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pharmacy claims adjudication specialist

Onco360

<div><div>We are seeking a Pharmacy Adjudication Specialist for our Specialty Oncology pharmacy.</div>
<div><b>As our company continues to grow, we strive to hire new team members with a passion for making a difference in our patient's lives.</b></div>
<div></div><div><b>Full-Time position working out of the State of Indiana</b>.<b> This position may work remotely.</b></div>
<div></div><div><b>Shift times currently available: 9:00am- 5:30pm EST or 10:00am-6:30 pm EST</b></div>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div><b>Starting salary from $25.00 an hour and up</b></div>
<div><b>Sign-On Bonus: </b><b>$5,000 for employees starting before July 31, 2026.</b></div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections</div>
<div></div><div>Pharmacy Adjudication Specialists at Onco360...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.</li>
<li>Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.</li>
<li>Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.</li>
<li>Documents and submit requests for Patient Refunds when appropriate.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Pharmacy Technician License/Registration with Board of Pharmacy as required by state law</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li></ul></li></ul></div></div>

Pharmacy Claims Adjudication Specialist

OneAmerica Financial Partners, Inc

<div><p>At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together. Come be a part of this journey with us as we champion lives!</p>
<p>
The Supplemental Health Claims Manager is an individual contributor responsible for providing subject matter expertise to design, implement, and continuously improve supplemental health claims processes, procedures, and workflows. This role partners closely with Claims Operations, Product, Compliance, Training, and Technology teams to ensure customer-focused, compliant, and efficient claims practices. The position may also adjudicate claims and support quality initiatives as needed.</p>
<p><b>
Key Responsibilities:</b></p>
<ul>
<li>Process, procedure, and workflow design: Lead the development and implementation of new and revised supplemental health claims processes, standard operating procedures (SOPs), desk-level job aids, workflow diagrams, and controls to support consistent, scalable operations.</li>
<li>Technical claims subject matter expertise: Serve as the go-to expert for supplemental health products (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.) and interpret plan provisions, definitions, limitations, exclusions, riders, and administrative rules to guide accurate claims outcomes.</li>
<li>Systems design and requirements support: Partner with Technology and business stakeholders to translate operational needs into clear requirements (rules, routing, templates, decision logic, edits, and reporting), validate design, and support testing (UAT) to ensure systems enable compliant and efficient claims processing.</li>
<li>Eligibility and efficiency optimization: Identify opportunities to improve eligibility verification, evidence collection, and straight-through processing; recommend automation and controls to reduce rework, turnaround time, and preventable denials while maintaining accuracy and customer experience.</li>
<li>Training and knowledge enablement: Contribute to training program development by creating curriculum content, job aids, and scenario-based learning; deliver or support training for new hires and tenured staff on product knowledge, systems, and procedure changes.</li>
<li>Continuous improvement and quality: Analyze operational performance (e.g., turnaround time, accuracy, denial drivers, customer contacts), support root-cause investigations, and implement corrective actions; participate in audits and quality reviews to sustain high standards.</li>
<li>Regulatory compliance and industry awareness: Stay current on applicable federal/state regulations, market trends, and internal compliance requirements; assess impacts to claims handling and proactively recommend updates to procedures, controls, training, and communications.</li>
<li>Claims adjudication (as assigned): Review and adjudicate supplemental health claims in accordance with plan provisions and procedures</li>
</ul>
<p><b>Required Qualifications</b></p>
<ul>
<li>Bachelor&rsquo;s degree (or equivalent combination of education and related experience).</li>
<li>3+ years of experience in supplemental health (voluntary benefits) claims operations and/or claims adjudication (Accident, Critical Illness, Hospital Indemnity, Wellness, etc.).</li>
<li>Experience with process improvement methods, service-level management, and quality/audit programs.</li>
<li>Experience creating and maintaining operational documentation (SOPs, workflows, job aids) and communicating process changes to stakeholders.</li>
<li>Experience supporting implementations or migrations of claims platforms (requirements, configuration support, testing, training, go-live readiness).</li>
<li>Demonstrated training facilitation experience (live sessions, virtual training, train-the-trainer).</li>
<li>Demonstrated ability to interpret plan provisions/contract language and apply it consistently to claim scenarios.</li>
<li>Working knowledge of claims systems and operational controls (queue routing, decision rules, correspondence templates, work item management) and participation in testing/UAT.</li>
<li>Ability to analyze operational issues, identify root causes, and implement improvements that enhance accuracy, compliance, and cycle time.</li>
<li>Strong written and verbal communication skills, with the ability to explain claim outcomes and technical concepts clearly and professionally.</li>
</ul>
<p><b>Preferred Qualifications</b></p>
<ul>
<li>Experience applying Lean and Six Sigma methodologies to drive process improvements</li></ul><br>
<p></p>
<p>
Salary Band: 6A</p>
<p>
#LI-SC1</p>
<p>
This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team building and collaboration.</p>
<p>
We offer a comprehensive total rewards package designed to support you both at work and at home. Full‑time and part‑time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:</p>
<ul>
<li>Medical &amp; prescription, dental, vision insurance</li>
<li>Health Savings Account &amp; Flexible Spending Accounts</li>
<li>Paid Time Off</li>
<li>10 weeks 100% paid parental leave (after completing 12 months of employment)</li>
<li>401(k) Plan with company match</li>
<li>Pension Plan</li>
<li>Company paid life &amp; disability insurance</li>
<li>Wellness Program &amp; Company paid employee assistance program</li>
<li>Clinic access subject to location* <i>(*Indianapolis, Charlotte, Cincinnati</i>)</li>
</ul>
<p>If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York.</p>
<p>
Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.</p>
<p>
Disclaimer: American United Life Insurance Company (&ldquo;OneAmerica Financial&rdquo;) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, gender identity), age, physical or mental disability, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local law.</p>
<p>
For all positions:</p>
<p>
Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered.</p>
<p>
To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.</p><p>
Equal Opportunity Employer<br>
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.</p></div>

Supplemental Health Claims Manager

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><p><b>
Position Summary</b></p><p>
Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems.</p><ul><li>
Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.
</li><li>Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.</li><li>
Performs claim re-work calculations.</li><li>
Follow through completion of claim overpayments, underpayments, and any other irregularities.</li><li>
Process complex non-routine Provider Refunds and Returned Checks.</li><li>
Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks.
</li><li>Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.</li><li>
Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures.</li><li>
Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.</li><li>
May provide job shadowing to lesser experience staff.</li><li>
Utilize all resource materials to manage job responsibilities.</li></ul><p><b><br>
Required Qualifications</b></p><ul><li>
2+ years medical claim processing experience.</li><li>
Experience in a production environment.</li><li>
Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.</li>
Effective communications, organizational, and interpersonal skills.<br>
<li>
</li></ul><p><br>
<b>Preferred Qualifications</b></p><ul><li>
DG system claims processing experience.</li><li>
Associate degree preferred.</li></ul><p><b><br>
Education</b></p><ul><li>
High School Diploma or GED.</li></ul><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$18.50 - $42.35<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 06/19/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Senior Claims Benefit Specialist

Liberty Mutual Insurance

<div>
 <strong>
  Description
  <br/>
  <br/>
 </strong>
 <strong>
  Are Ready to Launch Your Career in Insurance with a Fortune 100 Company?
  <br/>
  <br/>
 </strong>
 <strong>
  Come Grow with Us!
  <br/>
  <br/>
 </strong>
 Advance your career by building a strong foundation in insurance, with a clear path to grow into a claims role and expand your expertise.
 <br/>
 <br/>
 You will serve as a subject matter expert in initiating Auto and Property claims with precision and professionalism. This role demands a strong command of technical processes and policy interpretation, as well as the ability to apply consultative guidance to help customers understand coverage and next steps. You&rsquo;ll leverage your expertise and problem-solving skills to navigate complex claim scenarios, ensure accurate First Notice of Loss (FNOL) documentation, and coordinate resources effectively. Your ability to think critically, communicate clearly, and collaborate across teams will be essential to delivering high-quality outcomes and supporting claim resolution.
 <br/>
 <br/>
 <strong>
  Work Arrangement
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   This is a fully remote role.
  </li>
  <li>
   Candidates must reside within a 50-mile radius of a designated claims office.
  </li>
  <li>
   The position may require weekday afternoon/evening shifts and rotating weekends. Additional details will be shared during the phone screen and interview process.
   <br/>
   <br/>
  </li>
 </ul>
 Core Responsibilities
 <br/>
 <br/>
 <ul>
  <li>
   Claims Intake &amp; FNOL: Accurately and efficiently capture new Auto and Property claims, ensuring all First Notice of Loss (FNOL) documentation is complete and precise. Leverage the best available resources to triage exposures and take the most appropriate action to advance the claim and pay what we owe.
  </li>
  <li>
   Consultative Policy Guidance: Provide clear, expert counsel to customers on coverage, filing options, and the claims process. Help safeguard and repair property while delivering peace of mind through informed, empathetic guidance.
  </li>
  <li>
   Effortless Customer Experience: Make every interaction seamless and easy for customers and agents. Be available, responsive, and proactive in setting expectations and outlining next steps.
  </li>
  <li>
   Speed of Execution: Match the pace of service to customer expectations. Expedite claims outcomes by removing friction, anticipating needs, and driving timely resolution.
  </li>
  <li>
   Collaborative Resolution: Partner with internal teams and external vendors to facilitate claim progression and ensure service continuity.
  </li>
  <li>
   Creative Problem Solving: Apply critical thinking and innovative approaches to resolve a wide variety of claims challenges and customer concerns.
  </li>
  <li>
   Accuracy &amp; Compliance: Maintain high standards for documentation accuracy, confidentiality, and compliance. Meet or exceed service level goals for call handling and transaction quality.
  </li>
  <li>
   Logistical Coordination: Arrange support services such as rental cars and towing with care and efficiency, ensuring customers receive timely assistance.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Successful Candidates Will Demonstrate
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Technical Proficiency: Ability to accurately document claims, interpret policy language, and leverage internal tools and resources to triage exposures and advance claims appropriately.
  </li>
  <li>
   Consultative Communication: Strong oral and written communication skills with the ability to counsel customers on coverage, filing options, and the claims process in a clear and reassuring manner.
  </li>
  <li>
   Customer-Focused Mindset: A commitment to making every interaction effortless and empathetic, while matching the speed of execution to customer expectations.
  </li>
  <li>
   Problem-Solving Agility: Creative and analytical thinking to resolve diverse claims challenges and deliver timely, effective outcomes.
  </li>
  <li>
   Attention to Detail: High standards for documentation accuracy, confidentiality, and compliance.
  </li>
  <li>
   Adaptability &amp; Ownership: Ability to manage multiple tasks in a fast-paced environment, take initiative, and follow through on commitments.
  </li>
  <li>
   Learning Orientation: Receptiveness to coaching and a willingness to continuously build expertise in claims processes, systems, and coverage.
  </li>
  <li>
   Technology Skills: Proficiency in Microsoft Outlook, keyboard shortcuts, and claims systems; demonstrated typing proficiency.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Minimum of 1&ndash;2 years of experience in a customer-facing or consultative role, preferably within insurance, financial services, healthcare, hospitality, or retail.
  </li>
  <li>
   Demonstrated success in roles requiring high attention to detail, problem-solving, and decision-making under time-sensitive conditions.
  </li>
  <li>
   Experience using claims systems, CRM platforms, or workflow tools to manage documentation and customer interactions a plus.
  </li>
  <li>
   Proven ability to deliver accurate, empathetic, and efficient service in a fast-paced environment.
  </li>
  <li>
   High school diploma or equivalent required.
  </li>
  <li>
   Bachelor&rsquo;s degree in Business, Communications, Insurance, or a related field preferred.
  </li>
  <li>
   Willingness to obtain and maintain applicable licenses through company-sponsored training programs.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  About Us
  <br/>
  <br/>
 </strong>
 <strong>
  Pay Philosophy:
 </strong>
 The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
 <br/>
 <br/>
 At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
 <br/>
 <br/>
 We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits
 <br/>
 <br/>
 Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
 <br/>
 <br/>
 <strong>
  Fair Chance Notices
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   California
  </li>
  <li>
   Los Angeles Incorporated
  </li>
  <li>
   Los Angeles Unincorporated
  </li>
  <li>
   Philadelphia
  </li>
  <li>
   San Francisco
  </li>
 </ul>
</div>


Auto Claims Trainee - Remote

American Family Insurance

<div>You will investigate and maintain property claims, secure information, review coverages, complete field inspections, and settle claims. You will handle moderately complex homeowner property field claims, typically within the Northwest Indiana: Hammond, Highland, Merrillville, Schererville or surrounding area (you must be located in this market). You will also occasionally handle desk claims.
<br>
<br>
This is a fully remote/work from home role where you will spend 80% of your time in the field. On occasion you may be asked to travel to an office location for in person engagement activities such as team meetings, training and culture events. Relocation support offered for eligible candidates.
<br>
<br>
You will report to the Property Claim Manager. A company fleet vehicle is provided with the position and there's an option to use the vehicle for personal use.<p></p><p>
Position Compensation Range:</p>
$57,000.00 - $94,000.00<p></p><p>
Pay Rate Type:</p>
Salary<p></p><p><i>
Compensation may vary based on the job level and your geographic work location. </i><i>Relocation support is offered for eligible candidates.</i></p><p></p><p><b>
Primary Accountabilities</b></p><ul><li>
Investigates origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel, etc.</li><li>
Identifies complex issues and seeks assistance as needed. Handles claims on a good faith basis.</li><li>
Handles both 1st party and 3rd party claims under multiple policy types and numerous endorsements.</li><li>
Conducts on-site inspections when needed, evaluates damages, and handles claim negotiations with insureds, claimants, attorneys, public adjusters.</li><li>
Responds to customer inquiries, makes appropriate decisions and closes file as needed.</li><li>
Interprets and determines policies, leases, by-laws, declarations, articles and contract coverages and applies to all parties for assigned losses.</li><li>
Proactively provides all parties with claim process and status as appropriate; answers questions or redirects to other areas.</li><li>
May be required to complete other assignments, job duties, or participate in projects based upon skills, achievements, or experience.</li></ul><p><b><br>
Specialized Knowledge &amp; Skills Requirements</b></p><ul><li>
Demonstrated experience providing customer-driven solutions, support, or service.</li><li>
Demonstrated experience handling 1st and 3rd party, multi-line claims across our operating territories, or other equivalent experience.</li><li>
Demonstrated experience handling moderately complex claims, or other equivalent experience.</li><li>
Solid knowledge and understanding of policies and endorsements related to casualty coverages, or other equivalent knowledge.</li><li>
Solid knowledge and understanding of each phase of the claim handling process, or other equivalent knowledge.</li><li>
Property claims adjusting experience preferred.</li></ul><p><b><br>
Licenses</b></p><ul><li>
Valid driver's license required plus an acceptable driving record.</li><li>
Obtain state specific property casualty claims licensing as required.</li></ul><p><b><br>
Travel Requirements</b></p><ul><li>
Up to 50%.</li><li>
Catastrophe duty up to 75% as applicable.</li></ul><p><b><br>
Physical Requirements</b></p><ul><li>
Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like. This position may require employees to visit areas that have a higher hazard than a typical office such as customer homes, body shops, or other locations.</li><li>
Moving self in different positions to accomplish tasks in various environments including tight and confined spaces.</li><li>
Adjusting or moving objects up to 50 pounds in all directions.</li></ul><p><b><br>
Working Conditions</b></p><ul><li>
Low temperatures.</li><li>
High temperatures.</li><li>
Outdoor elements such as precipitation and wind.</li><li>
Noisy environments.</li><li>
Hazardous conditions.</li><li>
Poor ventilation.</li><li>
Small and/or enclosed spaces.</li></ul><p></p><h3 class="jobSectionHeader"><b>
Additional Information</b></h3><ul><li>
To ensure a strong start, all employees participate in our New Employee Orientation during their first week. This experience is held in person at our Madison, WI Headquarters or one of our AmFam core locations to help you connect with our mission, meet key team members and build relationships that support your growth. At times, sessions may be delivered virtually based on scheduling and availability.</li><li>
Offer to selected candidate will be made contingent on the results of applicable background checks</li><li>
Offer to selected candidate is contingent on signing a non-disclosure agreement for proprietary information, trade secrets, and inventions</li><li>
Sponsorship will not be considered for this position unless specified in the posting</li></ul><p><br>
#LI-Hybrid</p><p></p><p>
We provide benefits that support your physical, emotional, and financial wellbeing. You will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution, a pension plan, an annual incentive, 9 paid holidays and a paid time off program (23 days accrued annually for full-time employees). In addition, our student loan repayment program and paid-family leave are available to support our employees and their families. Interns and contingent workers are not eligible for American Family Insurance Group benefits.</p><p></p><p>
We are an equal opportunity employer. It is our policy to comply with all applicable federal, state and local laws pertaining to non-discrimination, non-harassment and equal opportunity. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.</p><p></p><p>
American Family Insurance is committed to the full inclusion of all qualified individuals. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please email AskHR@AmFam.com to request a reasonable accommodation.</p><p></p>
#LI-JA2</div>

Property Field Claims Adjuster (Northwest Indiana)

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><div><p><b>
Position Summary</b></p><p>
Provides strategic ownership of Claims workforce management by leveraging deep analytical expertise to forecast demand, develop capacity and staffing models, and optimize workforce utilization. Serves as the primary subject matter expert for Claims Workforce Management (WFM), partnering closely with senior leadership and cross‑functional stakeholders to support operational decision-making, performance outcomes, and scalability. Leads workforce planning initiatives, drives process improvements, and delivers actionable insights to ensure claims operations are staffed efficiently, consistently, and in alignment with business objectives.</p><p></p><ul><li><b><i>The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location</i></b></li></ul><p></p><p><b>
What you will do</b></p><ul><li><p>
Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.</p></li><li><p>
Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.</p></li><li><p>
Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.</p></li><li><p>
Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.</p></li><li><p>
Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.</p></li><li><p>
Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.</p></li><li><p>
Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.</p></li><li><p>
Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.</p></li><li><p>
Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.</p></li><li><p>
Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.</p></li><li><p>
Owns ongoing monitoring of claims performance against performance guarantees and operational commitments; proactively identifies risk and drives workforce reprioritization or resource reallocation to protect SLA, compliance, and financial outcomes.</p></li><li><p>
Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.</p></li></ul><p></p><p><b>
Required Qualifications</b></p><ul><li><p>
Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments</p></li><li><p>
Demonstrated expertise in forecasting, capacity planning, and workforce modeling</p></li><li><p>
Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations</p></li><li><p>
Proven ability to operate independently with a high level of ownership and accountability</p></li><li><p>
Strong communication skills and experience influencing leaders without direct authority</p></li><li><p>
Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques</p></li><li><p>
Experience partnering with senior leadership on staffing strategy and operational planning</p></li><li><p>
Experience designing or evolving workforce management operating models</p></li><li><p>
Strong business acumen with the ability to balance service, quality, cost, and compliance considerations</p></li></ul><p></p><p><b>
Education</b></p><ul><li><p>
Bachelor&rsquo;s degree preferred or equivalent combination of relevant experience, training, and professional development</p></li></ul></div><p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$67,900.00 - $199,144.00<p><br>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company&rsquo;s equity award program.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 07/12/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Senior Manager, Claims Workforce Management, Meritain TPA

Erie Insurance Group

<div><div><div><div><div><p><b>Division or Field Office:<br>
</b></p></div><div><p>Property &amp; Material Damage Div</p></div><br>
</div><br>
<div><div><b>Department of Position:</b></div> <div>Property Damage Dept</div></div><br>
<div>
<div><p><b>Work from:</b></p>
</div>
<div> Remote</div>
</div><br>
<div><div><b>Salary Range:</b></div>
<div>
<p>$63,130.00 - $100,843.00 *</p>
<p><i>
salary range is for this level and may vary based on actual level of role hired for</i></p>
</div>
</div><br>
</div></div><ul><li><i>This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.</i></li></ul><br>
<p></p>
<p>
At Erie Insurance, you&rsquo;re not just part of a Fortune 500 company; you&rsquo;re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.<br>
<br>
<b>Benefits That Go Beyond The Basics</b></p>
<p>
We strive to be Above all in Service&reg; to our customers&mdash;and to our employees. That&rsquo;s why Erie Insurance offers you an exceptional benefits package, including:</p>
<ul>
<li><b>Premier health, prescription, dental, and vision benefits for you and your dependents.</b> Coverage begins your first day of work.</li>
<li><b>Low contributions to medical and prescription premiums.</b> We currently pay up to 97% of employees&rsquo; monthly premium costs.</li>
<li><b>Pension. </b>We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.</li>
<li><b>401(k) with up to 4% contribution match.</b> The 401(k) is offered in addition to the pension.</li>
<li><b>Paid time off.</b> Paid vacation, personal days, sick days, bereavement days and parental leave.</li>
<li><b>Career development. </b>Including a tuition reimbursement program for higher education and industry designations.</li><br>
</ul>
<p>Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.</p><p></p><div><div><div><h2 class="jobSectionHeader"><b><br>
Position Summary</b></h2>
</div><div><p><i>
Exercises independent discretion or judgment in handling all types of property claims. Also assists or acts on behalf of the claims supervisor when required.</i></p><br>
<p></p>
<ul>
<li><b><i>This is a remote, work from home position in Indiana</i></b></li>
<li><b><i>The selected candidate will ideally live in Marion County and/or surrounding areas</i></b></li>
<li><b><i>The hiring manager will also consider candidates for Property Adjuster I. Level of position offered will be based upon the depth and breadth of selected candidate's experience and qualifications.</i></b></li>
<li><b><i>A company car and equipment to work from home will be provided</i></b></li>
<li><b><i>Good time management and organization skills preferred</i></b></li>
</ul></div></div><div><div><h2 class="jobSectionHeader"><b>Duties and Responsibilities</b></h2>
</div><div><ul><li>Conducts investigations, interviews, and inspects damage, driving to site of damage within assigned territory or other if required. Prepares estimates, makes recommendation, and handles coverage questions, and litigation.</li>
<li>Sets and maintains reserves, reviews reports and related materials, directs experts, determines coverage and claim value, issues or declines payment, and negotiates claims with plaintiff attorneys when necessary.</li>
<li>Documents claim files and submits report for closure.</li>
<li>Recognizes subrogation situations and initiates appropriate action.</li>
<li>Services assigned territory and brings assigned claims to conclusion.</li>
<li>Interacts with Agents and district sales managers on matters of mutual concern.</li>
<li>Assists claims supervisor or acts on his/her behalf, including representing the company at legal proceedings, as required.</li>
<li>Completes industry-related training programs and continues to attend training programs to remain informed on policy changes, interpretation or new legislation.</li>
<li>Assists in training of new claims adjusters.</li>
<li>Participates on Catastrophe Team when required.</li></ul><br>
<p><br>
<i>The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.</i></p><br>
<p><br>
<i>This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.</i></p>
</div></div><div><div><h2 class="jobSectionHeader"><b>
Capabilities</b></h2>
</div><ul><li>Values Diversity
</li><li>Nimble Learning
</li><li>Self-Development
</li><li>Collaborates
</li><li>Customer Focus
</li><li>Information Management Skills
</li><li>Cultivates Innovation
</li><li>Instills Trust
</li><li>Job-Specific Knowledge
</li><li>Optimizes Work Processes (IC)
</li><li>Ensures Accountability
</li><li>Decision Quality
</li></ul></div><div><div><h2 class="jobSectionHeader"><b>Qualifications</b></h2>
</div><div><p><b>
Minimum Educational and Experience Requirements
</b></p><ul><li>High School Diploma or GED and five years of claims handling experience, or equivalent required; or</li>
<li>Bachelor&rsquo;s Degree and two years of claims handling experience, or equivalent required.</li></ul><br>
<p><br>
<b>Additional Experience
</b></p><ul><li>Incumbent must live in territory assigned unless a change is approved by the company.</li>
<li>Position requires the incumbent to serve on Catastrophe Team, which may include travel on short notice to other locations for periods in excess of two consecutive weeks.</li></ul><br>
<p><br>
<b>Designations and/or Licenses
</b></p><ul><li>Willingness to obtain and maintain any required licenses.</li>
<li>Successful completion of Associate in Claims (AIC) program preferred.</li>
<li>Valid driver's license and good driving record required.</li>
</ul></div></div><div><div><h2 class="jobSectionHeader"><b>Physical Requirements</b></h2>
</div><ul><li>Use of Personal Protective Equipment (PPE) is required for this role.
</li><li>Ability to move over 50 lbs using lifting aide equipment; Often (20-50%)
</li><li>Climbing/accessing heights; Moderate (30-40%)
</li><li>Driving; Frequent (50-80%)
</li><li>Lifting/Moving 0-20 lbs; Often (20-50%)
</li><li>Lifting/Moving 20-50 lbs; Often (20-50%)
</li><li>Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)
</li><li>Pushing/Pulling/moving objects, equipment with wheels; Occasional (&lt;20%)</li></ul></div></div><br>
<p><br>
<b>Nearest Major Market: </b>Indianapolis</p></div>

Property Adjuster II

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