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claims specialist

AXIS Capital

<div><div>This is your opportunity to join AXIS Capital &ndash; a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.</div><div></div><div>
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.</div><div></div><div>
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.</div><div></div><div>
Cyber/Media Claims Specialist &ndash; Salary Grade I<br>
<br>
This is your opportunity to join AXIS Capital &ndash; a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.<br>
<br>
At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.<br>
All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.<br>
<br>
'Please note this role requires hybrid work, with in office attendance 3 days a week. The role can be based in any of these Axis office locations: NYC, Short Hills - NJ, Red Bank &ndash; NJ, Princeton &ndash; NJ, Alpharetta, Kansas City, or Chicago.<br>
<br>
Exercises critical thinking, proper judgment and decision making in a best practices claim environment to promptly analyze the claim exposure, determine the proper course of action, and pursue claims to conclusion.<br>
<br>
Set accurate and timely claim reserves and make referrals to senior members of the team where necessary.<br>
<br>
Obtain relevant policies, review policy wordings to validate coverage for claims and escalate any issues arising.<br>
<br>
Prepare coverage positions to be reviewed and approved by Claim Manager.<br>
<br>
Work closely with Insureds, Claimants, attorneys and brokers ensuring a premier and best practices claim service is maintained, escalating issues as appropriate.<br>
<br>
Documents claim file notes, stores electronic documents, documents claim details in an effective and timely manner.<br>
<br>
Develop a working knowledge of the legal frameworks and claims handling practices relevant to the jurisdictions in which the claims arise.<br>
<br>
Monitor and investigate assigned claims and develop resolution strategy.<br>
<br>
Attend mediation, arbitration and other claim meetings as needed.<br>
<br>
Participate in presentations and discussions with Underwriters.<br>
<br>
Additional responsibilities for this role include validation of indemnity and fee payments, ensuring these are processed accurately and promptly, including monitoring and processing of claims bordereaux and ISO searches and reporting.<br>
<br>
Ensure file set up accurately with proper coding, LOB, Danger Signal and CAT Codes.<br>
<br>
REQUIRED EDUCATION/TRAINING &amp; EXPERIENCE:<br>
Bachelor&rsquo;s degree or equivalent; JD a plus.<br>
Claims adjuster license required; valid adjusting licenses in required states and additional states as needed<br>
Minimum of 2-5 years claim adjusting experience required.<br>
Experience handling cyber primary and excess claims, including first party and third-party privacy liability claims, and media liability claims. Experience handling technology errors and omissions is a plus.<br>
Attain expert comfort level in remote and work from home virtual working practices and platforms<br>
Excellent written and verbal communication skills, to liaise with numerous customers, both internal and external<br>
Solid understanding of individual and group performance metrics and KPIs<br>
Experience with Excel, Word, PowerPoint, OneNote and SharePoint a plus<br>
Availability for occasional travel<br>
Team player who has a positive outlook, flexible, organized, efficient and timely<br>
For this position, we currently expect to offer a base salary in the range of $87K-115K. The specific salary offer will be based on an assessment of a variety of factors including the experience of the successful candidate and their work location. <i>Where this role is based in the United States of America, this role is</i><i> </i><i>Exempt</i><i> </i><i>for FLSA purposes.</i></div></div><div></div>

Cyber/Media Claims Specialist

<div></div><div><div>Primary Details</div>
Time Type: Full time<div></div>
Worker Type: Employee<div></div><div>
Senior Claims Specialist Construction Liability</div><div></div><ul><li><div>
Location: USA &ndash;New York NY, Atlanta GA, Boston MA and Chicago, ILL</div></li><li><div>
Work Arrangement: Hybrid</div></li><li><div>
The salary range for this role is: $ 112,000-210,000</div></li></ul><div></div><div>
The Opportunity</div><div></div><div>
Manages the complete investigation, evaluation and resolution of assigned portfolio of claims emanating from Construction Auto Liability and General Liability claims, including high‑severity bodily injury, catastrophic loss, and multi‑party construction defect matters. Engages, directs and manages external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants across highly complex portfolio of matters.</div><div></div><div>
Primary Responsibilities<br>
<br>
Manage a diverse portfolio exclusively of high severity claims which includes conducting fact, liability and loss investigations and interpreting insurance contracts in an effective and efficient manner<br>
<ul><li>Evaluate and negotiate the resolution of assigned claims in a timely manner, within appropriate authority and in accordance with applicable laws, regulations, statutes, best practices and Department of Insurance (DOI) compliance</li><li>Drive the highest level of customer care, responsiveness, and satisfaction when managing assigned claims to deliver superior claim outcomes</li><li>Collaborate with outside representative counsel to formulate litigation strategy ensuring achievement of desired outcome and effective litigation management strategies</li><li>Directs and manage external advisors and vendors including legal service professionals, discovery vendors, data and security experts and consultants.</li><li>Oversee projects and planning surrounding departmental initiatives to achieve strategic objectives</li><li>Analyze, develop and determine appropriate case reserves on all assigned claim files and recommend changes where necessary to ensure actuarial accuracy</li><li>Advise on specific Construction areas of specialization and coordinates efforts to disseminate information and guide learning and thought leadership in those areas; serve as the subject matter expert</li><li>Represent QBE by participating in and attending industry seminars or authoring articles pertaining to Construction subjects</li><li>Collaborate with Underwriters to identify, understand and address novel or complex risks to appropriately price and negotiate terms including participation in sales calls and requests for proposals (RFPs)</li><li>Manage relationships with external vendors to deliver accurate, timely, and cost effective solutions.</li><li>Take ownership for personal development and career planning, and development of required skills, tools, techniques, and technology to continually add value to the organization.</li><li>Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility</li></ul><br>
Required Education<br>
<br>
<ul><li>Bachelor's Degree or equivalent combination of education and work experience</li></ul><br>
Required Experience<br>
<br>
<ul><li>8 years relevant experience</li></ul><br>
Preferred Competencies/Skills<br>
<br>
Generate original, innovative solutions to difficult or unusual situations<br>
<ul><li>Identify and locate information and facts which are necessary and relevant for the purposes of evaluating a claim</li><li>Financial and business acumen and awareness of financial responsibility</li><li>Quickly change direction when working on multiple projects or issues</li><li>Properly document investigation findings and preserve evidence in accordance with internal and external laws and procedures</li><li>Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems</li><li>Assume a methodical approach to a given situation and develop a systematic procedure as a response</li><li>Develop effective negotiation strategies and prepare a plan of action</li><li>Build and capitalize on beneficial internal and external relationships including competitors</li><li>Actively contributes towards continuously improving performance and mentor team with feedback, on-the-job skill enhancement opportunities and career advice</li><li>Build and establish constructive and cooperative working relationships and open lines of communication</li><li>Utilize effective communication skills to influence and persuade decision makers</li><li>Manage a diverse and extensive portfolio of Construction liability claims with varying levels of complexity and activity.</li><li>Collaborate with internal resources to resolve difficult claims situations and drive resolution opportunities with internal and external stakeholders</li></ul><br>
Preferred Education<br>
<br>
<ul><li>Juris Doctorate</li></ul><br>
Preferred Experience<br>
<br>
<ul><li>Experience handling Construction liability matters including Auto Liability, General Liability and Construction Defect claims.</li></ul><br>
Preferred Knowledge</div><div>
Advanced working knowledge of current and possible future Construction products, policies, practices, trends, technology and information affecting the business and organization; knows how the business works<br>
<ul><li>Advanced working knowledge of relevant Construction claims legal and technical knowledge for all US jurisdictions</li><li>Advanced working knowledge of insurance policy and contract language</li><li>Advanced working knowledge of business and management principles involved in strategic planning, resource allocation, leadership technique and coordination of people and resources</li><li>Advanced working knowledge of experts in field of concentration, including attorneys, mediators, judges and experts</li></ul></div><div></div><div>
Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate&rsquo;s professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE&rsquo;s annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.</div><div></div><div>
QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:</div><ul><li><div>
Hybrid Working &ndash; a mix of working from home and in the office</div></li></ul><ul><li><div>
22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis</div></li></ul><ul><li><div>
Competitive 401(k) program with company match up to 8%</div></li></ul><ul><li><div>
Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice</div></li></ul><ul><li><div>
Tuition Reimbursement for professional certifications, and continuing education</div></li></ul><ul><li><div>
Employee Network and Community &ndash; QBE actively supports six Employee Networks, and many ways to give back to your community</div></li></ul><div></div><div>
To learn more, click here: <div>Benefits | QBE US</div>.</div><div></div><div>
Why QBE? What if you could have a positive impact &ndash; at work and in the world?</div><div>
At QBE, we&rsquo;re enabling a more resilient future &ndash; for our customers, communities, environment, and for our people. We&rsquo;re building momentum to achieve something significant and know our people are at the center of our success.</div><div>
Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you&rsquo;ll get to spend every day working with people who are passionate, talented and kind. And our international scale means we&rsquo;re big enough for your ambitions, yet small enough for you to make a real impact.</div><div>
Join us now, so you can be part of our success &ndash; and we can be part of yours!</div><div><div>
https://www.linkedin.com/company/qbe-north-america/</div></div><div></div><div><br>
QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.</div><div></div><div><br>
Equal Employment Opportunity:</div><div>
QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status.</div><div></div><div>
This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship.</div><div></div><div><div><br>
Supplementary information</div></div><div></div><div>
Global Disclaimer:</div><div></div><div>
The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee&rsquo;s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.</div><div></div><div>
US Only Disclaimer:</div><div></div><div>
To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.</div><div></div><div>
US Only - Travel Frequency:</div><div></div><div>
Infrequent (approximately 1-4 trips annually)</div><div></div><div>
US Only - Physical Demands:</div><div></div><div>
General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs.</div><div></div><div>
Skills:</div>
Adaptability, Claims Settlement, Commercial Acumen, Conflict Resolution, Critical Thinking, Customer Value Management, Insurance Claims Processing, Intentional collaboration, Managing performance, Mentorship, Personal Initiative, Project Delivery, Regulatory Compliance, Risk Management, Team Development<div></div><div>
How to Apply:</div><div>
To submit your application, click &quot;Apply&quot; and follow the step by step process.</div><div></div><div>
Equal Employment Opportunity:</div><div>
QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.</div></div>

Senior Claims Specialist Construction Liability

Argo Group

<div><p><b>Company
</b></p>Argo Group
<p></p><p>Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.<br>
</p><p><br>
<b>Job Description
</b></p><p></p><div><div><p><b>Business Title(s): </b>Senior Technical New York Labor Law Claims Specialist
</p></div><div><p><b>Employment Type: </b>Full-Time
</p></div><div><p><b>FLSA Status: </b>Exempt
</p></div><div><p><b>Location: </b>In-Office
 </p></div><div><p>____________________________________________________________________________
</p></div><div><p><b>Summary:
</b></p></div><div><p>Due to continued growth, we are looking for a highly capable Senior Technical New York Labor Law Claims Specialist to join our team and work from our New York City office. We work together in the office five days a week in order to strengthen our culture, build team connections, and drive profitability. This role will be adjudicating claims of general liability, third party property damage, and third party bodily injury with a focus on New York Labor Law.<br>
<br>
</p></div><div><p>This is a 100% in -office position. Candidates must be able to work on-site at a designated company office during standard business hours.<br>
<br>
</p></div><div><p><b>Essential Responsibilities </b><b>:
</b></p></div><div><ul><li><p>Working under limited oversight under broad management direction, adjudicate New York Labor Law claims at the highest authority limits on assignments reflecting the highest degree of technical complexity, potentially with major impact on departmental results.
</p></li></ul></div><div><ul><li><p>Conducting detailed information gathering, analysis and investigation to find solutions to issues that are numerous and undefined.
</p></li></ul></div><div><ul><li><p>Reporting to senior management and underwriters on claims trends and developments.
</p></li></ul></div><div><ul><li><p>Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.
</p></li></ul></div><div><ul><li><p>Investigating claims promptly and thoroughly, including interviewing all involved parties.
</p></li></ul></div><div><ul><li><p>Managing claims in litigation
</p></li></ul></div><div><ul><li><p>Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
</p></li></ul></div><div><ul><li><p>Properly setting claim reserves, taking into account how different policy wordings impact the claims reserving process.
</p></li></ul></div><div><ul><li><p>Identifying loss drivers and claims trends to reduce claims frequency and severity through data analysis and improved claim management.
</p></li></ul></div><div><ul><li><p>Identifying , assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution.
</p></li></ul></div></div><div><div><ul><li><p>Preparing reports for file documentation
</p></li></ul></div><div><ul><li><p>Applying creative solutions which result in the best financial outcome.
</p></li></ul></div><div><ul><li><p>Negotiating highly complex settlement packages within scope of authority in order to settle claims in most cost effective manner.
</p></li></ul></div><div><ul><li><p>Processing mail and prioritizing workload.
</p></li></ul></div><div><ul><li><p>Responsible for telephone calls and written correspondence to/from various parties (insured, claimant, etc.).
</p></li></ul></div><div><ul><li><p>Having an appreciation and passion for strong claim management.<br>
<br>
</p></li></ul></div><div><p><b>Qualifications / Experience Required:
</b></p></div><div><ul><li><p>A deep knowledge of adjudicating New York Labor Law claims, as well as exceptional customer service focus, typically achieved through a minimum of:
</p></li></ul></div><div><ul><li><p>Seven years&rsquo; experience adjudicating commercial general liability claims with a focus on New York Labor Law.
</p></li></ul></div><div><ul><li><p>Bachelor&rsquo;s degree from an accredited university required . Juris Doctor from an accredited law school is strongly preferred . Two or more insurance designations or four additional years of related experience adjudicating environmental claims beyond the minimum experience required above may be substituted in lieu of a degree.
</p></li></ul></div><div><ul><li><p>Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers&rsquo; ability to be profitable).
</p></li></ul></div><div><ul><li><p>Ability to regularly exercise discretion and independent judgment with respect to matters of significance.
</p></li></ul></div><div><ul><li><p>A strong focus on execution in getting things done right . Proven ability to consistently produce and deliver expected results to all stakeholders by:
</p></li></ul></div><div><ul><li><p>Finding a way to achieve success through adversity.
</p></li></ul></div><div><ul><li><p>Being solution (not problem) focused
</p></li></ul></div><div><ul><li><p>Thinking with a global mindset first.
</p></li></ul></div><div><ul><li><p>Must have excellent communication skills and the ability to build lasting relationships.
</p></li></ul></div><div><ul><li><p>Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
</p></li></ul></div><div><ul><li><p>Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast-paced environment that is evolving constantly.
</p></li></ul></div><div><ul><li><p>Excellent evaluation and strategic skills required .
</p></li></ul></div></div><div><div><ul><li><p>Strong claim negotiation skills a must .
</p></li></ul></div><div><ul><li><p>Knows how claims reserving techniques are used and how to assess whether a claim reserve is accurate .
</p></li></ul></div><div><ul><li><p>Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information.
</p></li></ul></div><div><ul><li><p>Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
</p></li></ul></div><div><ul><li><p>Demonstrates innovative thinking and regularly shares ideas to help the team whenever possible
</p></li></ul></div><div><ul><li><p>Intellectual curiosity . Consistently considers all options and is not governed by conventional thinking.
</p></li></ul></div><div><ul><li><p>Client focus &ndash; the ability to effectively determine specific client needs and to provide value added solutions.
</p></li></ul></div><div><ul><li><p>Ability to articulate the financial value of your work at multiple responsibility levels inside our clients&rsquo; business which may include CEO.
</p></li></ul></div><div><ul><li><p>Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis .
</p></li></ul></div><div><ul><li><p>Proficient in MS Office Suite and other business-related software.
</p></li></ul></div><div><ul><li><p>Polished and professional written and verbal communication skills in order to present information accurately and effectively.
</p></li></ul></div><div><ul><li><p>The ability to read and write English fluently is required .
</p></li></ul></div><div><ul><li><p>Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.
</p></li></ul></div><div><ul><li><p>Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims. within 120 Days<br>
<br>
</p></li></ul></div><div><p>The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary, all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package.
</p></div><div><ul><li><p><b>New York City Pay Range: </b>$165,000 - $227,500<br>
</p></li></ul></div><p></p><div><p><b>About Working in Claims at Argo Group
</b></p></div><div><p>Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful.<br>
<br>
</p></div><div><p>Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.<br>
<br>
</p></div></div><div><p>We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses.<br>
<br>
</p></div><div><p>Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.<br>
<br>
</p></div><div><p>We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
</p></div><p></p><div><p><b><i>PLEASE NOTE:
</i></b></p><p>Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.
</p><p></p><p>If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at 210-321-8400.
</p><p></p><p><b>Notice to Recruitment Agencies:
</b><br>
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.
</p><p></p><p>We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
</p><p></p><p>The collection of your personal information is subject to our HR Privacy Notice
</p><p></p><p><b>Benefits and Compensation
</b></p><p>We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program&mdash;including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.</p></div></div><p></p>

Senior Technical New York Labor Law Claims Specialist

NYC Health + Hospitals

<div><div><div><h2 class="jobSectionHeader"><b>About NYC Health + Hospitals</b></h2><div><br>
<div><div>
</div><p>MetroPlus<b>Health</b> provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus<b>Health</b>'s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus<b>Health</b> has been committed to building strong relationships with its members and providers.</p><p><b>
Position Overview</b></p><p>
As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post-paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position will be responsible for responding to inquiries from providers whose claims may be paid incorrectly and performing accurate data entry and maintenance accurate records and files.</p><br>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Work Shifts</b></h2><div><br>
<div><div>
</div><p><b>9:00 A.M &ndash; 5:00 P.M</b></p><br>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>
Duties &amp; Responsibilities</b></h2>
<div>
<div></div><div><ul><li>High School Degree or evidence of having passed a High School Equivalency Program required. Associate degree preferred.</li><li>
Minimum 2 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required.</li><li>
Experience using a PC and claim adjudication system(s)</li><li>
Experience using Customer Relationship Management (CRM) software; Salesforce is a plus.</li><li>
Experience working with large data and spreadsheets.</li><li>
Knowledge of medical terminology, CPT, ICD-10, and Revenue Codes</li><li>
Processing of Medical Claim Forms (HCFA, UB04)</li><li>
Knowledge of Medical Terminology</li><li>
Knowledge of HIPPA Guidelines regarding Protected Health Information</li><li>
Data Entry of Provider Claim/Billing information</li><li>
Experience handling or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.</li></ul><p><b>
Professional Competencies</b></p><ul><li>
Integrity and Trust</li><li>
Customer Focus</li><li>
Functional/Technical skills</li><li>
Written/Oral Communication</li><li>
Strong Analytical Skills</li><li>
Knowledgeable in MS Word and Excel</li></ul>
</div></div></div></div><div><div><h2 class="jobSectionHeader"><b>Benefits</b></h2><div><br>
<div><div>
</div><p>NYC Health and Hospitals offers a competitive benefits package that includes:</p><ul><li>
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week</li><li>
Retirement Savings and Pension Plans</li><li>
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts</li><li>
Loan Forgiveness Programs for eligible employees</li><li>
College tuition discounts and professional development opportunities</li><li>
College Savings Program</li><li>
Union Benefits for eligible titles</li><li>
Multiple employee discounts programs</li><li>
Commuter Benefits Programs</li></ul></div></div></div></div></div>

Claims Adjustment Specialist I

Great American Insurance Group

<div><p><b>Be Here. Be Great. </b>Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a &quot;small company&quot; culture where your ideas will be heard with &quot;big company&quot; expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.</p><p></p><p>
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.</p><p></p><p>
Our Fidelity/Crime Division underwrites fidelity &amp; crime, kidnap &amp; ransom, and fine art policies worldwide. Customers include Fortune 500 publicly traded companies, privately held companies, financial institutions, and governmental entities. Coverages offered include employee dishonesty/theft, forgery, on premises, computer fraud, as well as kidnap &amp; ransom and extortion coverage. These coverages are offered for diverse classes of business including specialized industries such as gaming, security guards, check cashers, armored car companies, and programmatic business.</p><p></p><p>
We are looking for applicants ideally in East Brunswick, New Jersey, New York City, New York, Windsor, Connecticut, Chicago, Illinois, Richmond, Virginia, or Cincinnati, Ohio. We are, however, open to fully remote candidates depending on the successful applicant&rsquo;s level of experience, amongst other factors.</p><p></p><p>
Great American&rsquo;s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in‑office days are Tuesday&ndash;Thursday, with the fourth day determined by business needs.</p><p></p><p>
Essential Job Functions and Responsibilities</p><ul><li>
Investigates claims:<ul><li>
Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, reports or other documents) in the investigation of claims.</li><li>
Maintains claim documentation.</li><li>
Reviews and evaluates coverage.</li></ul></li><li>
Works toward the successful resolution of claims, and attends arbitrations, mediations, depositions, or trials as necessary.</li><li>
Settles matters and sets reserves within prescribed limits and submits recommendations to supervisor on cases exceeding authority.</li><li>
Conveys complex information (coverage, decisions, outcomes, negotiations, etc.) to all appropriate parties while maintaining a professional demeanor in all situations.</li><li>
Ensures that claims payments are issued in a timely and accurate manner and that claims handling is conducted in compliance with applicable statutes, regulations, and other legal requirements, while following all applicable company procedures and policies.</li><li>
Provides technical advice to lower-level positions and other functional areas, where appropriate.</li><li>
May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.</li><li>
Performs other duties as assigned.</li></ul><p></p><p>
Job Requirements</p><ul><li>
Education: Bachelor&rsquo;s Degree or equivalent experience.</li><li>
Field of Study: Liberal Arts, Business or a related discipline.</li><li>
Experience: Generally, 5 or more years of related experience.</li></ul><p></p><p>
This job is non-exempt in California and Washington.</p><p></p><p><b>
Business Unit:</b></p>
Fidelity / Crime<p></p><p><b><br>
Salary Range:</b></p>
$80,000.00 -$131,000.00<p></p><p><b>
Benefits:</b></p><p>
We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.</p><p></p><p><br>
Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.</p><p></p><ul><li><br>
<b>Excludes seasonal employees and interns.</b></li></ul></div>

Senior Claims Representative/Claims Specialist-Fidelity and Crime

SCOR

<div><p>Senior Claim Experts are hands-on managers of individual higher exposure/complicated claims; expected to regularly conduct outside claim audits, market and client visits; initiate regular contact with underwriters, actuaries and accounting staff; and have the ability to review and analyse overall loss portfolios. A comfort level with technology is required as the digitalization of our departmental operations is a key part of our corporate strategy. While many meetings can be conducted remotely, the role will require business travel from time to time. The position reports to the Vice President Head of Claims - Americas.</p></div>
<br><div><ul><li><p>Oversee and manage a portfolio of Excess Casualty (General Liability, Umbrella, Wrap policies) insurance claims P&amp;C accounts which entails:
</p></li><li><p>Superior claim knowledge and expertise
</p></li><li><p>E valuating, developing, reporting on and resolving complex and/or higher value claims and/or loss bordereaux.
</p></li><li><p>Capability to develop market lead status in market committees or litigation.
</p></li><li><p>Ability to formulate independent views on coverage, liability and quantum and provide timely reporting.
</p></li><li><p>Approving financial transactions on claims within authority. This includes assessing and evaluating liability, coverage, and quantum, as well as establishing and updating reserves (as appropriate).
</p></li><li><p>Manage the lifecycle of a claim to achieve an optimal outcome for Scor, including the positioning of reserves, engagement of third parties (including but not limited to legal counsel, loss adjusters, forensic accountants etc), attendance at market/settlement meetings and/or forums for the resolution of the claim (mediation, arbitration, court etc).
</p></li><li><p>Collaborating and assisting in the management of assigned accounts or product line business, often with other internal department representatives and providing marketing support relating to cedents, insured and/or brokers.
</p></li><li><p>Conducting claim audits and/or participating in active reviews of service providers and providing marketing support relating to insureds, cedents, and brokers.
</p></li><li><p>Analyzing loss and expense trends on product line business, emerging risks and large losses; assisting in the development and implementation of plans to improve results.
</p></li><li><p>Anticipating client needs and expectations and delivering superior customer service.
</p></li><li><p>Working collaboratively with others within the claim department, particularly with other claim experts and those staffing the claim analyst or technical accounting unit, to ensure prompt turnaround and response to clients.
</p></li><li><p>Excellent organizational skills and ability to consistently meet deadlines. High degree of accountability, both personally and within the team.
</p></li><li><p>Contributing to the company&rsquo;s international community of claims expertise by sharing knowledge and experience on a global basis.
</p></li><li><p>Keeping abreast of claim and industry developments/trends in order to maintain a high level of expertise.
</p></li><li><p>Leading or participating in projects as required.
</p></li><li><p>Coaching, mentoring, and assisting in the training of more junior claim staff.
</p></li><li><p>Participate in operational performance reviews and establish a culture of continuous improvement to support overall claim strategy of providing a &ldquo;Centre of Excellence&rdquo; in claims.
</p></li><li><p>Excellent verbal and written communication skills. At ease with presenting findings, ideas, and other information in front of a group at Senior Management level.
</p></li><li><p>Participating in projects as required.</p></li></ul></div>
<br><p></p><div><ul><li>10+ years of Product line business P&amp;C claim handling experience.
</li><li>Expertise in managing a caseload of more complex claims.
</li><li>Ability to manage and organize and analyze data.
</li><li>Some managerial experience is a positive; whether people, projects and/or accounts.
</li><li>Handling of claims across international geographies a benefit.
</li></ul><p><b>Personal Competences:
</b></p><ul><li>Superior claim knowledge and expertise.
</li><li>Acute focus on customer service.
</li><li>Strong persuasive and people management skills.
</li><li>Developing experience in leadership in client engagement and/or litigation dispute resolution.
</li><li>Effective in communicating all trends and major claim for product lines within the business area.
</li><li>Exceptional team player while capable of operating independently.
</li><li>Excellent verbal and written communication skills. Able to write technical claims reports for segment at a high standard for distribution at senior leadership level.
</li><li>Ability to analyze data and information.
</li><li>At ease with presenting findings, ideas, and other information in front of a group. Ability to marshal resources to achieve desired outcomes.
</li><li>Comfort level with technology.
</li><li>A thought leader, particularly within the product line business, leading on initiatives and driving innovation.
</li><li>Holds self to account; owns the solution and takes personal responsibility and accountability.
</li><li>Comfortable having challenging conversations, including 360 feedback, constructively critical and analytical.
</li>Sets example of honesty, integrity, and respectfulness in all dealings.<br>
<li>
</li></ul><p></p><div><b>Relocation assistance within the U.S. is available for this position. Candidates must have valid authorization to work in the U.S. without the need for employer sponsorship now or in the future.<br>
</b></div><div></div><div><b><i>Hybrid Work Policy: </i></b><i>SCOR is committed to an &ldquo;in-office&rdquo; culture where people can collaborate, exchange ideas, and establish stronger working relationships while still providing flexibility. To support employee work-life balance and increase opportunities for employees to excel every day, SCOR operates with a hybrid working arrangement. SCOR employees work 3 days per week in an office with the flexibility to work 2 days per week remotely.<br>
</i></div><div></div><div><i>At SCOR, we CARE about clients, people, and societies, and we are committed to placing them at the center of everything we do. Providing great benefit choices to you and your family is just one of the ways we support the physical, financial, and emotional well-being of the people who make our company successful &ndash; you.<br>
</i></div><div></div><div><b><i>Benefits We Offer
</i></b></div><div><i>&bull; Medical, vision, and dental coverage
</i></div><div><i>&bull; 401(k) Plan with a competitive match
</i></div><div><i>&bull; Company-funded Defined Contribution Retirement Program
</i></div><div><i>&bull; Life and AD&amp;D insurance
</i></div><div><i>&bull; Long- and Short-Term Disability
</i></div><div><i>&bull; Flexible Parental Leave
</i></div><div><i>&bull; Unlimited Sick Days
</i></div><div><i>&bull; Volunteer Time
</i></div><div><i>&bull; Summer Fridays
</i></div><div><i>&bull; Learning &amp; Development Resources
</i></div><div><i>&bull; Personal Wellness Tools and Rewards
</i></div><div><i>&bull; Competitively priced gym memberships from a large nationwide network of gym brands and local fitness studios
</i></div><div><i>&bull; And More!<br>
</i></div><div></div><div><i>SCOR welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process.<br>
</i></div><div></div><div><b><i>Compensation: </i></b><i>Pay Range for roles performed in Illinois: $[136,500 - 184,500] base salary per year. Pay Range for roles performed in New York: $[148,000 - 200,500] base salary per year. Actual salaries may vary based on various factors including but not limited to location, experience, role and performance. The range listed is just one component of SCOR's total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives. In addition, we provide a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement saving plan, paid holidays and paid time off.&quot;</i></div></div><div></div>
<br><div><p>As a leading global reinsurer, SCOR offers its clients a diversified and innovative range of reinsurance and insurance solutions and services to control and manage risk. Applying &ldquo;The Art &amp; Science of Risk,&rdquo; SCOR uses its industry-recognized expertise and cutting-edge financial solutions to serve its clients and contribute to the welfare and resilience of society in around 160 countries worldwide.
</p><p>Working at SCOR means engaging with some of the best minds in the industry &ndash; actuaries, data scientists, underwriters, risk modelers, engineers, and many others &ndash; as we work together to find solutions to pressing challenges facing societies.
</p><p>As an international company, our common culture is defined by &ldquo;The SCOR Way.&rdquo; Serving both to build momentum that drives the Group forward and as a compass to guide our actions and choices, The SCOR Way is anchored by five core values, reflecting the input of employees at all levels of the Group. We care about clients, people, and societies. We perform with integrity. We act with courage. We encourage open minds. And we thrive through collaboration.
</p><p>SCOR supports inclusion and the diversity of talents, and all positions are open to people with disabilities.</p></div>

AVP, Senior Claims Expert

Zurich Insurance

<div><p>Zurich is currently looking for a Legal Claims Professional for our growing Management Solutions group.</p><p><br>
If you are ready for a career move, consider working for a company with a global footprint that offers terrific benefits including an incentive plan, 401K match and an additional 401K contribution, flexible work options, work/life balance, summer hours and a great culture.</p><p><br>
The Claims Professional will handle Private/Non-Profit D&amp;O, EPL, and Fiduciary claims of moderate to high complexity under limited supervision. The ideal candidate will have experience reviewing complaints and all other legal pleadings and discovery, arbitration demands, coverage analysis, determining exposure and setting appropriate reserves. They will resolve claims according to Best Practices and within authority limits. They will regularly communicate with customers and brokers and may be dedicated to handle claims for specific accounts.<br>
</p><p><br>
Additional responsibilities include:<br>
</p><p></p><ul><li>Analyze coverage, liability, damages and exposure</li><li>
Participate in mediations and settlement negotiations</li><li>
Draft reservation of rights and coverage denial letters</li><li>
Notify Underwriter of claim issues</li><li>
Draft case summary reports in connection with significant reserve increases and trial preparation</li><li>
Direct and engage with the activities of defense counsel</li></ul><p></p><p><br>
At Zurich North America we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected. The candidate selected for this opportunity should be able to report into our Manhattan NY; Parsippany NJ; or Schaumburg IL office on a hybrid schedule.</p><p></p><p><br>
Basic Qualifications:<br>
<br>
<br>
</p><ul><li>Juris Doctor and 5 or more years of experience in the Legal area<br>
AND</li><li>
JD and 5 or more years of legal practice experience in the insurance area
</li><li>Must obtain and maintain required adjuster license(s)</li><li>
Experience in insurance claims and the insurance legal and regulatory environment</li><li>
Negotiation experience</li><li>
Customer service experience</li><li>
Microsoft Office experience</li></ul><div></div><div><br>
Preferred Qualifications:<br>
<br>
<br>
</div><ul><li>Member of the Bar</li><li>
Claims handling experience including Private/Non-Profit D&amp;O, EPL, Fiduciary and/or insurance coverage defense</li><li>
Analytical skills</li><li>
Strong communication skills</li><li>
Ability to multi-task</li><li>
Organization and time management skills</li><li>
Ability to work independently</li><li>
Experience collaborating across work groups</li><li>
Insurance designations such as SCLA, CPCU, AIC</li></ul><div></div><p><br>
</p><p>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 pay range shown is a national average and may vary by location. The proposed Salary range for this position is $135,000.00 - $165,000.00, with short-term incentive bonus eligibility set at 15%.</p><p></p><p><br>
We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.]</p><p></p><p><b><br>
Why Zurich?</b></p><p>
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;.</p><p></p><p><br>
Join us for a brighter future&mdash;for yourself and our customers.</p><p></p><p><br>
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.</p><p></p><p><br>
Zurich complies with 18 U.S. Code &sect; 1033.</p><p></p><p><b><br>
Please note:</b> Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal.</p><p>
Location(s): AM - New York, AM - Parsippany, AM - Schaumburg<br>
Remote Working: Hybrid<br>
Schedule: Full Time<br>
Employment Sponsorship Offered: No<br>
<br>
Linkedin Recruiter Tag: #LI-KO1 #LI-ASSOCIATE #LI-HYBRID</p></div>

Legal Claims Professional - Financial Lines

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