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claims specialist

First Chicago Insurance Company

<div>At First Chicago Insurance Company, our employees are our biggest asset! It is our mission to attract and retain intelligent, motivated, ethical employees who strive for excellence and growth, and to keep those employees happy and engaged. We provide the tools and the support our employees need to grow both professionally and personally. We encourage self-improvement and celebrate success by rewarding ideas and results. We realize the strength of teamwork and its ability to join individuals together and push and pull each other, with a synergy that can only be found in groups of good people sharing ideas. Join in on the excitement and become part of our thriving organization!
We are seeking an experienced Casualty Claims Specialist! 
The Casualty Claims Specialist will be responsible for investigating and settlement of automobile bodily injury claims. They will settle complex liability claims which require greater investigation and verification, as well as casualty claims including severe injuries which may result in extended disability or bodily injury as well as coverage related litigation.
The Casualty Claims Specialist will have the following duties and responsibilities:<ul><li>
Review &amp; determine course of action on each file assigned, utilizing technical knowledge &amp; experience for the purpose of supporting final disposition of a loss.</li><li>
Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage, liability status, and damages that are applicable for each claim.</li><li>
Process Bodily Injury, and coverage claims in accordance with established office procedures.</li><li>
Work closely with Third Parties, plaintiff counsel, Claim Director and Chief Operating Officer to determine necessary injury and coverage investigation.</li><li>
Research case and statutory law in order to conduct proper claim investigation.</li><li>
Document policy status, coverage, liability and damages on all claims and notify re-insurer on qualifying claims.</li><li>
Prepare and present claim evaluations for the appropriate settlement authority.</li><li>
Maintain reasonable expense factors.</li><li>
Handle other duties as assigned</li></ul>
QUALIFICATIONS REQUIRED:<ul><li>
3-5 years in Casualty claims experience a MUST!</li><li>
Knowledge of legal and medical terminology.</li><li>
Excellent negotiation, communication, written, organizational and interpersonal skills.</li><li>
Ability to pass written examinations where required by state statutes to become a licensed claims adjuster.</li><li>
Proficiency in Microsoft Office products.</li></ul>
First Chicago Insurance Company provides a competitive benefits package to all full- time employees. Following are some of the perks First Chicago employees receive:<ul><li>
Competitive Salaries</li><li>
Commitment to your Training &amp; Development</li><li>
Medical and Dental</li><li>
Telemedicine Benefit</li><li>
401k with a generous company match</li><li>
Paid Time Off and Paid Holidays</li><li>
Tuition Reimbursement Training Programs</li><li>
Wellness Program</li><li>
Fun company sponsored events</li><li>
And so much more!</li></ul>
Visit our company website at firstchicagoinsurance.com</div>

Casualty Claims Specialist

Liberty Mutual Insurance

<div>Description
<div>Under direct supervision, develops the knowledge and skills needed to conduct thorough investigations, make decisions about liability / compensability, evaluate losses, negotiate settlements and manage an inventory of commercial property/casualty and disability claims by participating in a comprehensive training program, one-on-one mentoring, and on-the-job training. Assists in providing service to policyholders/customers on mid-sized and/or large commercial accounts. 
Training is a critical component of your success, and that success starts with reliable attendance. Attendance and active engagement during training are mandatory. Training will require 1 week in our Plano, TX office onsite in July 2026. 
To be considered for this position, candidates must reside within 50 miles of Hoffman Estates, IL, or Indianapolis, IN, and will be required to work in the office twice a month. Candidates located in Ohio, Montana, Virginia and Minnesota are eligible for 100% remote work, as we do not have claims offices in these states. Please note that this policy is subject to change. 
Responsibilities 
<ul><li>
Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly.</li><li>
Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.</li><li>
Manages an inventory of property/casualty and disability claims (e.g. workers` compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits.</li><li>
Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols.</li><li>
Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action.</li><li>
Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources.</li><li>
Updates files and provides comprehensive reports as required.</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></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

<div>At First Chicago Insurance Company, our employees are our biggest asset! It is our mission to attract and retain intelligent, motivated, ethical employees who strive for excellence and growth, and to keep those employees happy and engaged. We provide the tools and the support our employees need to grow both professionally and personally. We encourage self-improvement and celebrate success by rewarding ideas and results. We realize the strength of teamwork and its ability to join individuals together and push and pull each other, with a synergy that can only be found in groups of good people sharing ideas. Join in on the excitement and become part of our thriving organization! 
 
We are seeking an experienced Litigation Specialist! 
The Litigation Specialist will be responsible for handling litigated and/or complex injury claims stemming from Personal Auto and Commercial Auto Liability policies. 
 
DUTIES &amp; RESPONSIBILITIES:
<ul><li>Handle litigation claims in accordance with established office procedures.
</li><li>Determine coverage and draft any applicable reservations of rights letters.</li><li>
Conduct prompt investigations by securing statements from the involved parties/witnesses and obtaining all necessary documents, including but not limited to, police reports, medical specials, photographs, and/or appraisals.
</li><li>Litigation Management including strategizing with defense counsel and experts on defense cases, as well as declaratory judgment actions.</li><li>
Maintain an appropriate diary on all open files.</li><li>
Conduct business with vendors in a manner which maintains a reasonable expense factor and upholds the company's reputation for quality service.
</li><li>Ability to research and interpret case law, statute, and coverage forms in order to properly adjust and conclude claims.</li><li>
Evaluates and determine potential use of experts and/or field investigators.</li><li>
Maintain claim files and document all claim activity in accordance with applicable regulations and company policies.</li><li>
Prepare and present claim evaluations to secure appropriate settlement authority.
</li><li>Establish and maintain proper indemnity and expense reserves.</li><li>
Conduct onsite review of defense counsel as required by management.
</li><li>Adhere to the rules and regulations of the Department of Insurance specific to the loss state.</li>
Additional duties as deemed necessary by direct supervisor / management. 
<li>
</li></ul> 
QUALIFICATIONS:
Required:
<ul><li>College Degree and / or 5 years of applicable claims adjusting experience.
</li><li>Knowledge of legal and medical terminology.
</li><li>Excellent negotiation, communication, organizational and interpersonal skills.
</li><li>Ability to pass written examinations where required by state statutes to become a licensed claim adjuster.</li></ul> 
First Chicago Insurance Company provides a competitive benefits package to all full- time employees. Following are some of the perks First Chicago employees receive:<ul><li>
Competitive Salaries</li><li>
Commitment to your Training &amp; Development</li><li>
Medical and Dental</li><li>
Telemedicine Benefit</li><li>
401k with a generous company match</li><li>
Paid Time Off and Paid Holidays</li><li>
Tuition Reimbursement Training Programs</li><li>
Wellness Program</li><li>
Fun company sponsored events</li><li>
And so much more!</li></ul>
Visit our company website at firstchicagoinsurance.com</div>

Litigation Specialist

Healthcare Chaos Management (HCM)Healthcare Chaos Management (HCM) is a nationally scaled healthcare revenue cycle organization with over 40 years of industry experience, currently evolving into a modern Healthcare company. We partner with hospitals and healthcare systems across the United States to optimize revenue operations, improve patient financial experiences, and drive measurable outcomes through a blend of human expertise and intelligent automation.At HCM, we convert complexity into coherence, combining deep revenue cycle knowledge, advanced technology, and a people-first mindset.Position OverviewThe Revenue Cycle Specialist is responsible for supporting end-to-end revenue cycle operations for assigned clients, ensuring claims are processed accurately, timely, and in compliance with payer and regulatory requirements. This role plays a critical part in driving reimbursement, resolving denials, and maintaining clean accounts receivable.This is an ideal opportunity for a revenue cycle professional who is detail-oriented, analytical, and motivated to grow within a fast-evolving healthcare and technology-driven organization.Key ResponsibilitiesClaims Submission &amp; Insurance Follow-Up<ul><li>Submit professional and/or institutional claims in accordance with payer guidelines.</li><li>Monitor insurance aging reports and prioritize unpaid or underpaid claims for follow-up.</li><li>Perform insurance follow-up via payer portals and telephone communication to drive timely resolution.</li></ul>Denial Management &amp; Appeals<ul><li>Research, analyze, and resolve claim denials efficiently.</li><li>Identify root causes of denials and take corrective action to prevent recurrence.</li><li>Prepare and submit appeals with appropriate documentation to maximize reimbursement.</li></ul>Insurance Verification &amp; Authorizations<ul><li>Collaborate with internal teams and external partners to support authorization and utilization management processes.</li><li>Verify insurance coverage and ensure accurate documentation within billing systems.</li></ul>Remittance Transaction Posting<ul><li>Post payments, adjustments, and transactions accurately and timely.</li><li>Resolve payment discrepancies, underpayments, and delays to effectively manage AR.</li><li>Communicate with payers to reconcile payment issues and ensure proper reimbursement.</li></ul>Credit Balance Resolution<ul><li>Review and resolve credit balance accounts.</li><li>Process refunds to appropriate parties or initiate correction of posting or adjustment errors.</li></ul>Compliance &amp; Documentation<ul><li>Ensure all work complies with federal, state, local, and client-specific policies and procedures.</li><li>Maintain accurate and complete documentation within billing systems.</li><li>Adhere to HIPAA and confidentiality requirements when handling protected health information.</li></ul>Collaboration &amp; Process Improvement<ul><li>Identify trends, discrepancies, or process gaps and escalate to appropriate departments.</li><li>Partner with internal teams (coding, patient access, analytics, technology) to support continuous improvement initiatives.</li><li>Contribute to a collaborative, solution-oriented team environment.</li></ul>Customer Service &amp; Communication<ul><li>Provide professional and timely support to internal stakeholders and external clients.</li><li>Communicate clearly and effectively, both verbally and in writing, to resolve issues and align on next steps.</li></ul>Key Performance Indicators (KPIs)Performance in this role will be measured by:<ul><li>Production: Consistently meet or exceed account resolution targets by completing an expected volume of accounts and timely completion of assigned worklists and tasks</li><li>Quality: Accuracy and compliance in claims processing, follow-up, and documentation.</li><li>Resolution Rate: Successful resolution of unpaid claims and denials.</li></ul>What We Offer<ul><li>Competitive Compensation: Based on experience and role alignment.</li><li>Medical, Dental &amp; Vision Insurance: Comprehensive coverage options.</li><li>Life Insurance: Employer-provided life insurance.</li><li>Flexible Time Off (FTO):</li><li>401(k) Plan: Employer match to support long-term financial goals.</li><li>Additional Benefits: Flexible scheduling options, collaborative team culture, and growth opportunities.</li></ul>Minimum QualificationsExperience &amp; Knowledge<ul><li>Minimum of 2+ years of experience in revenue cycle management, medical billing, or healthcare reimbursement.</li><li>Experience working with Medicare, Medicaid, and commercial insurance payers.</li></ul>Systems &amp; Technical Skills<ul><li>Proficiency in Microsoft Office (Word, Excel, Outlook).</li><li>Experience using healthcare billing systems such as Epic or Meditech.</li><li>Experience with Salesforce or similar CRM/workflow platforms is a plus.</li><li>High Speed Internet</li></ul>Core Competencies<ul><li>Strong attention to detail and analytical skills.</li><li>Ability to research, interpret, and resolve billing and reimbursement issues.</li><li>Excellent written and verbal communication skills.</li><li>Demonstrated customer service mindset when working with internal teams and clients.</li><li>Dedicated workspace within your residence</li></ul>Work Environment &amp; Schedule<ul><li>Location: Hybrid remote role based in Indianapolis, IN (46220)</li><li>Schedule: Full-time, Monday through Friday</li><li>Environment: Primarily office-based with moderate noise levels</li></ul>Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions.Join the HCM TeamAt Healthcare Chaos Management, you will play a meaningful role in strengthening revenue cycle performance for healthcare organizations nationwide. If you are driven by accuracy, accountability, and impact&mdash;and want to grow with a company at the intersection of healthcare and technology&mdash;we encourage you to apply and join our team.Benefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Health savings account</li><li>Paid time off</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>Which areas of the revenue cycle have you worked in, and for how many years?</li></ul>(Select all that apply and indicate total years of experience.) ☐ Patient Access / Registration (Years: _) ☐ Eligibility &amp; Benefits Verification (Years: _) ☐ Charge Entry / Coding Support (Years: _) ☐ Claims Submission (Years: _) ☐ Accounts Receivable Follow-Up (Years: _) ☐ Denials Management / Appeals (Years: _) ☐ Payment Posting / Reconciliation (Years: _) ☐ Credit Balance Resolution / Refunds (Years: _) ☐ Credentialing (Years: _) ☐ I do not have revenue cycle experience<ul><li>How many years of experience do you have submitting claims, following up on unpaid claims, and managing claim denials or appeals?</li></ul>☐ Less than 1 year ☐ 1&ndash;2 years ☐ 3&ndash;5 years ☐ 5+ years ☐ No experience<ul><li>How many years of experience do you have working with insurance payers and billing portals (Medicare, Medicaid, and/or Commercial)?</li></ul>☐ Less than 1 year ☐ 1&ndash;2 years ☐ 3&ndash;5 years ☐ 5+ years ☐ No experience<ul><li>Which of the following EMR or billing systems have you used while working live patient calls (proficient level)?</li></ul>(Select all that apply) ☐ Epic ☐ Cerner ☐ Meditech ☐ Athenahealth ☐ NextGen ☐ Allscripts / Veradigm ☐ Waystar ☐ Change Healthcare ☐ Availity ☐ Other EMR or billing system ☐ I do not have EMR experience<ul><li>How many years of experience do you have managing accounts receivable follow-up, transaction posting, or credit balance resolution?</li></ul>☐ Less than 1 year ☐ 1&ndash;2 years ☐ 3&ndash;5 years ☐ 5+ years ☐ No experience<ul><li>Please indicate your desired hourly pay range for this role.</li></ul>Work Location: Remote

A/R - Revenue Cycle Representative (Healthcare)

Gregory & Appel Insurance

<div>Description:

The Claims Advocate (CA) at Gregory &amp; Appel works closely with our clients, insurance company representatives, producers, and commercial operations department to assist with claims at the time of loss. The CA works in our office communicating with clients and insurance company adjusters to achieve a fair claim settlement for our clientele. The CA takes the initial loss report from our client, sets expectations about the claims process, files the claim with the insurance company, notes the claim file as needed during the life of the claim, and follows it to closure.
Requirements:
<ul><li>Provides claim kit reporting instructions to new clients and current clients when they are placed with a different insurance company at renewal.</li><li>Provides claim advocacy for assigned clients including setting expectations for clients at time of loss, claim consulting, reporting, and tracking the claim to closure.</li><li>Serves as resource to clients at time of loss, directing emergency restoration to mitigate damage; Confirms coverage and deductibles; Coordinates service with insurance company adjusters, while being a voice for the client with the adjuster when disagreements arise during the claim.</li><li>Proactively identifies opportunities to reduce the cost of risk for our commercial clientele.</li><li>Prepares claim trending and analysis reports to identify causes of loss for clients upon request from the Client Service Consultant, Producer or the Manager of Client Services.</li><li>Responds or refers risk control consulting services desired by commercial clientele to insurance company Loss Control Representatives, the Manager of Client Services, and/or the Client Services Risk Consultant.</li><li>Available to respond to claim emergencies outside of normal business hours: holidays, weekends, and evenings.</li></ul>
Skills<ul><li>Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.</li><li>Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.</li><li>Service Orientation: Actively looking for ways to help people.</li><li>Complex Problem-Solving Skills: Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.</li><li>Data Skills: Using a computer application to manage large amounts of information, including creating and editing simple databases, inputting data, retrieving specific records, and creating reports to communicate the information.</li><li>Spreadsheets: Using a computer application to enter, manipulate, and format text and numerical data; insert, delete, and manipulate cells, rows, and columns; and create and save worksheets, charts, and graphs.</li></ul>
Qualifications<ul><li>1-2 years of experience in claims service experience, property &amp; casualty commercial claims</li><li>Bachelor's Degree; or combined equivalent years of education and experience</li><li>P&amp;C License Required</li><li>Professional designations such as AIC, PLCS, CRM, or ARM desired</li><li>Ability to carry out complex tasks with concrete and/or abstract variables</li><li>Ability to communicate and explain to others complex issues, receives and interprets claim information, and responds appropriately.</li></ul></div>

Claims Advocate

Sedgwick

&lt;p&gt;By joining Sedgwick, you&amp;#39;ll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies&lt;/p&gt;&lt;p&gt;Certified as a Great Place to Work&reg;&lt;/p&gt;&lt;p&gt;&lt;span style=&quot;font-size:14px&quot;&gt;Fortune Best Workplaces in Financial Services &amp;amp; Insurance&lt;/span&gt;&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;Disability Representative Sr&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:&lt;/span&gt;&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Dubuque, IA&lt;/span&gt;&lt;/b&gt;&lt;span&gt; : 4141 Westmark Drive, Dubuque, IA 52002&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Cedar Rapids, IA&lt;/span&gt;&lt;/b&gt;&lt;span&gt; : 333 1st Street SE Ste. 200 Cedar Rapids IA 52401&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Coralville, IA: &lt;/span&gt;&lt;/b&gt;&lt;span&gt; 3273 Ridgeway Drive Coralville IA 52241&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Dublin, OH&lt;/span&gt;&lt;/b&gt;&lt;span&gt; : 5500 Glendon Court Dublin OH 43016&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;New Albany, OH&lt;/span&gt;&lt;/b&gt;&lt;span&gt; : 7795 Walton Parkway New Albany, OH 43054&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Indianapolis, IN:&lt;/span&gt;&lt;/b&gt;&lt;span&gt; 8909 Purdue Road Suite 501 Indianapolis, IN 46268&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Irving, TX&lt;/span&gt;&lt;/b&gt;&lt;span&gt;: 2201 W. Royal Lane Suite 125 Irving, TX 75063&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Memphis, TN : &lt;/span&gt;&lt;/b&gt;&lt;span&gt;8125 Sedgwick Way, Memphis TN 38125&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Southfield, MI&lt;/span&gt;&lt;/b&gt;&lt;span&gt; : 300 Galleria Officentre Southfield MI 48034&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;span&gt;Orlando, FL : &lt;/span&gt;&lt;/b&gt;&lt;span&gt;12650 Ingenuity Dr Orlando FL 32826&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;PRIMARY PURPOSE&lt;/u&gt;&lt;/b&gt;: Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors.&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;ESSENTIAL FUNCTIONS and RESPONSIBILITIES &lt;/u&gt;&lt;/b&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.&lt;/li&gt;&lt;li&gt;Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.&lt;/li&gt;&lt;li&gt;Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.&lt;/li&gt;&lt;li&gt;Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.&lt;/li&gt;&lt;li&gt;Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.&lt;/li&gt;&lt;li&gt;Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.&lt;/li&gt;&lt;li&gt;Communicates with the claimants&rsquo; providers to set expectations regarding return to work.&lt;/li&gt;&lt;li&gt;Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.&lt;/li&gt;&lt;li&gt;Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.&lt;/li&gt;&lt;li&gt;Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.&lt;/li&gt;&lt;li&gt;Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.&lt;/li&gt;&lt;li&gt;Negotiates return to work with or without job accommodations via the claimant&rsquo;s physician and employer.&lt;/li&gt;&lt;li&gt;Refers cases to team lead and clinical case management for additional review when appropriate.&lt;/li&gt;&lt;li&gt;Maintains professional client relationships and provides excellent customer service.&lt;/li&gt;&lt;li&gt;Meets the organization&rsquo;s quality program(s) minimum requirements.&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;u&gt;&lt;b&gt;ADDITIONAL FUNCTIONS and RESPONSIBILITIES&lt;/b&gt;&lt;/u&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Performs other duties as assigned.&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;QUALIFICATIONS&lt;/u&gt;&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Education &amp;amp; Licensing&lt;/u&gt;&lt;/b&gt;&lt;br /&gt;High School diploma or GED required. Bachelor&amp;#39;s degree from an accredited university or college preferred. &lt;span&gt;State certification or licensing in statutory leaves is preferred or may be required &lt;span&gt;based on state regulations.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Experience&lt;/u&gt;&lt;/b&gt;&lt;br /&gt;Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred.&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Skills &amp;amp; Knowledge&lt;/u&gt;&lt;/b&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures&lt;/li&gt;&lt;li&gt;Knowledge of state and federal FMLA regulations&lt;/li&gt;&lt;li&gt;Working knowledge of medical terminology and duration management&lt;/li&gt;&lt;li&gt;Excellent oral and written communication, including presentation skills&lt;/li&gt;&lt;li&gt;Proficient computer skills including working knowledge of Microsoft Office&lt;/li&gt;&lt;li&gt;Analytical, interpretive, and critical thinking skills&lt;/li&gt;&lt;li&gt;Ability to manage ambiguity&lt;/li&gt;&lt;li&gt;Strong organizational and multitasking skills&lt;/li&gt;&lt;li&gt;Ability to work in a team environment&lt;/li&gt;&lt;li&gt;Ability to meet or exceed performance competencies as required by program&lt;/li&gt;&lt;li&gt;Effective decision-making and negotiation skills&lt;/li&gt;&lt;li&gt;Ability to exercise judgement autonomously within established procedures&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;WORK ENVIRONMENT&lt;/u&gt;&lt;/b&gt;&lt;br /&gt;When applicable and appropriate, consideration will be given to reasonable accommodations.&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Mental&lt;/u&gt;&lt;/b&gt;&lt;b&gt;:&lt;/b&gt; Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Physical&lt;/u&gt;&lt;/b&gt;&lt;b&gt;:&lt;/b&gt; Ability to sit at a desk for extended periods while operating a computer and phone system. Travel as required.&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;u&gt;Auditory/Visual&lt;/u&gt;&lt;/b&gt;&lt;b&gt;:&lt;/b&gt; Hearing, vision and talking&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;p&gt;The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;p style=&quot;text-align:left&quot;&gt;Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.&lt;/p&gt;&lt;p style=&quot;text-align:inherit&quot;&gt;&lt;/p&gt;&lt;h2&gt;&lt;span&gt;If you&amp;#39;re excited about this role but your experience doesn&amp;#39;t align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. &lt;/span&gt;&lt;/h2&gt;

Disability Representative Sr

Ryder System

<div>Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) .
Job Description :
Job Description Summary
Experienced with handling Auto Liability claims to include under Ryder's self-insured, self-administered liability program. Familiar with coverage / contracts. Customer focused and self-motivated. Experience with Commercial Auto claims is a plus.
SUMMARY
The Liability Claim Representative II handles low to mid-range bodily injury claims and property damage claims.
ESSENTIAL FUNCTIONS
<ul><li>Investigates and adjusts claims, as well as directs independent adjusters, experts, and other vendors in the claim handling processes</li>
<li>Interacts, on an on-going basis, with field and operations management, legal counsel, safety managers, customers, insurance carriers, and third party claimants</li>
<li>Manages litigation to ensure claims are handled appropriately, according to the applicable jurisdiction</li>
<li>Assists Claim Manager in the identification of exposures and recommends solutions</li>
<li>Manages indemnity and expense costs properly</li>
<li>Interacts with primary and excess insurance carriers, and re-insurers on files meeting reporting thresholds</li>
<li>Alerts Claim Manager to changes and proposed changes in laws that could impact Ryder's liability program</li>
<li>Updates field operations personnel on claim status when requested</li>
<li>Supervises outside vendors and experts retained to assist in the investigation</li>
<li>Recommends and sets reserves to ensure the reserves represent the probable ultimate payout based on documented file developments</li>
</ul>ADDITIONAL RESPONSIBILITIES
Performs other duties as assigned
EDUCATION
Preferred Bachelor's degree and/or a minimum of two (2) years&rsquo; experience in casualty claims
EXPERIENCE
Two (2) years or more experience in casualty claims
Licenses are a plus
SKILLS
<ul><li>Demonstrated ability to handle and resolve low-to-mid range liability exposures</li>
<li>Requires strong claim technical skills</li>
<li>Strong commitment to the principles of customer focus</li>
<li>Effective interpersonal skills and ability to communicate clearly in verbal and written communications</li>
<li>Strong negotiation skills and ability to deal effectively with insurers</li>
</ul>KNOWLEDGE
<ul><li>Understanding of relevant laws and regulations governing liability claims in the U.S.; beginner level.</li>
<li>Understanding of insurance coverage; beginner level.</li>
<li>Comprehensive understanding of relevant laws and regulations; beginner level.</li>
<li>Will need to obtain specific licenses if needed</li>
</ul>TRAVEL
1-10%
Job Category: Risk Management
Compensation Information :
The compensation offered to a candidate may be influenced by a variety of factors, including the candidate&rsquo;s relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. The position may also be eligible to receive an annual bonus, commission, and/or long-term incentive plan based on the level and/or type. Compensation ranges for the position are below:
Pay Type :
Salaried
Minimum Pay Range:
$70,900.00
Maximum Pay Range:
$76,900.00
Benefits Information :
For all Full-time positions only : Ryder offers comprehensive health and welfare benefits, to include medical, prescription, dental, vision, life insurance and disability insurance options, as well as paid time off for vacation, illness, bereavement, family and parental leave, and a tax-advantaged 401(k) retirement savings plan.
For more information about benefits, click here (https://ryder.icims.com/icims2/servlet/icims2?module=AppInert&amp;action=download&amp;id=4022345&amp;hashed=256118533) to download the comprehensive benefits summary.
Ryder is proud to be an Equal Opportunity Employer and Drug Free workplace.
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Important Note :
Some positions require additional screening that may include employment and education verification; motor vehicle records check and a road test; and/or badging or background requirements of the customer to which you are assigned.
Security Notice for Applicants:
Ryder will only communicate with an applicant directly from a [@ryder.com] email address and will never conduct an interview online through a chat type forum, messaging app (such as WhatsApp or Telegram), or via an online questionnaire. During an interview, Ryder will never ask for any form of payment or banking details and will never solicit personal information outside of the formal submitted application through www.ryder.com/careers .
Should you have any questions regarding the application process or to verify the legitimacy of an interview or Ryder representative, please contact Ryder at careers@ryder.com .
Current Employees :
If you are a current employee at Ryder, please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process.
Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) .
\#wd</div>

Claims Representative II - REMOTE

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