liability claims examiner

Sedgwick

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Claims Examiner, General Liability | Remote, Wisconsin
<p></p><div><p><b>PRIMARY PURPOSE OF THE ROLE </b>: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
</p><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>We are seeking experienced professionals to manage complex general liability claims, including litigated matters and high‑exposure losses. Ideal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to driving timely, cost‑effective claim resolutions while maintaining strong client relationships.
</p><p></p><p><b>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</b></p><ul><li>Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
</li><li>Assesses liability and resolves claims within evaluation.
</li><li>Negotiates settlement of claims within designated authority.
</li><li>Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
</li><li>Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
</li><li>Prepares necessary state fillings within statutory limits.
</li><li>Manages the litigation process; ensures timely and cost effective claims resolution.
</li><li>Coordinates vendor referrals for additional investigation and/or litigation management.
</li><li>Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
</li><li>Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
</li><li>Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
</li><li>Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
</li><li>Ensures claim files are properly documented and claims coding is correct.
</li><li>Refers cases as appropriate to supervisor and management.
</li><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul><p></p><p><b>QUALIFICATIONS
</b></p><p>Education &amp; Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required.
</p><ul><li>Bachelor's degree from an accredited college or university preferred.
</li><li>Professional certification as applicable to line of business preferred.
</li><li>Adjusters license required
</li></ul><p></p><p><b>TAKING CARE OF YOU
</b></p><ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul><p></p><p><b>Work environment requirements include &ndash;
</b><br>
Physical: Computer keyboarding
<br>
Auditory/visual: Hearing, vision and talking
<br>
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
</p><p></p><p>The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
</p></div><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Claims Examiner, General Liability | Remote, Wisconsin

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Claims Examiner - Liability | Property Damage | Licensing: Reciprocal required | Jurisdiction: Multi State - Hybrid
<p></p><div><div><div>Job Description
</div></div><div><div><div><div><div><div><div><div><div><p>Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
</p><ul><li><p>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</p></li><li><p>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</p></li><li><p>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</p></li><li><p>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</p></li><li><p>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</p></li><li><p>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</p></li><li><p>Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.
</p></li></ul><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>To analyze complex or technically difficult property damage claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
</p><p></p><p><b>PRIMARY PURPOSE OF THE ROLE: </b>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</b></p><ul><li><p>Responsible for end‑to‑end management of complex property damage claims, from investigation through resolution, ensuring accurate liability assessment and timely outcomes
</p></li><li><p>Oversees reserve strategy, settlement negotiations, payments, and statutory filings while maintaining compliance with authority levels and regulatory requirements
</p></li><li><p>Manages litigation, vendor partnerships, excess carrier reporting, and recovery efforts to drive cost‑effective claim resolution
</p></li><li><p>Serves as a primary point of contact for claimants and clients, maintaining clear communication, strong relationships, and well‑documented claim files
</p></li><li><p>Collaborates with leadership to escalate complex matters appropriately and support strategic claim handling decisions
</p></li><li><p>Ensures adherence to internal quality standards, regulatory compliance, and best practices while contributing to continuous improvement initiatives
</p></li></ul><p></p><p><b>QUALIFICATIONS
</b></p><p><b>Education and Licensing: </b>Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
</p><p><b>Experience: </b>Five (5) years of claims management experience or equivalent combination of education and experience required.
</p><p></p><p><b>TAKING CARE OF YOU
</b></p><p>Flexible work schedule.
</p><p>Referral incentive program.
</p><p>Career development and promotional growth opportunities.
</p><p>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</p></div></div></div></div></div></div></div></div></div></div><p></p><p><b>WORK ENVIRONMENT
</b><br>
When applicable and appropriate, consideration will be given to reasonable accommodations.
</p><p><b>Mental: </b>Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
</p><p><b>Physical: </b>Computer keyboarding, travel as required
</p><p><b>Auditory/Visual: </b>Hearing, vision and talking
</p><p></p><p>The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
</p><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Claims Examiner - Liability | Property Damage | Licensing: Reciprocal required | Jurisdiction: Multi State - Hybrid

J.B. Hunt

<div><p><b>Job Title:
</b></p>Casualty Claims Examiner II
<p></p><p><b>Department:
</b></p>Insurance
<p></p><p><b>Country:
</b></p>United States of America
<p></p><p><b>State/Province:
</b></p>Arkansas
<p></p><p><b>City:
</b></p>Lowell
<p></p><p><b>Full/Part Time:
</b></p>Full time
<p></p><p><b>Job Summary:
</b></p>Under general supervision, this position is responsible for the investigation and resolution of complex claims. This incumbent will work closely with internal and external contacts to investigate claims, negotiate settlements, and prepare reports to ensure accurate and timely processing of casualty claims.
<p></p><p><b>Job Description:
</b></p><p><b>Key Responsibilities:
</b></p><ul><li>Utilize independent knowledge and experience to conduct claims investigations to determine liability exposure of each assigned claim. This investigation includes analysis of state and federal laws, retaining services of field investigators, outside legal counsel to obtain a full picture of exposure and documentation of all findings for each claim within the claims matter management system for management review as well as internal and external audit processes. Manage complex claims involving alleged property damage and bodily injury through the interview of key witnesses; securing evidence, reviewing applicable statutes and laws, analysis of estimates of repair, and analyzing medical reports
</li><li>Handle all monetary aspects of assigned claims through the calculation of financial exposure analysis leading to the establishment of reserves at proper levels within assigned approval levels. And, by keeping management aware of claims with exposures above approved levels for continuous timely and efficient resolutions of assigned claims.
</li><li>Manage negotiations with claimants, claimant's legal representatives or third parties by utilizing strong communication and negotiation skills in sharing investigative results and rationale, listening to claimant perspective and arguments, and influencing claimant perspective to achieve consensus on appropriate and final resolution of assigned claims
</li><li>Utilize strong communication skills to keep all stakeholders aware of findings, decisions, and resolutions to support plans and initiatives to meet business unit needs while establishing accountability in achieving results and identifying and addressing improvement opportunities.
</li><li>Prioritize and manage assigned claims workload to keep all involved parties informed and provide timely claims status updates
</li><li>Initiate prompt contact with claimants to obtain information and establish the claims process; process incoming calls, emails, and notifications to support workload surges and/or extenuating situations including the creation of accident reports from the accident hotline.
</li><li>Collect and analyze data from internal departments and third-parties to create repair estimates for company equipment to subrogate against adverse parties; present collected data to adverse party for collection or reimbursement of damages
</li><li>Ensure compliance with company and departmental policies and procedures that support the mission, values and standards of ethics and integrity of the company
</li><li>Pursue continual education in the practice of transportation claims management through internal training, seminars, and other educational materials to stay abreast of the changing claims and legal environment
</li><li>Retain and manage outside counsel to assist in the investigation, preservation, and documentation of any complex claims. Utilizing independent knowledge and experience to interpret legal guidance in forming personal evaluations of claims from a liability and financial exposure standpoint.
</li></ul><p></p><p><b>Qualifications:
</b></p><p><b>Minimum Qualifications:
</b></p><ul><li>High School Diploma/GED with 3-4 years of experience in Auto/General Liability Claims, Insurance, or related field, or suitable combination of education, experience, and training
</li><li>AND/OR Demonstration of the following skills and abilities through education, certifications, military, or other experiences
</li><li>Ability to uphold a professional demeanor in all customer interactions, demonstrating empathy and patience in the face of challenging situations
</li><li>Ability to accurately analyze situations and reach productive decisions based on informed judgment
</li><li>Ability to adapt to a dynamic work environment and shifting priorities and directives
</li><li>Ability to effectively transmit, receive, and accurately interpret ideas through various mediums
</li><li>Ability to work with a variety of individuals and groups in a constructive and collaborative manner
</li><li>Ability to capture and document relevant business information in an auditable, organized, and easily retrievable manner
</li>Ability to process information with high levels of accuracy<br>
<li>
</li></ul><p><br>
<b>Preferred Qualifications:
</b></p><ul><li>Bachelor's Degree with 3-4 years of experience in Auto/General Liability Claims, Insurance, or related field
</li><li>Experience in a call center, particularly within the Insurance industry
</li><li>Ability to maintain composure under pressure
</li><li>Ability to type at least 30 words-per-minute
</li><li>Knowledge of claim investigation procedures
</li><li>Knowledge of approaches and techniques for recognizing, anticipating, and resolving problems
</li>Proficiency in documenting case details accurately and assessing payment eligibility<br>
<li>
</li></ul><p><br>
This position is not eligible for employment-based sponsorship.
</p><p></p><p><b>Compensation:
</b></p><p>Factors which may affect starting pay within this range may include skills, education, experience, geography, and other qualifications of the successful candidate. This position may be eligible for annual bonus and incentives based on profitability or volumes in accordance with the terms of the Company&rsquo;s bonus and incentive plans, as applicable and in effect from time to time.
</p><p></p><p><b>Benefits:
</b></p><p>The Company offers the following benefits for full-time positions, subject to applicable eligibility requirements, as may be in effect from time to time: medical benefit, dental benefit, vision benefit, 401(k) retirement plan, life insurance, short-term and long-term disability coverage, paid time off commensurate with tenure (includes vacation and sick time), six weeks of paid maternity leave along with two weeks of paid parental leave, and six paid holidays annually.
</p><p></p><p><b>Education:
</b></p>Bachelors: Law, GED (Required), High School
<p></p><p><b>Work Experience:
</b></p>Loss Prevention/Claims Management
<p></p><p><b>Job Opening ID:
</b></p>00622697 Casualty Claims Examiner II (Open)
<p></p><p><b><i>&ldquo;This job description has been designed to indicate the general nature and level of work performed by employees within this </i></b><b><i>classification. </i></b><b><i>It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
</i></b></p><p></p><p><b><i>To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.&rdquo;
</i></b></p><p></p><p><b><i>J.B. Hunt Transport, Inc. is committed to basing employment decisions on the principles of equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, persons with disabilities, protected veterans or other bases by applicable law.</i></b></p></div>

Casualty Claims Examiner II

Kinsale Insurance Company

<div><p>As a Claims Examiner, you will play a key role in managing casualty claims from investigation through resolution. This position combines analytical thinking, decision-making, and negotiation to ensure fair and timely claim outcomes. You&rsquo;ll work closely with experienced claims professionals and legal partners while handling a diverse portfolio, including litigated claims. This is a great opportunity to grow your expertise in a fast-paced, team-oriented environment that values learning and career development.</p>
<h4 class="jobSectionHeader"><b>
What You&rsquo;ll Do</b></h4>
<ul><li>Manage a variety of casualty claims under the guidance of a Claims Supervisor</li>
<li>Conduct and coordinate investigations across all phases of the claims process</li>
<li>Evaluate liability and exposure to develop effective resolution strategies</li>
<li>Analyze policy coverage, make determinations, and draft clear coverage correspondence</li>
<li>Communicate claim decisions and updates with policyholders and key stakeholders</li>
<li>Maintain accurate, detailed, and timely documentation within claim files</li>
<li>Oversee litigated claims by appointing and managing defense counsel</li>
<li>Drive claims and litigation toward efficient and fair resolution</li>
<li>Participate in mediations, settlement discussions, and trials as needed</li>
</ul><h4 class="jobSectionHeader"><b>What You Bring</b></h4>
<ul><li>Bachelor&rsquo;s degree in Business, Risk Management, or a related field</li>
<li>2+ years of experience handling commercial general liability claims involving bodily injury and property damage</li>
<li>Strong analytical, problem-solving, and decision-making skills</li>
<li>Excellent written and verbal communication abilities</li>
<li>Experience managing litigated claims and working with defense counsel</li>
<li>Ability to analyze medical records, contracts (including risk transfer provisions), property damage estimates, and litigation documents</li>
<li>Strong organizational and time management skills with the ability to multitask</li>
<li>Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint)</li>
<li>A collaborative mindset with strong negotiation skills</li>
</ul>
<p><i>Adjuster licenses or industry designations are a plus.</i></p>
<h4 class="jobSectionHeader"><b>
Why You&rsquo;ll Love Working at Kinsale</b></h4>
<ul><li><b>Competitive Pay &amp; Bonus Opportunities</b> &ndash; Rewarding performance and initiative.</li>
<li><b>Comprehensive Benefits</b> &ndash; Health, dental, and vision insurance with up to $3,600 (individual) or $6,800 (family) in HSA contributions per year.</li>
<li><b>Work-Life Balance</b> &ndash; Generous paid time off including 22 days of PTO and 10 paid company holidays.</li>
<li><b>Career Growth</b> &ndash; Clear promotion paths, mentorship, and ongoing professional development.</li>
<li><b>Retirement &amp; Security</b> &ndash; Up to 6% matching 401(k) contributions on base salary and bonus, standard life insurance, and disability coverage.</li>
<li><b>Continuous Learning</b> &ndash; Annual $3,000 reimbursement for educational training and certifications.</li>
</ul><h4 class="jobSectionHeader"><b>Integrity &amp; Responsibility</b></h4>
<p>
Kinsale values strong financial responsibility. A credit check may be conducted as part of the selection process for roles that require sound judgment and trustworthiness.</p>
<h4 class="jobSectionHeader"><b>
Ready to Apply?</b></h4>
<p>
If you&rsquo;re a detail-oriented claims professional who thrives in a collaborative and fast-paced environment, this is your opportunity to grow your career with Kinsale Insurance. Join a company that values innovation, excellence, and continuous learning.</p>
<p><b>
Apply today and take the next step in your career!</b></p></div>

Claims Examiner

Benecard Services Inc.

<p></p><div><div><div><div><div><div>The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</div><div></div><div><br>
This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week and is a Union position.</div><div></div><div><b><br>
Key Responsibilities</b></div><ul><li>
Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li>
Process complex or high-dollar claims requiring supervisory overrides</li><li>
Distribute daily claim workloads and support operational workflow efficiency</li><li>
Prepare and maintain documentation for internal and external audits</li><li>
Ensure compliance with prompt pay regulations and timely filing requirements</li><li>
Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li>
Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li>
Support monthly claims reporting and departmental performance tracking</li><li>
Collaborate with leadership to meet monthly productivity and accuracy goals</li><li>
Respond promptly and professionally to internal and external communications</li><li>
Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><div></div><div><b><br>
Required Qualifications:</b></div><ul><li>
5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li>
Strong knowledge of Medicaid and Medicare claim processing</li><li>
Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li>
Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li>
Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li>
In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li>
Familiarity with appeals and reconsideration processes for government payers</li><li>
Experience researching and resolving claim denials and timely filing issues</li><li>
Working knowledge of AS400 or similar claims processing systems</li><li>
Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li>
Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><div></div><div><b><br>
Preferred Qualifications:</b></div><ul><li>
Previous leadership experience would be preferred</li><li>
Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li>
Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li>
Experience supporting or participating in claims audits or compliance reviews</li></ul><div></div><div><b><br>
Why Join Us?</b></div><ul><li>
Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li>
Opportunity to specialize in eye care and vision insurance claims</li><li>
Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul><p></p><p><br>
National Vision Administrators</p><p>
For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.</p><p>
Website: http://www.e-nva.com</p><p>
We are an equal opportunity employer</p></div></div></div></div><br>
Monday - Friday 8:30am - 5:00pm</div>

Gallagher

<div><b>Introduction</b><br>
<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><br>
<b>Overview</b><div><b><br>
Role specifics:</b></div><div><b>
Jurisdictions: </b>United States</div><div><b>
Location: </b>This role is eligible for fully remote work.</div><div><b><br>
Professional designations such as Certified Fraud Examiner (CFE) or similar is preferred. This role will not have direct reports.</b></div><div></div><p><br>
We are seeking a highly analytical and professionally skeptical Deepfake Specialist specializing in Workers&rsquo; Compensation and Liability claims. In this role, you will audit high‑risk payments to identify potential fraud, errors, and non‑compliance with GB Best Practices. Your work directly supports the integrity of our claims payment processes and supporting our commitment to delivering exceptional service to our clients.</p><p></p><div><b><br>
Required Qualifications</b></div><ul><li>
Associate degree in a related field.</li><li>
5&ndash;7 years of experience in claims auditing, Workers&rsquo; Compensation, Liability claims, or a closely related discipline.</li><li>
Strong understanding of Workers&rsquo; Compensation and Liability regulations, claims processes, and industry standards.</li></ul>
<br>
<b>How you'll make an impact</b><div><b><br>
Key Responsibilities</b></div><ul><li>
Conduct detailed audits of Workers&rsquo; Compensation and Liability claim payments with a strong fraud‑risk mindset and professional skepticism to identify, investigate, and escalate potential internal fraud, errors, and non-compliance with GB Best Practices.</li><li>
Review supporting documentation&mdash;including invoices, medical bills, and settlement agreements&mdash;for accuracy, appropriateness, and alignment with policy.</li><li>
Collaborate with adjusters, managers, and cross‑functional teams to resolve discrepancies and implement corrective actions.</li><li>
Maintain current knowledge of jurisdictional regulations, industry trends, and best practices relevant to Workers&rsquo; Compensation and Liability claims.</li><li>
Contribute to the development and enhancement of audit procedures to improve audit quality, consistency, and effectiveness.</li><li>
Participate in special projects or process improvement initiatives as needed.</li></ul>
<br>
<b>About You</b><div><b><br>
Required Qualifications</b></div><ul><li>
Associate degree in a related field.</li><li>
5&ndash;7 years of experience in claims auditing, Workers&rsquo; Compensation, Liability claims, or a closely related discipline.</li><li>
Strong understanding of Workers&rsquo; Compensation and Liability regulations, claims processes, and industry standards.</li><li>
Demonstrated analytical skills with exceptional attention to detail and accuracy.</li><li>
Proficiency with audit software and Microsoft Office (especially Excel).</li><li>
Strong written and verbal communication skills.</li><li>
High ethical standards and the ability to consistently apply professional skepticism.</li><li>
Ability to work both independently and collaboratively.</li></ul><div></div><div><br>
#LI-NZ1</div><div>
#REMOTE</div><br>
<br>
<b>Compensation and benefits</b><p><br>
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.
</p><p>Below are the <b>minimum core benefits</b> you&rsquo;ll get, depending on your job level these benefits may improve:
</p><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><b>
Other benefits include:</b></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><i>
**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.</i></div><div></div><div><b><br>
We value inclusion and diversity</b></div><p>
Click Here to review our U.S. Eligibility Requirements</p><p>
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.
</p><p>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.</p><p>
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.
</p><p>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.</p></div>

Deepfake Specialist

Athens Administrators

<div>
 ATHENS POSITION DETAILS
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 <strong>
  Position Title:
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  <br/>
 </strong>
 Assistant Claims Examiner - Flex
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 <strong>
  Department:
  <br/>
  <br/>
 </strong>
 Workers&rsquo; Compensation
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 <strong>
  Reports To:
  <br/>
  <br/>
 </strong>
 Claims Supervisor
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 <strong>
  FLSA Status:
  <br/>
  <br/>
 </strong>
 Non-Exempt
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 <strong>
  Job Grade:
  <br/>
  <br/>
 </strong>
 6
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 <strong>
  Career Ladder:
  <br/>
  <br/>
 </strong>
 Next step in progression could include Future Medical Examiner or Claims Examiner Trainee
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 <strong>
  ATHENS ADMINISTRATORS
  <br/>
  <br/>
 </strong>
 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!
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 <strong>
  Position Summary
  <br/>
  <br/>
 </strong>
 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.
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 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.
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  Primary Responsibilities
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  <br/>
 </strong>
 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:
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 <ul>
  <li>
   Process new claims in compliance with client&rsquo;s Service Agreement
  </li>
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   Issue all indemnity payments and awards on time
  </li>
  <li>
   Process all approved provider bills timely
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  <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
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  <li>
   Contact treating physician for disability status
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  <li>
   Contact employer for return-to-work status or availability of modified work.
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  <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
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  <li>
   Calculate wage statements and adjust disability rates as required
  </li>
  <li>
   Keep diary for all delay dates and indemnity payments
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  <li>
   Documents file activity on computer
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   Update information on computer, i.e., address changes, etc.
  </li>
  <li>
   Schedule appointments for AME, QME evaluations
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  <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>
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   Verify mileage and dates of treatment for reimbursement to claimant
  </li>
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   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
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Essential Position Requirements
  <br/>
  <br/>
 </strong>
 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.
 <br/>
 <br/>
 <ul>
  <li>
   High School Diploma or equivalent (GED) required for all positions
  </li>
  <ul>
   <li>
    AA/AS or BA/BS preferred but not required
   </li>
  </ul>
  <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
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  APPLY WITH US
  <br/>
  <br/>
 </strong>
 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
 <br/>
 <br/>
 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.
 <br/>
 <br/>
 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.
 <br/>
 <br/>
 <strong>
  THANK YOU!
  <br/>
  <br/>
 </strong>
 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!
 <br/>
 <br/>
 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
 <strong>
  https://www.athensadmin.com/careers/why-work-here
 </strong>
</div>


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