17 senior claim examiner jobs found

The Professional Review Specialist analyzes medical services and billing across various claim types to evaluate the accuracy of charges and the medical necessity of care provided. This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Appropriately document work and final conclusions in designated computer program Additional duties as assigned   KNOWLEDGE & SKILLS: Thorough knowledge of ICD Diagnoses and Procedure Codes, and C.P.T., as well as an understanding of medical terminology Knowledge of applicable fee schedule and or applicable U&C Guidelines Proficient in Microsoft Office applications Technical...

The New England Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises claims staff in their day-to-day operations Assists Claims Manager with recruitment, interviewing, and onboarding new staff, ensuring proficiency in procedures and job functions Ensures staff compliance with Workers’ Compensation laws and mandated regulatory reporting requirements Ensures optimal team performance through ongoing training, coaching, and regular performance evaluations; recommends merit-based actions (subject to managerial approval) Provides technical and jurisdictional guidance to claims...

- Multi-state commercial insurance carrier is seeking a qualified Senior Claims Examiner for a position in their Long Beach, NY office. A hybrid work schedule is available. Key Accountabilities/Deliverables: Investigate large and complex commercial insurance automobile, cargo and general liability claims. Key tasks include investigation of policy coverage and liability with a detailed analysis of applicable state laws, damage determination for property, commodity and personal injury claims and the management of litigation on large and complex commercial claims. Responsibilities include establishing a course of action to conclude claims timely and in compliance with state regulatory requirements. Exposures are to be analyzed and proper reserves established. Discussion and presentation of high exposure claims with senior management is required. Task assignments to outside vendors, including outside defense counsel is required along with oversight and...

The Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a Remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Expectation that Senior Claims Specialist maintain independent NY adjuster license as a casualty or general adjuster.  Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the...

The Claims Specialist 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 remote role.    ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives 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 and non-problematic medical only claims and minor 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 problematic claims as...

Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description A Brief Overview We are looking for a highly capable Senior Environmental Claims Adjuster to help us on a temporary assignment through 12 December 2025 (and possibly through May 2026) and work from anywhere in the United States. This individual will report to a manager who works in New York City and is focused on adjudicating first and third party commercial environmental claims (mostly complex storage tank claims) and contributing to providing superb results for our clients. The...

The Claims Specialist 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 remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives 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 and non-problematic medical only claims and minor 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 problematic claims as...

Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description A Brief Overview We are looking for a highly capable Senior New York Labor Law Technical Claims Specialist to join our team and work from our New York City office. We work together in the office five days a week in order to strengthen our culture, build team connections, and drive profitability. This role will be adjudicating claims of general liability, third party property damage, and third party bodily injury with a focus on New York Labor Law. How You Will Make an Impact:...

Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description A Brief Overview We’re seeking a highly skilled Senior New York Labor Law Technical Claims Specialist to join our New York City team. In this key role, you will handle complex general liability claims including third-party property damage and bodily injury with a focus on New York Labor Law. We believe great work happens together. That’s why our claims professionals collaborate in our New York City office, just five blocks from Penn Station, five days a week to build culture,...

Argo Group International Holdings, Inc .  and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. (“BWS”), a New York and Toronto-listed public company. BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. Job Description A Brief Overview We are looking for a highly capable Senior Environmental Technical Claims Specialist to join our team and work from any one of the our offices in Chicago, Los Angeles, New York City, Omaha, Richmond (VA), Rockwood (PA), or San Antonio, or remotely from home in the continental United States. This individual will report to a manager who works in New York City and is focused on adjudicating first and third party commercial environmental claims (mostly complex storage tank...

Senior Contract Drafter– US A&H Product Team Job Summary:   The primary function for the Product Contract Analyst Senior role is to prepare and design new and enhanced product forms for the US Accident & Health team.  The role requires close collaboration with key partners in the following business functions – Underwriting, Distribution, Actuarial, Legal, Claims and Marketing to ensure the success of the strategic goals of US A&H are met from a product perspective. How you will create an impact Draft language for generic and state specific product policy forms for assigned projects for filing with state DOI’s based on company standards and all relevant legal and regulatory requirements, including necessary forms to facilitate approval/sign-off from management and relevant business teams.  Review proposed insurance policies, endorsements, rate and rules and assist business units on filing strategies, pre-filing research and areas of deficiency....

Established in 2021,   Independence Pet Holdings   is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America.   We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands.  Independence American Insurance Company (IAIC) , a subsidiary of IPH, has over 50 years of underwriting experience and a history of innovation in the pet insurance industry. IAIC has built a reputation as a trusted and dependable partner. We are a pet-focused underwriter with deep insurance industry...

Established in 2021,   Independence Pet Holdings   is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America.   We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands.  Independence American Insurance Company (IAIC) , a subsidiary of IPH, has over 50 years of underwriting experience and a history of innovation in the pet insurance industry. IAIC has built a reputation as a trusted and dependable partner. We are a pet-focused underwriter with deep insurance industry...

The 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.   This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager   Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: 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...

Job Description SUMMARY OF JOB PURPOSE :  The Senior Property Adjuster effectively determines and communicates the extent of loss or damage associated with commercial property claims in a variety of business classes. The Senior Property Adjuster is typically assigned loss or damage assessments in a moderate cost range, based on incumbent’s experience and demonstrated ability for handling larger or more complex claims. PRIMARY JOB RESPONSIBILITIES : Investigates insurance claims in any of a variety of settings, including, but not limited to, retail establishments, private or public office buildings, commercial habilitation, hospitality, corporate facilities, transportation sites, manufacturing sites, governmental facilities, schools, clinics, or hospitals; assesses loss or damage resulting from various events including, but not limited to, inclement or catastrophic weather, earthquakes, fire, vandalism, or accidents.  May be called upon to assess time-element and...

Job Description TITLE:                                    Senior Casualty/General Liability Property Adjuster DEPARTMENT:                  National Casualty Practice REPORTS TO:                      Casualty Claims Manager STATUS:                               Regular, full-time; exempt           This is a field position. The candidate should be located near New York City and have ability to work remotely when not in the field. SUMMARY OF JOB PURPOSE   The Senior Casualty/General Liability Property Adjuster manages all aspects of liability claims in a variety of business classes, effectively determining and communicating the extent of liability or damage associated with each claim. The incumbent assists the client in fulfilling its obligation to policyholders and maintaining the client’s claims processing functions, including evaluating potential coverage issues, liability and evaluation of damages, risk transfer opportunities, litigation and settlement matters...

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℠. Responsibilities and Accountabilities: Manage assigned broker portfolio of accounts to achieve efficient returns of profitability and growth Underwrite new and renewal accounts to meet top and bottom line targets Negotiate price, terms and conditions with producer Underwrite and evaluate Natural Catastrophe Accumulation, ensuring an understanding of catastrophe modeling and interpretation of scenarios (for relevant LoBs) Specialist / Technical Expert in Product Line within Middle Market Business Underwrite in line with LoB governance framework - e.g. Underwriting Authorities, global MSU, Underwriting Guidelines, Rules and Principles Proactively develop...