities within the assigned area</li><li>
Support and train users as needed</li><li>
Distinguish between user error and problems requiring escalation to software vendors</li><li>
Identify and coordinate solutions for security gaps and compliance issues</li><li>
Participate in ongoing continuous U-Haul education through U-Haul University
</li><li>In addition to technical responsibilities, the Field Computer Specialist will support store operations by acting as a field relief manager when needed. This includes providing coverage during store manager vacations/coverage</li><li>
Work hours are scheduled Monday through Saturday, with an expected weekly total of 40&ndash;50 hours based on business needs.</li></ul>
Field Computer Specialist Minimum Qualifications:<ul><li>
Experience with technologies such as administration, security monitoring equipment, storage gates, alarm systems, doors, digital video equipment, printers, computers, VOIP, analog phones, air phones, and cash drawers</li><li>
Current, valid driver&rsquo;s license and clean driving record</li></ul>
Compensation for this role ranges
<ul><li>From $25 to $30 per hour, commensurate with experience.</li></ul>
Work Environment:
The work involves moderate risks or discomforts which require special safety precautions, e.g., working around moving parts, machines, fumes, or irritating chemicals. May be required to use protective clothing, or gear such as masks, goggles, gloves, or shields.
Physical Demands:
The work requires some physical exertion such as long periods both indoors and outdoors of remaining stationary, traversing spaces, repositioning to reach and use tools, and moving a minimum of 50 lbs. assisted or unassisted. 
 
 
U-Haul is an equal opportunity employer. All applications for employment will be considered without regard to race, color, religion, sex, national origin, physical or mental disability, veteran status, or any other basis protected by applicable federal, provincial, state, or local law. Individual accommodations are available on requests for applicants taking part in all aspects of the selection process. Information obtained during this process will only be shared on a need to know basis.</div>
 <div><h3 class="jobSectionHeader">About Us</h3>
Since 1945, U-Haul has been serving do-it-yourself movers and their households. Like many other successful ventures, the concept for U-Haul was generated out of need. After World War II, there existed the widespread need for do-it-yourself moving equipment that would be available on a one-way, nationwide basis.
U-Haul co-founders L.S. &quot;Sam&quot; Shoen and his wife, Anna Mary Carty Shoen, recognized that need and acted upon it. Their visionary approach spread the cost of ownership among many users, facilitating the mobility of the populations of the U.S. and Canada. The covered wagon of the pioneers morphed into orange U-Haul trailers. In the process, an industry was born.
U-Haul Holding Company and its family of companies, including U-Haul, have strived to create a culture of health and wellness. As of February 1, 2020, and consistent with applicable law, no U-Haul Holding Company or its family of companies will hire individuals in states where it may lawfully decline to hire individuals who use nicotine products (Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Pennsylvania, Texas, Utah, Vermont, Virginia and Washington). This policy will not apply to team members hired before February 1, 2020.</div>

Computer Support Specialist

Oscar Health

<div>
 Hi, we're Oscar. We're hiring a Data Scientist II to join our Data team.
 
 
 Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves - one that behaves like a doctor in the family.
 
 
 
 About The Role
 
 
 
 Oscar's data team is focused on pushing our understanding of this complex landscape of health care and insurance business. Insurance companies sit on a trove of data that is both broad and deep, spanning financial claims, clinical medical records, and rich product interaction data from our members. Connecting the dots across these datasets gives us unique insight into how the healthcare system functions and allows us to improve care coordination, better manage risk, build higher-performing provider networks, and create a standout consumer experience in our product.
 
 
 As a Data Scientist II you will drive data science projects across multiple teams and domains. In this role, you&rsquo;ll take ownership of analytical and modeling work, contribute to technical direction, and partner closely with business, engineering, product and data stakeholders to deliver impactful solutions.
 
 
 This is a mid-level role for data scientists who can operate independently, manage ambiguity, and apply advanced analytics or modeling techniques with minimal oversight.
 
 
 You will report into a leader on the Data team (Senior Data Scientist and above). This posting is representative of multiple roles, and final team placement will be determined during the interview process.
 
 
 
 Work Location:
 
 This position is a hybrid role based in our New York City office, Los Angeles Office, or Tempe Office requiring a hybrid work schedule with 3 days of in-office work per week Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.
 
 
 
 Pay Transparency:
 
 The base pay for this role is: $131,200 - $172,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, and annual performance bonuses.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Research, develop, and maintain data pipelines, statistical models, and advanced analytical solutions
 </li>
 <li>
 Own projects end-to-end, including problem definition, implementation, validation, and iteration
 </li>
 <li>
 Deliver high-quality analytical and modeling outputs with limited manager oversight
 </li>
 <li>
 Collaborate closely with data science peers and cross-functional partners across business units
 </li>
 <li>
 Help ensure data science processes and outputs align with broader team strategies and roadmaps
 </li>
 <li>
 Provide guidance or informal mentorship to junior data scientists or analysts when needed
 </li>
 <li>
 Contribute to improving data science practices, tooling, and documentation
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 <ul>
 <li>
 3+ years of experience in data science, applied analytics, or a related quantitative field (industry, academia, or both)
 </li>
 <li>
 2+ years of experience using SQL and Python and/or R to query, analyze, and manipulate data
 </li>
 <li>
 2+ years of experience building data models, using more advanced analytics methods, statistical modeling, and/or data processing
 
 
 </li>
 </ul>
 
 Bonus Points
 
 
 
 <ul>
 <li>
 Master&rsquo;s degree in a quantitative or technical field
 </li>
 <li>
 Knowledge of or previous work experience in health care or health insurance
 </li>
 <li>
 Experience mentoring or supporting junior team members
 </li>
 <li>
 Experience deploying or supporting models in production environments
 
 
 </li>
 </ul>
 This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
 
 
 At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
 
 
 
 Pay Transparency:
 
 Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
 
 
 
 Artificial Intelligence (AI):
 
 Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
 
 
 
 Reasonable Accommodation:
 
 Oscar applicants are considered solely based on their qualifications, without regard to applicant&rsquo;s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
 
 
 
 California Residents:
 
 For information about our collection, use, and disclosure of applicants&rsquo; personal information as well as applicants&rsquo; rights over their personal information, please see our Privacy Policy.
 
 
</div>

Data Scientist II

Netflix

<div>
 At Netflix, our mission is to entertain the world. Together, we are writing the next episode - pushing the boundaries of storytelling, global fandom and making the unimaginable a reality. We are a dream team obsessed with the uncomfortable excitement of discovering what happens when you merge creativity, intuition and cutting-edge technology. Come be a part of what&rsquo;s next.
 
 
 We are seeking a data-driven Risk Analyst to support and elevate our risk management capabilities. You will manage casualty claims directly while simultaneously leveraging analytics to drive strategic improvements across auto liability, general liability, and workers' compensation.
 
 
 This role involves leading internal and external claims processes and teams to positive results, deep-diving into claims data analysis to identify trends and improvements, enhancing risk mitigation strategies, and supporting process automation initiatives. Success requires a strong background in claims with proficiency in leveraging data to drive simple, intuitive, and actionable insights.
 
 
 This role reports to a Senior Manager within Risk Management and joins a technical risk team responsible for managing Netflix's insured and self-funded claims. The ideal candidate is a collaborative team player eager to &ldquo;roll up their sleeves&rdquo; and do hands-on work. They possess the ability to quickly build trust and effectively manage risk by working collaboratively with internal and external stakeholders.
 
 
 This is a demanding, fast-paced role within a high-performing team. The ideal candidate will exhibit curiosity, significant initiative, and a proactive approach to tackling challenges, consistently pushing for excellence in risk management.
 
 
 
 Key Responsibilities
 
 
 
 Claims Oversight &amp; Risk Mitigation
 
 
 <ul>
 <li>
 Manage WC, auto liability, and general liability claims, leading Third-Party Administrators (TPAs), insurers, and legal teams to positive results
 </li>
 <li>
 Build intuitive reports that enable analysis of claim drivers
 </li>
 <li>
 Recommend data-driven mitigation strategies to reduce claim costs, claims frequency, and improve outcomes.
 </li>
 <li>
 Collaborate with cross-functional teams (e.g., Finance, Legal, Safety) to ensure claims data is leveraged for operational improvements.
 </li>
 <li>
 Ensure compliance with insurance program requirements
 </li>
 <li>
 Ensure compliance with Netflix reserving philosophy, approve reserves and settlements within designated authority levels, escalating high-risk cases to the Senior Manager as necessary.
 </li>
 <li>
 Review and analyze claims for delays, denials, and other potential issues, providing guidance on resolutions.
 </li>
 <li>
 Drive claim reviews and manage/lead TPA within assigned claims inventory and support overall TPA management
 
 
 </li>
 </ul>
 Return to Work (RTW) Program Support
 
 
 <ul>
 <li>
 Drives and manages RTW within assigned claims. Supports the management and success of the RTW program, ensuring compliance with relevant regulations and assisting injured employees in their transition back to work.
 </li>
 <li>
 Collaborates with HR, Safety, and Legal teams to develop and implement effective RTW strategies and policies.
 </li>
 <li>
 Manages return to work for assigned claims, communicates work restrictions, and coordinates modified duty to reduce claims costs.
 
 
 </li>
 </ul>
 Data Analytics &amp; Reporting
 
 
 <ul>
 <li>
 Extract, clean, and structure large claims datasets to improve risk visibility and decision-making.
 </li>
 <li>
 Develop and maintain interactive dashboards and reports to track claims performance, cost trends, and loss projections.
 </li>
 <li>
 Leverage data analytics tools (e.g., SQL, Tableau, Power BI, Python, Excel) to identify risk exposure, claim patterns, and cost-saving opportunities.
 </li>
 <li>
 Identify opportunities to streamline and automate claim reporting processes and ensure data integrity in risk management platforms (e.g., Origami Risk, Riskonnect).
 </li>
 <li>
 Conduct deep-dive analyses on claim frequency, severity, legal spend, and loss development.
 </li>
 <li>
 Utilize predictive modeling and trend forecasting to support proactive risk management initiatives.
 </li>
 <li>
 Familiarity with actuarial fundamentals and actuarial reports.
 
 
 </li>
 </ul>
 
 
 Collaboration with Stakeholders
 
 
 
 
 <ul>
 <li>
 Develops strong partnerships and communicates/collaborates closely with internal Netflix teams, productions, and external partners (TPAs, brokers, physicians, vendors, and payroll companies).
 </li>
 <li>
 Provides guidance and support for loss prevention matters to ensure an open, proactive, and effective loss prevention culture.
 </li>
 <li>
 Supports operational/internal customer needs.
 </li>
 <li>
 Liaison (as appropriate) between Productions and TPAs.
 </li>
 <li>
 Maintains flexibility and openness to take on additional projects as needed.
 </li>
 <li>
 Presents to cross-functional partners on an ongoing basis for updates to the program, training, etc.
 
 
 </li>
 </ul>
 
 Qualifications &amp; Skills
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s Degree in Business/Finance preferred.
 </li>
 <li>
 7+ years of experience in risk management, casualty claims, and insurance (preferably with Workers&rsquo; Compensation and Auto liability exposure)
 </li>
 <li>
 Strong proficiency in data analysis and visualization tools (e.g., Excel, Power BI, Tableau, SQL, RMIS).
 </li>
 <li>
 Experience working with claims management systems (e.g., Origami Risk, Riskonnect, or similar)
 </li>
 <li>
 Knowledge of insurance policies, coverage interpretation, and claims handling best practices.
 </li>
 <li>
 Strong problem-solving and critical-thinking skills with a keen attention to detail.
 </li>
 <li>
 Excellent communication and collaboration skills, with the ability to present complex data to stakeholders.
 </li>
 <li>
 Strong project management skills.
 </li>
 <li>
 Highly analytical, with the ability to use data to drive desired results and support intelligent risk-taking.
 </li>
 <li>
 Ability to challenge the status quo and drive change where appropriate. Thrives on change, pace, action, and accountability combined with an ability to adjust to changing priorities.
 </li>
 <li>
 Ability to support and contribute to a high-performing team and lead external TPAs to desired results. Demonstrated high level of collaboration within a claims team and broader cross-functional partners.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience on a corporate casualty/liability claims team
 </li>
 <li>
 High level of organization, and the ability to multitask and manage time effectively.
 
 
 </li>
 </ul>
 Generally, our compensation structure consists solely of an annual salary; we do not have bonuses. You choose each year how much of your compensation you want in salary versus stock options. To determine your personal top of market compensation, we rely on market indicators and consider your specific job family, background, skills, and experience to determine your compensation in the market range. The range for this role is $170,000.00 - $265,000.00.
 
 
 Netflix provides comprehensive benefits including Health Plans, Mental Health support, a 401(k) Retirement Plan with employer match, Stock Option Program, Disability Programs, Health Savings and Flexible Spending Accounts, Family-forming benefits, and Life and Serious Injury Benefits. We also offer paid leave of absence programs. Full-time hourly employees accrue 35 days annually for paid time off to be used for vacation, holidays, and sick paid time off. Full-time salaried employees are immediately entitled to flexible time off. See more details about our Benefits here.
 
 
 Netflix is a unique culture and environment. Learn more here.
 
 
 Inclusion is a Netflix value and we strive to host a meaningful interview experience for all candidates. If you want an accommodation/adjustment for a disability or any other reason during the hiring process, please send a request to your recruiting partner.
 
 
 We are an equal-opportunity employer and celebrate diversity, recognizing that diversity builds stronger teams. We approach diversity and inclusion seriously and thoughtfully. We do not discriminate on the basis of race, religion, color, ancestry, national origin, caste, sex, sexual orientation, gender, gender identity or expression, age, disability, medical condition, pregnancy, genetic makeup, marital status, or military service.
</div>

Senior Analyst, Casualty Claims

Athens Administrators

ATHENS POSITION DETAILS Position Title: Division Claims Manager Department: Workers&rsquo; Compensation Reports To: Executive Vice President, Workers Compensation FLSA Status: Exempt Job Grade: 17 ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Division Claims Manager to support our Workers Compensation department by leading a team of supervisors in our Southern California market. Management that lives less than 36 miles from the Orange, CA offices AND have a direct report in the office, are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Southern California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday. The Division Claims Manager is a key leader within Athens Administrators&rsquo; Workers&rsquo; Compensation division, responsible for overseeing the performance, development, and results of a team of Claims Supervisors and ancillary claims staff. This role serves as a strategic partner to senior leadership, clients, and internal stakeholders, ensuring high‑quality claims handling, operational excellence, and alignment with client expectations. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Strategic &amp; Operational Leadership <ul><li>Serve as a member of the Senior Operations Group (SOG), collaborating with executives on company initiatives, process improvements, and performance goals.</li><li>Oversee claims operations to ensure regulatory compliance, consistent application of best practices, and high-quality claim outcomes.</li><li>Lead process optimization efforts, leveraging data and cross-departmental partnerships to enhance efficiency and client results.</li><li>Ensure accurate and consistent claims coding, reserve practices, diary maintenance, and overall file quality across the division.</li><li>Review audit results and incorporate findings into department quality initiatives.</li></ul>Team Leadership, Coaching &amp; Development <ul><li>Provide daily guidance, coaching, and direct supervision to Claims Supervisors and partial supervision to Hearing Representatives, Investigators, and other ancillary staff.</li><li>Lead staff meetings, communicate company priorities, and foster an open-door environment that encourages transparency and collaboration.</li><li>Oversee hiring processes in partnership with Human Resources, including candidate selection, interview evaluation, and feedback.</li><li>Set clear performance expectations and developmental goals and conduct formal performance evaluations.</li><li>Address employee relations issues promptly and consistently, working with HR as needed.</li><li>Support a culture that reflects Athens' values of integrity, collaboration, and service excellence.</li></ul>Client Relationship Management <ul><li>Manage key client relationships by being accessible, proactive, and solutions‑oriented.</li><li>Respond promptly to client inquiries and identify potential issues before they escalate.</li><li>Attend client meetings and present annual stewardship reports.</li><li>Document client interactions and meeting notes in appropriate shared systems.</li><li>Collaborate with the Sales Team on presentations for prospective clients.</li></ul>Claims Oversight &amp; Technical Expertise <ul><li>Provide daily direction on claim strategy, settlements, reserves, litigation planning, compensability decisions, and overall file handling.</li><li>Authorize settlement agreements and significant payments within assigned authority limits.</li><li>Work collaboratively with attorneys, investigators, and medical professionals to resolve complex or sensitive claims.</li><li>Ensure unit closing goals, reserve accuracy standards, and quality metrics are consistently achieved or exceeded.</li></ul>Training &amp; Knowledge Development <ul><li>Coordinate and deliver claims training for new and existing staff.</li><li>Promote continuous learning, professional development, and mastery of changing laws, practices, and internal procedures.</li></ul>ACCOUNTABILITIES Supervisory Responsibilities Supervising, scheduling, assigning, monitoring, and evaluating work of assigned staff are responsibilities for supervisory positions. <ul><li>Provide direct supervision to Claims Supervisors. Also provide partial direct supervision to ancillary staff, such as Hearing Representatives, investigators, etc.</li><li>Responsible for performance management of direct reports</li></ul>Fiscal Responsibilities <ul><li>Participate in budget development, forecasting, and cost-control initiatives.</li><li>Review and approve staff expense reports and educational reimbursement requests.</li><li>Ensure expenditures and resource allocation align with company objectives and financial responsibility.</li><li>Understand and enforce wage and hour laws applicable to supervised staff.</li><li>Accurately review and approve timecards when required.</li></ul>Managers in the Field Responsibilities: For designated branch locations, oversee facility operations including security, maintenance, safety, and parking coordination. ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. Education &amp; Professional Certifications <ul><li>High School Diploma or GED required; AA/AS or BA/BS strongly preferred.</li><li>Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained</li><li>Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)</li><li>Completion of IEA coursework or equivalent.</li></ul>Experience Requirements <ul><li>Minimum 3 years of supervisory experience, including hiring, training, coaching, developing, directing, and retaining staff.</li><li>Minimum 2 years of management experience in a Workers&rsquo; Compensation office.</li><li>Prior Workers&rsquo; Compensation claims handling experience, including reserve management, case valuation, and settlement negotiation.</li><li>Prior Third-Party Administrator (TPA) experience preferred.</li></ul>Technical &amp; Industry Knowledge <ul><li>Strong understanding of Workers&rsquo; Compensation laws, policies, procedures, and best practices.</li><li>Proficiency in evaluating claim exposure, quality file handling, and guiding claims to appropriate resolution.</li><li>Understanding of medical and legal terminology.</li><li>Proficient in Microsoft Office Suite; able to learn additional systems and leverage technology to improve efficiency.</li><li>Strong mathematical and analytical abilities.</li><li>Ability to type accurately and for sustained periods.</li></ul>Results &amp; Operational Excellence <ul><li>Ability to plan, organize, and delegate workload to ensure timely and high-quality outcomes.</li><li>Strong attention to detail; able to audit own work and participate in peer review.</li><li>Commitment to continuous improvement, process optimization, and adopting new methods or tools.</li><li>Demonstrated ability to adapt quickly to changing instructions, client needs, and business priorities.</li><li>Ability to meet or exceed audit standards, unit closing goals, diary timeliness, reserve accuracy, and other quality metrics.</li><li>Ability to use cross‑departmental resources to support strategic initiatives and drive results.</li><li>Demonstrates flexibility and composure in demanding, changing, or high‑pressure situations.</li></ul>Leadership, Coaching &amp; People Management <ul><li>Consistently demonstrates a positive attitude, cooperative spirit, and strong interpersonal effectiveness.</li><li>Skilled in developing staff through coaching, feedback, performance management, and formal development plans.</li><li>Maintains an open-door policy, fosters transparency, and encourages open communication.</li><li>Demonstrates self-awareness and accountability; models integrity, professionalism, and resilience.</li><li>Able to communicate organizational updates and leadership directives clearly to staff.</li><li>Skilled in managing employee relations issues and working collaboratively with HR to ensure timely, consistent actions.</li><li>Ability to support recruitment efforts through timely resume review, interview participation, and constructive candidate feedback.</li><li>Contributes to a respectful, compassionate, team-oriented culture consistent with company values.</li></ul>Client Relationship Management &amp; Service Commitment <ul><li>Strong client service orientation; responds promptly and works urgently to resolve issues.</li><li>Able to proactively manage client relationships, conduct service calls, and identify potential problems before they escalate.</li><li>Demonstrates integrity and consistently acts in the best interest of clients.</li><li>Ability to document client interactions and meeting notes in appropriate shared locations.</li></ul>Financial, Resource &amp; Operational Stewardship <ul><li>Manages staff resources, time, recognition funds, and operational tools efficiently.</li><li>Participates in annual budgeting and forecasting; able to anticipate and justify department expenses.</li><li>Uses monitoring and reporting mechanisms to control costs without compromising quality.</li><li>Identifies opportunities for cost savings or process efficiencies.</li><li>Understands and applies wage and hour regulations as they pertain to supervised staff.</li><li>When applicable, completes accurate, timely timecard reviews and approvals.</li></ul>Professionalism, Integrity &amp; Confidentiality <ul><li>Athens&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.</li><li>Acts with integrity, honesty, and professionalism in all interactions and decisions.</li><li>Dependable, trustworthy, team‑oriented, and aligned with company values.</li></ul>Work Environment &amp; Travel Requirements <ul><li>Ability to attend frequent in‑office meetings and file reviews.</li><li>Willingness to attend off‑site client meetings and conferences.</li><li>Valid driver&rsquo;s license and availability for travel, including overnight.</li></ul>APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses &amp; certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here Pay: $150,000.00 - $167,000.00 per year Benefits: <ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible schedule</li><li>Flexible spending account</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Professional development assistance</li><li>Referral program</li><li>Vision insurance</li><li>Wellness program</li><li>Work from home</li></ul>Work Location: Remote

Division Claims Manager - Workers' Compensation

Primeline Solutions LLC

<div>
 
 Insurance &amp; Financial Services Litigation Associate Attorney (ERISA / Disability / Benefits Defense) &ndash; 3&ndash;8 Years
 
 
 
 Locations: California (Remote)
 
 
 Compensation: $158,000 &ndash; $190,000 + bonus
 
 
 Work Model: Remote (California-based)
 
 
 Bar Admission: Active California Bar required
 
 
 IMPORTANT: WHO THIS ROLE IS FOR
 
 
 This is a law firm associate attorney role focused on insurance and ERISA-related litigation defense.
 
 
 
 Candidates Must
 
 
 
 
 Be a licensed attorney (JD required)
 
 
 
 
 Have 3&ndash;8 Years Of Litigation Experience
 
 
 
 
 Have experience drafting pleadings, motions, and discovery
 
 
 
 
 This Role Is Not Suitable For
 
 
 
 Transactional attorneys
 
 
 Candidates without litigation experience
 
 
 Plaintiff-side attorneys without defense exposure
 
 
 
 About The Opportunity
 
 
 
 We are working with a law firm seeking an Insurance &amp; Financial Services Litigation Associate to handle ERISA, disability, life, health, and benefits-related disputes.
 
 
 What You&rsquo;ll Be Doing
 
 
 Draft pleadings, motions, briefs, and discovery
 
 
 Handle depositions and support trial preparation
 
 
 Analyze claims and develop litigation strategy
 
 
 Engage with clients, experts, and opposing counsel
 
 
 What We&rsquo;re Looking For
 
 
 3&ndash;8 years of litigation experience
 
 
 Strong writing and analytical skills
 
 
 
 Experience With Insurance, ERISA, Or Benefits Litigation Preferred
 
 
 
 Ability to manage cases independently
 
 
 Core Keywords
 
 
 Insurance Litigation; ERISA Litigation; Disability Claims; Benefits Litigation; Defense Attorney; Civil Litigation; Trial Prep
 
 
 Skills: erisa,motions,defense,benefits litigation,financial services,disability claims,insurance,trial prep,litigation
</div>

Insurance & Financial Services Litigation Associate Attorney

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Insurance & Financial Services Litigation Associate Attorney