medical claims examiner

NTT DATA

<div>At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.<br>
<br>
For more than 25 years, NTT DATA Services have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.<br>
<br>
NTT DATA Services currently seeks Xcelys Medical Claims Examinersto join our team remotely for a 6-12 month contract role.<br>
<br>
<b>MUST HAVE XCELYS EXPERIENCE</b><br>
<br>
To serve as a Medical Claims Processor within the Xcelys environment. Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.<br>
<br>
<b>Role Responsibilities:</b>
<div><ul><li>Adjudication &amp; Review</li></ul>
</div><ul><li>Process comprehensive medical claims using Xcelys and associated subsystems</li>
<li>Resolve complex pends, coding issues, and contract exceptions</li>
<li>Author overpayment/underpayment determinations and coordinate appeals</li></ul>
<div><ul><li>Quality &amp; Compliance</li></ul>
</div><ul><li>Engage in quality reviews, audits, root cause analyses</li>
<li>Monitor accuracy, variance, and rework metrics</li>
<li>Ensure alignment with regulatory and internal compliance guidelines</li></ul>
<div><ul><li>Support</li></ul>
</div><ul><li>Act as escalation point and subject matter expert</li></ul>
<div><ul><li>Process &amp; System Improvement</li></ul>
</div><ul><li>Participate in system testing, UAT, and workflow enhancements</li>
<li>Recommend improvements, document system and process changes</li></ul>
<div><ul><li>Reporting &amp; Analytics</li></ul>
</div><ul><li>Prepare production, pending, and quality reports</li>
<li>Identify trends and recommend corrective actions</li></ul>
<div><ul><li>Cross-Functional Collaboration</li></ul>
</div><ul><li>Liaise with provider relations, legal, IT, compliance teams</li>
<li>Support internal initiatives related to claims systems / operational improvements</li></ul><br>
<b>
Required Skills/Experience
</b><ul><li>5+ years claims adjudication experience</li>
<li>Minimum of 1 year experience in Xcelys
</li><li>2+ years in coding (CPT, ICD-10, HCPCS)</li>
<li>2+ years provider contracts, pricing, regulatory guidelines experience</li></ul>
<b>Preferences</b>
<ul><li>Excellent analytical and communication skills</li>
<li>Experience training staff or acting as a mentor</li>
<li>Familiarity with system testing and documentation</li>
<li>Ability to manage high-volume workload and meet performance metrics</li></ul>
<b>Education: Verifiable high school diploma or GED</b><br>
<br>
About NTT DATA Services:<br>
<br>
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.<br>
<br>
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.<br>
<br>
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is <b>($20/hourly )</b>. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.<br>
<br>
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&amp;D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.</div>

Xcelys Medical Claims Examiner

<div>At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company's growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.<br>
<br>
For more than 25 years, NTT DATA Services have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.<br>
<br>
<b>Claims Examiner-Xcelys </b><b>Location: Fully Remote</b> <b>Pay Rate: $20.00 Per hour</b> <b>Start Date: 4/13/2026</b> <b>M-F 8:00am-5pm CT.</b> <b>Employment Type: Long Term Contract/Not Direct Hire</b><br>
<br>
<b>MUST HAVE XCELYS EXPERIENCE</b><br>
<br>
To serve as a Medical Claims Processor within the Xcelys environment. Provide subject-matter expertise on claims workflows and be a key contributor to system enhancements, audits, and process optimizations.<br>
<br>
<b>Role Responsibilities:</b>
<div><ul><li>Adjudication &amp; Review</li></ul>
</div><ul><li>Process comprehensive medical claims using Xcelys and associated subsystems</li>
<li>Resolve complex pends, coding issues, and contract exceptions</li>
<li>Author overpayment/underpayment determinations and coordinate appeals</li></ul>
<div><ul><li>Quality &amp; Compliance</li></ul>
</div><ul><li>Engage in quality reviews, audits, root cause analyses</li>
<li>Monitor accuracy, variance, and rework metrics</li>
<li>Ensure alignment with regulatory and internal compliance guidelines</li></ul>
<div><ul><li>Support</li></ul>
</div><ul><li>Act as escalation point and subject matter expert</li></ul>
<div><ul><li>Process &amp; System Improvement</li></ul>
</div><ul><li>Participate in system testing, UAT, and workflow enhancements</li>
<li>Recommend improvements, document system and process changes</li></ul>
<div><ul><li>Reporting &amp; Analytics</li></ul>
</div><ul><li>Prepare production, pending, and quality reports</li>
<li>Identify trends and recommend corrective actions</li></ul>
<div><ul><li>Cross-Functional Collaboration</li></ul>
</div><ul><li>Liaise with provider relations, legal, IT, compliance teams</li>
<li>Support internal initiatives related to claims systems / operational improvements</li></ul><br>
<b>
Required Skills/Experience
</b><ul><li>2+ years claims adjudication experience</li>
<li>Minimum of 1 year experience in Xcelys
</li><li>2+ years in coding (CPT, ICD-10, HCPCS)</li>
<li>2+ years provider contracts, pricing, regulatory guidelines experience</li></ul>
<b>Preferences</b>
<ul><li>Excellent analytical and communication skills</li>
<li>Experience training staff or acting as a mentor</li>
<li>Familiarity with system testing and documentation</li>
<li>Ability to manage high-volume workload and meet performance metrics</li></ul>
<b>Education: Verifiable high school diploma or GED</b><br>
<br>
About NTT DATA Services:<br>
<br>
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.<br>
<br>
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.<br>
<br>
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is <b>($20/hourly )</b>. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.<br>
<br>
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&amp;D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.</div>

Xcelys Medical 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

ClaimsPro LP

<div><h1 class="jobSectionHeader"><b>Company:</b></h1>
ClaimsPro LP - International Programs Group<p></p>
Senior Transportation Claims Examiner - Remote (Anywhere in the US)<p></p><p><br>
This senior level Adjuster position is responsible for investigating and settling transportation first party claims and third-party claims, with an emphasis on industry knowledge around commercial auto physical damage, motor truck cargo, towing, and salvage procedures</p><p></p><p>
IPG works as a Third Party Administrator in the contiguous 48 states, Hawaii, and Puerto Rico handling a variety of claims including, but not limited to auto physical damage and motor truck cargo. A nationwide knowledge base is a plus. Compensation will be based on experience and knowledge.</p><p></p><p><b>
Job Responsibilities:</b></p><ul><li><p>
Initiate the investigation of new claims</p></li><li><p>
Evaluate coverage and make appropriate policy decisions</p></li><li><p>
Evaluate and negotiate settlements of collision, specified perils, property damage, and transportation losses as appropriate.</p></li><li><p>
Manage and oversee the work of outside adjusters, appraisers and experts.</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>
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>
Preferred experience in Open Office</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>
Location: Remote working but may require some travel to home office, etc.</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>
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>

Senior Transportation Claims Examiner - Remote

<div><p>We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, culture and talent experience and our ability to be compelling to our clients. You&rsquo;ll find an environment that inspires and empowers you to thrive both personally and professionally. There&rsquo;s no one like you and that&rsquo;s why there&rsquo;s nowhere like RSM.</p><p></p><p><b>
Market Conduct Examiner (Health and PBM)
</b></p><p><b>Risk &amp; Regulatory Consulting, LLC</b></p><p><b>
(Regulatory Insurance)</b></p><p><b>
Work from home-any US location</b></p><p></p><p><b>
Position Overview</b><br>
The Market Conduct Examiner will be responsible for performing reviews of major insurance companies&rsquo; operations, marketing, underwriting, mental health parity quantitative and non-quantitative treatment limits, pharmacy benefit management practices, rating, policyholder service, producer licensing, complaint handling and claims handling processes to verify compliance with states&rsquo; insurance statutes and regulations.</p><p></p><p><b>
Specific Duties and Responsibilities</b></p><p><b><i>
(Responsibilities may vary slightly depending on seniority level)</i></b></p><ul><li>
Perform comprehensive, targeted and risk focused market conduct examinations to determine compliance with states&rsquo; insurance statutes and regulations on behalf of state insurance departments.</li><li>
Review and assess insurance company&rsquo;s documentation and data to determine compliance with states&rsquo; insurance statutes and regulations.</li><li>
Draft examination work papers in an organized manner for supervisory review.</li><li>
Assist with the preparation of reports, exhibits, and other supporting documentation and schedules that detail a company&rsquo;s compliance with insurance statutes and regulations and recommend solutions.</li><li>
Submit draft examination reports and other deliverables for supervisory review.</li><li>
Recommend/document actions to ensure compliance with insurance statutes and regulations.</li><li>
Must possess knowledge of and provide guidance of insurance laws, rules, and regulations.</li><li>
Review and analyze new, proposed, or revised laws, regulations, policies, and procedures in order to determine compliance with states&rsquo; insurance statutes and regulations and interpret their meaning and determine impact to the insurance company.</li><li>
Analyze reports and records relating to specific and overall operations of insurance companies; prepare clear, complete, concise, and informative compliance reports of condition of insurance companies for supervisory review.</li><li>
Consistently enhance knowledge of principles, practices, techniques, and methods of insurance examination and regulations; insurance laws and Insurance Commissioner&rsquo;s rulings; and related Attorney General Opinions and court decisions; insurance company practices; statistical sampling procedures; basic mathematics.<ul><li>
This includes, but is not limited to, analyzing compliance pertaining to review of pharmacy audits conducted by PBMs, spread pricing, pharmacy reimbursement, dispensing fee requirements, annual reports, contract review, financial review, internal and external appeals, claims processing, and network adequacy.</li></ul></li><li>
Complete examination work in the required state software platform.<ul><li>
This includes utilizing TeamMate+ and other software platforms as required.</li></ul></li><li>
Ensure all deadlines presented by examination workplan schedule and PBM management are met.<ul><li>
This includes, but is not limited to, ensuring all audit deliverables are met timely and accurately, including assisting in client and examinee company point(s) of contact relationships.</li></ul></li><li>
Ability to adapt to a fast-paced environment.</li></ul><p></p><p><b>
Requirements</b></p><ul><li>
Bachelor&rsquo;s Degree in Business, Risk Management, Accounting or Finance; MBA and/or professional certification/s preferred</li><li>
Minimum of 5+ years insurance experience with a State or Federal agency, insurance company, examination firm or with a public accounting firm as an internal or external auditor, adjuster, compliance professional or examiner.
 </li><li>Insurance industry experience is a must.</li></ul><ul><li>
Candidates must have completed or are pursuing professional insurance designations such as AIE/CIE, MCM, AIRC, FLMI, CPCU, or CLU.</li><li>
PC skills, including experience in using software for producing presentations, spreadsheets, and project planning (skilled in TeamMate, ACL/Access, and MS Excel, Word and Power Point).</li><li>
Demonstrated history of project management experience.</li><li>
Ability to interact with all levels including executives and senior managers.</li><li>
Strong interpersonal, presentation, analytical and examination/audit skills.</li><li>
Excellent organizational skills and the ability to prioritize multiple tasks, projects and assignments using effective time management skills.</li><li>
Strong written and verbal communication skills are required.</li><li>
Dynamic/flexible demeanor with exceptional client service skills.</li><li>
Forward-thinking leader with a collaborative focus who can consult effectively with key constituents and become recognized as a valued resource.</li><li>
Must be self-motivated, work well independently and possess a sense of urgency.</li><li>
Skilled in team building and team development.</li><li>
Flexibility for minimal travel</li></ul><p></p><p><b>
Preferred Qualifications</b></p><p></p><ul><li>
Strong knowledge of and experience in Health Lines of Business, with an emphasis in the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA).</li></ul><ul><li>
Extensive experience with examination software TeamMate.</li><li>
Moderate experience with ACL.</li></ul><p></p><p>
Risk &amp; Regulatory Consulting, LLC (RRC), an affiliate of RSM, is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. RRC offers services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. RRC is a results-oriented firm committed to success that builds long-term relationships with its clients. www.riskreg.com</p><p></p><p>
At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life&rsquo;s demands, while also maintaining your ability to serve clients. Learn more about our total rewards at https://rsmus.com/careers/working-at-rsm/benefits.</p><p></p><p>
All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.</p><p></p><p>
Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at 800-274-3978 or send us an email at careers@rsmus.com.</p><p></p><p>
RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate.</p><p></p><p>
RSM will consider for employment qualified applicants with arrest or conviction records. For those living in California or applying to a position in California, please click here for additional information.</p><p></p><p>
At RSM, an employee&rsquo;s pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range.</p><p></p>
Compensation Range: $69,800 - $132,000<p></p><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p>
Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance.</p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Market Conduct Examiner (Health and PBM)

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>
Handles healthcare malpractice/negligence claims including the following:</li><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>
Drafts coverage position letters</li><li>
Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure</li><li>
Handles claims in all jurisdictions</li><li>
Handles litigated and non-litigated bodily injury claims with values up to $450,000 in all jurisdictions, managing the process from inception of the claim until conclusion, including settlement, trial, or appeal, when litigated.</li><li>
Monitors excess and reinsurance claim files with varying levels of attachment point;</li><li>
Identify losses which should be reported to SIU.</li><li>
Participates in special projects or assists other team members as requested</li><li>
Provides excellent and professional customer service to insureds while maintaining a high level of production.</li><li>
Represents Markel in mediations, as required</li><li>
Monitors trial, as required</li><li>
Sets reserves within authority or makes recommendations concerning reserve changes to manager</li></ul><div></div><div>
Education</div><ul><li>
Bachelor&rsquo;s degree or equivalent work experience</li><li>
JD , advanced degree, or focused technical degree a plus</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>
Work Experience</div><ul><li>
Minimum of 7-15 years of claims handling experience or equivalent combination of education and experience in insurance</li><li>
Successful completion of 5 years as a Claims Examiner</li></ul><div></div><div>
Skill Sets</div><ul><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>
Experience in negotiation, mediations, arbitrations and monitoring trials on higher value complex claims</li><li>
Ability to influence claims stakeholders and to effectively direct claims strategy</li><li>
Strong vendor management skills are required including the ability to provide direction and guidance to defense attorneys, independent adjusters, building consultants, forensic accountants and other experts while controlling expenses.</li><li>
Ability to assist with technical training to team claim handlers as required</li><li>
Well developed and advanced expertise and knowledge in most technically complex claims topics</li><li>
Policy language skills enabling accurate and consistent policy wording interpretation</li><li>
Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement.</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></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, Global Medical & Healthcare Claims

<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

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