Claims Examiner - Workers Compensation Apidel TechnologiesClaims Examiner - Workers CompensationOrange, CARemoteContractorTo 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.
Workers Compensation Claims Specialist, Complex & Settlement Focus CNA Financial Corp.Workers Compensation Claims Specialist, Complex & Settlement FocusIrvine, CA$54,000–$103,000 / yearJOB 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 company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Complex Claims Consultant - Hospitals , Allied Facilities And Physicians CNA Financial Corp.Complex Claims Consultant - Hospitals , Allied Facilities And PhysiciansIrvine, CA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex healthcare claims, with large exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves 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, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
General Liability Claims Specialist CNA Financial Corp.General Liability Claims SpecialistBrea, CA$54,000–$103,000 / yearJOB DESCRIPTION: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Blended Claims Specialist, Construction CNA Financial Corp.Blended Claims Specialist, ConstructionBrea, CA$54,000–$103,000 / yearJOB 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 company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Complex Claims Consulting Director - Mass Tort Unit CNA Financial Corp.Complex Claims Consulting Director - Mass Tort UnitBrea, CA$97,000–$189,000 / yearManages an inventory of the most complex commercial claims, which generally involve multiple years of coverage, have 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 pursuit of risk transfer, extensive negotiations and management of complex litigation. Drives the resolution of claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, that often includes negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Major Litigation Unit Complex Claims Consulting Director CNA Financial Corp.Major Litigation Unit Complex Claims Consulting DirectorBrea, 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 commercial claims, 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 pursuit of risk transfer, 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, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Complex Claims Specialist - Professional Liability (Real Estate) CNA Financial Corp.Complex Claims Specialist - Professional Liability (Real Estate)Irvine, CA$54,000–$103,000 / yearJOB 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 company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
Complex Claims Consultant - Lawyers Professional Liability (Large Law) CNA Financial Corp.Complex Claims Consultant - Lawyers Professional Liability (Large Law)Irvine, CA$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex professional liability claims, with exposures that require a high degree of specialized technical expertise and coordination, by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits. Resolves 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, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
Claims Coordinator, PSA Collaborative SolutionsClaims Coordinator, PSASanta Ana, CaliforniaOur services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia. We grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
Claims Receivables And Recovery Specialist (50627) Western Growers AssociationClaims Receivables And Recovery Specialist (50627)Irvine, CAThe Claims Receivables and Recovery Specialist reports to the Supervisor, Payment Integrity, and works with various departments within the company to ensure all open claim receivables, which are results of claim overpayments and/or adjustments, are pursued and collected appropriately. Collect receivables for the Western Growers Assurance Trust (WGAT) and clients of the Third-Party Administrator (TPA) that may be a result of overpayments or claims adjustments by researching, writing letters, and actively making phone calls.
NewComplex Claims Consulting Director - Healthcare Severity & Excess Team CNA Financial Corp.Complex Claims Consulting Director - Healthcare Severity & Excess TeamIrvine, CA$97,000–$189,000 / yearCNA is a market leader in insuring Healthcare providers and entities including Allied Healthcare Facilities, Aging Services and Allied Healthcare Providers, including nurses, nurse practitioners, physical therapists, counselors, pharmacists, massage therapists, and more than 100 other categories of medical service providers. This role is responsible for analyzing complex coverage matters, driving claim resolution, managing complex litigation including risk transfer opportunities, advising leadership on legal and claim risks, and partnering with Underwriting and other business units on emerging trends and portfolio management.
Senior Claims Examiner - 4850 Athens AdministratorsSenior Claims Examiner - 4850Orange, CaliforniaATHENS POSITION DETAILS Position Title: Senior Claims Examiner Department: Workers’ Compensation California Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 12 Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. The Senior Claims Examiner will adjust police and fire 4850 workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
NewWorkers 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.
Workers Compensation Claims Specialist, West CNA Financial Corp.Workers Compensation Claims Specialist, WestBrea, 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.
Marine Claims Analyst MCD Tokio Marine GroupMarine Claims Analyst MCDLos Angeles, CaliforniaTM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims related services in the areas of transportation, product liability and overseas travel accident insurance. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.
Claims Support Specialist II Mercury Insurance Services, LLCClaims Support Specialist IIBrea, California$35,520.30–$43,413.70 / yearAbility to manage in a fast-paced high volume virtual contact center or office inbound and outbound calls in a timely manner, while maintaining a positive, empathetic, and professional demeanor towards customers at all times. Overview: Position Summary: The primary role of this position may be working in a fast-paced high volume remote virtual contact center environment or office that requires 100% phone-based customer interaction.
Claims Loss Reporting Specialist AAAClaims Loss Reporting SpecialistCosta Mesa, CaliforniaThe position receives and documents first notice of loss, takes overflow calls, and answers low complexity claims related questions for the Claims department while delivering a totally satisfying member experience through exceptional customer service. 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.
Medical Malpractice Claims Specialist KI Executive GroupMedical Malpractice Claims SpecialistOrange, CaliforniaThe Medical Malpractice Claims Specialist is responsible for managing assigned medical malpractice claim files, including complex and high exposure matters. This role oversees claim investigation, litigation coordination, reporting, and documentation while working closely with defense counsel and internal stakeholders.
General Liability Claims Consultant CNA Financial Corp.General Liability Claims ConsultantBrea, CA$72,000–$141,000 / yearThis individual contributor role operates under broad authority to manage commercial claims of high complexity and exposure within the Commercial Auto/General Liability/ Construction Auto and General Liability line(s) of business. Performs a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages.