38 workers compensation complex claims adjuster jobs found

Overview Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.   Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company’s success is grounded in our core values:  accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!...

You have a clear vision of where your career can go. And we have the leadership to help you get there.  At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.  CNA is a market leader in insuring skilled nursing, assisted living and independent living facilities and this role will support the business and interact closely with internal business partners such as Underwriting, to share claim insights that aid in good underwriting decisions. Our Healthcare Claims team is seeking a Complex Claims Consultant to support our Aging Services segment. This individual contributor role is responsible for the overall investigation and management of Aging Services claims in multiple states. Recognized as a technical expert in the interpretation of complex or unusual policy coverages in area of expertise. Under general management direction, works within assigned...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies has an immediate opportunity for an experienced workers compensation adjuster. We're looking for self-starters who can work under minimum direction, can achieve defined results, and are willing to accept ownership for their work product. This Claims Professional is responsible for the management of a caseload of workers compensation indemnity claims from inception to resolution, performing initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration to injured workers, and coordination of medical care and legal process, while maintaining the highest level of service to our insureds.   ESSENTIAL RESPONSIBILITIES Conducts the investigation of reported claims via three-point contact calls to determine coverage, compensability and severity, and to gather all other relevant information, documenting all relevant information thoroughly and...

WHAT WE'RE LOOKING FOR BHHC has an immediate opportunity for experienced Workers Compensation Claims Professionals. This position requires a self-starter who can work under minimum direction, can achieve defined results, and willing to accept ownership for their work product. The Senior Claims Professional is responsible for the management of a complex caseload of workers compensation indemnity claims from inception to resolution.  This individual works under general supervision with elevated reserve and settlement parameters and encouraged to participate in special projects focused on process efficiency.    RESPONSIBILITIES Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support. Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely...

WHAT WE'RE LOOKING FOR BHHC has an immediate opportunity for experienced Workers Compensation Claims Professionals. This position requires a self-starter who can work under minimum direction, can achieve defined results, and willing to accept ownership for their work product. The Senior Claims Professional is responsible for the management of a complex caseload of workers compensation indemnity claims from inception to resolution.  This individual works under general supervision with elevated reserve and settlement parameters and encouraged to participate in special projects focused on process efficiency.    RESPONSIBILITIES Helps injured workers achieve rapid and full medical recovery and early, safe return to work through effective, efficient and timely medical treatment and return-to-work support. Effectively communicates with injured workers and employers. Demonstrates expertise and empathy, building trust and moving the claim forward, including timely...

WHAT WE'RE LOOKING FOR Berkshire Hathaway Homestate Companies has an immediate opportunity for an experienced workers compensation adjuster. We're looking for self-starters who can work under minimum direction, can achieve defined results, and are willing to accept ownership for their work product. This Claims Professional is responsible for the management of a caseload of workers compensation indemnity claims from inception to resolution, performing initial investigation and compensability determination, reserve analysis and strategic planning, timely benefit administration to injured workers, and coordination of medical care and legal process, while maintaining the highest level of service to our insureds.   ESSENTIAL RESPONSIBILITIES Conducts the investigation of reported claims via three-point contact calls to determine coverage, compensability and severity, and to gather all other relevant information, documenting all relevant information thoroughly and...

The Claims Quality Assurance serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards. The primary responsibility is evaluating claim handling quality, accuracy, and timeliness in categories including but not limited to: coverage analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. This role has the ability to interpret results and trends in order to deliver operational reporting, and participate in the development and presentation of training.   This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Model ethical behavior and executes job responsibilities in accordance with CorVel’s core values, ethics, and information protection policies Serve as technical QA lead to assigned offices or departments Lead QA projects and serve as primary coordinator for senior leadership of assigned offices Support...

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 | Rancho Cordova, CA 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 of the...

Job Description Responsible for managing workers’ compensation claims as assigned by claims supervisor. Investigates claims.  Determines the compensability of the claim and extent of liability. Communicates directly with clients, employers, injured workers, physicians, and attorneys to bring claims to a timely conclusion. Job Description Summary Essential Duties and Responsibilities include the following. Other duties may be assigned : Interviews, telephones, or corresponds with claimant and witnesses; consults police and hospital records. Contacts physicians to obtain medical diagnoses and projected treatment plans. Monitors medical progress of claimants and coordinates follow-up treatments; reports to employers including any restrictions that may be imposed on claimants’ return to work. Documents all information from contacts with employers, claimants, physicians, and attorneys into the claims’ management system and ensures that...

You have a clear vision of where your career can go. And we have the leadership to help you get there.  At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.  This individual contributor position works under moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s). JOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following...

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...

Overview Works independently to manage Workers' Compensation cases, including complex and catastrophic claims.   Note commercial Workers' Compensation experience in California is required. Responsibilities DISTINGUISHING CHARACTERISTICS: Administers complex non-litigated and litigated workers’ compensation cases and integrates the delivery of benefits associated with sickness and long-term disability benefits.  Provides technical guidance, mentoring and support to claims assistants and clerical staff.     ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, the employee must be able to efficiently and effectively perform each of the following essential functions.  Reasonable accommodation may be made for individuals with disabilities.   The functions of this job include but are not limited to;            Set up claims and make timely three point contacts Ensure the privacy...

We are seeking a Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.  This position is remote. Candidates must hold a self-insured certificate. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: 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...

WHO WE ARE Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.   WHAT WE’RE LOOKING FOR The Senior Account Manager serves as the primary business contact for the client and is responsible for client satisfaction.  The person in this position is expected to consistently provide excellent customer service to assigned accounts, as well as represent client needs and goals within the organization to ensure quality.  In addition, the Senior Account Manager will build relationships with clients to encourage new and repeat business opportunities. A GLIMPSE INTO YOUR DAY...

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 position in CA. 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...

The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage. This role aims to achieve optimal outcomes for both CorVel and our clients. The Senior Liability Claims Specialist handles litigated files and works with delegated authority, adhering to company best practices. 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 Investigates claims and handles Auto and/or General Liability claims Establishes reserves and authorizes payments within reserving authority limits Communicates claim status with the customer, claimant, and client Adheres to client and carrier guidelines and participates in claims review as needed Collaborates with team members on more complex or problematic claims as necessary Additional duties as assigned...

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 the most complex Homeowners Claims. Determines coverage, damages and otherwise adjusts and negotiates claims within limit of authority. This role provides guidance and direction to junior employees. National General is seeking an experienced Desk Property Adjuster. The ideal candidate will reside in the Central or Eastern Time Zone, is proficient in Xactimate, and hold active licenses in TX/LA or other reciprocal states. We’re looking for someone with a strong foundation in property claims, solid negotiation skills, and the...

WHO WE ARE Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.   WHAT WE’RE LOOKING FOR The Account Manager manages the overall client relationship by providing strategic advice on coverage, risk management and business needs, ensuring that the client's insurance program aligns with long-term goals and growth plans.  The Account Manager remains knowledgeable of advances in the insurance business as well as stays abreast of the types of insurance products available.  A GLIMPSE INTO YOUR DAY Serves as the main point of contact for the clients, addressing...

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening in our San Diego office for a Claims Unit Supervisor. This individual will provide oversight and guidance to a team of Claims Professionals in the strategic management of workers' compensation indemnity claims while ensuring gold-standard service to injured workers and our insureds.   LEADERSHIP RESPONSIBILITIES Leads a unit of five to seven Claims Professionals of varying experience levels.  Establishes a workplace culture of professionalism, collaboration and inclusion, and excellence in service, aligning with our corporate mission and shared values. Establishes common goals.  Provides effective performance feedback through employee recognition, rewards, and disciplinary action, with the assistance of Human Resources as necessary. Able to transition between Supervisor and Claims Professional roles to effectively complete tasks and accomplish goals.  Actively...

ABOUT HUB: In a rapidly changing world, HUB advises businesses and individuals on how to prepare for the unexpected. As one of the world's largest insurance brokers, our focus is dedicated to providing our customers with the peace of mind that what matters most will be protected-through unrelenting advocacy and tailored insurance solutions that put our clients in control. Our growing team of professionals across North America represents a broad, deep and one-of-a-kind aggregation of entrepreneurs and leaders recognized for their excellence throughout the insurance community. WHY CHOOSE HUB? Throughout our network of more than 450 HUB offices in North America, we offer a competitive, exciting and friendly work environment that strategically positions our employees for longevity and success. At HUB, we believe in investing in the future of our employees, and provide continuous opportunities for growth and development.  Our entrepreneurial culture fosters an...