AVP, Claims Quality Assurance & Performance Management Argo Group International Holdings IncAVP, Claims Quality Assurance & Performance ManagementNew York City, NY$137,496–$189,516 / yearQualifications / Experience Required: A specialized knowledge of managing Quality Assurance programs typically achieved through: Bachelor's degree required; JD, advanced degree, CPCU, AIC, SCLA, Six Sigma/Lean, PMP, Prosci, Guidewire certification, or similar insurance, claims, audit, process improvement, project management, or change management credential preferred. In addition, the role will expand QA output into a broader claims performance management capability by linking QA findings to Guidewire data, KPI trends, process assessment analytics, adjuster and manager performance evaluation, and senior leadership reporting across Argo's claims organization.
Senior Quality Analyst (Claims) EmblemHealth IncSenior Quality Analyst (Claims)New York, NY$56,160–$99,360 / yearPerform audits and/or provide oversight and guidance to Claim Auditors in completing comprehensive random audits of claims, membership and service inquiry adjustment transactions. Perform comprehensive audits of service inquiry adjustment transactions to verify that inquiries from groups, providers and subscribers are resolved accurately and timely.
SIU Investigator - NY Labor Law Allied UniversalSIU Investigator - NY Labor LawManhattan, New York$32–$40 / hourFull timeAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance . High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud .
SIU Investigator - New York Labor Law Allied UniversalSIU Investigator - New York Labor LawBrooklyn, New York$32–$40 / hourFull timeAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance . High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud .
Licensed Public Adjuster (Nj) Velaz Solar & RoofingLicensed Public Adjuster (Nj)Elizabeth, NJ$40,000–$60,000 / yearThis is an excellent opportunity for a motivated professional who wants unlimited earning potential while helping homeowners navigate the insurance claims process after storm, wind, hail, or other property damage. Velaz Group LLC is seeking a licensed Public Adjuster to join our growing team in New Jersey.
SIU Investigator Allied UniversalSIU InvestigatorEdison, New Jersey$27–$32 / hourFull timeAcquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance . High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud .
General Liability Claims Consultant CNA Financial Corp.General Liability Claims ConsultantWarren, NJ$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.
Senior Claims Specialist, Cyber AXA SASenior Claims Specialist, CyberNEW YORK, NY$117,000–$184,400 / yearCoordinating and managing communication with internal colleagues and key external stakeholders (e.g., clients, brokers, reinsurers, vendors, etc.) ensuring we are providing the highest level of customer service Responsive claims management in direct coordination with a diverse team of specialists: computer forensics, data breach notification and call center services, credit and ID monitoring, public relations and expert legal counsel. Managing assigned complex Cyber and Technology claims across multiple jurisdictions, setting the case strategy for these claims in partnership with the Cyber Practice Leader and Claims Management, and taking all available steps to achieve the optimal outcome.
Claims Specialist, Cyber AXA SAClaims Specialist, CyberNew York, NY$83,500–$145,500 / yearCoordinating and managing communication with internal colleagues and key external stakeholders (e.g., clients, brokers, reinsurers, vendors, etc.) ensuring we are providing the highest level of customer service Responsive claims management in direct coordination with a diverse team of specialists: computer forensics, data breach notification and call center services, credit and ID monitoring, public relations and expert legal counsel. Managing assigned complex Cyber and Technology claims across multiple jurisdictions, setting the case strategy for these claims in partnership with the Cyber Practice Leader and Claims Management, and taking all available steps to achieve the optimal outcome.
Experienced Medical Claims Biller II POM RecoveriesExperienced Medical Claims Biller IIFarmingdale, New YorkJoin our team as an Insurance Claims Follow-up Specialist, where you'll leverage your expertise in medical collections, denial processing, appeal submission, and EOB review to resolve unpaid claims effectively. Are you a seasoned professional with a minimum of 2 years of hospital in-patient and out-patient claims follow-up experience?
Managing Director Strategic Claims Oversight - Healthcare Severity CNA Financial Corp.Managing Director Strategic Claims Oversight - Healthcare SeverityTarrytown, NY$97,000–$189,000 / yearDevelops and maintains collaborative working relationships with internal and external business partners including Operations, Underwriting, Actuary and Risk Control and regularly shares claims outcomes, trends, legal developments and other relevant business updates. Responsible for the ongoing management of staff by attracting talent, setting clear direction, providing appropriate guidance, managing performance, recognizing contributions, and developing capabilities.
Coverage & Complex Claims Lead Selby Jennings LtdCoverage & Complex Claims LeadMorristown, NJContribute to TPA oversight through training, audits, and best practice sharing, and support key proceedings such as mediations and trials while maintaining required licensing. This role will be responsible for handling bad faith suits filed against the major case unit while working heavily with coverage counsel and legal.
Auto Adjuster I, II or Sr. Allstate Insurance CompanyAuto Adjuster I, II or Sr.NJ$50,000–$74,350 / yearAuto Collision (Inactive), Auto Collision Repair, Auto Insurance, Auto Insurance Claims, Automobile Accidents, Automobile Liability, Case Management, Claims Administration, Claims Resolution, Claims Review, Customer Service, De-Escalation, Insurance Administration, Insurance Claims, Insurance Coverage, Insurance Policies, Investigative Skills, Multitasking, Negotiation, Task Organization, Time Management. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
Claims & Litigation Associate (Remote) Stanford Health CareClaims & Litigation Associate (Remote)NYRemote$100.03–$132.51 / hourInvestigates pre-suit claims, reviews medical records, interviews providers, retains consultants when necessary, communicates with patients and/or families, and directly negotiates settlements when warranted. Oversees legal defense strategy, retains outside counsel, coordinates support for investigation, reviews attorney invoices, and monitors counsel's compliance with litigation management guidelines.
Senior Claims Advocacy Specialist Ryan Specialty GroupSenior Claims Advocacy SpecialistNew York, New YorkThey 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.
Head of Disability & Voluntary Benefits Claims Operations Prudential FinancialHead of Disability & Voluntary Benefits Claims OperationsNewark, New JerseyLocation: Open to remote or hybrid candidates within the U.S. Candidates should be comfortable with regular travel and maintaining an in-person presence at a Prudential office as business needs require (Newark, NJ; Portland, ME; Fort Washington, PA; Hartford, CT). The successful candidate will lead a large-scale claims operation, ensuring exceptional customer outcomes, operational excellence, regulatory compliance, and continuous business transformation through technology, automation, and process innovation.
Engagement Lead - Risk Consulting- Forensic Accounting/Claims-Remote - US Marsh & McLennan Companies IncEngagement Lead - Risk Consulting- Forensic Accounting/Claims-Remote - USMorristown, NJRemote$112,600–$239,800 / yearAs an Engagement Lead - Forensic Accounting & Claims Services Consultant, you will act as a recognized subject matter expert, leading large-scale strategic projects, coaching team members, and solving complex client problems. Marsh Risk is a business of Marsh (NYSE: MRSH), a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries.
Claims Negotiation Analyst (Out of Network Mandates) Horizon Healthcare ServicesClaims Negotiation Analyst (Out of Network Mandates)Newark, New JerseyPrepares written responses including negotiation outcomes by completing a written justification on how Horizon BCBSNJ adjudicated the initial and adjusted claim, but not limited to, benefits, contracts, payment and pricing methodology, proof of plan and providing explanation of benefits within regulated timeframes. $58,029 - $77,074 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Complex Claims Consultant - Financial Lines/Public D&O CNA Financial Corp.Complex Claims Consultant - Financial Lines/Public D&OTarrytown, NY$72,000–$141,000 / yearPerforms a combination of duties in accordance with departmental guidelines: Manages an inventory of highly complex litigated 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.
Remote Claims Representative - 609986 Metro Public AdjustmentRemote Claims Representative - 609986Piscataway, NJRemoteIf you think you would be a great fit for our team, click Apply to seize this opportunity and shape your own future You will receive a link to schedule an informative interview session. Metro Public Adjustment is looking for people who are interested in helping homeowners receive the maximum amount they are entitled from their insurance claim.