claims specialist ii

State of Kansas

<div><div><div>Important Recruitment Information for this vacancy:<ul><li>
Job Posting closes: April 24, 2026</li></ul>
Agency Information:
Department of Administration, State Self Insurance Fund
https://ssif.healthbenefitsprogram.ks.gov/
Verification of identity and employment eligibility to work in the United States is required by federal law. For a list of acceptable documents that establish these criteria, please refer to the federal Form I-9. While the Department of Administration (D of A) welcomes all candidates legally eligible to work in the United States, D of A does not provide sponsorships for this position.
E-Verify: Kansas Department of Administration (D of A) participates in E-Verify and will provide the federal government with your I-9 information to confirm that you are authorized to work in the U.S. For additional information regarding E-Verify, please click here. For additional information regarding Immigrant and Employee Rights (IER) please click here.
About the Position<ul><li>
Who can apply: Anyone</li><li>
Classified/Unclassified Service: Unclassified</li><li>
Full-Time/Part-Time: Full-Time</li><li>
Regular/Temporary: Regular</li><li>
Work Schedule: 8:00am &ndash; 5:00pm, Monday - Friday</li><li>
Eligible to Receive Benefits: Yes</li><li>
Veterans' Preference Eligible: Yes</li><li>
Application Deadline: February 24, 2026</li></ul>
Compensation:<ul><li>
Hourly Salary Range: $24.00 &ndash; $25.02</li><li>Note: Salary can vary depending upon education, experience, or qualifications.</li></ul>
Employment Benefits:<ul><li>
 Comprehensive medical, mental, dental, vision, and additional coverage</li><li>
Sick &amp; Vacation leave</li><li>
Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave</li><li>
Paid State Holidays (designated by the Governor annually)</li><li>
Fitness Centers in select locations</li><li>
Employee discounts with the STAR Program</li><li>
Retirement and deferred compensation programs</li></ul>
Visit the Employee Benefits page for more information
Position Description:
The Program Specialist II position is fully in office, no remote available located in the State Self Insurance Fund (SSIF) of the State Employee Health Benefits Plan (SEHBP) and reports to the Claims Supervisor. This is a Level 2 position in SSIF. The working title is Claims Specialist
Job Responsibilities:
The primary duties and responsibilities are as follows:
Determine compensability based on facts and according to the provisions of the Workers Compensation Act, rules and regulations, office policy and prior case law. Acknowledge and respond promptly by phone and/or in writing to inquiries from injured workers, physicians, agencies, attorneys and others. Process compensation payments for injured workers. Notify injured worker and agency in writing when the claim is determined not to be compensable. Consult and educate injured workers regarding their rights and benefits, providing them with helpful information in order to access and receive benefits. Calculate and issue indemnity benefits. Compute and order separate checks for payment of child support when applicable. Research, calculate, prepare and negotiate settlements for functional disabilities within authority outlined in SSIF policy and procedures. Complete and determine whether medical bills are reasonable and necessary before approving payment. Verify claimant reimbursement for mileage, per-diem, and out of pocket medical expenses. Maintain effective working relationships with injured workers, agency officials, medical professionals, attorneys, co-workers and management.
Collaborate with injured workers, medical providers, Department of Administration, agency personnel and attorneys to maximize early Return to Work. Stimulate return to work discussions when injured workers have not been returned to duty. Coordinate job site evaluations or rehabilitation evaluations as necessary. Advise injured workers that other benefits such as vacation leave, sick leave and Family and Medical Leave Act may apply. Inform agency personnel office of injured workers status for the purpose of coordinating FMLA or other benefits for injured employees. Provide assistance to agencies and employees. Attend the annual DOL Workers Compensation Seminar and all technical training as determined by the administrator.
Mediate disputes, when possible, in order to resolve issues and avoid litigation. Provide claimant's counsel with records and information upon demand. Prepare and write a summary of legal issues and theory of defense in cases which require assignment of a defense attorney to argue compensability in preliminary, regular or review and modification settings. Retain management of all claims, including authority for defense measures, forms of settlements and other activities. Obtain settlement authorization from management on all settlements.
Receive electronic reports of accidents with a threshold up to $60,000; plan and conduct personal and telephone interviews of claimants, supervisors, witnesses and others relative to the accident (who, what, when, where, who witnessed, primary cause). Write a clear and concise summary of the investigation, findings of fact and conclusions of compensability. Collect personnel records, division records, medical records, wage statement and all other documentation as necessary to determine compensability. When necessary, report claims of fraud and/or abuse to an assistant attorney general for possible prosecution of claimants, attorneys, doctors and others. Determine if there is cause to review evidence to ensure recovery expenditures from negligent third parties, product liability and the Second Injury Fund.
Minimum Qualifications<ul><li>
High School/GED</li><li>
Two years of experience interacting with clients, customers, or the public in a social service, customer service, or problem resolution setting. Education may be substituted for experience as determined relevant by the agency.</li><li>
A valid driver&rsquo;s license is required.</li><li>
The incumbent will receive training in the provision of the HIPAA Privacy Regulations and HIPAA Security Regulations as they relate to the duties of this position and is required to sign a confidentiality agreement.</li></ul>
Post Offer Requirement:
Kansas Tax Clearance Certificate: A valid Kansas Tax Clearance Certificate is a condition of employment for all employees of the State of Kansas. Applicants (including non-residents) who receive a formal job offer for a State job, are required to obtain a valid Tax Clearance within ten (10) days of the job offer. A Tax Clearance can be obtained through the Kansas Department of Revenue who reviews individual accounts for compliance with Kansas Tax Law. Please be encouraged if you have a missing tax return(s) or you owe taxes to the State of Kansas, the Kansas Department of Revenue will work with you. The Kansas Department of Revenue can set you up on a payment plan to receive a Tax Clearance so you can get a job working for the State of Kansas. The Kansas Department of Revenue can be contacted at 785-296-3199. Kansas Department of Revenue - Tax Clearance Frequently Asked Questions
Recruiter Contact Information:
Name: Brianna Brandt
Email: brianna.brandt@ks.gov
Mailing Address: Department of Administration Office of Personnel Service 915 SW Harrison, Suite 260, Topeka, KS 66612
Job Application Process:<ul><li>
First Sign in or register as a New User.</li><li>
Complete or update your contact information on the Careers&gt; My Contact Information page. *This information is included on all your job applications.</li><li>
Upload required documents listed below for the Careers&gt; My Job Applications page.</li><li>
Start your draft job application, upload other required documents, and Submit when it is complete.<ul><li>
Manage your draft and submitted applications on the Careers&gt; My Job Applications page.</li></ul></li><li>
Check your email and My Job Notifications for written communications from the Recruiter.<ul><li>
Email &ndash; sent to the Preferred email on the My Contact Information page</li><li>
Notifications &ndash; view the Careers&gt; My Job Notifications page</li></ul></li></ul>
Helpful Resources at jobs.ks.gov: &ldquo;How to Apply for a Job &ndash; Instructions&rdquo; and &ldquo;How to Search for a Job &ndash; Instructions&quot;
Required Documents for this Application to be Complete:
Upload these on the Careers - My Job Applications page<ul><li>
DD FM 214 (if you are claiming Veteran&rsquo;s Preference)</li></ul>
Upload these on the Attachments step in your Job Application<ul><li>
Resume</li><li>
Letter of Interest / Cover Letter</li></ul>
How to Claim Veterans Preference:
Veterans' Preference Eligible (VPE): Former military personnel or their spouse that have been verified as a &quot;veteran&quot;; under K.S.A. 73-201 will receive an interview if they meet the minimum competency factors of the position. The veterans' preference laws do not guarantee the veteran a job. Positions are filled with the best qualified candidate as determine by the hiring manager.
Learn more about claiming Veteran&rsquo;s Preference
How to Claim Disability Hiring Preference
Applicants that have physical, cognitive and/or mental disabilities may claim an employment preference when applying for positions. If they are qualified to meet the performance standards of the position, with or without a reasonable accommodation, they will receive an interview for the position. The preference does not guarantee an applicant the job, as positions are filled with the best qualified candidate as determined by the hiring manager.
Learn more about claiming Disability Hiring Preference
PLEASE NOTE: The documentation verifying a person's eligibility for use of this preference should not be sent along with other application materials to the hiring agency but should be sent directly to OPS. These documents should be emailed to Gustavo.Victoriano@ks.gov, or can be mailed/delivered in person to:
ATTN: Disability Hiring Preference Coordinator 
Office of Personnel Services 
Docking State Office Building 
915 SW Harrison, Ste 260 
Topeka, KS 66612
Equal Employment Opportunity:
The State of Kansas is an Equal Opportunity Employer. All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.
If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the agency recruiter.</div></div></div>

Claims Specialist II

Nationwide

<div>
 If you&rsquo;re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide&rsquo;s Property and Casualty team could be the place for you! At Nationwide&reg;, &ldquo;on your side&rdquo; goes beyond just words. Our customers and partners are at the center of everything we do and we&rsquo;re looking for associates who are passionate about delivering extraordinary care.
 
 
 
 Job Description Summary
 
 
 
 If you can put your keen legal mind to work analyzing, managing and resolving insurance coverage and claims, we want to know more about you! Working on our team offers the opportunity to be involved in settling litigated and non-litigated claims of low to moderate complexity and severity in terms of exposure and coverage.
 
 
 As a Claims Specialist, you'll investigate, evaluate and negotiate claims to successful resolution. This role supports the management liability and specialty lines of business, including errors and omissions, directors and officers and employment practices liability. You will have low monetary authority and work under limited direct supervision and monitoring. We will count on you to collaborate and provide insight to our business partners on claims and policy wording questions and maintain, develop and influence relationships with customers and business partners.
 
 
 
 Job Description
 
 
 
 
 Key Responsibilities:
 
 
 
 <ul>
 <li>
 Investigates and evaluates coverage, liability and damages to set an appropriate claim strategy, settlement and file reserves within approved claims authority.
 </li>
 <li>
 Provides timely and appropriate evaluation of claims to identify and manage reserves in compliance with company standards.
 </li>
 <li>
 Analyze coverage and provide comprehensive coverage analysis and claim resolution strategies.
 </li>
 <li>
 Provide feedback on claim trends and development. Provide input to underwriters on review of potential and existing insured&rsquo;s claim experience.
 </li>
 <li>
 Delivers outstanding customer service and satisfaction through effective interactions with insured, agents, and legal counsel.
 </li>
 <li>
 Maintains current knowledge of applicable lines of insurance, insurance regulations, court decisions which may impact the claims function, current guidelines and policy changes and modifications. This may require attending various seminars and training sessions.
 </li>
 <li>
 Contributes to a collaborative environment by consistently demonstrating teamwork, motivation, positive behavior and effort to achieve goals and objectives.
 
 
 </li>
 </ul>
 
 May Perform Other Responsibilities As Assigned.
 
 
 
 
 Reporting Relationships:
 
 Reports to Claims Director, Freedom Specialty
 
 
 
 Typical Skills And Experiences
 
 
 
 
 Education:
 
 College degree preferred. Juris Doctorate desired.
 
 
 
 License/Certification/Designation:
 
 Associates must acquire the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails or is unable to acquire required licenses/registrations within the designated time period, the associate will be ineligible to continue in the position.
 
 
 
 Experience:
 
 Typically, two to four years of claims handling experience. Prior experience in directing defense counsel required. Specific experience in a specific line of business may be required by the hiring business unit.
 
 
 
 Knowledge, Abilities and Skills:
 
 Specific knowledge in a particular line of business and/or additional education may be required. Familiarity with various types of insurance policies preferred. The ability to evaluate and interpret information, strong written and verbal communication skills, the ability to multi-task, strong time management and organizational skills, the ability to effectively and efficiently manage all responsibilities.
 
 
 Other criteria, including leadership skills, competencies and experiences may take precedence.
 
 
 Staffing exceptions to the above must be approved by the hiring manager&rsquo;s leader and HR Business Partner.
 
 
 
 Values:
 
 Regularly and consistently demonstrates the Nationwide Values.
 
 
 
 Job Conditions
 
 
 
 
 Overtime Eligibility:
 
 Not Eligible (Exempt)
 
 
 
 Working Conditions:
 
 Normal office environment
 
 
 
 ADA:
 
 The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
 
 
 
 Credit/Background Check:
 
 Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
 
 
 
 Benefits
 
 
 
 We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.
 
 
 Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.
 
 
 #claims
 
 
 For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf
 
 
 
 Note To Employment Agencies
 
 
 
 We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means.
 
 
 Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule.
 
 
 The national salary range for Claims Specialist II - Management Specialty Lines : $69,500.00-$129,000.00
 
 
 The expected starting salary range for Claims Specialist II - Management Specialty Lines : $69,500.00 - $103,500.00
</div>

Claims Specialist II - Management Specialty Lines

DriveTime Automotive Group

<div>What&rsquo;s Under the Hood
DriveTime Family of Brands is the largest privately owned used car sales finance &amp; servicing company in the nation. Headquartered in Tempe, Arizona and Dallas, Texas, we create opportunities and improve the lives of our customers and our employees by placing a focus on putting the right customer, in the right vehicle, on the right terms and on their path to ownership.
The DriveTime Family of Brands spans across DriveTime, Bridgecrest and SilverRock. You can find us at the intersection of technology and innovation as we use our proprietary tools and over two decades of industry knowledge to redefine the process of purchasing, financing, and protecting your vehicle.
That&rsquo;s Nice, But What&rsquo;s the Job?
In short, the Corporate Claims Specialist II - Liability is a member of the Corporate Insurance &amp; Safety (CIS) Team and plays a key role in reducing the organization&rsquo;s total cost of risk. This position is responsible for independently managing designated auto and general liability claims while also overseeing TPA‑handled claims to ensure consistent strategy, timely resolution, and alignment with internal standards and risk objectives.
In long, as the Corporate Claims Specialist II - Liability, you will be responsible for:<ul><li>
Independently manage assigned auto and general liability claims, including bodily injury and property damage exposures, from initial notice through resolution.</li><li>
Oversee auto and general liability claims administered by Third‑Party Administrators (TPAs), ensuring compliance with internal handling guidelines, authority thresholds, service expectations, and regulatory requirements.</li><li>
Establish and direct claim strategy by evaluating liability, damages, coverage, and exposure, including providing direction to TPAs to drive timely, cost‑effective outcomes.</li><li>
Exercise sound, independent judgment in determining claim direction, settlement approach, reserve adequacy, and escalation needs, with the ability to clearly document and defend decisions.</li><li>
Collaborate with internal stakeholders, field locations, TPAs, insurance carriers, and vendors to resolve complex, high‑severity, or sensitive claims.</li><li>
Manage reserves, settlement authority, and payment activity for in‑house claims, while reviewing and approving TPA reserve and settlement recommendations.</li><li>
Identify and pursue subrogation and recovery opportunities, either directly or through directed TPA efforts.</li><li>
Analyze claim metrics and performance data to assess trends, evaluate TPA effectiveness, support reporting needs, and recommend risk reduction or process improvement initiatives.</li></ul>
So What Kind of Folks Are We Looking For?<ul><li>
Detail‑oriented professionals who can manage in‑house claims while effectively overseeing third‑party claim handling.</li><li>
Strong communicators who can confidently direct TPA activity and collaborate with internal and external partners.</li><li>
Independent thinkers who can assess exposure, make defensible decisions, and hold others accountable to expectations.</li><li>
Organized, self‑motivated individuals who take ownership of outcomes and can pivot priorities efficiently and effectively.</li><li>
Team‑oriented professionals who value collaboration, transparency, and continuous improvement.</li><li>
Analytical problem‑solvers who enjoy using data and claim insight to drive smarter results.</li></ul>
The Specifics<ul><li>
Minimum of 3 years of auto bodily injury and/or general liability claims adjusting experience, including investigation, evaluation, negotiation, and resolution.<ul><li>
Experience with high complexity/high dollar claims is strongly preferred.</li><li>
Commercial or Business Insurance experience is a plus!</li></ul></li><li>
Experience working in a hybrid environment involving both direct claim management and TPA oversight is a plus.</li><li>
Ability to communicate clearly, professionally, and confidently across multiple stakeholders and formats.</li><li>
Proven ability to manage multiple systems and priorities in a fast‑paced environment.</li><li>
Intermediate Microsoft Office skills (Excel, Word, PowerPoint).</li><li>
Experience with Riskonnect, Salesforce, or similar claim management platforms preferred.</li><li>
Bachelor&rsquo;s degree preferred but not required.</li></ul>
So What About the Perks? Perks matter<ul><li>
We take a hybrid work approach, finding balance between the benefits of in-person and work-from-home environments. This position has an on-site expectation of a minimum of three days a week.</li><li>
Medical, dental, and vision, oh my! DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage.</li><li>
But Wait, There&rsquo;s More. 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few.</li><li>
Growth Opportunities. You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year.</li><li>
Tuition Reimbursement. We&rsquo;re as passionate about your professional development as you are. With that, we&rsquo;ll put our money where our mouth is.</li><li>
Wellness Program. Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities!</li><li>
Gratitude is Green. We offer competitive pay across the organization, because, well&hellip; money matters!</li></ul><ul><li>
In-House Gym. We want our employees to be the best versions of themselves. So come early, take a break in your day or finish strong with a workout!</li><li>
Give Us a Reason (or not), and We&rsquo;ll Celebrate. Regardless of whether there is a holiday or not, we are finding ways to kick back and enjoy each other&rsquo;s company outside of day-to-day work.</li><li>
Smart-Casual Dress. Come dressed in jeans (you&rsquo;ll fit right in with the rest of us).</li><li>
Paid Time Off. Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn!</li></ul>
Anything Else? Absolutely.
DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we&rsquo;ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don&rsquo;t forget Phoenix Business Journal Healthiest Employers (okay, we&rsquo;ll stop there)!
Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer. 
And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!</div>

Corporate Claims Specialist II

SKYGEN

<div>Important things YOU should know:
<ul><li>Schedule: Monday - Friday 8:00am - 4:30pm CST
</li><li>Friday schedule includes covering a 7:00pm - 8:00pm shift on a rotational basis
</li><li>Fully Remote Opportunity
</li><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Potential to Flex Schedule 
</li></ul>What will YOU be doing for us? Responsible for ensuring departmental tasks are completed in order to meet client turnaround times for claim payment and authorization determination. Manages all special handling requests to support both internal and external requirements 
What will YOU be working on?
<ul><li>Manages daily work plan and distributes work out to the team to ensure client turnaround times are met.
</li><li>Provide second tier support to data entry processors by providing direction how to resolve submission discrepancies according to client business rules.
</li><li>Manage specialized workflows to support client requests that deviate from standard processes and procedures. Coordinate resolution with required departments as necessary.
</li><li>Responsible for ensuring all reporting is reviewed, work queues are completed, and open issues are resolved prior to claim payment and authorization review. Proactively communicate readiness to transfer data to appropriate departments.
</li><li>Proactively communicate potential issues to management to allow for timely resolution.
</li><li>Ability to multitask within multiple modules of the Enterprise System to retrieve and research information along with processing any submission requests or special handling requests received.
</li><li>Comprehensive understanding of client processing guidelines and requirements.
</li><li>Process primary insurance carries EOB&rsquo;s for appropriate payment.
</li><li>Act as a subject matter expert for items sent to the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
</li><li>Proactively bring forward provider submission errors and collaborate with internal teams for provider outreach and education.
</li><li>Manage and process urgent operating room (OR) authorization requests submitted via fax and coordinate with the authorization team to ensure timely review and determination outcome.
</li><li>Resolve provider data discrepancies submitted electronically that prevent the submission to proceed through the system. Utilize outside databases to validate provider credentials.
</li>Assists with training support of internal team members. 
<li>
</li></ul>Additional Responsibilities:
<ul><li>Partner with Claims Intake team in completing all other tasks as necessary to ensure accurate and timely completion of work to meet our client service level agreements.
</li>Assist with special projects requests assigned by leadership team. 
<li>
</li></ul>What qualifications do YOU need to have to be a GOOD candidate?
Required Level of Education, Licenses, and/or Certificates
High school diploma or equivalent. 
<ul><li>
</li></ul>Required Level of Experience
1+ year(s) of related experience such as claim processing, dental assistant, dental front office administration and/or health/dental insurance such as managed care operations, accounts receivable and/or billing environment. 
<ul><li>
</li></ul>Required Knowledge, Skills, and Abilities
<ul><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Ability to work effectively with multiple interruptions.
</li><li>Ability to organize work appropriately to meet deadlines.
</li><li>Excellent attention to detail.
</li><li>Ability to multi-task.
</li><li>Ability to utilize resources to solve problems independently.
</li><li>Excellent Critical thinking skills.
</li><li>Excellent verbal and written communication skills.
</li><li>Basic Microsoft applications.
</li><li>Knowledge of insurance EOB&rsquo;s and billing codes.
</li>Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim form or Member Reimbursement forms. 
<li>
</li></ul>What qualifications do YOU need to have to be a GREAT candidate?
Preferred Level of Education, License, and/or Certificates
Bachelor&rsquo;s Degree in a related field. 
<ul><li>
</li></ul>Preferred Level of Experience
<ul><li>2+ years of medical, dental or vision claim processing.</li></ul></div>

Claims Intake Specialist II

<div>Important things YOU should know:
<ul><li>Schedule: 8:00am - 1:00pm CST Monday - Friday
</li><li>Friday schedule includes covering a 7:00pm - 8:00pm shift on a rotational basis
</li><li>Fully Remote Opportunity
</li><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Potential to Flex Schedule 
</li></ul>What will YOU be doing for us? Responsible for ensuring departmental tasks are completed in order to meet client turnaround times for claim payment and authorization determination. Manages all special handling requests to support both internal and external requirements 
What will YOU be working on?
<ul><li>Manages daily work plan and distributes work out to the team to ensure client turnaround times are met.
</li><li>Provide second tier support to data entry processors by providing direction how to resolve submission discrepancies according to client business rules.
</li><li>Manage specialized workflows to support client requests that deviate from standard processes and procedures. Coordinate resolution with required departments as necessary.
</li><li>Responsible for ensuring all reporting is reviewed, work queues are completed, and open issues are resolved prior to claim payment and authorization review. Proactively communicate readiness to transfer data to appropriate departments.
</li><li>Proactively communicate potential issues to management to allow for timely resolution.
</li><li>Ability to multitask within multiple modules of the Enterprise System to retrieve and research information along with processing any submission requests or special handling requests received.
</li><li>Comprehensive understanding of client processing guidelines and requirements.
</li><li>Process primary insurance carries EOB&rsquo;s for appropriate payment.
</li><li>Act as a subject matter expert for items sent to the Claims Intake team; answering questions to internal and external contacts and resolving matters that may fall outside of the established workflows.
</li><li>Proactively bring forward provider submission errors and collaborate with internal teams for provider outreach and education.
</li><li>Manage and process urgent operating room (OR) authorization requests submitted via fax and coordinate with the authorization team to ensure timely review and determination outcome.
</li><li>Resolve provider data discrepancies submitted electronically that prevent the submission to proceed through the system. Utilize outside databases to validate provider credentials.
</li>Assists with training support of internal team members. 
<li>
</li></ul>Additional Responsibilities:
<ul><li>Partner with Claims Intake team in completing all other tasks as necessary to ensure accurate and timely completion of work to meet our client service level agreements.
</li>Assist with special projects requests assigned by leadership team. 
<li>
</li></ul>What qualifications do YOU need to have to be a GOOD candidate?
Required Level of Education, Licenses, and/or Certificates
High school diploma or equivalent. 
<ul><li>
</li></ul>Required Level of Experience
1+ year(s) of related experience such as claim processing, dental assistant, dental front office administration and/or health/dental insurance such as managed care operations, accounts receivable and/or billing environment. 
<ul><li>
</li></ul>Required Knowledge, Skills, and Abilities
<ul><li>Successfully complete a pre-employment online alphanumeric data entry assessment with a minimum score of 7000 KSPH and 98% accuracy rate.
</li><li>Ability to work effectively with multiple interruptions.
</li><li>Ability to organize work appropriately to meet deadlines.
</li><li>Excellent attention to detail.
</li><li>Ability to multi-task.
</li><li>Ability to utilize resources to solve problems independently.
</li><li>Excellent Critical thinking skills.
</li><li>Excellent verbal and written communication skills.
</li><li>Basic Microsoft applications.
</li><li>Knowledge of insurance EOB&rsquo;s and billing codes.
</li>Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim form or Member Reimbursement forms. 
<li>
</li></ul>What qualifications do YOU need to have to be a GREAT candidate?
Preferred Level of Education, License, and/or Certificates
Bachelor&rsquo;s Degree in a related field. 
<ul><li>
</li></ul>Preferred Level of Experience
<ul><li>2+ years of medical, dental or vision claim processing.</li></ul></div>

Claims Intake Specialist II - Part Time Remote!

Zurich Insurance

<div>Zurich is currently looking for a to join our Rural Community Insurance Services (RCIS) team. RCIS is one of the leading crop insurance providers in the U.S. RCIS offers insurance protection in all 50 states through a national network of about 3,600 licensed agents. RCIS offers a wide range of private product coverages, including a diverse selection of named-peril options, supplemental and stand-alone insurance products as well as federal crop insurance plans through the United States Department of Agriculture&rsquo;s Risk Management Agency. Together with RCIS agents, we protect America&rsquo;s farmers and ranchers. 
 
Zurich North America is hiring an RCIS Crop Claims Specialist or Claims Crop Field Adjuster I to join our team! 
 
We are open to hiring talent in one of the following locations within- Noble, Garfield, Payne, Kay, Grant County area in Oklahoma. You must live within 50 miles of these locations to be successful. 
 
If you are ready for a career move, consider working for a company with a global footprint that offers terrific benefits including a bonus plan, 401K match and a second 401K company contribution, flexible work options, summer hours, an excellent work/life balance and a great culture. 
 
Additional responsibilities will include: 
<ul><li>
Exercise judgement to determine liability by gathering and analyzing relevant facts, utilizing applicable procedures.</li><li>
Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.</li><li>
Participates in Risk Management Agency initiated reviews and referrals for sake of operations integrity and quality assurance.</li><li>
Protect Zurich&rsquo;s reputation by keeping claims information confidential.</li><li>
Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks. And participating in professional societies.</li></ul> 
This role will be filled at either the Crop Claims Specialist or Crop Claims Specialist II Level. The hiring manager will determine the appropriate level based upon the selected applicant&rsquo;s experience and skill set relative to the qualifications listed for this position. 
 
Crop Claims Specialist Basic Qualifications: 
<ul><li>
High School Diploma or Equivalent and 6 or more months of experience in the agricultural area</li><li>
Crop Adjuster Proficiency Program Certification (CAPP) must be obtained with 180 days of hire date.</li><li>
Reliable personal transportation and travel within territory</li><li>
RCIS Crop Adjuster Physical Requirements: walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs to 50 lbs, work outdoors in varying temperatures/weather conditions.</li></ul> 
OR 
 
Crop Claims Specialist II: 
<ul><li>
High School Diploma or Equivalent and 4 or more years of experience in the agricultural or the crop insurance industry 
AND</li><li>
Crop Adjuster Proficiency Program (CAPP) Certification must be obtained within 180 days of hire date</li><li>
Personal transportation and travel within assigned territory and travel outside of assigned are to assist with workload(s) , participate on CAT team and/or provide remote assistance for the CROP Claims Care Center calls and/or CCP Claims</li><li>
RCIS Crop Adjuster Physical Requirements; walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs to 50 lbs, work outdoors in varying temperatures/weather conditions</li></ul> 
Preferred Qualifications for both levels: 
<ul><li>
Strong verbal, written and interpersonal skills.</li><li>
Strong organization, multi-tasking and prioritization skills.</li><li>
Intermediate Microsoft office skills</li></ul> 
Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply&mdash;your unique background matters to us. The combined salary range for this position is $41,900.00 - $72,900.00. The proposed hourly rate for the Claims Crop Field Adjuster I is $20.14 - 27.79, with short-term incentive bonus eligibility set at 5%. The proposed salary range for the Crop Claims Specialist is $44,600.00 - $72,900.00, with short-term incentive bonus eligibility set at 10%. 
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.] 
Why Zurich?
At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment&mdash;so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500&reg;. 
Join us for a brighter future&mdash;for yourself and our customers. 
Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets. 
Zurich complies with 18 U.S. Code &sect; 1033. 
Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal. 
Location(s): AM - Oklahoma Virtual Office 
Remote Working: Hybrid 
Schedule: Full Time 
Employment Sponsorship Offered: No 
 
Linkedin Recruiter Tag: #LI-LC1 #LI-ASSOCIATE</div>

RCIS Crop Claims Specialist or Claims Crop Field Adjuster, OK

Liberty Mutual Insurance

<div>Description
<div>Ready to grow your career in a role that makes a meaningful impact? Liberty Mutual is hiring Workers' Compensation Claims Specialists in our Northeast Region to help injured workers navigate the claims process and return to work with confidence. 
We&rsquo;re hiring across multiple levels&mdash;Associate Claims Specialist, Claims Specialist I, and Claims Specialist II&mdash;depending on your experience. The salary range posted reflects the varying pay scale across various locations. 
In this role, you&rsquo;ll manage a caseload of routine to moderately complex claims, making key decisions on compensability, evaluating losses, and negotiating fair outcomes. You&rsquo;ll collaborate closely with claimants, policyholders, attorneys, and partners throughout the claim lifecycle. 
Training is a critical component of your success, and that success starts with reliable attendance and active engagement. Training will include 1 week of travel to our Plano, TX office in July. 
 
This role is remote within the Northeast region. Candidates must reside in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, or Vermont. Candidates residing within 50 miles of our offices in Weatogue, Connecticut, or Westborough, Massachusetts, will be expected to work onsite up to two days per month. On-site expectations may evolve based on business needs. 
Responsibilities<ul><li>
Manages an inventory of claims to evaluate compensability/liability.</li><li>
Establishes action plans based on case facts, best practices, protocols, regulatory issues, and available resources.</li><li>
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages.</li><li>
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves as necessary, during the processing of the claims, and refers claims to the subrogation group or Special Investigations Unit as appropriate.</li><li>
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.</li><li>
Performs other duties as assigned.</li></ul></div>
Qualifications<div><ul><li>
Effective interpersonal, analytical and negotiation abilities required</li><li>
Ability to provide information in a clear, concise manner with an appropriate level of detail</li><li>
Demonstrated ability to build and maintain effective relationships</li><li>
Demonstrated success in a professional environment; success in a customer service/retail environment preferred</li><li>
Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent</li><li>
Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory</li><li>
Licensing may be required in some states</li><li>
</li></ul></div>
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. 
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. 
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits 
 
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. 
 
Fair Chance Notices<ul><li>
California</li><li>
Los Angeles Incorporated</li><li>
Los Angeles Unincorporated</li><li>
Philadelphia</li><li>
San Francisco</li></ul></div>

Associate Claims Specialist - Workers Compensation - Northeast Region

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