65 claims examiner i jobs found

Job Title:   Claims Examiner I Location:   Encino, CA Reports to:   Claims Manager Employment Type:   Full time Job Req ID:   2026 Req Begin Date:  6 /12/2026 About TMHCC Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Every policy we write is special, enabling our clients to do amazing things. From insuring the crops that feed us to the rock concerts that entertain us, to rescuing international travelers in trouble. Organic growth and over 60 successful acquisitions have grown our 2023 Gross Written Premium (GWP) to over $7.5 Billion. Our workforce has grown to 4,300 worldwide … big, but not so big that you cannot make a difference. Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work....

Overview The Lead Claims Examiner is 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 understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.   This position will start remotely with an expectation to transition to a hybrid schedule upon opening of our Oakbrook IL office.  Responsibilities Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims,...

Job Description: We are seeking a Senior Claims Examiner I to join our team. This role is designed for an independent, self-sufficient professional responsible for managing death claims of moderate complexity. Responsibilities may include processing claims across Life, Annuity, RPS, or a combination of these lines of business. In this position, you will ensure accurate and timely claim processing in alignment with contract provisions, company policies, and regulatory requirements. While you will independently handle routine and moderately complex cases, highly complex or non-standard claims will be escalated for further review. This role serves as a developmental senior position, offering the opportunity to build advanced expertise, strengthen decision-making skills, and prepare for future growth within the organization. Responsibilities Review and adjudicate standard and moderately complex life and annuity claims in compliance with policies and regulations....

Overview The Lead Claims Examiner is 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 understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. Responsibilities Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing....

Company Details     As an elite Excess and Surplus Lines market, Nautilus Insurance Group offers commercial property and casualty insurance solutions to appointed wholesale surplus lines producers countrywide. We have specialized in providing these solutions for more than 35 years.   We have more flexible policy terms and premium rates on a non-admitted basis. Our focus is small to medium Property and Casualty risks on both an admitted and a non-admitted basis.   Our offerings are distributed through partnerships with appointed wholesale surplus lines producers. Our relationships are defined by mutual success, speed to market, customer-centric focus and an expanded appetite.   Coverage placed by Nautilus Insurance Group is provided by Nautilus Insurance Company and Great Divide Insurance Company, both W. R. Berkley Corporation members with A.M. Best (Superior) A+ XV ratings.   Benefit Highlights :  Paid Parental Leave! At...

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims.   The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations. Research Develop an understanding and working knowledge of disability and paid family leave Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements. Develop an operating knowledge of the applicable claims system(s). Develop basic claims skills and an understanding of claim practices and procedures. Utilizes most efficient means to obtain claim information. Analysis and Adjudication Fully investigates all relevant claim issues with oversight by Manager when...

Company Details     As an elite Excess and Surplus Lines market, Nautilus Insurance Group offers commercial property and casualty insurance solutions to appointed wholesale surplus lines producers countrywide. We have specialized in providing these solutions for more than 35 years.   We have more flexible policy terms and premium rates on a non-admitted basis. Our focus is small to medium Property and Casualty risks on both an admitted and a non-admitted basis.   Our offerings are distributed through partnerships with appointed wholesale surplus lines producers. Our relationships are defined by mutual success, speed to market, customer-centric focus and an expanded appetite.   Coverage placed by Nautilus Insurance Group is provided by Nautilus Insurance Company and Great Divide Insurance Company, both W. R. Berkley Corporation members with A.M. Best (Superior) A+ XV ratings.   Benefit Highlights :  Paid Parental Leave! At...

Overview The Senior Claims Examiner I, CA is responsible for prompt efficient review and disposition of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds or claimants. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust and Claims organization. Responsibilities Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimants or injured workers, witnesses and producers. Determines, reviews and analyzes coverage. While operating autonomously, elevates coverage issues as needed with appropriate resources and drafts positions as required. Responsible for setting of timely and accurate reserves based on facts, company standard and experience. Establishes effective litigation...

Job Responsibilities and Requirements Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.  Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth...

Overview The Lead Claim Examiner is 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 understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. Responsibilities   Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing....

Overview Assigned to Worker's Compensation claims, the Adjuster I is responsible for prompt and independent review of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds and claimants.  The Adjuster I is often assigned to mid-size or mid complexity claims in the Line of Business.  Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust and Claims organization.   This will be a hybrid position out of our Las Vegas, NV office.  Responsibilities Investigates the claim or coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured or employer representatives, claimant or injured workers, witnesses and producers. Analyzes coverage that may or may not be applicable to the claim by policy or statutes. Reviews coverage issues as needed with...

Overview The Lead Claims Examiner is 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 understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. Responsibilities Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing....

Overview The Lead Claim Examiner is 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 understanding of AmTrust’s mission, vision, and values. Upholds the standards of AmTrust and the Claims organization. Responsibilities Follows AmTrust policies and procedures in managing claims. Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers. Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience. Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing....

Overview AmTrust Financial Services, a fast-growing commercial insurance company, has an immediate need for a Senior Claims Examiner - WC .    The adjuster is responsible for the prompt and efficient examination, investigation, settlement or declination of worker’s compensation insurance claims through effective research, negotiation and interaction with insures, and claimants, ensuring that company resources are utilized in a cost-effective manner in the process. The adjuster reports to a WC Supervisor.  Responsibilities Thoroughly investigating workers’ compensation claims by contacting injured workers, medical providers, and employer representatives. Determining if claims are valid under applicable workers’ comp statutes. Communicating with medical providers to develop and authorize appropriate treatment plans. Reviewing and analyzing medical bills to confirm charges and treatment are workers’ comp injury-related and...

Overview AmTrust is actively seeking a skilled Resolution Examiner specializing in Workers' Compensation Claims. The  primary focus will be on negotiating and settling claims efficiently and at a cost effective value. In this role, you will be entrusted with the independent review and resolution of workers' compensation claims; utilizing your expertise in negotiation and settlement strategies to bring claims to resolution posture. Your ability to effectively interact with insureds, claimants, and their legal representatives will be essential in driving timely settlements while adhering to AmTrust’s mission, vision, and values. Responsibilities   Proactively negotiate settlements for workers' compensation claims, ensuring fair and expedient resolutions that meet the needs of all parties involved. Conduct thorough investigations by engaging with insured representatives, claimants, and witnesses to gather critical information...

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 hybrid role. Training is onsite Full Time, then Hybrid once trained . 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...

The Indemnity 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 position. 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...

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 Examiner | Jurisdiction: TX | Public Entity experience preferred 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?      Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.    ​   ARE YOU AN IDEAL CANDIDATE?   We are looking for driven...

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 Claims Examiner - Auto - Commercial Trucking I Remote (Pacific or Mountain Time Zone) 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...

It’s a great time to join AAA The Auto Club Group!   JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD Job Type: Full time   Exempt/Non Exempt:   Salary Job Description:   ****This position is currently able to work remotely from a home office location for day-to-day operations, “ TRAVELING TO FIELD LOCATIONS AS NECESSARY TO COMPLETE JOB RESPONSIBILITIES",  unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy. Field Auto Appraiser (NW Twin Cities Minnesota Territory)– The Auto Club Group Reports to: Claim Manager II What you will do: (Primary Duties & Responsibilities) Work under minimal supervision with a high-level authority to handle complex technical issues and complex claims.  Claim handling responsibilities will include the following: reviewing...