senior claims adjuster

Argo Group

<div><p><b>Company
</b></p>Argo Group
<p></p><p>Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.<br>
</p><p><br>
<b>Job Description
</b></p><p></p><div><div><p><b>Business Title(s): </b>Senior Commercial General Liability Property Damage Claims Adjuster
</p></div><div><p><b>Employment Type: </b>Full-Time
</p></div><div><p><b>FLSA Status: </b>Exempt
</p></div><div><p><b>Location: </b>In-Office<br>
<br>
</p></div><div><p><b>S </b><b>ummary:
</b></p></div><div><p>We are looking for a highly capable Senior General Property Damages Claims Adjuster to join our team and work from our New York City office. This individual will report to the Director of General Property Damages Claims Manager who works in the New York office. This role adjudicates moderately complex commercial general liability property damages claims and provides superb results for our clients.<br>
<br>
</p></div><div><p>This is a 100% in -office position. Candidates must be able to work on-site at a designated company office during standard business hours.<br>
<br>
</p></div><div><p><b>Essential Responsibilities </b><b>:
</b></p></div><div><ul><li><p>Working under limited technical direction and within broad limits and authority, adjudicate moderately complex commercial general liability property damage claims, potentially with significant impact on departmental results .
</p></li></ul></div><div><ul><li><p>Solving difficult problems that requires an understanding of a broader set of issues.
</p></li></ul></div><div><ul><li><p>Reporting to senior management and underwriters on claims trends and developments.
</p></li></ul></div><div><ul><li><p>Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.
</p></li></ul></div><div><ul><li><p>Investigating claims promptly and thoroughly, including interviewing all involved parties .
</p></li></ul></div><div><ul><li><p>Managing claims in litigation
</p></li></ul></div><div><ul><li><p>Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution .
</p></li></ul></div><div><ul><li><p>Creates and reviews reserves in line with market and Argo's reserving policy
</p></li></ul></div><div><ul><li><p>Identifying loss drivers and claims trends to reduce claims frequency and severity through data analysis and improved claim management
</p></li></ul></div><div><ul><li><p>Identifying , assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution .
</p></li></ul></div><div><ul><li><p>Preparing reports for file documentation
</p></li></ul></div><div><ul><li><p>Applying creative solutions which result in the best financial outcome .
</p></li></ul></div><div><ul><li><p>Negotiates in a timely and effective manner to provide cost effective solutions for the company and its customers within own limits using a range of negotiation styles.
</p></li></ul></div><div><ul><li><p>Processing mail and prioritizing workload .
</p></li></ul></div><div><ul><li><p>Completing telephone calls and written correspondence to/from various parties (insured, claimant, etc.) .
</p></li></ul></div><div><ul><li><p>Having an appreciation and passion for strong claim management.<br>
<br>
</p></li></ul></div></div><div><div><p><b>Qualifications / Experience Required:
</b></p></div><div><ul><li><p>An advanced knowledge of commercial general liability bodily injury claims typically acquired through:
</p></li></ul></div><div><ul><li><p>A minimum of five years&rsquo; experience adjudicating commercial general liability property damage claims.
</p></li></ul></div><div><ul><li><p>Bachelor&rsquo;s degree from an accredited university required . Two or more insurance designations or four additional years of related experience adjudicating general liability bodily injury beyond the minimum experience required above may be substituted in lieu of a degree.
</p></li></ul></div><div><ul><li><p>Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims within 120 Days. A NY State license is needed . In addition, the quickest way to obtain other state licenses would be to obtain a license in FL, GA, or TX as most states will offer reciprocal licenses from one of these three states.
</p></li></ul></div><div><ul><li><p>Must work independently and demonstrate the ability to exercise sound judgment.
</p></li></ul></div><div><ul><li><p>Must have excellent communication skills and the ability to build lasting relationships.
</p></li></ul></div><div><ul><li><p>Excellent evaluation and strategic skills required .
</p></li></ul></div><div><ul><li><p>Strong claim negotiation skills a must . Ability to take proactive and pragmatic approach to negotiation.
</p></li></ul></div><div><ul><li><p>Must possess a strong customer focus.
</p></li></ul></div><div><ul><li><p>Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
</p></li></ul></div><div><ul><li><p>Ability to articulate the financial value of your work at multiple responsibility levels inside our clients&rsquo; business which may include CEO.
</p></li></ul></div><div><ul><li><p>Ability to regularly exercise discretion and independent judgment with respect to matters of significance.
</p></li></ul></div><div><ul><li><p>Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis.
</p></li></ul></div><div><ul><li><p>A strong focus on execution in getting things done right . Proven ability to consistently produce and deliver expected results to all stakeholders by:
</p></li></ul></div><div><ul><li><p>Finding a way to achieve success through adversity.
</p></li></ul></div><div><ul><li><p>Being solution (not problem) focused
</p></li></ul></div><div><ul><li><p>Thinking with a global mindset first.
</p></li></ul></div><div><ul><li><p>Client focus &ndash; the ability to effectively determine specific client needs and to provide value added solutions.
</p></li></ul></div><div><ul><li><p>Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast paced environment that is evolving constantly.
</p></li></ul></div><div><ul><li><p>Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information.
</p></li></ul></div><div><ul><li><p>Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
</p></li></ul></div><div><ul><li><p>Uses listening and questioning techniques to effectively gather information from insureds and claimants.
</p></li></ul></div><div><ul><li><p>Demonstrates an understanding of mechanisms available for resolving claims settlement disputes ( e.g. arbitration and mediation) and when these are used.
</p></li></ul></div><div><ul><li><p>Proficient in MS Office Suite and other business-related software.
</p></li></ul></div><div><ul><li><p>Polished and professional written and verbal communication skills .
</p></li></ul></div><div><ul><li><p>The ability to read and write English fluently is required .
</p></li></ul></div><div><ul><li><p>Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.<br>
<br>
<br>
</p></li></ul></div></div><div><div><p>The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary, all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package.
</p></div><div><ul><li><p><b>New York City Pay Range: </b>$ 121,482 - $ 144,636<br>
</p></li></ul></div><p></p><div><p><b>About Working in Claims at Argo Group
</b></p></div><div><p>Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful.
</p></div><div><p>Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.<br>
<br>
</p></div><div><p>We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses.<br>
<br>
</p></div><div><p>Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.<br>
<br>
</p></div><div><p>We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
</p></div></div><p></p><div><p><b><i>PLEASE NOTE:
</i></b></p><p>Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.
</p><p></p><p>If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at 210-321-8400.
</p><p></p><p><b>Notice to Recruitment Agencies:
</b><br>
Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.
</p><p></p><p>We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
</p><p></p><p>The collection of your personal information is subject to our HR Privacy Notice
</p><p></p><p><b>Benefits and Compensation
</b></p><p>We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program&mdash;including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.</p></div></div><p></p>

Senior Claims Adjuster

AAA Auto Club Enterprises

Job Summary
<br>The Claims Senior Medpay Adjuster handles moderate to high complexity Auto claims matters involving material damage, property and / or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, and negotiation of moderate to high-complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices.
<br><br>
Job Duties
<br>Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address coverage issues.
<br>Conduct phone investigations to determine liability and damages. Identify and obtain statements from insureds, claimants and witnesses. Verify and resolve coverage by gathering necessary information to ensure policy applicability.
<br>Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
<br>Negotiate within settlement authority with insureds and claimants to resolve first and third party claims.
<br>Update database production reports, document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
<br>Control expenses for areas of responsibility.
<br>Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
<br>Independently resolve claim exposures within level of authority.
<br>Respond quickly to customer needs and problems.
<br>May attend and participate in legal proceedings.
<br><br>
Qualifications
<br>Bachelors Equivalent combination of education and experience Preferred
<br>7-9 years Prior claims handling experience. Required
<br>7-9 years Property, Auto, Casualty or relevant claims administration experience. Preferred
<br>Comprehensive knowledge of claims administration best practices and procedures.
<br>Comprehensive knowledge of building and vehicle repair procedures and third-party liability issues.
<br>Extensive knowledge of insurance, fault assessment, negligence and subrogation principles required.
<br>Advanced knowledge of Microsoft Office suite, general computer software and claims software.
<br>Advanced organization and planning recognition skills required.
<br>Advanced oral and written communication skills required.
<br>Advanced interpersonal skills required.
<br>Advanced leadership skills among peers required.
<br>Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
<br>An insurance/claims adjuster license may be required for claims administration in specific states.
<br><br>
Travel Requirements
<br>Occasional travel to off-site business meetings or conferences. (5% proficiency)
<br><br>
The starting pay range for this position is $35.94 - $47.87 per hour. Additionally, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.
<br><br>
<b>Remarkable benefits:</b><br>
<ul>
<li>Health coverage for medical, dental, vision</li>
<li>401(K) saving plans with company match AND Pension</li>
<li>Tuition assistance</li>
<li>Floating holidays and PTO for community volunteer programs</li>
<li>Paid parental leave</li>
<li>Wellness programs</li>
<li>Employee discounts (membership, insurance,</li>
</ul>
travel, entertainment, services and more!)
<br><br>
Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
<br><br>
"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
<br><br>
AAA is an Equal Opportunity Employer
<br><br>
Our organization participates in E-Verify

Claims Senior MedPay Adjuster

Job Summary
<br><br>
The Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The primary functions include liability investigation, coverage evaluation, negotiation strategies and claims resolution of moderate to high complexity claims. Employs discretion and independent judgment to ensure compliance with state and federal law, and with established company, technical, and customer service best practices. Under general supervision, works within specific limits of authority to resolve claims.
<br><br>
Job Duties
<br><br>
Conduct phone and/or field investigations to determine liability and damages. May attend and participate in legal proceedings. Identify and obtain statements from insureds, claimants and witnesses.
<br><br>
Communicate and interact with a variety of individuals including insureds and claimants. Explain benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address moderate complexity coverage issues.
<br><br>
Evaluate and determine claim values upon receipt and assessment of property, bodily injury and liability data.
<br><br>
Negotiate within settlement authority with insureds and claimants to resolve first and third party claims.
<br><br>
Update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, GUIDEWIRE, etc.
<br><br>
Control expenses for areas of responsibility.
<br><br>
Verify and interpret / resolve coverage by gathering necessary information to ensure policy applicability. Coordinate with internal and external departments as required.
<br><br>
Respond quickly to customer needs and problems.
<br><br>
Independently resolve claims within authority level.
<br><br>
Qualifications
<br><br>
Bachelors Equivalent combination of education and experience Preferred
<br><br>
7-9 years Prior claims handling experience. Preferred
<br><br>
4-6 years Property, Auto, Casualty or relevant claims administration experience. Required
<br><br>
Comprehensive knowledge of claims administration best practices and procedures.
<br><br>
Advanced knowledge of insurance, fault assessment, negligence and subrogation principles required.
<br><br>
Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
<br><br>
Advanced knowledge of Microsoft Office suite, general computer software and claims software.
<br><br>
Advanced organization and planning recognition skills required.
<br><br>
Advanced oral and written communication skills required.
<br><br>
Advanced interpersonal skills required.
<br><br>
Advanced leadership skills among peers required.
<br><br>
Exhibit proficiency and understanding of medical terminology and causality
<br><br>
Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
<br><br>
Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
<br><br>
Associate in Claims - Insurance Institute of America Preferred
<br><br>
An insurance/claims adjuster license may be required for claims administration in specific states.
<br><br>
Travel Requirements
<br><br>
Occasional travel to business meetings or conferences.
<br><br>
<b>The starting pay range for this position is:</b><br>
$38.64 - $51.46
<br>Additionally, for full time positions, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.
<br>.
<br><br>
<b>Remarkable benefits:</b><br>
<ul>
<li>Health coverage for medical, dental, vision</li>
<li>401(K) saving plans with company match AND Pension</li>
<li>Tuition assistance</li>
<li>Floating holidays and PTO for community volunteer programs</li>
<li>Paid parental leave</li>
<li>Wellness programs</li>
<li>Employee discounts (membership, insurance,</li>
</ul>
travel, entertainment, services and more!)
<br><br>
Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
<br><br>
“Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
<br><br>
AAA is an Equal Opportunity Employer
<br><br>
Our organization participates in E-Verify
<br><br>
The Automobile Club of Southern California will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance (FCIHO), the Unincorporated Los Angeles County (ULAC) regulation, and the California Fair Chance Act (CFCA).

Claims Senior Casualty Adjuster

Gallagher

<div><b>Introduction</b><br>
<div>
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it&rsquo;s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people&rsquo;s lives. It takes empathy, precision, and a strong sense of partnership&mdash;and that&rsquo;s exactly what you&rsquo;ll find here. We&rsquo;re a team of fast-paced fixers, empathetic experts, and outcomes drivers &mdash; people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you&rsquo;ll play a vital role in helping businesses and individuals move forward with confidence. Here, you&rsquo;ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you&rsquo;re here, you&rsquo;re part of something bigger. You&rsquo;re part of a team that shows up, stands together, and leads with purpose.
</div><br>
<b>Overview</b><div><b><br>
Role specifics:</b></div><div></div><ul><li><b><br>
Claims Background:</b><b> Construction Defect</b></li><li><b>
Jurisdictional Experience:</b><b> Any</b></li><li><b>
Active Adjusters' licenses</b><b>: Any</b></li><li><b>
Location: </b><b>This role is eligible for fully remote work</b></li></ul>
<br>
<b>How you'll make an impact</b><br>
<ul><li>
Independently conducts detailed analysis vital to investigating claims exposure and recommend appropriate settlement strategies and action plans.</li><li>
Create reservation of rights, coverage denial letters, negotiate and resolve settlements directly with involved parties.</li><li>
Interact extensively with various parties involved in the claims process, and may recommend retaining the advice of outside specialists.</li><li>
Handle claims consistent with clients&rsquo; and corporate policies, procedures in accordance with any statutory, regulatory and ethical requirements within specialized niche/industry.
</li><li>Document and communicate claim activity timely and efficiently and in a manner which supports the outcome of the claim file.
</li><li>Coach, mentor and may supervise lower level adjusters.</li></ul>
<br>
<b>About You</b><div><b><br>
As a key member of our Claims Adjuster team, you will:</b></div><br>
<div></div><ul><li>
Investigate, evaluate, and resolve complex Construction Defect claims, applying your claims experience and analytical skills to make informed decisions and bring claims to resolution.</li><li>
Work in partnership with our clients to deliver innovative solutions and enhance the claims management process</li><li>
Think critically, solve problems, plan, and prioritize activities to optimally serve clients</li></ul><div></div><div><b><br>
Required Qualifications:</b></div><ul><li>
High school diploma</li><li>
7 or more years related claims experience and proven track record to handle complex claims issues at a senior adjuster level</li><li>
Appropriately licensed and/or certified in all states in which claims are being handled</li><li>
Knowledge of accepted industry standards and practices</li><li>
Computer experience with related claims and business software</li></ul><div></div><div><b><br>
Desired Qualifications:
</b></div><ul><li>Bachelor's Degree</li><li>
Construction Defect</li><li>
Litigation</li></ul><div></div><div><br>
#LI-DF1 #LI-REMOTE</div><div>
#LI-DF1 #LI-REMOTE</div><br>
<br>
<b>Compensation and benefits</b><p><br>
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
</p><p>Below are the <b>minimum core benefits</b> you&rsquo;ll get, depending on your job level these benefits may improve:
</p><ul><li>Medical/dental/vision plans, which start from day one!</li><li>
Life and accident insurance</li><li>
401(K) and Roth options</li><li>
Tax-advantaged accounts (HSA, FSA)</li><li>
Educational expense reimbursement</li><li>
Paid parental leave</li></ul><div><b>
Other benefits include:</b></div><ul><li>
Digital mental health services (Talkspace)</li><li>
Flexible work hours (availability varies by office and job function)</li><li>
Training programs</li><li>
Gallagher Thrive program &ndash; elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing</li><li>
Charitable matching gift program</li><li>
And more...</li></ul><div><i>
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.</i></div><div></div><div><b><br>
We value inclusion and diversity</b></div><p>
Click Here to review our U.S. Eligibility Requirements</p><p>
Inclusion and diversity (I&amp;D) is a core part of our business, and it&rsquo;s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
</p><p>Gallagher embraces our employees&rsquo; diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.</p><p>
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as &ldquo;protected characteristics&rdquo;) by applicable federal, state, or local laws.
</p><p>Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</p></div>

Senior Resolution Specialist - Construction Defect

Mercor

<div>
 <strong>
  About The Job
  <br/>
  <br/>
 </strong>
 <strong>
  Mercor
 </strong>
 connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include
 <strong>
  Benchmark
 </strong>
 ,
 <strong>
  General Catalyst
 </strong>
 ,
 <strong>
  Peter Thiel
 </strong>
 ,
 <strong>
  Adam D'Angelo
 </strong>
 ,
 <strong>
  Larry Summers
 </strong>
 , and
 <strong>
  Jack Dorsey
 </strong>
 .
 <br/>
 <br/>
 <strong>
  Position:
 </strong>
 Claims Operations Expert
 <br/>
 <br/>
 <strong>
  Type:
 </strong>
 <strong>
  Contract
  <br/>
  <br/>
 </strong>
 <strong>
  Compensation:
 </strong>
 <strong>
  $55&ndash;$80/hour
  <br/>
  <br/>
 </strong>
 <strong>
  Location:
 </strong>
 <strong>
  Remote
  <br/>
  <br/>
 </strong>
 <strong>
  Role Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Develop long-horizon claims tasks with deterministic rubrics to evaluate agent performance against verifiable ground truth.
  </li>
  <li>
   Build scenarios in FNOL and triage, Adjudication, and Specialized handling to ensure tasks have checkable answers.
  </li>
  <li>
   Evaluate FNOL and triage processes, including intake against required-field checklists and coverage analysis with documented determinations.
  </li>
  <li>
   Review adjudication tasks such as reserve setting against guidelines and adjuster notes with required elements.
  </li>
  <li>
   Collaborate on specialized handling scenarios like subrogation screening and SIU fraud referrals using rule-based criteria.
  </li>
  <li>
   Work independently and asynchronously to meet deadlines while improving AI model performance.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  Must-Have
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   3+ years as a claims adjuster, claims operations specialist, or claims supervisor in P&amp;C, workers comp, or specialty lines.
  </li>
  <li>
   Expertise in specific claim types, coverage analysis, reserving practice, subrogation, SIU or fraud investigation, or claims systems like Guidewire ClaimCenter or Duck Creek.
  </li>
  <li>
   Comfortable with claims artifacts: FNOLs, coverage opinions, reserve memos, adjuster notes, settlement, and denial letters.
  </li>
  <li>
   Clear written communication; ability to articulate reasoning step by step and encode it into deterministic rubrics.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Adjuster licensure in at least one US state.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Compensation &amp; Legal
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Hourly contractor
  </li>
  <li>
   Strong contributors promoted based on task quality and throughput.
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
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Claims Adjuster | Upto $80/hr Part-time

Employers Insurance Group (EIG)

<div><h1 class="jobSectionHeader"><b>Workers' Compensation Claims Adjuster &mdash; California | 100% Remote</b></h1>
<p>EMPLOYERS has been a trusted name in workers' compensation insurance for over 100 years. We're a specialized WC carrier &mdash; it's all we do &mdash; and we're looking for a California experienced claims adjuster to join our fully remote team working Pacific hours. Learn more: About EMPLOYERS</p>
<p><b>All experience levels welcome. If you're a Medical Only adjuster ready to handle indemnity and grow your career, we want to hear from you.</b></p>
<h2 class="jobSectionHeader"><b>Compensation</b></h2>
<p>$60,000 &ndash; $85,000 base salary, plus a comprehensive benefits package that's genuinely competitive. Details at the link below.</p>
<h2 class="jobSectionHeader"><b>What You'll Do</b></h2>
<ul><li>Manage a caseload of California WC claims with moderate to complex medical and indemnity exposure, including litigation.</li><li>
Establish accurate reserves, evaluate compensability, and develop action plans from initial contact through closure.</li><li>
Coordinate medical treatment, work with defense counsel, and proactively resolve claims within your authority.</li><li>
Maintain compliance with California statutes, state forms, and company guidelines.</li></ul>
<h2 class="jobSectionHeader"><b>What We're Looking For</b></h2>
<ul><li>California WC claims experience &mdash; any level considered (Medical Only through complex indemnity).</li><li>
Ability to work Pacific hours, Monday&ndash;Friday 8am&ndash;5pm PDT.</li><li>
Strong knowledge of California WC law, statutes, and claim procedures.</li><li>
Self-directed, organized, and comfortable managing a full caseload remotely.</li><li>
CA adjuster license or ability to obtain within the state-mandated timeframe.</li><li>
WCCP, AIC, CPCU, or other insurance designation a plus &mdash; not required.</li></ul>
<h2 class="jobSectionHeader"><b>Why EMPLOYERS</b></h2>
<ul><li>100% remote &mdash;Committed to the remote environment</li><li>
Specialized WC carrier with over a century of experience and a strong industry reputation.</li><li>
Real growth path: we promote from within and invest in your licensing and development.</li><li>
Established company with the resources of a national carrier and the focus of a specialist.</li></ul>
<p>Must be located in the United States and authorized to work without sponsorship.</p>
<p>Ready to take the next step? Apply now and learn more about our benefits at <b>EMPLOYERS Benefits</b>.</p></div>

Claims Adjuster II (Workers' Compensation) | California

Risk Management and Information Systems, Inc.

<p>Looking to fill full-time position</p><p><b>Senior Workers Compensation Claims Adjuster with Litigation Experience in the Chicago Land Area</b></p><p>Duties to Include:</p><p>Must have a minimum of 5 years of Illinois Workers Compensation Claims Adjusting and Litigation experience. Investigate, evaluate, dispose and settle less complex claims with supervision and include the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves. Exercise proper judgment and decision-making to analyze the claims exposure to determine the proper course of action and to appropriately settle the claim. Interact extensively with various parties involved in the claim process. Handle claims consistent with clients' and corporate policies, procedures, and &quot;best practices&quot; and also in accordance with any statutory, regulatory and ethics requirements. Document and communicate all claim activity timely and effectively and in a manner that supports the outcome of the claim file. Incumbents at this level should be able to work at full caseload capacity. Salary will be commensurate with experience.</p><p>Job Types: Full-time, Contract</p><p>Pay: Up to $71,000.00 per year</p><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Education:</p><ul><li>Bachelor's (Preferred)</li></ul><p>Experience:</p><ul><li>Illinois Workers Compensation Claims Adjusting: 5 years (Required)</li><li>Litigation: 5 years (Required)</li></ul><p>Work Location: Remote</p>

Senior Workers Compensation Claims Adjuster

Search 9204+ Senior claims adjuster jobs near you this May. New roles added regularly across leading industries. Apply today.