15 complex claims director jobs found

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 Commercial Lines Account Manager to join our growing team in Wauwatosa or Mt Pleasant, WI!           The primary role of the Account Manager is to handle the day-to-day Client Service requirements on an assigned book of business. This book of business could have a Producer or Account Executive who has overall responsibility for Service, Placement and Business Development.    The Account Manager’s focus includes a significant amount of time spent on system activity and communication with the client via email or phone. They have great accountability to adhere to corporate initiatives, process and procedures, including system of record data integrity.    The AM is a key member of the client team and provides direction to any 3rd party vendors who have responsibility for the account....

We are adding a    Claims Team Lead to our Texas team!   Who We Are: Since 1909, National Guardian Life Insurance Company (NGL) has been one of America’s most successful and highly rated independent life insurance companies. We specialize in a suite of innovative products for life’s journey, giving people the financial stability, careful guidance and peace of mind to lead a life filled with confidence, dignity and grace.   NGL's Core Values – integrity, dependability, collaboration, compassion and growth are a foundation of our company and help to build on the interactions we have with our policyholders, partners, funeral homes and each other. We believe in creating an inclusive, welcoming environment for all where diversity is celebrated, and everyone is encouraged to live their best, most authentic self. We offer Employee Resource Groups for employees to get involved, learn, network, and offer professional and personal development opportunities....

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 / Remedy Analytics is looking for a full-time experienced Pharmacy Audit Engineer , with keen analytical skills and an eye for detail, to join our growing team . The Audit Engineer will be responsible for completing pharmacy claims audits to ensure compliance to PBM contracts. This role will involve facilitating calls with PBMs, obtaining claims audit data, perform data loading and data quality checks, data reconciliation, running and analyzing Oracle output reports, running ad-hoc analysis, reviewing PBM contracts, completing audit support documentation and working with the client support team to develop PBM & client deliverables. The audit engineer will utilize ad hoc SQL automation and build a highly customized framework to complete projects. This role will develop, prioritize, and conduct financial and...

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 \ Remedy Analytics is looking for a full-time experienced Senior Client Audit Engineer - Pharmacy. The Senior Client Audit Engineer will be responsible for completing pharmacy claims audits to ensure compliance to PBM contracts. This role will involve facilitating calls with PBMs, obtaining claims audit data, perform data loading and data quality checks, data reconciliation, running and analyzing Oracle output reports, running ad-hoc analysis, reviewing PBM contracts, completing audit support documentation and working with the client support team to develop PBM & client deliverables. How You Will Contribute: o    Plan and develop the audit approach for assigned projects consistent with guidelines established by Remedy internal Audit Standards o    Work simultaneously on multiple audits with differing...

We are adding an Agent Solutions Coordinator !  This is a hybrid position requiring individuals to work in office 10 days per month; or as needed for business needs.   Who We Are: Since 1909, National Guardian Life Insurance Company (NGL) has been one of America’s most successful and highly rated independent life insurance companies. We specialize in a suite of innovative products for life’s journey, giving people the financial stability, careful guidance and peace of mind to lead a life filled with confidence, dignity and grace.   NGL's Core Values – integrity, dependability, collaboration, compassion and growth are a foundation of our company and help to build on the interactions we have with our policyholders, partners, funeral homes and each other. We believe in creating an inclusive, welcoming environment for all where diversity is celebrated, and everyone is encouraged to live their best, most authentic self. We offer  Employee Resource Groups for...

We are adding a Claims Adjudicator to our team! Who We Are: Since 1909, National Guardian Life Insurance Company (NGL) has been one of America’s most successful and highly rated independent life insurance companies. We specialize in a suite of innovative products for life’s journey, giving people the financial stability, careful guidance and peace of mind to lead a life filled with confidence, dignity and grace.   NGL's Core Values – integrity, dependability, collaboration, compassion and growth are a foundation of our company and help to build on the interactions we have with our policyholders, partners, funeral homes and each other. We believe in creating an inclusive, welcoming environment for all where diversity is celebrated, and everyone is encouraged to live their best, most authentic self. We offer  Employee Resource Groups for employees to get involved, learn, network, and offer professional and personal development opportunities. With over...

The salary range for this job posting is $97,153.00 - $194,990.00 annually + bonus + benefits. Pay Type: Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. Encova Insurance has an immediate opening for Production Underwriter, Package Lines for accounts averaging over $75k in premium. Ideal candidates will reside in the Madison or Milwaukee, Wisconsin areas. This position will travel the assigned territory to visit agencies in order to develop new and existing relationships. A company vehicle will be provided. We may hire a senior level depending on candidate qualifications and the posting is inclusive of the non-senior and senior-level full range. This role will report to...

In this internship, you'll gain hands-on experience and work with a mentor to learn all about the Claims role and network with leadership at social events. Here at Sentry, we value real work experience for our interns. We offer not only an internship, but an experience for students to get a head start on their careers, early on. With the claim’s internship, you will work with a mentor to learn what claims are and how they play a vital role in the company’s success, as well as how claims are handled. You will also get opportunities to network by attending diverse social events and meeting leadership in multiple areas. What You’ll Do Our Claims internship offers opportunities to: Gain hands-on insight into claims negotiations and settlement processes to help reach fair resolutions for customers. Stand by customers during stressful times, guiding them through the claims process with genuine care and understanding. Review policy details to accurately verify coverage and...

SUMMARY:     This is the entry level professional claim handler. Handles medical only and indemnity benefits.  Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.    RESPONSIBILITIES/TASKS: Verifies workers’ compensation coverage of employers and injured employees.   Determines compensability under workers’ compensation by thorough investigation of the claim.   Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. Manages medical bills for...

SUMMARY:     This is the entry level professional claim handler. Handles medical only and indemnity benefits.  Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.    RESPONSIBILITIES/TASKS: Verifies workers’ compensation coverage of employers and injured employees.   Determines compensability under workers’ compensation by thorough investigation of the claim.   Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. Manages medical bills for...

Join Acuity's Legal Department as a Legal Support Specialist, where you'll help support corporate governance, regulatory compliance, and legal operations. You'll help maintain corporate records and filings, conduct research, support audit, and regulatory response efforts, and collaborate with internal partners to ensure compliance with legal and regulatory requirements. You will support business and regulatory matters rather than claims handling or claims litigation activities. You will report to the Director - House Counsel. Internal Deadline to Apply: Thursday, September 10th What you'll do: Support legal and compliance functions by maintaining regulatory inventories, compliance matrices, and internal tracking tools to support adherence to laws and regulations. Support corporate governance efforts by coordinating and submitting required filings and notices, annual reports, biographical affidavits, fingerprinting requests and other similar items. Assist in...

As a Healthcare Financial/Actuarial Manager you will be a key member of the Financial Actuarial & Analytics (FAA) Community of Expertise. You will substantially contribute to a wide variety of complex analyses and projects involving the design, financing, and measurement and financial analysis of the full spectrum of employer health and group benefit programs including medical, dental, life, disability, voluntary benefits, etc. You will interface with vendors and client service teams, prepare and communicate complex analyses to clients, and ensure quality standards are met. You will have the opportunity to position yourself to lead financial project with small-to-midsized clients, and work on cutting edge projects alongside leaders in the industry.   The Role With clear guidance and direction, play an active support role in multiple client teams developing financial analyses, outputs and client deliverables across a regional team. Develop working proficiency of core...

Crum & Forster Company Overview Crum & Forster (C&F) , with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+"(Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2024 Great Place to Work® Award  for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.   For more information about Crum & Forster, please...

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 Allstate’s sales organization is growing its virtual workforce, and we are looking for highly motivated individuals that thrive in a fast-paced sales environment and enjoy being rewarded for their efforts. At Allstate, we are committed to offering a reputable product suite that protects people from life’s uncertainties so they can realize their hopes and dreams. As a full-time Insurance Sales Representative, you will: Engage with active insurance shoppers via inbound/outbound calls, live chat, SMS, and more in a work from home call...

We are adding a Claims Adjudicator to our team! Who We Are: Since 1909, National Guardian Life Insurance Company (NGL) has been one of America’s most successful and highly rated independent life insurance companies. We specialize in a suite of innovative products for life’s journey, giving people the financial stability, careful guidance and peace of mind to lead a life filled with confidence, dignity and grace.   NGL's Core Values – integrity, dependability, collaboration, compassion and growth are a foundation of our company and help to build on the interactions we have with our policyholders, partners, funeral homes and each other. We believe in creating an inclusive, welcoming environment for all where diversity is celebrated, and everyone is encouraged to live their best, most authentic self. We offer  Employee Resource Groups for employees to get involved, learn, network, and offer professional and personal development opportunities. With over...