div>Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability.
2 years of relevant property claims adjusting experience of moderate complexity losses that includes writing estimates, involving dwelling and structural damages.
Union City, NJ26 days ago
CONSIDERED EXPERIENCE INCLUDES: Insurance Claims Examiner Adjuster Specialist Professional Liability Medical Malpractice MedMal Allied Healthcare #DiedreMoire #JobSearch #JobHunt #JobOpening #Hiring #Job #Jobs #Careers #Employment #jobposting #InsuranceJobs #UnderwriterJobs. Described compensation is not definite nor precise and may be estimated and approximate and is negotiable depending on market conditions and candidate availability and other factors and is solely at the discretion of employers.
p>Success in this role looks like:
p>Senior Claims Specialist, Excess Casualty - North America Claims Job Code 13573 About the Team AXIS is hiring a Senior Claims Specialist, Excess Casualty, to support its expanding presence in North America's Excess market. About You We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences, we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals.
Identifying opportunities for contribution, subrogation and contribution to the claim About You We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences, we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals. Our focus is on hiring, developing, retaining, and rewarding individuals who excel in: Purposeful Action: Delivering top-tier work with a data-driven approach and operating at AXIS speed.
p>We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals. Utilizing working knowledge of the legal frameworks and claims handling practices relevant to the specific jurisdiction (i.e., NY) in which the claims arise.
White Plains, New York28 days ago
Overview: A Disability Claims Manager oversees the process of reviewing and managing disability claims, ensuring compliance with applicable company policy, contract language and regulations by evaluating medical records, coordinating with providers, and communicating with claimants to determine eligibility for benefits.
The Manager reaches out to employers to verify if Claimant is working, appropriate return to work if Claimant is not working, and if possible light duty available.
Short Hills, NJ30+ days ago
li>Close collaboration with the Specialty Complex Claims team with regard to coverage disputes, including litigation and arbitration matters initiated by Axis issuing companies and when Axis issuing companies are parties to such litigation; Collaborating across disciplines and business units, including: the general counsel team overseeing errors and omissions issues arising from claims handling. Identifying, liability and coverage trends and issues with both individual and portfolio impact and formulating the processes and strategies for handling such claims as well as ensuring accurate and consistent claims management across impacted underwriting segments and lines of business.
p>MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics.
This role ensures accurate and timely claims processing, identifies and resolves discrepancies, and serves as a key liaison between internal teams, providers, and payers. Maintain working knowledge of billing concepts including HCPCS/CPT modifiers, reimbursement methodologies, and service-specific billing requirements (e.g., hospital, ambulance, anesthesia).
Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond. Architects and validates claims system configurations to ensure full alignment with provider contracts, reimbursement methodologies, and benefit structures, minimizing financial leakage and ensuring contractual integrity.
Berkley Heights, NJ4 days ago
Refer a friend: Referral fee programCareer Developers Inc., a distinguished staffing and consulting firm, is proud to celebrate 30 years of service excellence. Skilled at working with adjusters, brokers, insureds, and internal stakeholders to support timely claim resolution while maintaining accurate records and ensuring compliance with company procedures.
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Responsible for receiving, researching and resolving inquiries and requests from internal EmblemHealth departments and business partners (i.e., account management, provider network management, provider file operations, client retention, access to care, care café, membership, COB, Contact Center, G&A, etc.) regarding claim outcomes. Collaborate with EmblemHealth and CTS business partners as needed to validate accuracy of benefit configuration, NetworX rate sheets, provider participation status, provider file and membership file, including COB flags impacting the claim(s) adjudication outcome.
p>The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The Senior Claims Consultant, National Accounts serves as an advisor and primary claims resource for large, complex accounts through a range of internal and external resources.
Rye Brook, NY30+ days ago
li>Manage auto estimating processes, auto service management, auto body repair coordination, water damage restoration assessments, mold remediation evaluations, construction inspection reports, and automotive repair claims. This position offers an engaging opportunity for professionals experienced in insurance claim management who are committed to excellence in customer service while ensuring regulatory compliance across diverse claim types including workers' compensation, automotive repairs, medical billing, and property restoration projects.
Work At Home, NY18 days ago
Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
418318'',''true'',''418318'',''false'',''Submission for the position: Employee Benefits Claims Team Leader (HYBRID OR REMOTE) - (Job Number: 260000AW)'',''false'',''418318'',''false'',''true'',''Employee Benefits Claims Team Leader (HYBRID OR REMOTE)'',''260000AW'',''UNITED STATES-Remote'',''UNITED STATES-Remote'',''UNITED STATES-NC-Charlotte, UNITED STATES-NY-Syracuse'',''UNITED STATES-NC-Charlotte, UNITED STATES-NY-Syracuse'',''Equitable'',''Equitable'',''Full-time'',''Full-time'',''!*! Claims Management: Expertise in delivering a positive claims experience for Disability and/or Leave of Absence products, such as Short Term Disability, Statutory Disability Coverages, Long Term Disability, or State Paid Leaves.
New York, New York20 days ago
This role partners with Claims Operations and technical teams to troubleshoot processing issues, support system implementations and configuration changes, analyze claims data and trends, and identify opportunities to improve claims accuracy, turnaround times, and operational efficiency. Overview: The Business Analyst, Claims is responsible for supporting core claims processing operations for the health plan through workflow analysis, system support, and operational improvement initiatives.
Port Chester, NY28 days ago
Over 30 years of leadership under franchise owners Mike Vitti and Scott Fabrizio understanding the importance of delivering an immediate response for customers seeking cleaning, restoration or remediation services. The ideal candidate is comfortable working in a fast-paced environment, managing multiple files simultaneously, and supporting operational workflows related to water, fire, mold, and reconstruction claims.
White Plains, New York28 days ago
Overview: The Executive Director must directly manage the day-to-day Claims operations with direct oversight of Claims managers and their performance in meeting the needs of the departmental and company goals. Responsibilities:
- Direct the day-to-day activities, tasks, and processes to ensure the efficient operation of the claims processing units and all related tasks to meet the claims payment TAT, accuracy and production goals, and objectives.
p>About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products including but not limited to New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Healths network includes over 27,000 primary care providers, specialists, and participating clinics.
li>Attends internal and external training and self-study to keep abreast of changes relating to medical treatment, and jurisdictional and statue changes impacting workers compensation benefits.
Markets OnCall Nurse (OCN), Return to Work (RTW), Select Preferred Provider (SPP) to insured's and identifies non-use for corrective measures.
Perform multi-policy checks where appropriate to determine if New York Life claimants with active disability and/or Life claims may be eligible for additional VB benefits as a result of their condition(s) in support of GBS service integration initiatives. We provide a full package of benefits for employees and have unique offerings for a modern workforce, including leave programs, adoption assistance, and student loan repayment programs.
p>While each project involves unique tasks, contributors may: - Evaluate AI-generated auto insurance claims decisions for accuracy, coverage correctness, and regulatory compliance;
- Design FNOL scenarios with deliberate contradictions, decoy files, and outdated documents to test agent robustness;
- Write and grade fraud-flagging scenarios using structured reason codes (late reporting, recently purchased policy, inconsistent damage) for SIU referral;
- Build subrogation test cases applying state-specific negligence rules (comparative vs. Ideally, contributors will have:
- Degree in Insurance, Risk Management, Business Administration, Finance, Law, or any related field;
- 3+ years of insurance, claims, legal, or financial services experience;
- Current or recent experience in claims & adjusting or adjacent roles;
- Familiarity with auto insurance coverage decisions, state-specific negligence rules, and adjuster authority-limit culture;
- AIC, CPCU, CIFI, or SCLA credential is a strong positive signal, though not required if hands-on experience is solid;
- Strong written English (C1+).
Refer a friend: Referral fee programCareer Developers Inc., a distinguished staffing and consulting firm, is proud to celebrate 30 years of service excellence. The role also evaluates claims for reserve and settlement, executes settlement strategy, negotiates settlements proactively, attends arbitrations, and ensures appropriate file documentation.
By collaborating cross-functionally and acting as a trusted partner to agents, vendors, and internal teams, you will play a critical role in reducing risk, controlling costs, and strengthening relationships while continuously elevating the quality and integrity of the claims process. Step into a role where your expertise directly drives meaningful outcomes, leveraging your investigative instincts, sound judgment, and negotiation skills to bring clarity and resolution to complex claims.
li>Liaises with clients, and third parties as necessary such as attorneys and technology forensic firms, for claim/events-related issues or client service concerns to resolve complex issues with insurers on claims notifications, updates, information requests, the hiring of professionals, queries, acknowledgements or other issues, payment issues, keeping all relevant parties informed, as appropriate, of any potential problems, contentious claims or general claims trends.
Reviews incoming documentation and new claims notifications of a complex nature or for large and/or complex clients, informs all relevant parties of any potential problems or contentious claims, and refers to Claims Advocates as needed.
You will play a critical role in understanding healthcare reimbursement from both financial and operational perspectives, conducting audits, and performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs). To excel as a Full-Time HealthCare Claims Analyst at VillageCare, candidates must possess a Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering, with a Master's degree preferred.
Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; present findings to management. Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines.
ul>Bachelor's degree is required; a Master's degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency. The ideal candidate will have experience processing healthcare claims in a high-volume Claims Department.
New York, New York19 days ago
Responsibilities: We are looking for a Claims Associate who will assist in the administration and documentation of the property, casualty, workers’ compensation and financial/executive risk claims for the company’s real estate portfolios and corporate activities. This role requires strong organizational, communication, and interpersonal skills, as well as the ability to work collaboratively with insurers, brokers, legal counsel, third-party administrators, and internal stakeholders.
Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology.
New York, New York30+ days ago
They represent the company in high-level negotiations, monitor industry trends, and drive initiatives for operational efficiency and strategic development, fostering strong relationships for organizational success in the specialty insurance market. • Develops and implements advanced strategies for generating claims insights and advocacy, leveraging industry expertise and insights to optimize claim resolution outcomes.
p>Required Education, Training, & Professional Experience High School Diploma and minimum 7 years of claims operations experience in a healthcare field required or: - Associates degree and minimum 5 years of claims operations experience in a healthcare field.
Claims Supervisor Job Ref TE0049 Category: Claims Department CLAIMS Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Work Arrangement: Hybrid Salary Range: $60,000.00 - $70,000.00.
New York City, NY30+ days ago
p>Nesco Resource has partnered with a well-established, nationally recognized company with a long-standing presence in critical infrastructure and public service to identify a Claims Intake Specialist. - Prolonged sitting while answering phones at a computer terminal for the majority of the workday required.
Key Responsibilities Provide day-to-day support for Epic HB Admin, Claims, and Remittance (Remit) workflows across revenue cycle operations Troubleshoot and resolve issues related to claims processing, billing edits, and remittance posting Configure and maintain Epic HB billing rules, charge router, claim edits, and remittance logic Analyze claim rejections/denials and partner with operations teams to implement root cause solutions Support EDI transactions, clearinghouse integrations, and payer-specific requirements Monitor system performance and conduct proactive audits to ensure billing accuracy and compliance Collaborate with revenue cycle stakeholders (billing, coding, finance) to support end-to-end workflows Participate in system upgrades, enhancements, testing cycles, and optimization initiatives Develop and maintain documentation, workflows, and training materials for operational teams Provide production support including issue triage, incident management, and resolution tracking Required Qualifications Epic HB Certification(s) - required (HB Admin strongly preferred; Claims/Remit experience required) 5+ years of Epic HB experience, including Admin, Claims, and Remittance functionality Strong experience supporting hospital revenue cycle operations, including billing, claims management, and payment posting Deep understanding of claims lifecycle, denials management, and remittance processing (835/ERA) Hands-on experience with Epic build, configuration, and support within HB modules Knowledge of EDI transactions, clearinghouses, and payer rules Proven ability to troubleshoot complex issues and work directly with operational stakeholders Strong communication skills with the ability to translate technical concepts to non-technical users Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required. This individual will play a key role in maintaining and optimizing Epic HB (Hospital Billing) workflows, with a strong focus on claims processing, remittance, and operational support.
Scope of Role: Manage the claims process for Aon's Financial Services Group's ("FSG") clients from start to finish Provide expert advice on reporting procedures and claims process Ensure timely and accurate reporting of claims Obtain and review coverage positions from insurers Establish and manage lines of communication between clients and insurance carriers Serve as the point person for the client on all FSG claims related matters Serve as the client's advocate with the insurers Partner with clients to ensure that insurers are updated as necessary with respect to pending claims Obtain consent from insurers for retention of defense counsel and vendors Engage insurers in resolution of claims, such as seeking consent to settlement opportunities and ensuring payment of defense fees and expenses Assist clients and brokers on coverage issues for Directors and Officers Liability, Errors and Omissions, Employment Practices, Fiduciary, and Fidelity policies Maintain adequate documentation of claims related correspondence Work alongside Claims Attorneys to help clients resolve complex claims issues Contribute to data produced by the Legal and Claims Practice Group for the benefit of internal and external clients Any and all other responsibilities as deemed necessary by supervisor to achieve the purpose of the job Competencies, Knowledge & Experience Demonstrates a strong understanding of claims management process Possesses knowledge of Financial Lines market and insurer partners Analytical skills Attention to detail Customer and interpersonal skills Skilled in MS Office suite Has at least 5 years' experience handling claims or commensurate legal or insurance experience Education: Bachelor's degree or equivalent years of proven experience The salary range for this position is $91,800 - $114,800 annually. Aon is looking for a Senior Claims Advocate in the Financial Services Group As part of an industry-leading team, you will help empower results for our clients by delivering innovative and effective solutions as part of our Financial Services Group Legal and Claims Practice Group.
p>''418883'',''true'',''418883'',''false'',''Submission for the position: Employee Benefits Head of Claims (HYBRID or REMOTE) - (Job Number: 260000C9)'',''false'',''418883'',''false'',''true'',''Employee Benefits Head of Claims (HYBRID or REMOTE)'',''260000C9'',''UNITED STATES-Remote'',''UNITED STATES-Remote'',''UNITED STATES-NC-Charlotte, UNITED STATES-NY-Syracuse'',''UNITED STATES-NC-Charlotte, UNITED STATES-NY-Syracuse'',''Equitable'',''Equitable'',''Full-time'',''Full-time'',''!*! Customer Experience Management: Knowledge of customer experience management; ability to implement strategies and techniques used to ensure that customers have a positive experience with the organization''s products and services at every touch point.
New Jersey, NJ21 days ago
Experience in handling severity and excess casualty claims or related litigation Experience working claims in the Excess and Surplus Market preferred Experience working with complex coverage issues required Multi-jurisdictional claims and litigation experience preferred Adjuster license and/or certifications preferred Highly advanced knowledge of claim processes, policies, procedures, claim systems, regulation, coverage, liability, damage evaluation, and/or settlement with exposures in excess of $1M Excellent at establishing close working relationships with other departments, including underwriting, operations, finance, IT, actuarial and legal Strong negotiating, analytical, written, and organizational skills Mediation and arbitration experience Strong computer skills (Microsoft Office Suite and in-house claims systems) Ability to prioritize and manage deadlines Ability to work both independently and collaboratively as part of a team Bachelor's degree required; JD preferred Excellent verbal and written communication skills Ability to analyze data and make sound judgments Ability to prioritize and manage deadlines Ability to work both independently and collaboratively as part of a team. Dedicated and hard-working Willingness to learn and apply concepts Able to work autonomously with strong organizational skills and the ability to plan ahead Keen attention to detail, highly analytical and excellent problem-solving capability Collaborative spirit Results-oriented, forward-thinking, and growth mindset.
Complex Litigation Strategy: Partnering closely with the Global and Regional Heads of Litigation, the successful candidate will manage a comprehensive litigation management strategy, including panel counsel governance and cost-containment initiatives, to minimize legal expenses and optimize outcomes in a complex regulatory environment. By combining a comprehensive and efficient capital platform, data-driven insights, leading technology, and the best talent in an agile and inclusive workspace, empowered to deliver top client service across all our lines of business property, casualty, professional, financial lines and specialty.
We help companies and individuals around the globe address their most significant risk, workforce, wealth management and retirement challenges through custom solutions and a people-first approach. The base salary offered will be determined by factors including, but not limited to, experience, credentials, education, certifications, skill level required for the position, the scope of the position, and geographic location.
li>Frequently communicate key client and Family Office matters/concerns, team updates, market developments and claims trends with PCS field leadership teams (Zone Leaders and Zone Client Advisor Leaders) as well as MMA regions. Directs and interfaces with PCS Operations and EPIC Transformation teams to design and implement contemporary claims technologies, including claims 'use cases' for Risk Services and Solutions data platform.
p>Job Summary: Everest Insurance, a member of Everest Re Group, Ltd., has an opportunity for an experienced claims professional or attorney to join our Auto and GL TPA Oversight - Casualty Claims team in Warren, NJ, New York, NY or Philadelphia, PA.
Job Description:
About Everest:
Everest is a global leader in risk management, rooted in a rich, 50+ year heritage of enabling businesses to survive and thrive, and economies to function and flourish.
p>Role & Responsibilities (include but not limited to): Reviewing and analyzing complex coverage issues and preparation of coverage position letters Investigating, analyzing and evaluating liability and damages Managing and directing outside counsel Preparing case summary reports related to matters of significant reserve and trial activity Setting timely and appropriate case reserves Developing and executing claim strategies as well as resolution strategies Negotiating and resolving cases Attending trials, mediations and settlement conferences Working with underwriters to support policy construction and drafting, reporting claim trends, data analysis, and risk assessments Extensive communication with insureds, brokers, reinsurers, actuaries, and underwriters Attending client meetings and industry functions to support retention and development of client relationships and business Performing similar work-related duties as assigned. Qualifications: Strong analytical and organizational skills Excellent verbal and written communication skills Strong negotiation and investigation skills Ability to think strategically Ability to influence others and resolve complex, disputed claims In-depth knowledge of the litigation, arbitration, and trial process Currently holds or readily can obtain all required adjuster licenses Ability to identify and use relevant data and metrics to best manage claims Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency Ability and willingness to present to senior management and to others in other group settings Knowledge of the insurance industry, claims process and legal and regulatory environment 5-7 years of claims handling experience or legal experience B.A.