insurance claims examiner

ClaimsPro LP

<div><h1 class="jobSectionHeader"><b>Company:</b></h1>
ClaimsPro LP - International Programs Group<p></p>
Property Claims Examiner - Remote (anywhere in the US)<p></p><p><br>
Reporting to a Claims Supervisor, the Claims Examiner is responsible for investigating and settling property and first party claims and third-party claims, with an emphasis on strong communication and customer service, while utilizing state specific guidelines.</p><p></p><p>
IPG works in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage, inland marine cargo, dealers' open lot, property damage (commercial and homeowners) and general liability.</p><p></p><p><b>
Job Responsibilities:</b></p><ul><li><p>
Initiate the investigation of new claims</p></li><li><p>
Make liability/coverage decisions</p></li><li><p>
Evaluate and negotiate settlements of collision, specified perils, and property damage, as appropriate.</p></li><li><p>
Manage and oversee the work of outside adjusters, appraisers and experts.</p></li><li><p>
Establish contact with the insured and claimant within established protocol.</p></li><li><p>
Recognize coverage issues and bring them to the attention of the supervisor.</p></li><li><p>
Develop basic understanding of liability and coverage principles.</p></li><li><p>
Recognize state specific laws and claims regulations throughout the United States to insure proper compliance in claims investigation including sending and securing proper documentation.</p></li><li><p>
Complete research to determine market value on automobiles and heavy equipment to make recommendations on total loss settlement values using proper state valuation methods.</p></li><li><p>
Summarize and make recommendations for disposition of claims in excess of the individual settlement authority.</p></li><li><p>
Respond to time sensitive material including but not limited to intercompany arbitration hearings, and department of insurance complaints.</p></li><li><p>
Manage a diary system to systematically review and resolve claims within the specified state compliance guidelines.</p></li><li><p>
Maintain state license by completing continuing education coursework and/or work towards a claims designation.</p></li><li><p>
Handle small claim suits as needed.</p></li><li><p>
Other duties as assigned by the claims supervisor</p></li><li><p>
Duties may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.</p></li></ul><p></p><p><b>
Qualifications, Education and/or </b><b>Experience
</b></p><ul><li><p>High School Diploma or Equivalent required</p></li><li><p>
Bachelor&rsquo;s degree is preferred</p></li><li><p>
Experience with Lloyd&rsquo;s of London is considered an asset</p></li></ul><p></p><p><b>
Computer Skills</b></p><ul><li><p>
Proficient in Microsoft Office</p></li><li><p>
Experience with Xactimate</p></li></ul><p></p><p><b>
Certificates, Licenses, Registrations</b></p><ul><li><p>
Able to be licensed in states, countries where necessary</p></li><li><p>
AIC designation preferred</p></li></ul><p></p><p><b>
Competencies</b></p><ul><li><p>
Use of clear, rational, thinking supported by evidence to audit fees of independent adjusters, appraisers, and other vendors in order to properly manage and pay expense invoices.</p></li><li><p>
Strong writing skills and proper use of grammar to prepare written status reports for the principal. Document claim file notes clearly with all communications and activities that occur during of handling the claim using factual and objective information.</p></li><li><p>
Ability to plan and exercise conscious control over the amount of time spent on specific activities.</p></li><li><p>
Strong Communicator (verbal and written)</p></li><li><p>
Ability to multi-task and handle high volume of concurrent tasks</p></li><li><p>
Work collaboratively with others inside and outside the company</p></li></ul><p></p><p><b>
Environment/Working Conditions:</b></p><ul><li><p>
Dynamic environment with tight deadlines, number and changing priorities</p></li><li><p>
All prospective employees must pass a background check</p></li><li><p>
Office environment including prolonged periods of computer use</p></li><li><p><b>
Location: Remote working but may require some travel to home office, etc.</b></p></li></ul><p></p><p>
We welcome and encourage applications from people with disabilities. Accommodation is available on request for candidates throughout the recruitment and assessment process.</p><p></p><p><b>
Unsolicited Outreach Statement &ndash; Recruitment Agencies</b></p><p></p><p>
We will not accept unsolicited resume submittals from third- party recruiters and hereby request agencies not to contact our employees or managers directly to present candidates. Be advised we will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. We welcome resumes submitted directly from candidates.</p></div>

Property Claims Examiner - Remote

The Baldwin Group

<p></p><div><div><h2 class="jobSectionHeader"><b>Why MSI? We thrive on solving challenges.
</b></h2></div><p></p><div><div><div><div><div><div><div><div><div><p><b>As a leading MGA, MSI combines deep underwriting expertise with insurer and reinsurer risk capacity to create specialized insurance solutions that empower distribution partners to meet customers&rsquo; unique needs.
</b></p><p></p><p><b>We have a passion for crafting solutions for the important risks facing individuals and businesses. We offer an expanding suite of products &ndash; from fully-digital embedded renters coverage to high-value homeowners insurance to sophisticated commercial coverages, such as cyber liability and habitational property &ndash; delivered through agents, brokers, wholesalers and other brand partners.
</b></p><p></p><p><b>Our partners and customers count on us to deliver exceptional service through a dedicated team that makes rapid resolutions a priority. We simplify the insurance experience through our advanced technology platform that supports every phase of the policy lifecycle.
</b></p><p></p><p><b>Bring on your challenges and let us show you how we build insurance better.
</b></p><p></p><p>The Claims Examiner II is considered an expert in managing insurance claims for our policyholders, handling claims with a higher level of complexity. The Claims Examiner II must have technical knowledge in insurance claims handling and the skills needed to provide superior service for our customers. The ability to develop relationships and effectively communicate with a diverse range of clients, carriers and colleagues is a key success factor in this role. Strategic vision coupled with tactical execution to achieve results in accordance with goals and objectives is also critical to the overall success of this position
</p></div></div></div></div></div></div></div></div></div><p></p><div>PRIMARY RESPONSIBILITIES:
<br>
<ul><li>Analyzes insurance policies and other documents to determine insurance coverage.
</li><li>Investigates and analyzes claim information to determine extent of liability.
</li><li>Handles claims 1st Party Property Claims of a high level of complexity.
</li><li>Assist in suits, mediations and arbitrations. Works with Counsel in the defense of litigation.
</li><li>Sets timely, adequate reserves in compliance with the company&rsquo;s reserving philosophy.
</li><li>Engages experts to assist in the evaluation of the claim.
</li><li>Monitors vendor performance and controls expense costs.
</li><li>Evaluates, negotiates and determines settlement values.
</li><li>Communicates with all interested parties throughout the life of the claim. Proactively discusses coverage decisions, the need for additional information, and settlement amounts with interested parties.
</li><li>Handles all claims in accordance with Best Practices.
</li><li>Responsible for monitoring and completing assigned claims inventory.
</li><li>Acquire and maintain a state adjuster&rsquo;s license and meet state continuing education requirements.
</li><li>Provides Best-In-Class customer service for insureds and agents.
</li><li>Updates and maintains the claim file.
</li><li>Identifies opportunities for subrogation and ensures recovery interests are protected.
</li><li>Identifies fraud indicators and refers files to SIU for further investigation.
</li><li>Participates in claims audits, internal and external.
</li><li>Provides oversight of TPAs
</li></ul><br>
KNOWLEDGE, SKILLS &amp; ABILITIES:
<br>
<br>
EDUCATION &amp; EXPERIENCE:
<br>
High School/GED
<br>
5-9 years' experience in claims
<br>
Must have Property &amp; Casualty Insurance License
 </div><p></p><p>#LI-JW2
</p><p>#LI-REMOTE</p><p></p><p><br>
</p><p></p><p>The Baldwin Group will not accept unsolicited resumes from any source other than directly from a candidate who applies on our career site. Any unsolicited resumes sent to The Baldwin Group, including unsolicited resumes sent via any source from an Agency, will not be considered and are not subject to any fees for any placement resulting from the receipt of an unsolicited resume.</p></div>

Claims Examiner II- MSI

Jones Jones LLC

<div><p>Jones Jones LLC is a trusted leader in workers&rsquo; compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. Our firm values growth, integrity, and excellence across every level of our organization.</p><p>
We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow within a premier workers&rsquo; compensation firm.</p><p>
The Firm is located at 5 Hanover Square, New York, NY and this is a hybrid position.</p><p></p><p><b><br>
Essential Functions</b></p><p></p><p><br>
1. Claims Adjusting Work (NYTIC / Emerald):</p><ul><li>
Perform intake and coverage verification via WCB employer coverage search</li><li>
Initiate three-point contact (employer/clamant/provider) within 24 hours</li><li>
Conduct compensability analysis and develop action plans</li><li>
Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement</li><li>
Calculate AWW and benefit rates; set and review reserves at key milestones</li><li>
Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections</li><li>
Route medical bills to bill review and ensure fee schedule compliance</li><li>
Prepare for hearings and maintain eCase updates</li><li>
Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices</li></ul><p></p><p><br>
2. Licensing &amp; Compliance (Jones Jones):</p><ul><li>
Collaborate with the Compliance team on licensing forms and regulatory filings</li><li>
Review TPA scorecards and ensure compliance with WCB standards</li><li>
Track and invoice licensing fees and renewals</li><li>
Support examiner training and respond to licensing-related inquiries</li></ul><p></p><p><br>
3. ADR (MRM):</p><ul><li>
Manage intake, eligibility, and notices under the collectively bargained ADR program</li><li>
Coordinate and schedule mediations</li><li>
Draft case summaries and settlement proposals</li><li>
Ensure adherence to Medical Network protocols and document variances</li><li>
Prepare and route settlement paperwork, including Section 32 agreements</li><li>
Maintain dashboards of ADR cycle times and outcomes for annual reporting</li><li>
Obtain loss runs from wrap-up sponsors</li></ul><p></p><p><br>
4. MMG</p><div><ul><li>
Evaluate Independent Medical Examination (IME) reports for accuracy and compliance</li></ul></div><ul><li>
Assist with administrative tasks such as schedule coordination and provider panel management</li></ul><p></p><p><b><br>
Competencies</b></p><ul><li>
Excellent and professional verbal and written communication skills</li><li>
Strong understanding of workers&rsquo; compensation best practices</li><li>
Exceptional organizational skills and attention to detail</li><li>
Excellent time management skills with a proven ability to meet deadlines</li><li>
Strong analytical and problem-solving skills</li><li>
Ability to perform well in a fast-paced, dynamic environment</li><li>
Ability to maintain confidentiality and exercise discretion and sound judgment</li><li>
Proficient with Microsoft Office Suite or related software</li></ul><p></p><p><b><br>
Qualifications</b></p><ul><li>
Bachelor&rsquo;s degree in business administration or related field</li><li>
Active Independent Adjuster License (required)</li><li>
 2- 5 years of claims management experience</li></ul><p></p><p><br>
Apply today to join a firm with over a century of success and a future focused on innovation. Jones Jones LLC is an equal employment opportunity employer.</p></div>

Claims Examiner

Athens Administrators

<div><div>ATHENS POSITION DETAILS</div>
<div></div><div><div><div><div><div><b>Position Title:</b></div>
</div><div><div>Assistant Claims Examiner - Flex</div><br>
</div></div><br>
<div><div><div><b>Department:</b></div>
</div><div><div>Workers&rsquo; Compensation</div><br>
</div></div><br>
<div><div><div><b>Reports To:</b></div>
</div><div><div>Claims Supervisor</div><br>
</div></div><br>
<div><div><div><b>FLSA Status:</b></div>
</div><div><div>Non-Exempt</div><br>
</div></div><br>
<div><div><div><b>Job Grade:</b></div>
</div><div><div>6</div><br>
</div></div><br>
<div><div><div><b>Career Ladder:
</b></div></div><div><div>Next step in progression could include Future Medical Examiner or Claims Examiner Trainee</div>
</div></div><br>
</div></div><div></div><div><b>ATHENS ADMINISTRATORS</b></div>
<div>Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!</div>
<div></div><div><b>POSITION SUMMARY</b></div>
<div>Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers&rsquo; Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday &ndash; Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule.</div>
<div></div><div>The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens.</div>
<div></div><div><b>PRIMARY RESPONSIBILITIES</b></div>
<div>Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:</div>
<div></div><ul><li>Process new claims in compliance with client&rsquo;s Service Agreement</li>
<li>Issue all indemnity payments and awards on time</li>
<li>Process all approved provider bills timely</li>
<li>Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.</li>
<li>Answer questions over the phone from medical providers regarding bills</li>
<li>Contact treating physician for disability status</li>
<li>Contact employer for return-to-work status or availability of modified work.</li>
<li>Contact injured worker at initial set up</li>
<li>Send DWC notices timely</li>
<li>Issue SJDB Notices timely</li>
<li>Request Job Description from Employer</li>
<li>Handle Medical Only claim files</li>
<li>Calculate wage statements and adjust disability rates as required</li>
<li>Keep diary for all delay dates and indemnity payments</li>
<li>Documents file activity on computer</li>
<li>Update information on computer, i.e., address changes, etc.</li>
<li>Schedule appointments for AME, QME evaluations</li>
<li>Send appointment letters, issue TD/mileage, send medical file</li>
<li>Schedule interpreter for appointments, depositions, etc.</li>
<li>Request Employer&rsquo;s Report, DWC-1, Doctor&rsquo;s First Report if needed</li>
<li>Verify mileage and dates of treatment for reimbursement to claimant</li>
<li>Subpoena records</li>
<li>File and serve documents on attorneys, WCAB, doctors</li>
<li>Serve PTP&rsquo;s with medical file and Duties of Treating Physician (9785)</li>
<li>Request PD ratings from DEU</li>
<li>Draft Stipulated Awards and C&amp;R&rsquo;s</li>
<li>Submit C&amp;R, Stipulated Awards to WCAB for approval with documentation</li>
<li>Process checks &ndash; stop payment, cancellations, void, journal payments</li>
<li>Handle telephone calls for examiner as needed</li>
<li>Complete penalty calculations and prepare penalty worksheets</li>
<li>Complete MPN, HCO and/or EDI coding</li>
<li>Complete referrals to investigators</li>
<li>Complete preparation of documents for overnight delivery</li>
<li>Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners</li>
<li>Contact with clients, injured workers, attorneys, doctors, vendors, and other parties</li>
<li>Provide updates of claims status to Senior Claims Examiners and Athens management</li>
<li>Prepare professional, well written correspondence and other communications</li>
</ul>
<div></div><div><b>ESSENTIAL POSITION REQUIREMENTS
</b></div><div>The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.</div>
<div></div><ul><li>High School Diploma or equivalent (GED) required for all positions
<ul><li>AA/AS or BA/BS preferred but not required</li>
</ul></li><li>2+ years&rsquo; Claims Assistant experience supporting a workers compensation examiner or team preferred</li>
<li>Medical Only Adjuster designation required</li>
<li>Continuing hours must be current</li>
<li>Mathematical calculating skills</li>
<li>Completion of IEA or equivalent courses</li>
<li>Administrators Certificate from Self-Insurance Plans preferred</li>
<li>Knowledge of workers compensation laws, policies, and procedures</li>
<li>Understanding of medical and legal terminology</li>
<li>Must demonstrate accuracy and thoroughness in work product</li>
<li>Ability to sit for prolonged periods of time</li>
<li>Well-developed verbal and written communication skills with strong attention to detail</li>
<li>Excellent organizational skills and ability to multi-task</li>
<li>Ability to type quickly, accurately and for prolonged periods</li>
<li>Proficient in Microsoft Office Suite</li>
<li>Ability to learn additional computer programs</li>
<li>Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution</li>
<li>Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization</li>
<li>Seeks to include innovative strategies and methods to provide a high level of commitment to service and results</li>
<li>Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner</li>
<li>Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor</li>
<li>Athens&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.</li>
<li>Must be able to reliably commute to meetings and events as required by this position</li>
</ul>
<div></div><div><b>APPLY WITH US</b></div>
<div>We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf</div>
<div></div><div>This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.</div>
<div></div><div>Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.</div>
<div></div><div><b>THANK YOU!</b></div>
<div>We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!</div>
<div></div><div>Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses &amp; certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at <b>https://www.athensadmin.com/careers/why-work-here</b></div></div>

Assistant Claims Examiner - Remote or Hybrid in CA

<div><div><b>ATHENS POSITION DETAILS</b></div>
<div></div><div><div><div><div><div><b>Position Title:</b></div>
</div><div><div><b>Senior Claims Examiner &ndash; P&amp;C</b></div><br>
</div></div><br>
<div><div><div><b>Department:</b></div>
</div><div><div><b>Property &amp; Casualty</b></div><br>
</div></div><br>
<div><div><div><b>Reports To:</b></div>
</div><div><div><b>Claims Supervisor</b></div><br>
</div></div><br>
<div><div><div><b>FLSA Status:</b></div>
</div><div><div><b>Exempt in all state but California</b></div><br>
</div></div><br>
<div><div><div><b>Job Grade:</b></div>
</div><div><div><b>13</b></div><br>
</div></div><br>
<div><div><div><b>Career Ladder:</b></div>
</div><div><div><b>Next step in progression could include Complex Claims Examiner</b></div>
</div></div><br>
</div></div><div></div><div><b>ATHENS ADMINISTRATORS</b></div>
<div>Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!</div>
<div></div><div><b>POSITION SUMMARY</b></div>
<div>Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our Property &amp; Casualty department. Employees who live less than 26 miles from the Concord, CA, Orange, CA, San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). Athens Program Insurance Services is the centerpiece of P&amp;C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday through Friday at 37.5 hours per week.</div>
<div></div><div>The Senior Claims Examiner is responsible for the review, analysis and processing of complex claims, with emphasis on commercial property and residential property, business interruption, and inland marine claims within assigned authority limits and consistent with policy and legal requirements. These claims are typically high exposure, long term claims and will often entail litigation and coverage issues. The goal of this position is to ensure the delivery of quality service claims adjusting in full compliance with special claims handling obligations.</div>
<div></div><div><b>PRIMARY RESPONSIBILITIES</b></div>
<div>Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:</div>
<div></div><div>Advanced knowledge in the following areas:</div>
<div>1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge</div>
<div>2) functional knowledge of law and insurance regulations in various jurisdictions</div>
<div>3) demonstrated advanced verbal and written communications skills</div>
<div>4) demonstrated advanced analytical, decision making and negotiation skills</div>
<div></div><ul><li>Within prescribed settlement authority, establish appropriate reserves for both indemnity and expense and conduct reviews on a regular basis to ensure reserve adequacy. In matters exceeding settlement authority, should have the ability to recommend a specific reserve range, based on industry experience and the specific evidence secured in a specific claim investigation.</li>
<li>Fully evaluate losses, including expense budgeting and all available property limits (including sub-limits) to make recommendations and set proper reserves at appropriate levels for claims within and outside of client authority level. Demonstrate credibility with clients and other business professionals by discussing and explaining these recommendations.</li>
<li>Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to management.</li>
<li>Manage all processes requiring estimating, assessment, valuation, and applicable depreciation. Include interpretation and evaluation of applicable insurance contracts in the assessment process.</li>
<li>Possess familiarity with scoping, estimating and use of Xactimate and other valuation programs.</li>
<li>Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure.</li>
<li>Ensure appropriateness of all payments</li>
<li>Coordinate and work with vendor services such as independent adjusting firms, contractors, consultants, forensic accountants, engineers, emergency repair, cleaning services and various replacement services to ensure prompt, equitable and appropriate resolution of all commercial property claims.</li>
<li>Large loss commercial claim handling and oversight experience. Facilitate communication between claimants, clients and brokers for resolution of claims.</li>
<li>Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers.</li>
<li>Superior customer service skills. Ability to recognize matters of urgency and act promptly and efficiently to address them.</li>
<li>Participate in client meetings, status conferences, file reviews and fully comply with client instructions for all levels of communication and notification.</li>
<li>Be aware of insurance fraud and the internal and external requirements of notification/reporting of potential fraudulent matters.</li>
<li>Keep the client involved in decision making as required and comply with escalation process for advance notification of serious losses.</li>
<li>Investigate, evaluate, and determine settlement value or denial of liability for severe to major-level claims</li>
<li>Within prescribed settlement authority for line of business, establish appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Make recommendations to set reserves at an appropriate level for claims outside of authority level.</li>
<li>Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to management.</li>
<li>Manage the litigation process through the retention of counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment.</li>
<li>Ensure appropriateness of all payments</li>
<li>Capability to adjust large commercial property losses</li>
<li>Exchange information with clients, claimants, insurance brokers, inspectors producers and account managers</li>
<li>Assist in training of new employees</li>
<li>Provide training and daily guidance to other examiners</li>
<li>Some oversight of less experienced examiners and claims assistants</li>
<li>May fill-in for supervisor if necessary</li>
<li>Attend meetings and educational seminars for professional development and to maintain required licenses</li>
<li>Coordinate and work with a vendor services such as contractors, emergency repair, cleaning services and various replacement services.</li>
<li>Participate and/or conduct department meetings</li>
<li>Present company abilities in new client meetings</li>
</ul>
<div></div><div><b>ESSENTIAL POSITION REQUIREMENTS</b></div>
<div>The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.</div>
<div></div><ul><li>High School Diploma or equivalent (GED) required for all positions
<ul><li>AA/AS or BA/BS preferred but not required</li>
</ul></li><li>Relies on extensive experience and judgment to plan and accomplish goals with a minimum 8-10 years of complex/major property claims experience including proficiency in investigation and resolution of severe to major casualty claims</li>
<li>Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX or FL
<ul><li>Additional State Adjuster License(s) may be required within 180 days</li>
<li>Maintain licenses and continuing education requirements in all states.</li>
</ul></li><li>Experience with property and casualty insurance policies, insurance tort laws, codes and procedures</li>
<li>Knowledge of contractual/policy law and commercial property insurance policies. Experience in reviewing Condo By-Laws and Condo Rules and Regulations</li>
<li>Proficiency in investigation and resolution of moderate to major property claims. Understands principals of co-insurance and replacement cost evaluations</li>
<li>Understanding of medical, legal terminology and liability concepts</li>
<li>Time Management and project management skills</li>
<li>Negotiation skills</li>
<li>Well-developed verbal and written communication skills with strong attention to detail</li>
<li>Excellent organizational skills and ability to multi-task</li>
<li>Ability to type quickly, accurately and for prolonged periods</li>
<li>Proficient in Microsoft Office Suite</li>
<li>Ability to learn additional computer programs</li>
<li>Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution</li>
<li>Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization</li>
<li>Seeks to include innovative strategies and methods to provide a high level of commitment to service and results</li>
<li>Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner</li>
<li>Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor</li>
<li>Athens&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.</li>
<li>Must be able to reliably commute to meetings and events as required by this position</li>
</ul>
<div></div><div><b>APPLY WITH US</b></div>
<div>We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.</div>
<div></div><div>This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.</div>
<div>Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.</div>
<div></div><div><b>THANK YOU!</b></div>
<div>We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!</div>
<div></div><div>Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses &amp; certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at <b>https://www.athensadmin.com/careers/why-work-here</b></div></div><div></div>

Senior Property Claims Examiner

Cala Sourcing Solutions LLC

<div><h3 class="jobSectionHeader"><b>Workers&rsquo; Compensation Claims Examiner III (Contract)</b></h3><p>
Please no 3rd party recruiters, or C2C.
</p><p><b>Location:</b> Irving, TX<br>
<b>Schedule:</b> On-site | Monday&ndash;Friday (5 days/week) - only local candidates will be considered<br>
<b>Pay Rate:</b> $36.53 &ndash; $38.46 per hour<br>
<b>Contract Length:</b> 3&ndash;4 months (with potential extension)</p><h4 class="jobSectionHeader"><b>
About the Role</b></h4><p>
We&rsquo;re looking for a seasoned <b>Workers&rsquo; Compensation Claims Examiner III</b> to step into a fast-paced, high-volume environment and take ownership of Texas loss-time claims from start to finish. This role is ideal for an experienced examiner who is confident working independently, thrives in an in-office setting, and understands the importance of accuracy, urgency, and strong communication.</p><p>
This is a <b>fully on-site position</b> in Irving, TX. Daily in-person collaboration with colleagues and stakeholders is a core part of the role&mdash;remote or hybrid work is not available.</p><h4 class="jobSectionHeader"><b>
What You&rsquo;ll Be Doing</b></h4><ul><li><p>
Handle Texas Workers&rsquo; Compensation <b>indemnity claims</b> from initial intake through resolution</p></li><li><p>
Analyze coverage, investigate facts, and make compensability determinations in compliance with Texas statutes</p></li><li><p>
Administer indemnity and medical benefits within assigned authority levels</p></li><li><p>
Apply internal best practices and client-specific handling guidelines consistently</p></li><li><p>
Prepare and maintain detailed, captioned claim reports and documentation</p></li><li><p>
Serve as a key point of contact for claimants, employers, attorneys, and internal partners</p></li><li><p>
Clearly explain the claims process to employers and injured workers, setting expectations throughout the claim lifecycle</p></li><li><p>
Maintain accurate, timely claim files while balancing multiple deadlines</p></li><li><p>
Deliver a high level of customer service in a regulated, deadline-driven environment</p></li></ul><h4 class="jobSectionHeader"><b>
What We&rsquo;re Looking For</b></h4><ul><li><p><b>
Active Texas Workers&rsquo; Compensation Adjuster License (required)</b></p></li><li><p><b>
5+ years</b> of hands-on Texas Workers&rsquo; Compensation claims experience</p></li><li><p>
Prior experience handling <b>public entity and First Responder claims</b></p></li><li><p>
Strong working knowledge of Texas Workers&rsquo; Compensation laws and regulations</p></li><li><p>
Excellent written and verbal communication skills</p></li><li><p>
Ability to manage a full caseload with minimal supervision</p></li><li><p>
High School Diploma or GED required</p></li><li><p>
Bachelor&rsquo;s degree in a related field preferred</p></li></ul><h4 class="jobSectionHeader"><b>
Work Environment &amp; Expectations</b></h4><ul><li><p>
100% on-site role in a professional office setting</p></li><li><p>
Frequent interaction with internal teams and external stakeholders</p></li><li><p>
Use of standard office equipment and claims management systems</p></li><li><p>
Consistent, full-time in-office attendance required</p></li></ul><h4 class="jobSectionHeader"><b>
Additional Requirements</b></h4><ul><li><p>
Ability to pass a background check and drug screening</p></li><li><p>
Authorization to work in the United States</p></li></ul>
#Workwolf</div>

Worker's comp/Claims examiner III

Lio Insurance

<div><div><b>Summary/Objective:
</b></div><div>The Claims Examiner &ndash; Casualty is accountable for managing a portfolio of moderate complexity general liability claims across admitted and E&amp;S products, including exposure to construction-related and construction defect property damage claims, driving each claim from initial notice through resolution. This role requires applying sound coverage analysis, leading investigations, evaluating liability and damages, and crafting clear, defensible coverage positions. The Claims Examiner will proactively negotiate with claimants and attorneys, ensure timely and accurate claim payments, and deliver a high-quality claims experience. The ideal candidate is a strong communicator and critical thinker who can effectively engage with insureds, brokers, counsel, and internal partners while balancing customer experience, financial outcomes, and regulatory compliance.</div>
<div></div><div><b>Essential Duties &amp; Functions:
</b></div><ul><li>Manage a portfolio of moderate complexity casualty claims, including general liability and select construction-related / construction defect property damage exposures</li>
<li>Handle claims across admitted and E&amp;S platforms, applying sound judgment and seeking guidance on complex or high-exposure matters</li>
<li>Perform coverage analysis and policy interpretation, including drafting coverage positions for moderately complex claims and supporting more complex or layered matters</li>
<li>Conduct thorough investigations, evaluate liability and damages, and establish and adjust reserves in accordance with claim developments</li>
<li>Coordinate and actively manage defense counsel, experts, and vendors to ensure effective case strategy and cost control</li>
<li>Support the development and execution of litigation and settlement strategies aligned with claim facts, coverage, and business objectives</li>
<li>Participate in mediations, settlement negotiations, and discussions with claimants and counsel as appropriate</li>
<li>Maintain accurate, timely, and well-documented claim files, including clear reporting and adherence to internal guidelines and regulatory requirements</li>
<li>Proactively identify and escalate complex, high-severity, or coverage-sensitive issues to senior team members</li>
</ul><div><b>LIO LIFE &ndash; What we value:</b></div>
<ul><li><b>The Customer Lens</b> &ndash; Prioritizing our relationships, service and needs of our customers.</li>
<li><b>Innovative Thinking</b> &ndash; Fostering an environment that empowers and sustains bold thinking and actions.</li>
<li><b>Balance </b>&ndash; Creating an inclusive, diverse, and holistic balance to meet our personal and professional needs.</li>
<li><b>Simplicity </b>&ndash; Striving for simplicity in our service, products, and processes.</li>
<li><b>Accountability &ndash; </b>Owning our results and learning from them.</li>
</ul><div><b>Qualifications:</b></div>
<div>To perform this role successfully, an individual must be able to execute each essential duty effectively. The requirements below represent the key competencies needed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div>
<ul><li>Strong written and verbal communication skills, including the ability to clearly convey complex information and actively listen to understand key issues</li>
<li>Sound judgment and decision-making abilities, with the capacity to evaluate risk, think critically, and escalate appropriately</li>
<li>High degree of integrity and professionalism, with a strong commitment to confidentiality and ethical conduct</li>
<li>Customer-focused mindset, delivering responsive, solutions-oriented service to both internal and external stakeholders</li>
<li>Ability to build effective working relationships and collaborate across teams and levels, while also operating independently</li>
<li>Strong organizational and time management skills, with the ability to prioritize, manage competing demands, and meet deadlines</li>
<li>Analytical mindset, with the ability to assess information, identify key drivers, and support well-reasoned outcomes</li>
<li>Ability to influence, negotiate, and navigate challenging conversations with professionalism and confidence</li>
<li>Adaptability and accountability in a dynamic, fast-paced, and primarily virtual work environment</li>
<li>Demonstrated respect for diverse perspectives and the ability to work effectively across varied backgrounds and experiences</li>
<li>Ownership mindset, with the ability to plan, organize, and execute work from initiation through completion</li>
<li>Comfort working in a lean, entrepreneurial environment, with a willingness to take initiative and adapt to evolving priorities</li>
</ul><div><b>Required Education and Experience:</b></div>
<ul><li>Bachelor&rsquo;s degree or equivalent combination of education and relevant experience</li>
<li>3&ndash;6+ years of casualty claims handling experience</li>
<li>Experience handling general liability (GL) claims required; exposure to construction-related or construction defect claims preferred</li>
<li>Active state adjuster license(s) or ability to obtain required licenses within a defined timeframe</li>
</ul><div><b>Preferred Education and Experience:</b></div>
<ul><li>CPCU and/or AI</li>
</ul><div><b>Additional Eligibility Requirements (Certificates, Licenses, Required/Preferred):</b></div>
<ul><li>CPCU or AIS</li>
</ul><div><b>Benefits:</b></div>
<div>As a core value, LIO Insurance understands the importance of balance to meet both personal and professional needs. Our benefits include:</div>
<ul><li>Flexible (unlimited) Time Off and 13 paid holidays</li>
<li>401k</li>
<li>Maternity Leave</li>
<li>Competitive Medical to support holistic health
<ul><li>Medical, dental/ortho, vision, life and disability insurance</li>
<li>HSA/FSA/DCAP savings plans</li>
</ul></li></ul><div><b>Work Environment:</b></div>
<div>This job operates in a professional office environment. This role routinely uses standard office equipment.</div>
<div></div><div><b>Position Type/Expected Hours of Work:</b></div>
<div>This is a full-time position. Expected days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. This position may require long hours and weekend work.</div>
<div></div><div><b>Travel:</b></div>
<div>Occasional travel may be necessary for this position &ndash; to attend mediations, trials, or large property loss exposures.</div>
<div></div><div><b>EEO Statement:</b></div>
<div><b>LIO Insurance</b><b> prov</b>ides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, creed, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.</div>
<div></div><div>This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.</div>
<div></div><div><b>Other Duties:</b></div>
<div>Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.</div></div><div></div>

Claims Examiner (Casualty)

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