life claims examiner

AmTrust Financial

<div>Overview:
<div>
The Lead Claims Examiner is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. Maintains a solid understanding of AmTrust&rsquo;s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.</div>
Responsibilities:
<ul><li>Follows AmTrust policies and procedures in managing claims.</li><li>
Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers.</li><li>
Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience.</li><li>
Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing. Approaches discussions from merits or strengths of case.</li><li>
Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.</li><li>
Establishes effective relationships with internal or assigned counsel for customized defense plan. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.</li><li>
Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.</li><li>
Obtain medical records (past and present), police, ambulance and other agency reports as required.</li><li>
Provides insights and input when reviewing claims of others. May be sought out by others for advice.</li><li>
Writes in a clear, succinct and fact-based manner in claims files as well as in other communication.</li><li>
Manages mail and diary entries effectively and efficiently.</li><li>
Provides exceptional customer service.</li><li>
Performs other functional duties as requested or required.</li></ul>
Qualifications:
<div><b>
Required:</b></div><ul><li>
3+ years experience as a Workers Comp adjuster</li><li>
MS Office experience (Work, Excel, Outlook)</li><li>
Effective negotiation skills</li><li>
Strong verbal and written communication skills</li><li>
Ability to prioritize work load to meet deadlines</li><li>
Ability to manage multiple tasks in a fast-paced environment</li></ul><div></div><div><i><br>
This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.</i></div><div></div><div><i><br>
The expected salary range for this role is $32-$44/hr.</i></div><div></div><div><i><br>
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations</i></div>
What We Offer:
<div>
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical &amp; Dental Plans, Life Insurance, including eligible spouses &amp; children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.</div><div></div><div><br>
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.</div><div></div><div><br>
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.</div></div>

Lead Claim Examiner I, CA

Markel Corporation

<div><div>What part will you play? If you&rsquo;re looking for a place where you can make a meaningful difference, you&rsquo;ve found it.</div>
The work we do at Markel gives people the confidence to move forward and seize opportunities, and you&rsquo;ll find your fit amongst our global community of optimists and problem-solvers. We&rsquo;re always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.
Join us and play your part in something special!
This position will be responsible for the resolution of moderate to high complexity and moderate to high exposure claims which can be subject to disputes that must be resolved in mediation or litigation. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. The position will have increased responsibility for decision making within their authority and work with minimal oversight and will provide training and be a technical referral point for other team members.<div></div><div>
Responsibilities</div><ul><li>
Analyzes coverage and communicates coverage positions</li><li>
Conducts, coordinates, and directs investigation into loss facts and extent of damages</li><li>
Confirms coverage of claims by reviewing policies and documents submitted in support of claims</li><li>
Contributes to maintenance of claims guidelines and best practice procedures</li><li>
Coordinates loss information for business stakeholders and presents information during meetings with underwriters and/or insureds when applicable</li><li>
Delivers technical training to colleagues and external contacts as appropriate</li><li>
Directs and monitors assignments to experts and outside counsel, ensures effective vendor and litigation management on moderate to high complexity claims including demonstrable savings</li><li>
Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure</li><li>
Negotiates and settles claims typically in litigation either directly or indirectly</li><li>
Participates in special projects or assists other team members as requested</li><li>
Prepare coverage position letters on matters typically in litigation without assistance of outside coverage counsel.</li><li>
Prepares reports by collecting and summarizing information</li><li>
Present at roundtables to senior claims leaders and underwriters on cases going to trial</li><li>
Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.</li><li>
Sets reserves within authority or makes claim recommendations concerning reserve changes to manager</li><li>
Travel to mediations, trials, and conferences as required</li><li>
Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.</li></ul><div></div><div>
Education</div><ul><li>
Bachelor&rsquo;s degree or equivalent work experience</li></ul><div></div><div>
Certification</div><ul><li>
Must have or be eligible to receive claims adjuster license.</li><li>
Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) or</li><li>
Participation in industry training opportunities (CLM Claim College, Munich Re Training, FDCC, etc..)</li></ul><div></div><div>
Qualifications</div><ul><li>
Minimum of 5 years of claims handling experience or equivalent combination of education and experience</li><li>
Successful completion of 3 years as a Claims Examiner</li><li>
Excellent written and oral communication skills</li><li>
Strong analytical and problem solving skills</li><li>
Strong organization and time management skills</li><li>
Ability to deliver outstanding customer service</li><li>
Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)</li><li>
Ability to work in a team environment</li><li>
Strong desire for continuous improvement</li><li>
Markel offers hybrid (3 days in the office and 2 days remote ) and fully remote option for this opening. Your location distance will determine the working schedule.</li></ul><div></div><div>
US Work Authorization</div><div></div><div>
US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.</div><div></div><div>
Pay information:</div><div>
The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors. The salary for the position is $73,000 - $107,250 with a 15% bonus potential.</div><div></div><div><div><div>
Who we are:</div></div><div></div><div><div>
Markel Group (NYSE &ndash; MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.</div></div><div></div><div><div><br>
We&rsquo;re all about people | We win together | We strive for better</div></div><div></div><div><div><br>
We enjoy the everyday | We think further</div></div><div></div><div><div><br>
What&rsquo;s in it for you:</div></div><div></div><div><div>
In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.</div></div><div><ul><li><div>
We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees&rsquo; needs at all stages of life.</div></li></ul></div><div><ul><li><div>
All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&amp;D insurance.</div></li></ul></div><div><ul><li><div>
We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.</div></li></ul></div><div></div><div><div><br>
Are you ready to play your part?</div></div><div></div><div><div>
Choose &lsquo;Apply Now&rsquo; to fill out our short application, so that we can find out more about you.</div></div></div><div></div><div><div><div><br>
Caution: Employment scams</div></div><div></div><div><div>
Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These &quot;job offers&quot; include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:</div></div><div><ul><li><div>
All legitimate job postings with Markel will be posted on <div>Markel Careers</div>. No other URL should be trusted for job postings.</div></li></ul></div><div><ul><li><div>
All legitimate communications with Markel recruiters will come from Markel.com email addresses.</div></li></ul></div><div></div><div><div><br>
We would also ask that you please report any job employment scams related to Markel to <div>rarecruiting@markel.com</div>.</div></div><div></div><div><div><br>
Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.</div><div></div><div><br>
Should you require any accommodation through the application process, please send an e-mail to the <div>rarecruiting@markel.com</div>.</div><div></div><div>
No agencies please.</div></div></div></div>

Senior Claims Examiner

Chubb Insurance

<div><p><b>P2 Senior Claims Examiner - Employment Practices Liability
</b></p><p>Chubb is the world&rsquo;s largest publicly traded property and casualty insurer. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we think about things differently. For us, insurance is about one thing: craftsmanship. It&rsquo;s who we are. It&rsquo;s what we do. It&rsquo;s how we serve our clients.
</p><p><b>Jo </b><b>b Summary:
</b></p><p><i>This is not your average Claims role.
</i></p><p>When you think of a job handling insurance claims, you may think about storm damage or auto accidents. Or maybe a large stack of paper?
</p><p>A career in Employment Practices Liability exposes you to emerging issues in the workplace that have been and remain at the center of national and global media. Issues such as the Me Too movement, Racial Injustice and Covid.
</p><p>In this paperless environment, you will use your analytical skills to resolve workplace claims.
</p><p>We will teach you more about Employment Law, contracts and claims. You will use your influence skills and knowledge to partner with defense counsel and our insureds in resolving discrimination, harassment and other workplace related claims. This role handles both Administrative Charges and Litigated files.
</p><p>The work is interesting. The environment is collaborative.
</p><p>Our Claims Professionals in Employment Practices Liability enjoy the work they do and working with their peers that come from a variety of backgrounds (including Law Enforcement, Human Resources, other disciplines in Claims and Legal, to name a few) and bring different perspectives into the team.
</p><p><b>Responsibilities after training include:
</b></p><ul><li>Contribute to a collaborative environment by raising new ideas, demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives
</li><li>Complete accurate and timely coverage, liability and damage investigations and evaluations on complex Employment Practices Liability insurance policies
</li><li>Establish, document and execute appropriate strategies to bring early and cost-effective resolution to assigned claims
</li><li>Represent the company at meetings with management and business partners, as well as virtually or in person at mediations.
</li><li>Effectively utilize technology systems and tools to track and manage caseload in most efficient and effective manner.
</li><li>Build and maintain productive relationships with internal and external customers, including clients, underwriters and agents
</li><li>Consistently demonstrate sound claim handling practices by achieving compliance in areas including investigation, coverage, loss assessment, and case management
</li><li>Provide coaching and guidance to new claim examiners</li></ul></div>
<br><div><ul><li>BA/BS College Degree Preferred. JD is helpful, but not required
</li><li>3 to 5 years experience in EPL or handling claims of a comparable complexity or working in a legal position
</li><li>Excellent verbal and written communication skills
</li><li>A personal commitment to superior performance that adds value to our company
</li><li>Strong interpersonal skills with the ability to interact and build relationships with all levels of internal and external contacts
</li><li>An aptitude for evaluating, analyzing, and interpreting technical information
</li><li>Sound decision making skills
</li><li>Proven ability to work independently as well as part of a team
</li><li>Must demonstrate a high level of initiative and leadership skills
</li><li>Excellent time management, problem solving, and organizational skills are required
</li><li>An ability to adapt to new ideas and situations
</li><li>A willingness to use creative thinking to overcome obstacles and an ability to develop creative approaches to solving customer problems
</li>Internal candidates must have coverage authority for charges and demands<br>
<li>
<br>
</li></ul><p><b>Additional Requirements:
</b><br>
<br>
Licensing: You must obtain and maintain required adjuster licenses within 90 days of hire.
</p><p>Training: Chubb managers, claim examiners and defense counsel provide a combination of classroom and on-the-job training to ensure our Claim Examiners are prepared to assume full claim handling responsibilities. The training will involve a wide range of knowledge and skill development, including:
</p><ul><li>Cultivating relationships with internal clients (e.g. underwriters)
</li><li>Developing the ability to analyze initial claim reports
</li><li>Developing an understanding of the legal system
</li><li>Understanding how to effectively investigate and document findings
</li><li>Understanding Chubb&rsquo;s products to appropriately determine coverage
</li><li>Learning to interpret and apply insurance contracts
</li><li>Learning how to negotiate settlements</li></ul></div>
<br><div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.<br>
</div><div></div><br>
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

Senior Claim Examiner

UnitedHealthcare

<div><p><i>This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.</i></p><p>
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start <b>Caring</b>. <b>Connecting</b>. <b>Growing together</b></p><p>
Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjudicating Life claims. Authorizes the appropriate payment or refers claims to Team Lead or Manager for validation of adverse or over limit approvals.</p><p>
This position is full-time (40 hours/week). Employees are required to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST.</p><p>
We offer 2 - 3 months of paid training. The hours during training will be aligned with their schedule. Training will be conducted virtually from your home.</p><p></p><p><b><br>
Primary Responsibilities:</b></p><ul><li>
Review and render determinations on Life claims</li><li>
Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process</li><li>
Respond to all inquiries generated relative to Life claims within established service timeframe</li><li>
Provide accurate claim decisions in accordance with Policy, State and Federal guidelines</li><li>
Adjudicate Life claims with current average volumes of 50 claims weekly</li></ul><p></p><p><br>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.</p><p><b>
Required Qualifications:</b></p><ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR Older</li><li>
2+ years of experience in Customer Service, including analyzing and problem-solving issues for policyholders, employers, for both internal and external customers</li><li>
2+ years of recent experience in life claims processing</li><li>
Proficiency with computer and Windows personal computer applications, which includes the ability to navigate and learn new and complex computer system applications</li><li>
Ability to work our normal business hours of 7:00am - 6:00pm EST. Core hours business hours are 9:00 am - 4:00 pm EST.</li></ul><p></p><p><b><br>
Preferred Qualifications:</b></p><ul><li>
OnBase claims processing system experience</li></ul><p></p><p><b><br>
Telecommuting Requirements:</b></p><ul><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.</li></ul><p></p><ul><li><br>
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul><p></p><p><br>
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $49,700 - $88,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.</p><p></p><p><b><i><br>
Application Deadline:</i></b><i> This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.</i></p><p></p><p><i><br>
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.</i></p><p></p><p><i><br>
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></p><p></p><p><i><br>
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</i></p></div>

Life Claims Analyst

<div><p>This is not your average Claims role. When you think of a job handling insurance claims, you may think about storm damage or auto accidents. Or maybe a large stack of paper?
</p><p>A career in Employment Practices Liability exposes you to emerging issues in the workplace that have been and remain at the center of national and global media. Issues such as the #MeToo movement, Racial Injustice and Covid.
</p><p>In this paperless environment, you will use your analytical skills to resolve workplace claims.
</p><p>We will teach you about Employment Law, contracts and claims. You will use your influence skills and knowledge to partner with defense counsel and our insureds in resolving discrimination, harassment and other workplace related claims.
</p><p>The work is interesting. The environment is collaborative.
</p><p>Our Claims Professionals in Employment Practices Liability enjoy the work they do and working with their peers that come from a variety of backgrounds (including Law Enforcement, Human Resources, other disciplines in Claims and Legal, to name a few) and bring different perspectives into the team.
</p><p>Responsibilities after training include:
</p><ul><li><p>Contribute to a collaborative environment by raising new ideas, demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives
</p></li><li><p>Complete accurate and timely coverage, liability and damage investigations and evaluations on complex Employment Practices Liability insurance policies
</p></li><li><p>Establish, document and execute appropriate strategies to bring early and cost-effective resolution to assigned claims
</p></li><li><p>Represent the company at meetings with management and business partners, as well as virtually at mediations.
</p></li><li><p>Effectively utilize technology systems and tools to track and manage caseload in most efficient and effective manner.
</p></li><li><p>Build and maintain productive relationships with internal and external customers, including clients, underwriters and agent
</p></li><li><p>Consistently demonstrate sound claim handling practices by achieving compliance in areas including investigation, coverage, loss assessment, and case management
</p></li><li><p>Assume part of Training responsibilities for new claim examiners
</p></li><li><p>Provide coaching and guidance to new claim examiners
</p></li><li>BA/BS College Degree Preferred. JD is helpful, but not required
</li><li>3 to 5 years work experience, handling claims of a comparable complexity or working in a legal position
</li><li>Excellent verbal and written communication skills
</li><li>A personal commitment to superior performance that adds value to our company
</li><li>Strong interpersonal skills with the ability to interact and build relationships with all levels of internal and external contacts
</li><li>An aptitude for evaluating, analyzing, and interpreting technical information
</li><li>Sound decision making skills
</li><li>Proven ability to work independently as well as part of a team
</li><li>Must demonstrate a high level of initiative and leadership skills
</li><li>Excellent time management, problem solving, and organizational skills are required
</li><li>An ability to adapt to new ideas and situations
</li><li>A willingness to use creative thinking to overcome obstacles and an ability to develop creative approaches to solving customer problems
</li></ul><p>Training: Chubb managers, claim examiners and defense counsel provide a combination of classroom and on-the-job training to ensure our Claim Examiners are prepared to assume full claim handling responsibilities. The training will involve a wide range of knowledge and skill development, including:
</p><ul><li>Cultivating relationships with internal clients (e.g. underwriters)
</li><li>Developing the ability to analyze initial claim reports
</li><li>Developing an understanding of the legal system
</li><li>Understanding how to effectively investigate and document findings
</li><li>Understanding Chubb&rsquo;s products to appropriately determine coverage
</li><li>Learning to interpret and apply insurance contracts
</li><li>Learning how to negotiate settlements
</li><li>If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.</li></ul></div>
<br><div><div>Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.<br>
</div><div></div><br>
<div>At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.</div></div>

<div><p><b>ADP is hiring a Lead Claims Examiner.</b> In this position you will perform the following basic functions:</p>
<ul><li>Supervisory responsibility for Claims Examiner I and Senior Examiner</li>
<li>To aid in overall claim cost reduction by coordinating efforts between all involved vendors, clients and WES.</li>
<li>Additional level to monitor applicable claims assigned to Claims Examiner I and Senior Examiner</li>
<li>To ensure TPA/Carrier accountability in agreed performance standards and coordinate needs for changes with Claims Director</li>
<li>To accumulate data for the purpose of creating standards for measurement of various claim related issues, as well as customer service and internal staff performance</li>
</ul><p><b>At ADP we are driven by your success.</b> We engage your unique talents and perspectives. We welcome your ideas on how to do things differently and better. In your efforts to achieve, learn and grow, we support you all the way. If success motivates you, you belong at ADP.<br>
<br>
We strive for every interaction to be driven by our <b>CORE</b> values:<b> Insightful Expertise, Integrity is Everything, Service Excellence, Inspiring Innovation, Each Person Counts, Results-Driven, - Social Responsibility.</b><br>
<br>
<b>RESPONSIBILITIES:</b></p>
<ul><li>Reviews and recommends acceptability of all Workers' Compensation Claims within claim distribution</li>
<li>Accountability for the Claim Unit's efforts in all RTW efforts, OSHA documentation and all documentation of claim activity according to stated claim procedures.</li>
<li>Works directly with Claims Director to determine workloads and the necessity of procedure changes within the Claims Unit</li>
<li>Assists in online audits of TPA to insure quality compliance of claim procedures and client satisfaction in Workers' Compensation claims handling.</li>
<li>Maintaining e-time and PTO/Sick time coordination for the Claims Unit., has one administrative direct report and mentor/coaching responsibilities for the Claims Examiner.</li>
<li>Responsible for communication with internal/external clients, claimants, related vendors as well as TPA/Carrier activity for TotalSource work-site employee claims to include personal visits to each region.</li>
<li>Requires basic knowledge of Workers' Compensation laws for all jurisdictions.</li>
<li>Attends professional development courses and seminars to keep TotalSource current with related workers' compensation laws and standards.</li>
<li>Represents client in legal activities related to Workers' Compensation Claims within authority.</li>
<li>To review, audit and support the examiner positions.</li>
<li>To generate routine reports for productivity level evaluation.</li>
<li>To support the Claims Director in daily/monthly/quarterly tasks and projects that aid in the claim operation reach it's specified goals.</li>
</ul><p><b>QUALIFICATIONS REQUIRED:</b></p>
<ul><li>5+ years in WC Indemnity adjusting or industry related experience</li>
<li>Experience with complex claims cases</li>
</ul><p></p><p><b>PREFERRED QUALIFICATIONS:</b> Preference will be given to candidates who have the following:</p>
<ul><li>Direct or indirect leadership experience</li>
<li>PEO experience
</li><li>Maintain knowledge of basis Workers Compensation Laws in all applicable jurisdictions</li>
<li>Stay abreast of strategies and current industry related ideologies in dealing with Workers' Compensation Claims</li>
<li>Maintain adequate resources to enable continued education in Workers' Compensation and RTW issues.</li>
</ul><p>#LI-KD1</p>
<p>#LI-Remote</p><p></p>
<div>Base salary offers for this position may vary based on factors such as location, skills, and relevant experience. Some positions may include additional compensation in the form of bonus, equity or commissions. We offer the following benefits: Medical, Dental, Vision, Life Insurance, Matched Retirement Savings, Wellness Program, Short-and Long-Term Disability, Charitable Contribution Match, Holidays, Personal Days &amp; Vacation, Paid Volunteer Time Off, and more. The compensation for this role is USD $59,100.00 - USD $120,200.00 / Year*<br>
<br>
<ul><li>Actual compensation will not be less than the applicable minimum wage or minimum exempt salary requirement under federal, state and local laws.</li></ul><br>
</div><p><b>A little about ADP:</b> We are a comprehensive global provider of cloud-based human capital management (HCM) solutions that unite HR, payroll, talent, time, tax and benefits administration and a leader in business outsourcing services, analytics, and compliance expertise. We believe our people make all the difference in cultivating a down-to-earth culture that embraces our core values, welcomes ideas, encourages innovation, and values belonging. We've received recognition for our work by many esteemed organizations, learn more at ADP Awards and Recognition.</p>
<p><b>Diversity, Equity, Inclusion &amp; Equal Employment Opportunity at ADP:</b> ADP is committed to an inclusive, diverse and equitable workplace, and is further committed to providing equal employment opportunities regardless of any protected characteristic including: race, color, genetic information, creed, national origin, religion, sex, affectional or sexual orientation, gender identity or expression, lawful alien status, ancestry, age, marital status, protected veteran status or disability. Hiring decisions are based upon ADP&rsquo;s operating needs, and applicant merit including, but not limited to, qualifications, experience, ability, availability, cooperation, and job performance.</p>
<p><b>Ethics at ADP:</b> ADP has a long, proud history of conducting business with the highest ethical standards and full compliance with all applicable laws. We also expect our people to uphold our values with the highest level of integrity and behave in a manner that fosters an honest and respectful workplace. Click https://jobs.adp.com/life-at-adp/ to learn more about ADP&rsquo;s culture and our full set of values.</p></div>

Workers' Comp Claims Lead Examiner

TEEMA

<div><p><b>Job Summary</b></p><p>
Workers Compensation Claims Examiner III</p><p>
TeemaGroup</p><p>
Full-time</p><p>
In-Office | Kapolei, HI, United States</p><p><b><br>
POSITION SUMMARY</b></p><p>
At the direction of the Claims Supervisor and/or Claims Manager, the Claims Examiner II / III manages all aspects of workers&rsquo; compensation indemnity, medical-only, future medical, and litigated claims from inception through resolution, within established authority and company/client guidelines.</p><p>
This role requires frequent interaction with <b>clients, claimants, medical providers, attorneys, vendors, nurse case managers, vocational case managers, and internal staff</b>.</p><p>
The <b>level of complexity, litigation exposure, settlement authority, and leadership responsibility</b> will be commensurate with the examiner&rsquo;s experience and designation (Level II or Level III).</p><p><b>
DUTIES AND RESPONSIBILITIES</b></p><p><b>
Core Responsibilities (Applies to Examiner II &amp; III)</b></p><ul><li>Manage a full caseload of workers&rsquo; compensation claims, including <b>complex indemnity claims</b>.</li><li>Initiate, conduct, and document timely and thorough claim investigations.</li><li>Determine compensability and administer benefits in accordance with <b>state laws, rules, and company/client handling instructions</b>.</li><li>Manage medical treatment and medical billing; authorize services as appropriate.</li><li>Communicate effectively with claimants, medical providers, vendors, and clients regarding claim issues.</li><li>Compute and set reserves in accordance with Company and Client guidelines.</li><li>Maintain an organized diary system and document claim files to reflect status, strategy, and action plans.</li><li>Settle and/or finalize claims and obtain appropriate settlement authority.</li><li>Conduct scheduled file reviews and respond to client inquiries.</li><li>Identify injury trends, safety concerns, and other claim-related issues and communicate proactively to clients.</li><li>Adhere to all TRISTAR company policies, procedures, and best practices.</li><li>Utilize office systems and technology efficiently to manage caseload responsibilities.</li><li>Perform other related duties as assigned.</li></ul><p><b>
Advanced / Senior Responsibilities (Primarily Examiner III)</b></p><ul><li>Manage <b>very complex, catastrophic, and litigated indemnity claims</b> from inception to conclusion.</li><li>Refer cases to outside defense counsel and actively participate in litigation strategy, hearings, mediations, and settlements.</li><li>Identify and manage:</li><li>Subrogation opportunities</li><li>Apportionment potential</li><li>Excess reporting criteria and reimbursement</li><li>Prepare and assist with <b>state audits, regulatory reporting, and client-specific reporting requirements</b>.</li><li>Develop and execute proactive claim strategies to drive timely and cost-effective resolution.</li><li>Conduct detailed client file reviews and participate in client meetings as needed.</li><li>Mentor and provide technical guidance to less experienced Claims Examiners.</li><li>Handle multi-jurisdictional workers&rsquo; compensation claims as assigned.</li></ul><p><i>
Essential job functions.</i></p><p></p><p><b>
QUALIFICATIONS REQUIRED</b></p><p><b>
Education &amp; Experience</b></p><ul><li><b>Claims Examiner II:</b></li><li>Bachelor&rsquo;s degree in a related field (preferred)</li><li>Minimum <b>3+ years</b> of workers&rsquo; compensation claims experience, or equivalent combination of education and experience</li><li><b>Claims Examiner III:</b></li><li>Minimum <b>5+ years</b> of progressive workers&rsquo; compensation claims experience</li><li>Demonstrated experience handling <b>complex and litigated indemnity claims</b></li></ul>
#Workwolf</div>

Workers Compensation Claims Examiner III

Search 10000+ Life claims examiner jobs near you this March. New roles added regularly across leading industries. Apply today.

10000 life claims examiner jobs Near Me

Lead Claim Examiner I, CA

Senior Claims Examiner

Senior Claim Examiner

Life Claims Analyst

Senior Claim Examiner

Workers' Comp Claims Lead Examiner

Workers Compensation Claims Examiner III