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benefits specialist/case manager

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claims & project support specialist

claims specialist

Gallagher

<div>Introduction 
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div> 
Overview 
<ul><li>
Jurisdictions: NY, MA</li><li>
Licenses: Must have state license or reciprocal.</li><li>
Location: This role is fully remote work.</li></ul>
 
How you'll make an impact 
<ul><li>
Apply claims management experience to execute decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims.</li><li>
Interact extensively with various parties involved in the claim process to ensure effective communication and resolution.</li><li>
Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process</li><li>
Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements.</li></ul><div>
Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file</div> 
 
About You<div> 
Ideal candidates for this position will have:
 
<ul><li>Claims Background: Minimum 3 years of experience adjusting a workers compensation desk, including lost time/indemnity and litigation.</li><li>Jurisdictional Experience: NY, MA</li><li>Active Adjusters' licenses: Must have state license or reciprocal.</li></ul>
As a key member of our experienced Claims Adjuster team, you will:</div> 
<ul><li>
Investigate, evaluate, and resolve complex workers compensation claims applying your analytical skills to make informed decisions and bring claims to resolution.</li><li>
Work in partnership with our clients to deliver innovative solutions and enhance the claims management process.</li><li>
Think critically, solve problems, plan, and prioritize tasks to optimally serve clients and claimants.</li></ul><div> 
REQUIRED QUALIFICATIONS: 
 
<ul><li>High School Diploma.</li><li>Minimum of 3 years related claims experience.</li><li>Appropriately licensed and/or certified in all states in which claims are being handled.</li><li>Knowledge of accepted industry standards and practices.</li><li>Computer experience with related claims and business software.</li></ul></div><div> 
DESIRED: 
<ul><li>Bachelor's Degree</li></ul></div> 
#LI-Remote
#LI-AB2 
 
Compensation and benefits 
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you&rsquo;ll get, depending on your job level these benefits may improve:
<ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div>
Other benefits include:</div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</div><div></div><div> 
We value inclusion and diversity</div>
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</div>

Claims Adjuster Workers Compensation - NY, MA

Progressive Insurance

<div>
 
 Progressive is dedicated to helping employees move forward and live fully in their careers. Your journey has already begun. Apply today and take the first step to Destination: Progress.
 
 
 
 As a
 
 claims adjuster trainee
 
 , you&rsquo;ll learn how to help customers get back on the road after an accident. This is not a field position, which means you&rsquo;ll be building relationships with customers over the phone. In a fast-paced environment, you&rsquo;ll learn how to resolve a full case load of claims efficiently while managing the claims process from start to finish. You&rsquo;ll have the support of a collaborative team and ongoing coaching from leaders. We&rsquo;ll also teach you the insurance stuff &ndash; providing in-depth training on property damage and insurance contracts so you can confidently and independently adjust claims.
 
 
 This is a hybrid role, which means you&rsquo;ll work in-office two days that are selected by local leadership and choose where you want to work the other three days, whether that&rsquo;s at home or in the office, for a period of 12 months. After that period, the days you&rsquo;ll be expected to report to an office for important meetings, training, and collaboration will vary based on business need. In this hybrid work environment, you&rsquo;ll be supported by your leaders and tenured colleagues to develop relationships, establish connections, and share practices that are important to your development. If you prefer an in-office environment, you&rsquo;re welcome to work in the office as often as you would like.
 
 
 
 You must reside within 50 miles of Progressive's Rochester Claims office at 30 Becker Road, West Henrietta, NY 14586.
 
 
 
 
 Duties &amp; Responsibilities (upon Completion Of Training)
 
 
 
 <ul>
 <li>
 Determine coverage
 </li>
 <li>
 Determine liability (who&rsquo;s at fault for the damages)
 </li>
 <li>
 Interview customers, claimants, and witnesses
 </li>
 <li>
 Partner with appraisers/estimators to manage vehicle repairs
 </li>
 <li>
 Negotiate with customers and other insurance carriers and resolve claims
 
 
 </li>
 </ul>
 
 Must-have Qualifications
 
 
 
 <ul>
 <li>
 Three years of work experience OR
 </li>
 <li>
 Bachelor&rsquo;s degree OR
 </li>
 <li>
 Two years work experience and an associate degree
 
 
 </li>
 </ul>
 
 Schedule
 
 : During onboarding, Monday - Friday 8:30 AM - 5:30 PM. After training, Monday - Friday 8:00 AM - 5:00 PM or 9:00 AM - 6:00 PM, depending on business need
 
 
 
 Location
 
 : Rochester, NY
 
 
 
 Compensation
 
 
 
 <ul>
 <li>
 Once you complete training (which includes passing any necessary testing requirements), your salary will be $60,500 - $63,000/year. However, during training, you will be paid an hourly rate based on your annual salary.
 </li>
 <li>
 Gainshare annual cash incentive payment up to 16% of your eligible earnings based on company performance
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 401(k) with dollar-for-dollar company match up to 6%
 </li>
 <li>
 Medical, dental &amp; vision, including free preventative care
 </li>
 <li>
 Wellness &amp; mental health programs
 </li>
 <li>
 Health care flexible spending accounts, health savings accounts, &amp; life insurance
 </li>
 <li>
 Paid time off, including volunteer time off
 </li>
 <li>
 Paid &amp; unpaid sick leave where applicable, as well as short &amp; long-term disability
 </li>
 <li>
 Parental &amp; family leave; military leave &amp; pay
 </li>
 <li>
 Diverse, inclusive &amp; welcoming culture with Employee Resource Groups
 </li>
 <li>
 Career development &amp; tuition assistance
 
 
 </li>
 </ul>
 Energage recognizes Progressive as a 2025 Top Workplace for: Innovation, Purposes &amp; Values, Work-Life Flexibility, Compensation &amp; Benefits, and Leadership.
 
 
 Equal Opportunity Employer
 
 
 Applicants must be authorized to work for any employer in the U.S. without the need or potential need, of current or future sponsorship for employment. Progressive does not hire candidates with (e.g., F-1 CPT, OPT, or STEM OPT, H-1B, O-1, E-3, TN) statuses for this role.
 
 
 For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://www.progressive.com/careers/how-we-hire/faq/job-scams/
 
 
</div>

Claims Adjuster Trainee

TEEMA Group

<div><h2 class="jobSectionHeader">Commercial Auto &amp; General Liability Claims Examiner II</h2><h3 class="jobSectionHeader">
Role Summary</h3>
Empower your professional journey in a role that values intellectual curiosity and file ownership over high-volume &quot;churn.&quot; As a Claims Examiner II, you will manage and resolve complex Commercial Auto, No-Fault/PIP, and General Liability claims from initial intake through final disposition. This position is perfect for a strategic thinker who excels at evaluating exposure, guiding investigative strategy, and collaborating with legal counsel to achieve fair and efficient resolutions. You will join a stable, rapidly growing organization that prides itself on autonomy, high-quality claims administration, and a professional work environment.
Key Duties:<ul><li>
Technical Policy Analysis: Review and interpret complex insurance policies to accurately determine liability and coverage exposure.</li><li>
Comprehensive Claims Management: Independently investigate and evaluate Commercial Auto, PIP, and General Liability claims to ensure high-quality outcomes.</li><li>
Litigation Oversight: Direct and coordinate efforts with outside investigators, legal counsel, and various vendors to drive claim strategy.</li><li>
Financial Management: Evaluate total claims exposure to establish and maintain appropriate financial reserves.</li><li>
Negotiation &amp; Settlement: Develop and execute sophisticated settlement strategies and communicate recommendations to key stakeholders.</li><li>
Strategic Reporting: Prepare detailed loss reports that synthesize liability, damages, and coverage issues.</li><li>
Recovery Initiatives: Identify and pursue subrogation and risk transfer opportunities to protect client interests.</li><li>
Professional Communication: Provide elite-level service and maintain transparent communication with both internal and external stakeholders.</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
Experience: 2+ years of dedicated experience handling Commercial Auto and General Liability claims.</li><li>
Technical Mastery: Strong understanding of claims handling practices, coverage analysis, and litigation management.</li><li>
Communication: Exceptional written and verbal communication skills.</li><li>
Decision Making: Proven ability to evaluate complex data, make independent decisions, and negotiate effectively.</li><li>
Organizational Skills: Superior time management skills and proficiency with claims management software and standard computer applications.</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Specialized Expertise: Direct experience managing No-Fault/PIP claims.</li><li>
Education: Bachelor&rsquo;s degree or equivalent professional experience.</li><li>
Jurisdictional Knowledge: Familiarity with multi-jurisdictional claims handling requirements.</li><li>
Remote Proficiency: Ability to work productively and independently in a fast-paced, 100% remote environment.</li></ul><h3 class="jobSectionHeader">
Location and Work Type</h3><ul><li>
Location: 100% Fully Remote</li><li>
Work Type: Full-Time | Direct Hire</li><li>
Schedule: Standard Business Hours</li><li>
Benefits: Full suite of premium benefits, including medical, dental, vision, and Paid Time Off (PTO).</li></ul>
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you! 

#Workwolf</div>

Commercial Auto & General Liability Claims Examiner II

Fetch

<div>About Fetch

At Fetch, we're dedicated to helping pets live their healthiest and happiest lives. Our comprehensive insurance coverage is designed with modern pet parents in mind, and we're proud to support the veterinary, shelter, and breeder communities. We believe in ensuring pets receive the best care possible and are committed to making that vision a reality every day.

Fetch is a high-growth Warburg Pincus portfolio company with an expanding team of over 350 pet-loving employees working together to shape the future of pet health and wellness.

About the Industry

The pet insurance industry is more important than ever, offering peace of mind and financial protection for pet owners. The sector is expanding quickly, fueled by growing awareness of the need for accessible, high-quality veterinary care. With advances in veterinary medicine, pets now have access to the most effective treatments available, making pet insurance an essential component of modern pet care.

Job Overview

Fetch Pet Insurance is seeking a detail-oriented and compassionate Claims Adjuster (Veterinary) to join our growing remote team. In this role, you will be responsible for reviewing and adjudicating pet insurance claims in accordance with policy terms and company guidelines, ensuring accurate, fair, and timely determinations for our pet parents.

This position plays a critical role in supporting Fetch's mission to make veterinary care more accessible and affordable. The ideal candidate brings strong veterinary medical knowledge, excellent analytical skills, and a commitment to delivering high-quality service in a fast-paced, remote environment.

Responsibilities:
<ul>
<li>Adjudicate assigned claims in accordance with the Terms &amp; Conditions of the individual pet's policy</li>
<li>Review medical records, lab results, invoices, and claims forms for complete and thorough assessment</li>
<li>Process claims determinations to include assessment and payment for submitted claims</li>
<li>Verify claims coverage through in-depth knowledge of policy Terms &amp; Conditions</li>
<li>Consult with treating veterinary practices regarding medical records evaluation and necessary documentation</li>
<li>Maintain an average quality assurance score above department minimums</li>
<li>Complete assigned tasks within compliance deadlines</li>
<li>Maintain an average productivity rate above department minimums</li>
<li>Provide feedback on process opportunities to further strengthen SOPs</li>
</ul>
Required Skills:
<ul>
<li>Comprehensive understanding of disease processes and veterinary medical terminology</li>
<li>Ability to read and interpret veterinary medical records and invoices</li>
<li>Ability to identify chronic and acute medical conditions</li>
<li>Adapt quickly in a fast-paced, ever-changing environment and operate multiple computer systems simultaneously</li>
<li>Work independently in a remote capacity, while also fostering teamwork and collaborating with others</li>
<li>Superior communication skills for collaboration with team members and support from managers</li>
<li>Demonstrated problem solving skills and ability to work through complex medical/vet-related scenarios affecting a pet's diagnosis and/or treatment plan</li>
</ul>
Qualifications:
<ul>
<li>Minimum of five years experience as a veterinary technician</li>
<li>Bachelor's degree in veterinary science OR CVT or equivalent preferred</li>
<li>Property and Casualty Adjuster license in good standing preferred</li>
<li>Complete and pass state adjuster licensing</li>
<li>Be reliable with good attendance</li>
<li>Able to work a minimum of 42 hours per week, with occasional weekends and extra hours as needed</li>
</ul>
Compensation
<ul>
<li>The pay range for this position is $21.63 - $26.44 a full-time basis</li>
<li>Along with base salary, your position may qualify for additional bonuses</li>
<li>This position is eligible for the Company's bonus plan(s)</li>
</ul>
Work-From-Home- Set-Up:
<ul>
<li>Subscription to reliable high-speed internet connection (minimum of 100 Mbps download and 30 Mbps 
upload speed)</li>
<li>A quiet, dedicated place to work in your home that is not easily disrupted by background noises or 
distractions</li>
<li>Office workspace must be large enough to accommodate two 19&quot; dual monitors, laptop, mouse, keyboard, 
and headset</li>
<li>Ability to set up and connect (with instructions and remote IT team assistance) equipment that is shipped 
to your home</li>
</ul>
Benefits &amp; Perks

At Fetch, we recognize the importance of work-life balance and prioritize our employees' mental health and well-being, ensuring everyone can flourish both professionally and personally. Not just pets, we want our employees to live their best lives too &mdash; here at Fetch, you have access to the valuable benefits listed below.
<ul>
<li>Comprehensive Medical, dental, and vision plan for you and your family</li>
<li>Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are available</li>
<li>Highly competitive 401(k) matching</li>
<li>Generous 20-day PTO Policy, with rollover options. Earn an additional day of PTO each year on your anniversary with Fetch, for a maximum of 30 days</li>
<li>Paid company (9) holidays, including (1) floating holiday</li>
<li>Fetch Pet Insurance discount - up to 50% off, up to $1,000 savings/year</li>
<li>Educational Assistance Program</li>
<li>Fetch Discount Perks Program</li>
<li>Volunteering - earn up to 8 hours per calendar year at nonprofit organizations</li>
<li>NYC Office Amenities: Pet-friendly environment, free lunch, snacks, and additional amenities; transit accessible</li>
<li>Employee Referral Incentive</li>
<li>Tuition Assistance</li>
<li>Commuter Benefits</li>
<li>Employee Assistance Program (EAP)</li>
</ul>
Recruiting Fraud Alert

At Fetch, your personal information and online safety are paramount. Please be aware that only Fetch Recruiters and Hiring Managers will contact you regarding your application or background. All official communications from Fetch employees will originate from a fetchpet.com email address. You will never be asked for payments, financial details, or sensitive information like social security numbers by our Recruiters or Hiring Managers.

EEO Statement

Fetch is proud to be an equal opportunity employer.

We're committed to building a workplace that reflects the diversity of pet parents everywhere&mdash;hiring and developing individuals from all backgrounds and experiences to strengthen our inclusive, collaborative culture. We welcome applications from all qualified candidates regardless of race, color, religion, national origin, sex, gender, age, marital status, appearance, sexual orientation, gender identity or expression, family responsibilities, disability, medical condition, student status, political affiliation, military or veteran status, citizenship, genetic information, or any other status protected by law. Fetch will provide reasonable accommodations for individuals with disabilities throughout the hiring process.

If you need assistance or an accommodation to apply, please contact us at people@fetchpet.com 
Read our Privacy Notice for California Residents<div>

Recruiting Fraud Alert

At Fetch, your personal information and online safety are paramount. Please be aware that only Fetch Recruiters and Hiring Managers will contact you regarding your application or background. All official communications from Fetch employees will originate from a fetchpet.com email address. You will never be asked for payments, financial details, or sensitive information like social security numbers by our Recruiters or Hiring Managers. 
EEO Statement

Fetch is proud to be an equal opportunity employer.

We're committed to building a workplace that reflects the diversity of pet parents everywhere&mdash;hiring and developing individuals from all backgrounds and experiences to strengthen our inclusive, collaborative culture. We welcome applications from all qualified candidates regardless of race, color, religion, national origin, sex, gender, age, marital status, appearance, sexual orientation, gender identity or expression, family responsibilities, disability, medical condition, student status, political affiliation, military or veteran status, citizenship, genetic information, or any other status protected by law. Fetch will provide reasonable accommodations for individuals with disabilities throughout the hiring process.

If you need assistance or an accommodation to apply, please contact us at people@fetchpet.com 
Read our Privacy Notice for California Residents</div></div>

Claims Adjuster

Artcreativity

What You&rsquo;ll DoThis is a hybrid support role combining Amazon claims, project coordination, and operations support for our Ordering, Shipping &amp; Compliance Team. You&rsquo;ll work closely with the department Head to keep projects moving and ensure issues are resolved quickly.Key responsibilities include:<ul><li>Proactively pursue and assist with Amazon cases and claims (lost, damaged, or missing inventory, shipments, listings, etc.) and track case progress</li><li>Follow up on open cases in Amazon Seller Central</li><li>Assist Project Coordinator with overseas suppliers to support ongoing projects when needed</li><li>Track timelines and ensure deadlines are met</li><li>Upload and manage product documentation, testing reports, and certifications</li><li>Support shipping and logistics coordination</li><li>Maintain organized spreadsheets and internal records</li><li>Handle day-to-day follow-ups and administrative tasks for the team, especially in regard to Amazon cases, Amazon SAS cases, and phone calls to Amazon.</li></ul>What We&rsquo;re Looking For<ul><li>Highly organized with strong attention to detail</li><li>Comfortable managing multiple tasks and priorities</li><li>Strong written and verbal communication skills</li><li>Proficient in Excel or Google Sheets</li><li>Self-motivated and reliable</li></ul>Nice to have (not required):<ul><li>Exposure to Amazon Seller Central or e-commerce</li><li>Experience in admin, logistics, or coordination roles</li></ul>Pay: From $20.00 per hourBenefits:<ul><li>Paid time off</li></ul>Work Location: In person

Claims & Project Support Specialist

National General Insurance

<div>National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers&rsquo; evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.
Job Description
Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority.
We are seeking a Bodily Injury Extended Handler Adjuster to join our growing team. The ideal candidate will have a 2+ years of experience handling attorney-represented bodily injury claims. This role manages claims across the Northeastern states, with exposure ranging from soft tissue injuries to fracture claims. Litigation experience is not required. Experience with Colossus is preferred. Candidates located within Eastern Time Zone states are encouraged to apply.
<h3 class="jobSectionHeader">Key Responsibilities</h3><ul><li>Applies advanced understanding of insurance policies written by the company, the industry, and organizational relationships within the company and department</li><li>Handles investigation regarding all aspects of advanced auto claims (coverage, liability and damages) with the exercise discretion and independence within increased level of authority</li><li>For claims involving injuries (if handled), learns how to review, evaluate, and negotiate basic to moderate injury claims</li><li>Recognizes and identifies body parts of a vehicle and understanding other potential property damage</li><li>Identifies customer needs and works to meet those needs using appropriate customer service skills</li><li>Determines subrogation or fraud potential and how to handle</li><li>Applies increased experience in the Adjuster II level or a rotation into a specialty position (Coverage, Investigation Specialist, Total Loss, Initial Handler, Extended Handler, etc.)</li></ul><h3 class="jobSectionHeader">
Supervisory Responsibilities</h3><ul><li>This job does not have supervisory duties.</li></ul>
#LI-KR1 
Skills
Auto Insurance Claims, Automobile Accidents, Bodily Injury Claims, Case Management, Casualty Insurance, Claims Administration, Claims Resolution, Claims Review, Complex Claims, Customer Service, De-Escalation, Fractures, Insurance Claims Investigations, Litigation, Multitasking, Negotiation, Personal Injury Claims, Soft Tissue, Soft Tissue Injuries 
Compensation
Base compensation offered for this role is:
BI Adjuster Cons I: $50,000 - $86,400
BI Adjuster Cons II: $56,000 - $93,250
BI Adjuster Sr Cons I: $68,500 -$117,700
And is based on experience and qualifications. Total compensation for this role is comprised of several factors, including the base compensation outlined above, plus incentive pay (i.e. commission, bonus, etc.) if applicable for the role.
Joining our team isn&rsquo;t just a job &mdash; it&rsquo;s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger &ndash; a winning team making a meaningful impact.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
For jobs in San Francisco, please click &ldquo;here&rdquo; for information regarding the San Francisco Fair Chance Ordinance. 
For jobs in Los Angeles, please click &ldquo;here&rdquo; for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.
To view the &ldquo;EEO Know Your Rights&rdquo; poster click &ldquo;here&rdquo;. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs.
To view the FMLA poster, click &ldquo;here&rdquo;. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint.
It is the Company&rsquo;s policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee&rsquo;s ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.
National General Holdings Corp., a member of the Allstate family of companies, is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A&ndash; (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
Companies &amp; Partners
Direct General Auto &amp; Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.
Benefits
National General Holdings Corp. is an Equal Opportunity (EO) employer &ndash; Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas. In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.</div>

Bodily Injury Adjuster I, II or Sr. - National General

EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Support eligibility and benefits configuration and deployment, including collaboration with pharmacy benefits manager (PBM) and Cognizant, formulary teams, for configuration. Responsible for Quality Assurance and Testing for operations and implementations. Coordinate and manage the pharmacy plan/ benefit design implementation process in partnership with PBM to ensure the accuracy and timeliness of members&rsquo; pharmacy benefit administration for superior member experience.</div><div>
Responsibilities</div><ul><li>
Maintain in-depth understanding of and ability to create and maintain plan/benefit design rules and limitations to include: Adjudication rules, Clinical rules, Payment rules, and Plan/group management. 
</li><li>
Partner with Sales and Product teams, assist in developing pharmacy benefit plan designs, meeting client requests, Health Plan strategic/ business parameters and all regulatory and other oversight agencies&rsquo; requirements. 
</li><li>
Responsible for creating and maintaining plan/benefit design documentation to support internal and external requirements 
</li><li>
Lead communication and coordination between Health Plan and PBM for receipt of required information for claims adjudication system set up, reporting and claim adjudication process. 
</li><li>
Assess all requests for new/ changes to plan benefit information to ensure compatibility with PBM claim adjudication logic. 
</li><li>
Submit accurate and complete requests to the PBM for new and changing benefit plan designs. 
</li><li>
Test pharmacy benefit plan designs for accuracy and alignment with business requirements. 
</li><li>
Serve as liaison to PBM to troubleshoot and resolve benefit-related questions/ issues, researching plan/benefit design options and requirements. 
</li><li>
Participate in PBM implementation meetings as required. 
</li><li>
Review and approve PBM benefit set up requirements. 
</li><li>
Perform claim testing to ensure accurate claim adjudication. 
</li><li>
Work with the pharmacy clinical team to implement formulary updates in the claim adjudication system. 
</li><li>
Participate in the research and resolution of claims adjudication-related discrepancies, errors, and problems. 
</li><li>
Acts as a resource to operational areas in support of the pharmacy claims adjudication process and responding to issues related to plan/ benefit design. 
</li><li>
Conduct quarterly audits of pharmacy benefit configurations to ensure alignment with plan design, regulatory requirements, and accurate claim adjudication across all lines of business. 
</li><li>
Recommend streamlined work processes and systems that impact plan/ benefit design to create efficiency and quality outcomes. 
</li><li>
Maintain acceptable and appropriate quality levels and production SLA response time. 
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Perform other projects and duties as assigned</li></ul>
<div><div>Qualifications</div><ul><li>
Bachelor&rsquo;s degree. 
</li><li>
Pharmacy Technician Certification (Required) 
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Additional years of related experience may be considered in lieu of degree (Required) 
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Ability to perform in office environment with extended periods of sitting, using telephone, and viewing computer screens (Required) 
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Ability to prioritize tasks daily and trouble shoot urgent customer issues to successful completion (Required) 
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Advanced knowledge of MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required) 
</li><li>
Exceptional problem solving, analytical, interpersonal and communication skills to resolve issues within Operations (Required) 
</li><li>
Professionally skilled in verbal and written communication (Required) 
</li><li>
Meticulous organization skills, with the ability to multi-task, and ability to make sound decisions in a timely and independent manner (Required)</li></ul>
</div><div>Additional Information
<ul><li>Requisition ID: 1000003022</li>
<li>Hiring Range: $56,160-$99,360</li></ul></div></div>

Pharmacy Benefits Operations Specialist - Remote

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