13 claim examiner jobs found

Overview We are seeking experienced professionals to join our Workers’ Compensation team in two key roles: Senior Claim Examiner and Lead Claim Examiner . Both positions play a critical role in managing workers compensation claim files and ensuring compliance with state regulations while delivering exceptional service.   Senior Claim Examiner Manage complex and high-exposure workers’ compensation claims from start to resolution. Investigate claims, determine compensability, set reserves, and negotiate settlements. Serve as a resource for junior examiners and assist with mentoring. Requires 5+ years of workers’ compensation claims experience and strong technical knowledge.   Lead Claim Examiner Responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. Maintains a solid...

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Senior Claim Examiner is a highly skilled professional responsible for the end-to-end management of complex commercial insurance claims, with a particular emphasis on liability exposures within educational institutions. This role requires advanced legal and analytical expertise, including policy interpretation, litigation strategy, and negotiation. The Senior Examiner serves as a subject matter expert in liability claims, ensuring resolution is achieved efficiently, equitably, and in compliance with regulatory and organizational standards. This position involves direct engagement with school administrators, district representatives, and legal counsel, requiring...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Jurisdiction Experience & NY License Required | Dedicated Client Job Description Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?   Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  Deliver innovative customer-facing...

The Subrogation Examiner evaluates automobile claims to determine recovery (subrogation) opportunity based on sound claim knowledge. They manage the recovery process, including investigation, evaluation, and disposition of the claim in compliance with applicable insurance regulations and NYCM’s best practices. They assess customer needs and develop solutions to meet and/or exceed the customer’s expectations throughout the claim process. Duties & Responsibilities: Investigate each claim to evaluate the cause of the loss and determine subrogation potential. Identify opportunities for subrogation and refer files to subrogation partner for recovery. Manage claim investigation ensure viability of subrogation recovery opportunity. Identify adverse at-fault party, insurance carrier, or legal representative. Identify the need for outside experts and attorneys and manage their involvement in the claim process. Establish scope of recovery, determine subrogation...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | Jurisdictions: MA, CT, NH, RI, VT | Licensing: VT, CT, NH, RI Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?    Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.   Deliver innovative customer-facing solutions to clients who represent virtually...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | Jurisdiction Experience: NY | Licensing Required: NY Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?    Apply your New York Workers Compensation knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.   Deliver innovative customer-facing solutions to clients who...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NY Jurisdiction | NY Licensing | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?  Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Adjuster | Jurisdiction Expertise: NY | Licensing: NY Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?    Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.   Deliver innovative customer-facing solutions to clients who represent virtually every industry and...

The Fraud Investigator conducts investigations and reports suspected instances of insurance fraud. They review and research evidence and documents to analyze the overall fact pattern of claim and synthesis data into professional reports with recommendations. Duties & Responsibilities: Conduct investigations in accordance with company, SIU, statutory, regulatory, and other legal guidelines. Identify leads and potential investigations from data, databases, and/or spreadsheets. Give regular, timely, and accurate written reports to the referring party in accordance with New York State regulation and company policies. Conduct interviews and take recorded or written statements. Verify receipts, complete activity checks, and other investigative processes with SIU resource materials such as cameras, computers, and recorders. Maintain chronological case order. Report all suspected instances of insurance fraud in accordance with regulations. Testify in court....

Job Type: Permanent Build a brilliant future with Hiscox   Our Senior Complex Claims Specialist - Allied Healthcare is an individual contributor role, responsible for the handling of mostly high-severity primary Allied Healthcare Professional Liability claims from inception to resolution. This includes, but is not limited to, mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies and testing laboratories. The role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required.   This Role: Acts as subject matter expert within the team Models gold standard for litigation best practices and file integrity Identifies and provides potential solutions for emerging exposures and claims trends Identifies suspected fraudulent claims and tracks with...

Job Type: Permanent Build a brilliant future with Hiscox   Our Complex Claims Specialist - Allied Healthcare is an individual contributor role, responsible for the handling of mid to high-severity primary Allied Healthcare Professional Liability claims from inception to resolution. This includes, but is not limited to, mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies and testing laboratories. The role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required.   The Role: Adjusts and resolves complex mid to severity claims that include all phases of litigation With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters Reviews and provides analysis of claim documentation and legal...

The Company    At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected. Utica National Insurance Group is an "A" rated $2.0B award-winning, nationally recognized property & casualty insurance carrier. Operating along the Eastern half of the United States, our Home Office is based in Central New York, with Regional Office locations in NYC, Dallas and Charlotte. What you will do: This is a leader position that will supervise and develop a team of Coverage and Specialty Claims Examiners and Staff Attorneys who handle complex general liability and commercial auto claims. With technical skills in coverage review, evaluation, and determination, the Manager of Coverage and Specialty Claims will establish and maintain coverage review practices across the company's casualty claims teams. Additionally, the Manager of Coverage and Specialty Claims will oversee the...

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. Brown & Brown is seeking a  WC Loss Time Claims Adjuster  to join our growing team!      The role of the WC Loss Times Claims Adjuster is to manage Workers’ Compensation claims within specific limits and authority.    How You Will Contribute:     Investigate and gather information to determine compensability by conducting three-point contact interviews with the employer, claimant, and healthcare provider.  Secure and file necessary documents, including FROI & SROI forms with the NYS Workers’ Compensation Board, claimant and claimant’s attorney.  Establish reserves, authorize payments & treatment within the NYS Medical Treatment Guidelines, under a set of authority.  Examine and authorize payment of medical bills.  Recognize and refer cases when IMEs are indicated.   Prepare and...