Claims Adjuster Kinetic Personnel GroupClaims AdjusterMonrovia, CA$55,000–$75,000 / yearTemporaryThe ideal candidate has a strong understanding of coverage analysis, liability evaluation, and California insurance regulations, and is able to resolve claims efficiently and fairly. This role is responsible for providing high-quality customer service while managing a volume of property damage claims.
Claims Examiner - Workers Compensation (Hourly) IconmaClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities:Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
NewClaims Examiner - Workers Compensation IconmaClaims Examiner - Workers CompensationRancho Cucamonga, CA$45–$50 / hourResponsibilities: 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. Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
NewAssociate Attorney WinCorp SolutionsAssociate AttorneyIrvine, CA$130,000–$150,000 / yearFull timeOur dynamic Insurance Services Practice Group is known for its comprehensive approach to complex insurance claims analysis and for representing insurance company clients in high-stakes coverage litigation cases across the country, including matters involving defective products, mass torts, environmental contamination, habitability, transportation, personal injury, professional liability, and intellectual property. WinCorp Solutions is looking to hire an Associate Attorney (Civil Litigation/Insurance Coverage) for a large award-winning law firm based in Irvine, CA.
NewRisk Manager MV TransportationRisk ManagerEl Monte, CA$97,000–$114,000This role is exclusively assigned to the potential contract and plays a crucial role in mitigating risk exposure, supporting safe operations, and driving continuous improvement in loss prevention efforts. The Risk Manager will serve as the primary point of contact for all Agency-related risk management matters and must be available and responsive at all times via mobile phone, email, or text message.
Workers Compensation Claims Examiner TEEMA GroupWorkers Compensation Claims ExaminerChino, CA$93,000–$104,000This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits. This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders.
Senior Major Loss Claims Manager Kemper CorpSenior Major Loss Claims ManagerCerritos, CA$99,000–$164,800 / yearWe believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. The Claims Manager will provide technical expertise, staff development and guidance on California claims handling practices/procedures and provide training as appropriate and necessary.
CA Claims Specialist - Bilingual (Spanish) CorVel Enterprise Claims, Inc.CA Claims Specialist - Bilingual (Spanish)Rancho Cucamonga, CARemote$25.48–$41.09 / hourPart timeThe Workers’ Compensation 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. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Claims Auditor Western GrowersClaims AuditorIrvine, CAThis position reports to the Supervisor of Payment Integrity and performs in-depth audits to ensure existing health (medical/dental) benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management, Inc. clients are in compliance with the respective employers summary plan descriptions. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management.
Associate Bond Claims Attorney HCC Service CompanyAssociate Bond Claims AttorneySanta Ana, CaliforniaAs an insurance company, however, we must comply with certain Federal and state laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC § 1033(e)), which limits our ability to employ individuals with certain types of criminal convictions. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report.
Claims Administrator - US Domestic & GeneralClaims Administrator - USNorwalk, CaliforniaRemoteAs a Claims Administrator, you’ll be the key point of contact between our customers and our service partners, ensuring extended warranty claims are handled quickly, accurately, and with empathy. Provide occasional backup support to our Contact Center teams across general warranty inquiries, claims, credits, sales, and product registration.
NewClaims Coordinator ServiceMaster RestoreClaims CoordinatorRedlands, CA$25–$30 / hourAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call.
Sr. Claims Specialist - Commercial Auto BI Philadelphia Insurance CompaniesSr. Claims Specialist - Commercial Auto BIMission Viejo, CA$102,150–$120,177 / yearEvaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner. Marketing Statement: Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries.
Business Analyst Sr, Claims - Covered California CalOptimaBusiness Analyst Sr, Claims - Covered CaliforniaOrange, CA$77,863–$124,581 / yearWe are hoping you will join us as a Business Analyst Sr, Claims - Covered California and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Provides analytical support and technical expertise to executives, directors and staff by delivering insights on Covered California performance, trends and compliance, while partnering with department leadership and internal teams to identify and implement process improvements that enhance efficiency and compliance in claims operations.
Claims Resolution Specialist CalOptimaClaims Resolution SpecialistOrange, CA$53,813–$80,720 / yearWe are hoping you will join us as a Claims Resolution Specialist and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.
GLOVIS: Analyst, Operations Administration Claims Temp Elevated ResourcesGLOVIS: Analyst, Operations Administration Claims TempIrvine, CaliforniaHandle and process insurance claims on behalf of customers on force majeure/act of god related incidents: • Collect incident report. To handle and resolve claims issues and disputes from dealers and transportation vendors.
Claims Specialist Elite SourcingClaims SpecialistCosta Mesa, CaliforniaYou will be responsible for investigating and evaluating property damage claims arising from automobile accidents, working closely with the demands team and clients to ensure fair compensation for damages. Investigate property damage claims involving auto accidents, including reviewing police reports, witness statements, and damage assessments.
Claims Coordinator RiversideClaims CoordinatorRiverside, CaliforniaAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call.
Workers Compensation Claims Manager, West CNA Financial CorpWorkers Compensation Claims Manager, WestBrea, CA$72,000–$141,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Oversees the work activities of a team of claims professionals and has full management responsibility by setting and communicating expectations, providing direction and coaching, facilitating training and development, managing employee performance, and contributing to employee engagement. Builds and maintains collaborative relationships with internal and external work partners by participating in round table discussions, working with claims operations and coverage resources, providing insights to underwriters, partnering with SIU and Recovery Services and interacting with external customers, brokers and vendors as appropriate.
Senior Claims Counsel - Financial Institutions/Public D&O CNA Financial CorpSenior Claims Counsel - Financial Institutions/Public D&OBrea, CA$97,000–$189,000 / yearThe position requires the ability to independently evaluate liability and coverage; proactively formulate and execute claim resolution strategies; and, without the assistance of counsel, attend mediations, navigate complex settlement dynamics and drive and influence best possible claim outcomes. The individual in this position will primarily focus on high severity D&O and E&O claims under policies issued to Public Companies as well as Financial Institutions such as large depository institutions, insurance companies, asset managers, private equity and venture capital firms and REITs.
NewVP, Claims Technical Lead, Workers Comp Sompo International Holdings LimitedVP, Claims Technical Lead, Workers CompIrvine, CA$170,000–$225,000 / yearThe successful candidate will supervise the internal Sompo TPA oversight claims team, manage TPAs who handle claims on Sompo's behalf, and work closely with internal and external business partners. Below is a summary of our current comprehensive U.S. benefit programs: Two medical plans to choose from, including a Traditional PPO & a Consumer Driven Health Plan with a Health Savings account providing a competitive employer contribution.
Manager, Schedule Delay Claims The Vertex Companies, LLCManager, Schedule Delay ClaimsIrvine, CA$85,000–$202,000 / yearFull timeThe salary ranges for this role are as follows: $85,000 - $202,000 USD annually (Geographical Tier AA - Sample Locations: NY Metro, San Franscisco, San Jose, Seattle) $78,000 - $186,000 USD annually (Geographical Tier A - Sample Locations: Irvine CA, Middlesex NJ, Tacoma WA, Boston, Alexandria) $72,000 - $171,000 USD annually (Geographical Tier B - Sample Locations - Baltimore, Chicago, Anchorage, Portland) Time away matters—so we provide a generous paid time off program, including vacation, sick time, and paid holidays (with prorated options for eligible part-time employees). The Vertex Companies, LLC (VERTEX) is a $180M global consulting firm that integrates strategic advisory, project management, and dispute resolution services for organizations facing complex challenges in a world of risk.
Analyst III, Epic Application Professional Billing and Claims Pacific Dental Services IncAnalyst III, Epic Application Professional Billing and ClaimsIrvine, CA$103,000–$133,000 / yearOwns highly complex projects, such as multi-module implementations or enterprise-wide systems upgrades; leads medium-scale projects, including scoping, design, implementation, testing and go-live support. This role ensures accurate and efficient billing workflows, claim generation, and revenue cycle operations by collaborating with finance, billing, and operational teams.
Workers Compensation Claims Manager, West CNAWorkers Compensation Claims Manager, WestPlacentia, CaliforniaBuilds and maintains collaborative relationships with internal and external work partners by participating in round table discussions, working with claims operations and coverage resources, providing insights to underwriters, partnering with SIU and Recovery Services and interacting with external customers, brokers and vendors as appropriate. Performs a combination of duties in accordance with departmental guidelines: Oversees the work activities of a team of claims professionals and has full management responsibility by setting and communicating expectations, providing direction and coaching, facilitating training and development, managing employee performance, and contributing to employee engagement.
Claims Examiner - Workers Compensation eTeam Inc.Claims Examiner - Workers CompensationBrea, CARemote$45–$48 / hourPRIMARY 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. Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Claims Client Service Executive Sales The Hartford Insurance Group IncClaims Client Service Executive SalesBrea, CA$108,000–$162,000 / yearWe look to the Client Service Executive, Sales to support the end-to-end service mission while delivering engaging customer presentations that demonstrate professional diplomacy, articulated messaging and a friendly confidence that drives positive outcomes for our customers. Responsibilities: As the integral member of the Client Service Team, supports the overall service mission by delivering customer presentations that demonstrate professional diplomacy, articulated messaging and confidence that drives positive outcomes for our customers.
Claims Recovery Representative II SchoolsFirst Federal Credit UnionClaims Recovery Representative IITustin, CA$24.56–$35.62 / hourAt SchoolsFirst FCU we are dedicated to building and growing a diverse, inclusive, and authentic Dream Team, so if you're excited about a position or wanting to make a career change but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. Responsible for assisting and completing basic debit and credit card investigations, including fraud, and/or reviewing basic cardholder claim reports in order to take appropriate action to mitigate loss to the organization.
Claims Auto Adjuster AAAClaims Auto AdjusterCosta Mesa, CaliforniaThis entry-level position supports the Auto Claims Operation by providing service pursuant to the policy by handling claims of material damage, property damage, and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
NewSenior Claims Examiner BerkleySenior Claims ExaminerIrvine, California$110,000–$125,000 / yearThis role actively supports and participates in the company’s culture of continuous learning and innovation, including engagement in innovation groups focused on identifying opportunities for process improvement, enhancement, and transformational change. Key functions include but are not limited to: Adjust all aspects of complex claims and loss notices, including coverage and compensability analysis, reserve setting, reinsurance reporting, and coverage litigation.
Claims Litigation Attorney AAAClaims Litigation AttorneyRiverside, CaliforniaClaims Litigation Attorney This position specializes in defending complex, high exposure trials and arbitrations with exposure in excess of policy limits, objective injury cases, and high profile fraud cases. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Claims Associate - Workers Compensation Apidel TechnologiesClaims Associate - Workers CompensationBrea, CARemoteContractorSkills & Knowledge Excellent oral and written communication skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Claims Director(WC & TPA Oversight) CNA Financial CorpClaims Director(WC & TPA Oversight)Brea, CA$97,000–$189,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Leads the work activities of claims professionals and/or claims managers and has full management responsibility for setting and communicating expectations, providing direction and coaching, facilitating ongoing training and development, managing employee performance and contributing to employee engagement. This director-level role operates under general direction with broad authority to lead the oversight of complex, high-exposure commercial Workers' Compensation claims managed by Third-Party Administrators (TPAs), while also managing and developing a team of claim professionals.
Risk and Claims Specialist SA Recycling LLCRisk and Claims SpecialistOrange, CA$30–$34 / hourThe essential and critical functions include answering calls, initial processing of new claims, maintaining accurate digital files, managing high-volume correspondence and acts as a primary point of contact for injured workers. The ideal candidate is detail-oriented, highly organized, maintains a professional and caring demeanor, listens well, provides excellent customer service and manages sensitive medical and financial data with strict confidentiality.
Claims Auditor 26-00102 Alura Workforce SolutionsClaims Auditor 26-00102Rancho Cucamonga, CA3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines. DESCRIPTION Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.
Claims Coordinator ServiceMaster Restore 9430 - RiversideClaims CoordinatorRiverside, CAAs the hub of all claims, the coordinator is responsible for speaking with the customer, ongoing customer follow up, handling service complaints, logistics of dispatching field personnel to jobs while ensures that the required Cycle Time and insurance Service Level Agreement tasks deadlines are met. Ensure that uploading photos, and other documents are appropriately described, titled and uploaded in real time, as well as follows up to get missing required data from homeowner and insurance/mortgage information not obtained on initial call .
CA Senior Claims Specialist - Temporary CorVel Enterprise Claims, Inc.CA Senior Claims Specialist - TemporaryRancho Cucamonga, CARemote$29.35–$47.28 / hourPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
NewCA Senior Claims Specialist CorVel Enterprise Claims, Inc.CA Senior Claims SpecialistRancho Cucamonga, CARemote$29.35–$47.28 / hourPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
CA WC Senior Claims Specialist (Floater) CorVel Enterprise Claims, Inc.CA WC Senior Claims Specialist (Floater)Rancho Cucamonga, CARemote$29.35–$47.28 / hourPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
Senior Claims Specialist Your Next CareerSenior Claims SpecialistSanta Fe Springs, CaliforniaEnsure the timely logging of all new claims (delegate to Claims Assistant if necessary) and timely reporting to our Insurance Carrier, with guidance by the Dir of Risk Management. Recognized as the 2026 “Top Hispanic Supermarket in the U.S.” by Abasto, we are committed to serving our customers, supporting our communities, and creating growth opportunities for our team members.
NewXcelys Medical Claims Examiner-REMOTE NTT DATAXcelys Medical Claims Examiner-REMOTEOntario, CARemoteActual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.
Claims Examiner - Workers Compensation (Hourly) ICONMA, LLCClaims Examiner - Workers Compensation (Hourly)Brea, CA$43–$48 / hourResponsibilities: Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
NewBond Claims Attorney Trainee Growth & Mentorship HCC Service CompanyBond Claims Attorney Trainee Growth & MentorshipSanta Ana, CA$85,400–$117,500 / yearThe role is tailored for early-career attorneys and includes structured training to develop expertise in surety bond claims. The position offers a competitive salary ranging from $85,400 to $117,500 per year, based on experience and skills.#J-18808-Ljbffr.
Claims Adjudicator Sr Loma Linda University Medical CenterClaims Adjudicator SrRedlands, CAAble to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Knowledge and Skills: Extensive experience in health insurance claims processing, HMO claims or managed care environment is required, in-depth knowledge of medical billing and coding, knowledge of health insurance, HMO and managed care principles.
NewVP, Claims Technical Lead, Workers Comp Endurance Services LimitedVP, Claims Technical Lead, Workers CompIrvine, North CarolinaThe successful candidate will supervise the internal Sompo TPA oversight claims team, manage TPAs who handle claims on Sompo’s behalf, and work closely with internal and external business partners. Below is a summary of our current comprehensive U.S. benefit programs: Two medical plans to choose from, including a Traditional PPO & a Consumer Driven Health Plan with a Health Savings account providing a competitive employer contribution.
NewComplex Claims Consulting Director - EPL, Private & NFP D&O CNA Financial CorpComplex Claims Consulting Director - EPL, Private & NFP D&OBrea, CA$97,000–$189,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of the most complex EPL and Private and Not-For-Profit D&O, which are generally multi-year and have very significant loss exposure, by following company protocols to manage and oversee all aspects of the claim handling, including coverage determinations, investigations, and resolution strategies which may include extensive negotiations and complex litigation management. Drives the resolution of claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that includes management of timely and adequate reserves, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing settlements within scope of authority.
Commercial General Liability Claims Representative CNA Financial CorpCommercial General Liability Claims RepresentativeCA$47,000–$78,000 / yearJOB DESCRIPTION: Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit. Exercises judgement to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim.
Workers Compensation Claims Specialist, West CNA Financial CorpWorkers Compensation Claims Specialist, WestIrvine, CA$54,000–$103,000 / yearPartners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims. Performs a combination of duties in accordance with departmental guidelines: Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
Claims Senior Casualty Adjuster AAAClaims Senior Casualty AdjusterDiamond Bar, CaliforniaThe Claims Senior Casualty Adjuster handles moderate to high complexity claims involving material damage, property and/or liability lines of insurance written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.
Workers Compensation Claims Specialist, West CNAWorkers Compensation Claims Specialist, WestPlacentia, CaliforniaPartners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims. In District of Columbia,California, Colorado, Connecticut, Illinois , Maryland, Massachusetts , New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually.
Claims Auditor 26-00128 Alura Workforce SolutionsClaims Auditor 26-00128Rancho Cucamonga, CA3. Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines. DESCRIPTION Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Provider Recovery Auditor is responsible for the audit and recovery of claims overpayments including COB and third-party liability.