14 claims adjuster iii jobs found

The Indemnity Claims Adjuster  manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel. This is a hybrid position and candidate must reside in Texas. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex lost-time workers’ compensation claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier guidelines and participates in claims review as needed Assists other claims professionals with more complex or...

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. A $2,500 SIGN-ON BONUS will be given to all external candidates hired into this role. Half of the bonus will be paid after 3 months of employment and the remainder will be paid after 9 months of employment.    Territory: This role covers the San Angelo, TX and surrounding areas. Ideal Candidate Locations: The ideal candidate will live in San Angelo, TX or surrounding area.   This is a work-from-home position with day travel to policy locations (on...

We have an immediate need and exciting opportunity for a Field Property Claims Representative II in the DFW Area - Collin County. This position requires independent work, using your investigative and negotiation skills to investigate and resolve a variety of large or severe property loss claims. In this role, you will travel to the loss site to conduct a thorough analysis. Every day is a new exciting challenge as you assist our customers through their claims process.   Responsibilities include: On-site investigation of property damage, thorough review, and application of policy information and coverage details, proper setting of financial reserves, and accurate and timely settlement of claims. Utilize experience, judgement, and investigation techniques to arrive at fair and accurate claim decisions. Provide an exceptional customer experience to customers and third parties.   A qualified candidate will preferably have a college degree and/or three or more...

Overview The Medical Bill Review Support Analyst supports the Medical Management department's key goals of enhancing cost containment. Provides strategic and technical bill review to assist claim offices and adjusters. Accomplishes Managed Care objectives by working processes; planning and evaluating adjuster activities and Medical bill review activities.  Technical abilities and industry-specific knowledge to review Workers Compensation medical bills.   *This role is hybrid out of our Dallas, TX office* Responsibilities Plan, execute, and oversee bill audits related to state fee disputes. Assist in the development of fee dispute processes, including overall management and monitoring programs. Perform fee dispute reviews and submit relevant formwork related to re-pricing and network vendors. Review and audit bills to verify correct billing practices and contractual rates. Ongoing development of cost...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description This role is responsible for investigating and managing advanced homeowners claims from initial inspection through resolution. You will evaluate coverage, assess damages, and prepare detailed estimates to support accurate and timely claim outcomes. In this role, you will work directly with customers, contractors, and internal teams to move claims forward efficiently. You will also apply regulatory and policy knowledge to ensure compliance and provide a clear, supportive claims experience. We are seeking a Field Property Adjuster to support homeowners claims across Dallas Fort Worth Texas. In this...

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.  Job Description The Negotiation Trainer develops standardized playbooks and delivers training to help adjusters navigate estimating differences, structure negotiations, and manage objections with auto body shops and contractors. This role also equips adjusters to communicate clearly, secure agreements, and deliver claim decisions in a way that builds trust and minimizes friction. Allstate is currently seeking a Negotiation Trainer based in Irving, TX to support Claims teams through in-person training and coaching. In this role, you will equip...

The Revenue Cycle Specialist is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Analyze and adjust/reprice claims to ensure accurate reimbursement rates in accordance with contractual agreements and payer guidelines Establishing and maintaining accurate pricing structures and rules to ensure competitive and profitable pricing strategies across various claims  with precision Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners. Performs contract and reimbursement variance analysis. Analyzes claims data to identify...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced Homeowner's Claims. Determines coverage, damages and otherwise adjusts and negotiates claims within limit of authority. Responsible for creating or auditing a comprehensive estimate of damages for homeowners first party claims leading to the proper disposition. National General is seeking a Field Property Adjuster to join our Austin, TX Claims team. The ideal candidate will have experience handling a wide range of residential property claims and be proficient in both Xactimate and XactAnalysis . If you're a skilled...

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 Desk Adjuster PRIMARY PURPOSE : Handles losses and claims valued up to $15,000 for property and casualty insurers through the thorough examination of documents, records, loss reports, and other relevant documentation.  Efficiently manages a case load using technology for efficient claim processing. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Evaluates insurance policies, claims forms, policies, endorsements, carrier instructions, and other records to determine...

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 Contents Adjuster PRIMARY PURPOSE :   To handle losses and claims for property and casualty insurers. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Examines insurance policies and other records to determine insurance coverage. Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. Consults police and hospital records and inspects property damage to determine extent of company's liability and varying methods of investigation according...

Description At Liberty, you'll thrive in a hybrid setting that fosters in-person collaboration, innovation and growth. This approach optimizes both remote and in-person interactions, enabling you to connect and ideate with your team and deepen valuable relationships across the company, while still enjoying the flexibility of remote work for focused tasks and projects.   The  Claims Specialist  analyzes complex Personal Injury Protection (PIP) and Medical Payment (Med-Pay) No Fault claims, determines benefits owed, manages and adjudicates high‑exposure claims to meet service standards and client requirements. The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about coverage and eligibility, evaluating losses, medically managing claims, paying medical bills, and...

Description At Liberty, you'll thrive in a hybrid setting that fosters in-person collaboration, innovation and growth. This approach optimizes both remote and in-person interactions, enabling you to connect and ideate with your team and deepen valuable relationships across the company, while still enjoying the flexibility of remote work for focused tasks and projects.   The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim’s management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers....

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and...

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 Executive General Adjuster - Power/Energy (SE & SW Regions) PRIMARY PURPOSE :  To investigate claims internationally of any size or complexity, against insurance or other companies for personal, casualty, or property loss or damages and attempts to effect out-of-court settlement with claimants. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Handles complex losses locally unassisted up to designated authority; assists on larger losses, including handling...