1,327 Claims Examiner jobs in the United States

**Finding a job that fits your lifestyle isn't always easy. That's where we come in.**
We're seeking a **Claims Examiner - Workers' Compensation** to support a leading provider of technology-enabled risk, benefits, and integrated business solutions. This fully **remote** opportunity is available to qualified professionals **residing in California** . Sound good? Take a closer look below. We're here to help you find something great that works for you-so you won't miss a moment of what really matters in your life.
**Why you should apply to be a Claims Examiner - Workers' Compensation:**
+ Opportunity to work with a highly regarded Third-Party Administrator (TPA)
+ Fully **remote** position-must reside in **California**
+ Work-life balance with a **Monday-Friday** schedule
+ Competitive **pay rate: $50.00/hr**
+ **Contract assignment:** August 5, 2025 - February 7, 2026
**What's a typical day as a Claims Examiner? You'll be:**
**Essential Duties and Responsibilities**
+ Analyzing and processing complex or litigated **California workers' compensation claims**
+ Investigating claims to determine liability, exposure, and benefits due
+ Assigning and adjusting reserves; authorizing timely claim payments
+ Negotiating settlements within designated authority
+ Preparing state filings and ensuring regulatory compliance
+ Managing litigation and coordinating with attorneys and vendors
+ Identifying subrogation opportunities and managing claim recoveries
+ Communicating effectively with claimants, clients, and medical providers
+ Maintaining accurate claim documentation and professional client relationships
+ Supporting internal quality programs and team collaboration
**This job might be an outstanding fit if you have:**
+ **5+ years of recent experience** handling **California workers' compensation claims**
+ Strong understanding of **CA WC laws, reserve management, and litigation processes**
+ SIP-compliant home setup and ability to pass **credit and background checks**
+ Proficiency with Microsoft Office and industry claims platforms
+ Excellent communication, negotiation, and documentation skills
+ Bachelor's degree or **professional certification** (WCCA, WCCP) preferred
**Work Schedule & Location:**
+ **Schedule:** Monday-Friday, 37.5 hours/week (exact hours set by Hiring Manager)
+ **Location:** **Remote** - Must be located in **California**
+ **Client Site Address (for reference):** 3870 Murphy Canyon Rd, San Diego, CA 92123
**What happens next:**
Once you apply, you'll move to the next steps if your background aligns with the role. Even if this opportunity doesn't work out, you'll stay in our network-giving you access to other opportunities across our platform.
Helping you discover what's next in your career is what we're all about.
**Apply today to be a Claims Examiner - Workers' Compensation!**
As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here ( for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.
Get a complete career fit with Kelly ® .
You're looking to keep your career moving onward and upward, and we're here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career.
About Kelly
Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year.
Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.

Job Description
An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working 1-2 days on site. The training for this role will be conducted on site 5x/week for the first few weeks. This individual will be responsible for the investigation, determination, and reporting of claims processing through auditing billing processes, including pre and post-billing activity. The Examiner will audit, conduct root cause analysis, identify issues and propose solutions to correct and prevent recurrence. They will assist management with implementation of measures to ensure claim processing and payment accuracy. They will also help monitor and review appeals processing of assigned accounts. This individual must have strong analytical skills as they will help run the formulas and find errors to determine the issues within the system, as well as how to best correct the issue.
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form ( . The EEOC "Know Your Rights" Poster is available here ( .
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: .
Skills and Requirements
3+ years of recent medical insurance/healthcare billing experience; including following responsibilities: deductibles, copayments, coinsurance, out of pocket maximums, out of network deductibles and exclusions, with strong understanding of medical terminology.
Previous experience as a medical claims examiner or auditor preferred.
Experience with claim investigation, quality assurance process, ad-hoc audits, claim reviews, claim auditing management, claim process improvement, and claim appeals; knowledge of claim settlement policies, and EOB interpretation.
Experience working with excel
In the job experience of EHR systems and medical insurance claims management softwares
Knowledge of state, federal, and applicable regulations pertaining to EHR and HIPAA.
Expertise with medical billing software or systems, and interacting with third party vendors.
Must have analytical experience (individual will be pulling claims and will go through a lot of manual auditing to find errors, review, edit and submit to billing. null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to

**Duration: 3+ months contract**
**Responsibilities:**
+ Review, adjudicate, and process medical claims for HMO patients
+ Work closely with affiliated medical groups and hospitals
+ Evaluate provider reimbursement terms and flag non-contracted providers
+ Ensure claims are processed accurately and timely per policy guidelines
**Experience:**
2+ years of experience in claims adjudication (HMO, IPA, or hospital environment)
**Skills:**
+ Claims reimbursement knowledge
+ Experience working with DOFR (Division of Financial Responsibility)
+ Hands-on experience processing lab claims
+ Familiar with UB-92 and HCFA-1500 forms
+ Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims
+ Strong knowledge of timeliness, payment accuracy, and compliance standards
+ Basic computer and data entry skills
**Education:**
High school diploma, GED, or higher
**About US Tech Solutions:**
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ( .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
national origin, disability, or status as a protected veteran.

Finding a job that fits your lifestyle isn't always easy. That's where Kelly® comes in. We're seeking a **Workers' Compensation Claims Adjuster** to work with one of our top clients onsite in California. Sound good? Take a closer look below. We're here to help you find something great that works for you-so you won't miss a moment of what really matters in your life.
**Why you should apply to be a Workers' Compensation Claims Adjuster:**
+ Competitive pay rate: **$50/hr**
+ Opportunity to work with a respected industry leader in claims management
+ Chance to handle high-exposure and technically complex cases
+ Build expertise with litigation, subrogation, and rehabilitation claims
+ Work in a collaborative, professional environment with growth potential
**What's a typical day as a Workers' Compensation Claims Adjuster? You'll be:**
+ Analyzing and processing complex or technically difficult workers' compensation claims by investigating, gathering information, and managing cases to timely resolution
+ Negotiating settlements within designated authority
+ Assigning and managing reserves; ensuring adequacy throughout the life of the claim
+ Calculating and approving claim payments and adjustments
+ Preparing state filings within statutory limits
+ Managing litigation processes and coordinating vendor referrals for investigations or legal matters
+ Using cost containment techniques and strategic vendor partnerships to reduce claim costs
+ Overseeing recoveries such as subrogation, Second Injury Fund excess, and Social Security/Medicare offsets
+ Communicating claim activity and status updates to clients and claimants, maintaining strong professional relationships
+ Ensuring claim files are documented accurately with correct coding
**This job might be an outstanding fit if you have:**
+ **3+ years of relevant workers' compensation claims experience**
+ A valid **CA Adjuster License** (required)
+ Strong knowledge of insurance principles, workers' compensation laws, recoveries, offsets, and medical management practices
+ Excellent negotiation, analytical, and organizational skills
+ Strong communication skills (oral and written)
+ Ability to work both independently and in a team environment
+ Proficiency in Microsoft Office and claims management systems
**Additional Details:**
+ **Job Location:** Onsite, California
+ **Schedule:** Full-time, standard business hours
+ **Requirements:** Background credit check required; travel may be necessary
+ Must be able to handle multiple priorities and meet deadlines in a fast-paced environment
**What happens next**
Once you apply, you'll move forward in the process if your skills and experience align. But don't worry-even if this role doesn't work out, you'll stay in our Kelly® network, giving you access to more opportunities.
Helping you discover what's next in your career is what we're all about, so let's get to work. **Apply to be a Workers' Compensation Claims Adjuster with Kelly® today!**
As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here ( for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.
Get a complete career fit with Kelly ® .
You're looking to keep your career moving onward and upward, and we're here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career.
About Kelly
Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year.
Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.

Title: Claims Examiner

State Role Title: Salary Non-Specified

Hiring Range: Minimum starting salary $47,003, commensurate with experience.

Pay Band: UG

Agency: VA Workers' Compensation Comm

Location: RICHMOND HEADQUARTERS

Agency Website:
Recruitment Type: Agency Employee Only - A
This position is open to agency only employees. Candidates must be currently employed by Virginia Workers' Compensation Commission to be considered.
Do you wonder who processes the thousands of claims VVF receives from victims of crime? The Fund has a team of claims examiners who review police reports, medical records, billing statements, and receipts, and determine which expenses are eligible for reimbursement.

This claims examiner position is not for the faint of heart - you must thrive handling a voluminous case load, utilize critical thinking skills, and stay positive when speaking with frustrated callers. On a brighter note, you will feel appreciated and supported by an engaging team, you will enjoy a healthy work life balance in a telework environment, and you will feel a deep sense of pride in your work. If you're still reading and are interested, this may be the perfect opportunity for you!

Job Duties

Virginia Workers' Compensation Commission administers the Virginia Compensating Victims of Crime Act through the Criminal Injuries Compensation Fund also known as the Virginia Victims Fund (VVF). The Criminal Injuries Compensation Fund helps victims of violent crime with out-of-pocket expenses including medical bills, prescriptions, funeral expenses, and many other expenses. While money can never erase the scars and painful memories of a crime, our programs may ease some of the financial burdens faced by victims and their families.

The Criminal Injuries Compensation Fund is seeking a highly qualified, energetic team player to fill one Claims Examiner positions. This position will initiate the claims process, review files for accuracy and completeness, make follow-up requests, as needed, and examine documentation that supports the basis of the claim in order to determine eligibility. This position also examine circumstances of crime to determine eligibility, determine amount of awards, analyze collateral resources, apportion, reduce, or compromise, if necessary, and make claim determinations based upon documentation and information received from claimant and stakeholders. Additional responsibilities include answering inquiries and corresponding with clients and allied professionals via phone or in person; corresponding and collaborating with stakeholders to promote and enhance the claims process; and supporting training and outreach. This position may also help manage VVF's grants. Must past criminal background check as a condition of employment.

VWC Compensation Structure

Virginia Workers' Compensation Commission is an independent agency which allows us to have a more competitive and unique pay structure. This position is a pay grade 5 based on a 14 grade pay structure. Our positions are not classified under DHRM's pay bands.

Telework Structure

Our agency is currently using a hybrid model for teleworking. Our positions at this time are not 100% teleworking. All candidates would be expected to report to our Headquarters/Regional Office as requested. Telework scheduling is at the discretion of the Manager based on the business needs of the department. Upon hire, candidates should expect to have all training and orientation conducted at the Headquarters Office.

Virginia Workers' Compensation Commission Overview

Led by a Senior Leadership team consisting of three Commissioners, an Executive Director and a Chief Deputy Commissioner. Our mission is to serve injured workers, victims of crimes, employers, and related industries by providing exceptional services, resolving disputes, and faithfully executing the duties entrusted to us by the Commonwealth of Virginia. Our vision is to lead the nation as the most effective and innovative state agency. VWC employees demonstrate seven core values: innovation, respect, accountability, reliability, impartiality, integrity, and effectiveness.

We are a "Virginia Values Veterans" (V3) official certified state agency that supports Veterans and Members of the Reserves and/or National Guard. If you are a Veteran or Spouse of a Veteran or Active Military Member, we urge you to respond accordingly on your state application. Virginia Workers' Compensation Commission is an Equal Opportunity Employer and we encourage diversity within our workforce. Virginia Workers' Compensation Commission does not provide sponsorship for employment.

VWC is the recipient of the following awards:

• 2022 - 2025 Top USA Workplace
• 2021 - 2025 Top Workplace Richmond Region
• 2023 - 2025 Top Award for Mid-Sized Companies
• 2022 - 2023 Doers Award
• 2024 Manager's Award
• 2025 Leadership Award, McGill

Minimum Qualifications

• Experience providing high-volume case management in a fast-paced, criminal justice, human services, or related environment
• Experience with claims examination to include billing and payment determination
• Experience interacting with a diverse group of professionals and customers via verbal and written communication
• Experience gathering information and creating and presenting reports
• Working knowledge of victims' issues and the resources available to victims; Virginia's criminal justice system and/or criminal code
• Strong analytical and logical reasoning and administrative research skills and abilities
• Strong work ethic and attention to detail
• Demonstrated ability to exercise good judgment and work within deadlines in a high volume, fast-paced environment
• Demonstrated ability to work both independently and as part of a team
• Ability to travel overnight on occasion
• Proficiency with Microsoft applications including Word, Outlook, Power Point, and Excel; data entry and retrieval from computer databases such as CICF, VEC, and LOPAS; and Internet research principle

Additional Considerations

• Experience with claims examination, case management, victims' compensation, and/or the Code of Virginia sections applicable to CICF
• Working knowledge of the Code of Virginia sections relating to the Criminal Injuries Compensation Fund and medical billing processes and terminology
• Knowledge of federal grant processes to occasionally assist with managing VVF grants.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to "Your Application" in your account to check the status of your application for this position.

Contact Information

Name: Amy Habel

Phone:

Email:

In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at .

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

Job Description

An employer in the Irvine area is seeking a Claims Examiner II. This is a hybrid position, working 1-2 days on site. The training for this role will be conducted on site 5x/week for the first few weeks. This individual will be responsible for the investigation, determination, and reporting of claims processing through auditing billing processes, including pre and post-billing activity. The Examiner will audit, conduct root cause analysis, identify issues and propose solutions to correct and prevent recurrence. They will assist management with implementation of measures to ensure claim processing and payment accuracy. They will also help monitor and review appeals processing of assigned accounts. This individual must have strong analytical skills as they will help run the formulas and find errors to determine the issues within the system, as well as how to best correct the issue.

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form ( . The EEOC "Know Your Rights" Poster is available here ( .

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: .

Skills and Requirements

3+ years of recent medical insurance/healthcare billing experience; including following responsibilities: deductibles, copayments, coinsurance, out of pocket maximums, out of network deductibles and exclusions, with strong understanding of medical terminology.

Previous experience as a medical claims examiner or auditor preferred.

Experience with claim investigation, quality assurance process, ad-hoc audits, claim reviews, claim auditing management, claim process improvement, and claim appeals; knowledge of claim settlement policies, and EOB interpretation.

Experience working with excel

In the job experience of EHR systems and medical insurance claims management softwares

Knowledge of state, federal, and applicable regulations pertaining to EHR and HIPAA.

Expertise with medical billing software or systems, and interacting with third party vendors.

Must have analytical experience (individual will be pulling claims and will go through a lot of manual auditing to find errors, review, edit and submit to billing. null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to

THIS ROLE IS FOR:
1571 Sawgrass Parkway, Sunrise FL

The Role is 100% ON SITE

Position Summary:

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.

Responsibilities:

• Provides voice to voice contact within 24 hours of first report.
• Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
• Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
• Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
• Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals.
• Utilizes evaluation documentation tools in accordance with department guidelines.
• Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
• Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
• Maintains and document claim file activities in accordance with established procedures.
• Attends depositions and mediations and all other legal proceedings, as needed.
• Protects organization's value by keeping information confidential.
• Maintains compliance with Claim Department's Best Practices.
• Provides quality customer service and ensures file quality
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
• Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
• Participates in special projects as assigned.
• Some overnight travel maybe required.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.

Qualifications:

• Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
• 620 Licensure required.
• One to three years of experience processing claims; property and casualty segment preferred.
• Experience with Xactware products preferred.
• Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
• Proficiency with Microsoft Office products required; internet research tools preferred.
• Demonstrated customer service focus / superior customer service skills.
• Excellent communication skills and ability to interact on a professional level with internal and external personnel
• Results driven with strong problem solving and analytical skills.
• Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
• Detail-oriented and exceptionally organized
• Collaborative partner; ability to contribute to a positive work environment.

General Information:

All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.

Claims Examiner

Position Summary:

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.

Responsibilities:

• Provides voice to voice contact within 24 hours of first report.
• Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
• Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
• Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
• Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals.
• Utilizes evaluation documentation tools in accordance with department guidelines.
• Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
• Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
• Maintains and document claim file activities in accordance with established procedures.
• Attends depositions and mediations and all other legal proceedings, as needed.
• Protects organization's value by keeping information confidential.
• Maintains compliance with Claim Department's Best Practices.
• Provides quality customer service and ensures file quality
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
• Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
• Participates in special projects as assigned.
• Some overnight travel maybe required.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.

Qualifications:

• Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
• Adjuster Licensure required.
• One to three years of experience processing claims; property and casualty segment preferred.
• Experience with Xactware products preferred.
• Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
• Proficiency with Microsoft Office products required; internet research tools preferred.
• Demonstrated customer service focus / superior customer service skills.
• Excellent communication skills and ability to interact on a professional level with internal and external personnel
• Results driven with strong problem solving and analytical skills.
• Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
• Detail-oriented and exceptionally organized
• Collaborative partner; ability to contribute to a positive work environment.

General Information:

All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.