1,511 Claims Adjuster jobs in the United States

JOB DESCRIPTION

The Claims Adjuster with SteadPoint Risk Management Solutions is responsible for maintaining and handling workers'
compensation claims by determining compensability, investigating with specific focus on acquisition of recorded statements
of claimant or witnesses, coordinating medical care, assigning legal counsel if deemed necessary, and directing or
coordinating workers' compensation benefits. The Claims Adjuster will focus on reserve practices, medical terminology,
communication, organization, and directing claim development from onset to conclusion or settlement. Prefer candidate to have experience handling multiple jurisdictions, including GA and TN. Candidate must be comfortable working in a fast paced environment.

JOB FUNCTIONS AND RESPONSIBILITIES

• Receipt, review, and analyze incoming claims.
• Produce necessary documentation for justification of
  compensability and/or denial of claim.
• Must be able to answer, service, and document calls
  pertaining to policy benefits and determine whether
  the call needs to be referred to a supervisor.
• Follow up and complete work that originates from the
  calls received if applicable.
• Maintaining caseload by managing lost time claims.
• Take statements of injured worker, insured, potential
  witnesses, as necessary, in the scope of investigative
  duties of the claim.
• Process lost time benefits and coordinate meds, assign
  nurse case management, assign legal counsel if deemed
  necessary, and/or surveillance when appropriate.
• Solicit PPI from physician, calculate awards, and initiate
  settlements to resolve claim.

• Some college preferred or equivalent insurance claims
  handling experience of at least 5 years.
• Appropriate ICA continuing education coursework.
• State claims adjuster license.

• HEALTH & DENTAL BCBS
• LONG-TERM DISABILITY
• TERM LIFE INSURANCE
• FITNESS REIMBURSEMENT
• GROWTH OPPORTUNITIES
• VSP VISION
• SHORT-TERM DISABILITY
• 401K MATCHTING
• COMPETITIVE PTO

A winner of Best Places to Work in Insurance seven years in a row, Virtus is looking for innovative individuals to join our fast-paced, rapidly growing team headquartered in Overland Park, Kansas. Virtus is a next generation insurance consulting firm that focuses on middle market clients in a variety of lines of coverage. With locations in Kansas City, Memphis, Ft. Collins, Ft. Worth, and Austin, our team has a national scope and with a sophisticated client base that thrives on new ideas and our consultative approach. We're shaking up a tired insurance industry and creating something better: an experience that empowers our people to evolve, take smart risks, and face the future boldly.

The Claims Adjuster role presents an opportunity to join one of the fastest growing firms in the industry and play a significant role in shaping a team of consultants into an innovative group. The Claims Adjuster will oversee the handling and adjusting of property and liability claims that are submitted to Habitat Specialty's programs in accordance with Habitat's designated claims authority from Lloyd's. Responsible for claims intake, review, adjustment and/or referral to carrier or third-party administrator, as applicable, and steering the claim through the entire claim lifecycle.

The Ideal Candidate:

• Lives the Virtus Core Values - brings their A game and a great attitude each day.

• Detail-oriented, service motivated, and accountable to working harmoniously and thoroughly with their team to achieve results

that are aligned with Virtus' company goals.

• Recognizes this role is people facing; must have strong interpersonal skills, persuasive speaking, and a client service mindset.

• Presents complex information to groups of people in a clear manner - either in person or via technology.

• Has the ability to think outside of the box as needed while also working within a workflow structure.

• Enjoys working in an empowered, entrepreneurial environment of innovation and creativity.

• Showcases their natural and specialized technical skills through drive, determination, and self-discipline.

Essential Duties and Responsibilities:

• Adjust Commercial Property contents and tenant caused damage claims files for the life of the claim.
• Determine covered insurance losses by studying provisions of a policy or certificate.
• Establish proof of loss by studying documentation and assembling additional information from outside sources.
• Document specific claims by completing and recording forms, reports, logs, and records.
• Analyze insurance claims and interview claimants to prevent fraud.
• Prepare reports by collecting, analyzing, and summarizing information in accordance with service level agreements and requirements with Lloyd's
• Resolve claims by approving or denying documentation, calculating benefits due, and determining compensation settlement as permitted by Coverholder Agreement.
• Ensure legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
• Maintain quality customer service by following customer services practices and responding to customer inquiries in a timely and consistent fashion.
• Communicate with all claim stakeholders, including claimants, brokers, internal underwriting and client success team, carriers/syndicates, etc.
• Assist with the completion of ad hoc projects as needed.
• Resolve claims fairly and timely abiding by all regulatory (DOI) mandates.
• Maintain all necessary claim licensing.
• Ensure legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
• Other duties as assigned by the team and leadership.
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• 2-5 years of property and casualty insurance claims and coverage experience.
• Experience with Lloyd's policies is a plus.
• Subrogation experience Is a plus.
• Required to have active insurance adjusters license in the candidate's home state, Texas or Florida (or be willing to re-activate a prior license immediately upon hiring) as well as all states that require a license for claims adjusting.
• Position requires direct communication with clients; therefore, strong written, oral and presentation communication skills, with a commitment to impeccable client service are required; ability to adjust easily to working well with a variety of workstyles.
• Great, positive attitude and the ability to work independently under pressure.
• Ability to complete quality work and solve Insured/claimant Issues minimal supervision.
• Ability to manage and analyze high volumes of complex information.
• Advanced analytical and problem-solving skills.
• Outstanding organizational skills and attention to detail.
• Willingness to grow and develop.
• Must have familiarity and good working knowledge of various Microsoft software applications (Excel), Agency Management Systems, and the ability to learn new software systems.
• Ability to be flexible, adaptable, and work in a team environment that is constantly evolving.
• Ability to negotiate and utilize conflict management skills.
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• Lead claims resolution : Investigate, evaluate, and adjust property claims, with a focus on contents within claimants' storage units
• Drive fair settlements : Negotiate effectively with claimants and third-party representatives to reach equitable resolutions
• Ensure accuracy : Process payments and maintain precise, up-to-date claim records to support operational excellence
• Tackle complexity : Provide expertise and support for complex claims, ensuring thorough and efficient handling
• Uphold standards : Adhere to company policies and procedures while delivering exceptional service
• Operate efficiently : Perform desk-based adjusting, focusing on streamlined processes without field inspections

• Licensed with 3+ years of experience as a claims adjuster
• Proven experience in handling liability and injury claims
• Ability to clearly and professionally communicate with internal and external stakeholders
• Experience analyzing claims data and make informed decisions swiftly, balancing risks and available resources
• Ability to document and ensure compliance while helping improve internal processes and efficiency
• Ability to adapt to priority shifts and fast-paced environment by working both autonomously and collaboratively
• Desire to work in an in-person or hybrid work environment from our beautiful downtown Austin office

Job Type

Full-time

Description

For 70 years George Hills has offered our clients unparalleled service and innovative excellence in claims administration and offered our employees a positive and collaborative culture that builds relationships based on pride and respect. As an "Employer of Choice", we are pleased to offer employees a flexible hybrid work schedule, competitive salary, and excellent benefits including medical, dental, vision, PTO, holidays, and 401k. To learn more, please visit our website at . George Hills is an equal-opportunity employer.

The Claims Adjuster investigates, evaluates, and adjusts General and Automobile Liability claims. Although assigned claims generally consist of low to medium exposure, first and third-party automobile bodily injury and property damage claims, as well as premises liability accidents, product liability claims, the claims adjuster must be qualified legally and technically to handle all claims competently.

Requirements

Primary responsibilities:

Based on the area of responsibility, the employee shall be asked to all of the following essential functions:

• Investigate, analyze, and determine the extent of insurance provider's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants.

• Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.

• Investigate claims:

• Assess and estimate vehicle damage.
• Assist with business or managerial research.
• Compile information through interviews.
• Evaluate customer records.
• Examine evidence to determine if it will support claims.
• Follow contract, property, or insurance laws.
• Follow rules of evidence procedures in legal setting.
• Gather physical evidence.
• Inspect property to determine damages.
• Research property records.
• Search legal records Interviews, telephones, and or corresponds with claimant and witnesses.

• Review insurance applications.
• Review insurance policies to determine appropriate coverage.
• Obtain, review and evaluate records, police, medical, etc.
• Recommend claim action.
• Properly reserve for the claim.
• Adjust reserve as appropriate.
• Comply with accepted guidelines regarding reserving practice and authority levels.

• Maintain records, reports, and files which are primarily found on the SIMS and/or Renaissance system.
• Maintain all cases on an active diary on the SIMS and/or Renaissance system pursuant to established Company criteria.
• Prepare timely reports to clients.
• Comply with all reporting requirements/steps set out in the GHC Procedure Manual.
• Comply with regulatory requirements.
• Diary spoken or written information.

• Collect evidence to support contested claims in court.
• Keep clients advised.

Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.

LANCER CLAIMS SERVICES

Claims Adjuster

Ideal candidates will have experience as a securities attorney, 5 years handling securities claims, or 3+ years engaged in the selling and servicing of various financial products such as annuities, life insurance, securities etc. Ideal candidates may also have 3+ years in a compliance roll handling financial institutions customer complaints.

Summary:

The Claims Adjuster is the lead adjuster on the programs in which he/she handles claims for the financial services group where the pending is comprised mostly of large national accounts; analyze coverage under professional liability policies, including but not limited to, Securities Broker/Dealer Insurance, Investment Management Insurance, Financial Institution Professional Liability Insurance and Life Agents Professional Liability Insurance. Manage litigation and engage in settlement negotiations daily with outside counsel and claimants; attend mediations; this would require better than ordinary knowledge of the coverages, types of claims, and problems/solutions on the program. The Claims Adjuster is a troubleshooter for the account.

Essential Duties include:

• Exercise judgment in applying legal liability to assigned claims and will have full settlement authority up to their specific authority, which may vary from carrier to carrier.
• Assign defense counsel to answer and defend lawsuits when appropriate. Monitor and direct defense counsel, independent adjusters and experts.
• Secure supporting documentation for assigned claims E&O, e.g.: insured's file materials and notes, underwriting guidelines, carrier's investigation package, phone logs, etc. Investigate facts of underlying loss by securing statements and supporting documentation such as copy of policy, police reports, estimates of repair, new account profile, risk tolerance questionnaire, etc.
• Identify claims with potential exposure in excess of authority and advise Claims Supervisor/Team Lead and the underwriting company contact.
• Responsibilities include the overall control of a particular program. In addition, the Claims Adjuster-Financial Institutions may also be asked to coordinate reports, statistics, results, etc. on the account.
• The Claims Adjuster-Financial Institutions may be asked to participate in general discussions on the account with the underwriting company or sponsoring company. She/he is the chief liaison with Professional Groups at CalSurance and would be responsible for marketing calls, information, and coordination.
• Research applicable coverage for our insureds. Document coverage dates, limits and restrictions.
• Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by Coverage Senior Director.
• Handle claims within guidelines of the Fair Claims Practices 790.03.
• Provide insureds, claimants and sponsoring companies with regular updates on status of file handling.
• Discuss unique and complex files or issues with Claims Supervisor/Team Lead.
• This position may require routine or periodic travel which may require the teammate to drive their own vehicle or a rental vehicle. Teammates who drive for the Company are subject to a Motor Vehicle Record report at the time of hire and periodically thereafter, acceptable MVR results and maintenance of minimum acceptable auto insurance coverages are a requirement.

• 3-5 years litigation and claims management experience.
• B.A or B.S required; J.D. helpful.
• Excellent communication skills.
• Must be licensed as a Qualified Claims Manager within 90-days of hire and in other states as needed.
• Must a critical thinker, detail oriented, have good organizational skills, and be self-motivated.
• Must be able to handle multiple and changing priorities.
• Proficient computer skills including Microsoft Office Outlook, Word, Excel, TEAMS.

• Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance
• Financial Benefits: ESPP; 401k; Student Loan Assistance; Tuition Reimbursement
• Mental Health & Wellness: Free Mental Health & Enhanced Advocacy Services
• Beyond Benefits: Paid Time Off, Holidays, Preferred Partner Discounts and more.

• Mandatory: Workers Comp experience in Southeast state jurisdictions some or all AL. GA, FL, NC, SC, TN
• Experience: 5+ years of relevant WC experience with above mentioned states.

• To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

• Bachelor's degree from an accredited college or university preferred.

• Four (5) years of claims management experience or equivalent combination of education and experience required.

Benefits:

401(k) matching

Company parties

Competitive salary

Dental insurance

Free food & snacks

Health insurance

Opportunity for advancement

Paid time off

Vision insurance

Claims Advocate

Worthy Insurance Group, a national Property & Casualty Insurance Brokerage located in Skokie, IL, is looking for a Claims Advocate to join our Risk Management team. Gain superb, well-rounded training and experience in all facets of insurance: claims, coverages, sales, and the law. As Claims Advocate, you will be exposed to a wide variety of fascinating matters – from medical malpractice lawsuits to federal criminal investigations to ransomware cyber-attacks. You will have the chance to cultivate the skills that lead to success in all areas of business.

Key Responsibilities

In-take and report all claim to carriers, track when acknowledgments are received and when the first contact is made from adjuster to insured

Explain the claims process to insureds in an effective and detailed manner

Facilitate discussions between claims adjusters and insured’s and monitor all claim activity and follow up with all relevant parties ensure a seamless process

Review carrier reserve amounts throughout the claims process to ensure accuracy and update the insured as necessary

Provide regular updates to insured’s corporate entities with full updates regarding claims

Assist Account Managers in gathering claim information as needed for marketing and renewals

Assist in identifying loss trends in reported claims and communicating with the Loss Control and Account Management teams to address them

Maintain and document all claim activity within agency management system (EPIC)

Utilize and facilitate effective communication both internally and externally, including but not limited to clients, claims adjusters, Account Managers, Producers, and the remainder of the Risk Management Team

Be a collaborative and flexible member of the Risk Management Team

Must be able to take initiative and research relevant statutes as applies to claims

Qualifications

Preferred

College Degree OR equivalent work experience

3+ years of Property & Casualty Insurance experience

Applied Epic -Property & Casualty agency management system.

Claims handling experience

Paralegal background/experience

Required

Proficient with computers and standard Microsoft software packages especially Excel

Excellent oral and written communication

Creative problem-solving skills

Superior organizational skills

Exceptional time management and attention to detail

Who We Are:

Worthy Insurance focuses on providing creative insurance solutions to the healthcare, social service, and real estate industries. Taking care of people and their businesses while protecting their livelihoods and assets is at the core of what we do. Worthy empowers our employees to grow with personal and professional development opportunities. We work hard, but we love to have fun!

Worthy employees enjoy:

Generous Paid Time Off (PTO)

401k with company match

Health, Dental, and Vision Insurance

Onsite Gym Membership

Insurance education bonus program

Paid Time Off for Volunteering

This agency is independently owned and operated. Your application will go directly to the agency, and all hiring decisions will be made by the management of this agency. All inquiries about employment at this agency should be made directly to the location, and not to Big I of Illinois Association.

Position Overview

Fetch Pet Insurance, a tech-enabled pet wellness company, has consistently been an innovative leader in the pet insurance industry, offering the most extensive and all-inclusive pet insurance and health advice.

Put simply, Fetch makes vet bills affordable. We offer a comprehensive product that does not have any restrictions based on breed, age, or size. We are believers in helping pets get through their bad days but also focus on extending the good days. How do we do that? – through a wide portfolio of products + offerings, which include Fetch Health Forecast, our pet health and lifestyle blog, The Dig, and our partnerships with Project Street Vet and animal no-kill shelters across North America.

Our business is growing and we are looking for compassionate professionals that want to join a team that works hard and celebrates success! You will have an opportunity to hone your skills and develop new skills as you learn the ins-and-outs of Fetch pet insurance and support our pet parents. Your success is our success!

RESPONSIBILITIES.

• Adjudicate assigned claims in accordance with the Terms & Conditions of the individual pet’s policy
• Review medical records, lab results, invoices, and claims forms for complete and thorough assessment
• Process claims determinations to include assessment and payment for submitted claims
• Verify claims coverage through in-depth knowledge of policy Terms & Conditions
• Consult with treating veterinary practices regarding medical records evaluation and necessary documentation
• Maintain an average quality assurance score above department minimums
• Complete assigned tasks within compliance deadlines
• Maintain an average productivity rate above department minimums
• Provide feedback on process opportunities to further strengthen SOPs

REQUIRED SKILLS.

• Comprehensive understanding of disease processes and veterinary medical terminology
• Ability to read and interpret veterinary medical records and invoices
• Ability to identify chronic and acute medical conditions
• Adapt quickly in a fast-paced, ever-changing environment and operate multiple computer systems simultaneously
• Work independently in a remote capacity, while also fostering teamwork and collaborating with others
• Superior communication skills for collaboration with team members and support from managers
• Demonstrated problem solving skills and ability to work through complex medical/vet-related scenarios affecting a pet’s diagnosis and/or treatment plan

QUALIFICATIONS.

• Minimum of five years experience as a veterinary technician
• Bachelor's degree in veterinary science OR CVT or equivalent preferred
• Property and Casualty Adjuster license in good standing preferred
• Complete and pass state adjuster licensing
• Be reliable with good attendance
• Able to work a minimum of 42 hours per week, with occasional weekends and extra hours as needed

WORK-FROM-HOME SET-UP.

• Subscription to reliable high-speed internet connection (minimum of 100 Mbps download and 30 Mbps upload speed)
• A quiet, dedicated place to work in your home that is not easily disrupted by background noises or distractions
• Office workspace must be large enough to accommodate two 19” dual monitors, laptop, mouse, keyboard, and headset
• Ability to set up and connect (with instructions and remote IT team assistance) equipment that is shipped to your home

—ABOUT FETCH—

Fetch is a high-growth, Warburg-Pincus portfolio company. We are a passionate group of 200+ employees and partners across the U.S. and Canada dedicated to helping pets live their best lives. We have two offices (New York City, NY, and Winnipeg, Canada), and we currently provide security to over 360,000 pet parents.

We don’t just accept differences — we celebrate it, we support it, and we thrive on it for the benefit of our employees, our products, and our community. We are proud to be an equal opportunity employer. We recruit, hire, pay, grow and promote no matter of gender, race, color, sexual orientation, religion, age, protected veteran status, physical and mental abilities, or any other identities protected by law.