259 claims adjudicator jobs found

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...

Position Summary The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements.   "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."   Key Duties and Responsibilities Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims. Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers’ Compensation, or disability.  May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. Performs other duties as assigned.   Minimum Qualifications High school diploma or GED. Six months of experience processing health and welfare...

Company Details     At Berkley Human Services, a Berkley Company, we insure those who serve others. We are devoted to meeting the needs of Human Services Organizations. We insure both nonprofit and for-profit social service organizations, such as child daycare, sheltered workshops, group homes, senior citizen centers, senior independent living, schools, counseling services, YMCAs, YWCAs, and Boys & Girls Clubs.   Responsibilities We are seeking an experienced, dynamic, creative and collaborative insurance professional and attorney who wants to join us in creative “outside the box” solutions to our customers needs when faced with challenging claims. At Berkley Human Services, a Berkley Company, we insure those who serve others. We are devoted to meeting the needs of Human Services Organizations. We insure both nonprofit and for-profit social service organizations, such as child daycare, group homes, senior citizen...

Description About Reserv Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans with deep experience in SaaS and digital claims, Reserv is venture-backed by Bain Capital and Altai Ventures and began operations in May 2022. We are focused on automating highly manual tasks to tackle long-standing problems in claims and set a new standard for TPAs, insurance technology providers, and adjusters alike. We have ambitious (but attainable!) goals and need adjusters who can work in an evolving environment. If building a leading TPA and the prospect of tackling the long-standing challenges of the claims role sounds exciting, we can’t wait to meet you. About the role As a Team Lead at Reserv, you will be a working leader providing support to a Claims manager with leadership and claim technical responsibilities. Leadership responsibilities will include overseeing work...

Primary Details Time Type: Full time Worker Type: Employee The Opportunity: This role will support the Claims Manager in managing assumed reinsurance excess of loss and proportional business for QBE Reinsurance's A&H portfolio, ensuring proper reporting and documentation of all claims following reinsurance contract terms. The Lead Claims Specialist will perform complex claims review by conducting claims data analyses, health and billing records assessments and validation of eligible benefits and losses under the plan contracts. The role will assure timely and accurate reserves are approved and recorded. Adjudicate claim payments within approved authority level and refer complex claims for clinical review when appropriate. Provide effective communications, data support, and collaboration with Global Claim department, Underwriting, Actuary, Legal and other internal teams. Participate in program management and provide claims support to external clients, brokers,...

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 General Liability Claims Examiner | Hybrid 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 world’s most respected...

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 Adjuster - Workers Compensation (Remote - FL exp required) PRIMARY PURPOSE:   To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long term...

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 - Workers Compensation (Remote -Southeast State exp needed) PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements....

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 Medical Only Adjuster Claims Associate | Dedicated Client | Hybrid Schedule One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred. Hybrid Schedule after 30 day in-office training period. Hybrid 2 days in-office/3 days work from home PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication...

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.   Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by  core values and operating principles  that guide every decision we make. The Senior Claims Adjuster will play a critical role in delivering quality claim file management and  an industry-leading customer claims experience., This will be completed  by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers..  How You’ll Do It Claims...

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 Adjuster - Workers Compensation - Phoenix, AZ - Hybrid PRIMARY PURPOSE:   To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long...

Job Type: Permanent Build a brilliant future with Hiscox   Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception through resolution. This involves the negotiation and settlement of Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required. The Team:       The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering...

Job Type: Permanent Build a brilliant future with Hiscox   Bring your Passion and Enthusiasm to our Team! We are a fun, innovative and growing Claims team where you’ll get the opportunity to learn multiple insurance products and interact with business leaders across the organization. Individual contributor role responsible for the handling of Miscellaneous Professional Liability claims for the organization from inception to resolution. This involves the negotiation and settlement of mid to high severity Miscellaneous Professional Liability insurance claims. May be responsible for single or multi-country claims and will be responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting) as required. The Senior Complex Claims Specialist is the most senior technical role in the organization. This person adjudicates assigned claims within given authority and provides...

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 Associate - Workers Compensation - El Dorado Hills, CA PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Supports other claims representatives, examiners and leads...

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 Office Assistant | Entry Level | Pasadena, CA (In-Office) 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 world’s most...

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 Team Lead Assistant PRIMARY PURPOSE:  To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers' compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide...

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 - Workers Compensation (Need VA & Longshore Exp) Claims Examiner – Workers Compensation Primary Purpose : To analyze complex or technically difficult workers' compensation claims to determine benefits due under the Long Shore and Harbor Workers Compensation Act. To work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific...

We’re thrilled that you are interested in joining us here at the Amynta Group! Claims Adjuster Adjudicate Claims The Amynta Group (the “ Company ”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants. Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal...

We’re thrilled that you are interested in joining us here at the Amynta Group! Automotive Claims Adjuster - Warranty This is a hybrid work opportunity in the DFW area. Must have previous experience in the automotive Industry to be considered. Handle inbound phone claims. Work in a call center environment focused on handling calls daily with expected performance metrics, handle times, and volume. Probe and troubleshoot mechanical breakdown claims to determine whether customer complaint, repair facility diagnosis, and failed parts meet the criteria for approval based on the terms and conditions of the extended service contract. Review and verify repair costs using standard “national labor guides” (including labor rates and time) to ensure estimates are within approval guidelines. Use other resources such as technical bulletins, recalls and system comments, and other requirements during the adjudication process. Verify repair information to determine if coverage is...

We’re thrilled that you are interested in joining us here at the Amynta Group! Automotive Claims Adjuster - Warranty This is a hybrid work opportunity in the DFW area. Must have previous experience in the automotive Industry to be considered. Handle inbound phone claims. Work in a call center environment focused on handling calls daily with expected performance metrics, handle times, and volume. Probe and troubleshoot mechanical breakdown claims to determine whether customer complaint, repair facility diagnosis, and failed parts meet the criteria for approval based on the terms and conditions of the extended service contract. Review and verify repair costs using standard “national labor guides” (including labor rates and time) to ensure estimates are within approval guidelines. Use other resources such as technical bulletins, recalls and system comments, and other requirements during the adjudication process. Verify repair information to determine if coverage is...