249 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...

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...

Customer Service Rep I Full-time Shift: 8:00 am to 8:00 pm  (Shift bidding process based on seniority) Grand Rapids, MI Assessment required -  Customer Service Rep   Analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e., Facility, Professional). Provide responses by telephone, check-off letters, and/or automated letters. Follow department/corporate reporting requirements (i.e., PCRS, ICS, Special Surveys and Manual counts).  Organize work to meet Nati45onal/Corporate/Department Production and Quality Standards.  Reroute misdirected inquiries.  Primarily evaluates membership issues/inquiries and price/adjudicates low complexity claims/inquiries.  Interact with others inside and outside the...

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 Workforce Absence Team Lead - ADA PRIMARY PURPOSE :  To supervise the operations of multiple teams of examiners and technical staff for disability claims for clients; to monitor colleagues' workload, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims within the teams including frequent diaries on complex or high exposure claims. ESSENTIAL...

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 Examiner | HYBRID | Brea, 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? ​Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.  Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.  Take advantage of a...

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 Team Lead - Workers Compensation 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...

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....

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Injury Examiner , you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM , and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations....

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated First Party Injury Adjuster- PIP/Med Pay you will be responsible to adjust non-attorney involved soft tissue bodily injury or auto PIP/MP medical claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and...

Job Description TITLE:                                                 Marine Claims Consultant DEPARTMENT:                                  EIMC REPORTS TO:                                     Team Leader or Director of Marine Claims STATUS:                                              Regular, full-time; exempt           SUMMARY OF JOB PURPOSE   EIMC, an Engle Martin company, is an independent marine consulting services company providing supply chain loss control and claims investigation expertise to insurers, brokers, 3PLs and industrial partners. The Marine Consultant effectively determines and communicates the extent of loss or damage associated with ocean marine claims in a variety of business classes. PRIMARY JOB RESPONSIBILITIES Independently opens and handles assigned cases within basic limits of complexity. Identifies, recommends, and pursues appropriate mitigation strategy with supervisory oversight as necessary. Expands knowledge base to include...

Customer Service Rep I Full-time Shift: 8:00 am to 5:30 pm (Shift bidding process based on seniority) (Both training and position will be based out of the Detroit location) Assessment required-  Customer Service Rep   Analyzes, evaluates, resolves and primarily responds to low complexity level membership issues under various product lines. Primarily conducts low complexity internal and external research to determine and request the data needed to handle inquiries regarding membership.  Analyze and service various product lines in the area (i.e. Commercial, Medicare, Provider, etc.). Provide responses by telephone, email, chat, check-off letters, and/or automated letters. Follow department/corporate reporting requirements. Organize work to meet National/Corporate/Department Production and Quality Standards.  Reroute misdirected inquiries.  Primarily evaluates membership issues/inquiries and price/adjudicates low complexity claims/inquiries.  Interact with others inside...

Company Argo Group Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Business Title(s):    Senior Environmental Technical Claims Specialist   Employment Type:  Full-Time    FLSA Status:  Exempt    Location:  In-Office    Summary:      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 Albany, Chicago, Los Angeles, New York City, Omaha, Richmond (VA), Rockwood (PA), or Springfield (MO) .    Alternatively, we are also open to consider candidates working from home anywhere in the continental United States This individual will...

Company Argo Group Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Business Title(s):   Senior Environmental Claims Adjuster Employment Type:  Full-Time  FLSA Status : Exempt  Location:  Field   Summary:   We are looking for a highly capable Senior Environmental Claims Adjuster to join our team and work from our office in New York City.  We can also consider candidates in our Albany, Chicago, Houston, Los Angeles, Omaha, or Richmond (VA) offices. Alternatively, we can fill this role fully remote except in the states of AK, DE, HI, KY, MI, MS, MT, ND, SD, or VT. This individual will report to a manager who works in New York City and is focused on adjudicating first and third party commercial...

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 | DE & CT Jurisdiction Knowledge Required | PA NJ MA Preferred | Dedicated Client & Capped Caseloads 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 adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.   Deliver innovative customer-facing...

AffirmedRx is on a mission to improve health care outcomes by bringing clarity, integrity, and trust to pharmacy benefit management. We are committed to making pharmacy benefits easy to understand, straightforward to access and always in the best interest of employers and the lives they impact. We accomplish this by bringing total clarity to business practices, leading with clinical approaches, and utilizing state-of-the-art technology. Join us in improving health care outcomes for all!  We promise to do what’s right, always. Position Summary: The Manager, Benefit Design & Requirements (PBM) will be the founding individual contributor of this function, establishing the processes, standards, and institutional knowledge from the ground up. As the function matures, this Manager will have the opportunity to scale the team, hiring and developing analysts beneath them who will carry out the work they defined. In the near term, this person serves as AffirmedRx’s resident...

Company Argo Group Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Business Title(s):  Senior Construction Defect Technical Claims Specialist Employment Type:  Full-Time  FLSA Status:  Exempt  Location:  In-Office or Remote   Summary:      We are looking for a highly capable Senior Construction Technical Claims Specialist Team Lead to join our team and work from any of the following Argo offices: Albany, Chicago, Los Angeles, New York City, Omaha, or Richmond (VA). Alternatively we can fill this role with a fully remote employee, except in the States of AK, DE, HI, KY, MI, MS, MT, ND, SD, or VT.  This role will be adjudicating our most complex construction defect claims for our customers and...

Company Argo Group Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Business Title(s):  Senior Construction Defect Technical Claims Specialist Employment Type:  Full-Time  FLSA Status:  Exempt  Location:  In-Office or Remote   Summary:      We are looking for a highly capable Senior Construction Technical Claims Specialist Team Lead to join our team and work from any of the following Argo offices: Albany, Chicago, Los Angeles, New York City, Omaha, or Richmond (VA). Alternatively we can fill this role with a fully remote employee, except in the States of AK, DE, HI, KY, MI, MS, MT, ND, SD, or VT.  This role will be adjudicating our most complex construction defect claims for our customers and...

Company Argo Group Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc. Job Description Business Title(s):  Senior Construction Defect Technical Claims Specialist Employment Type:  Full-Time  FLSA Status:  Exempt  Location:  In-Office or Remote   Summary:      We are looking for a highly capable Senior Construction Technical Claims Specialist Team Lead to join our team and work from any of the following Argo offices: Albany, Chicago, Los Angeles, New York City, Omaha, or Richmond (VA). Alternatively we can fill this role with a fully remote employee, except in the States of AK, DE, HI, KY, MI, MS, MT, ND, SD, or VT.  This role will be adjudicating our most complex construction defect claims for our customers and...

Title: Claims Processor 1                             Department: Claims Union: OPEIU 29                                               Grade: 16 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....

Title:   Claims Processor 2   Department:   Claims Bargaining Unit:   OPEIU 29   Grade:   17 Position Type:   Non-Exempt   Hours per Week:   40 Position   Summary The Claims Processor 2 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....