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• Examining, processing, calculatingand adjudicatingclaims in compliance to plan documentation
• Processing any open audits daily
• Following daily direction to process high dollar claims and other priorities/issues listed on the daily reports that are distributed twice each day (morning and afternoon)
• Maintaining customer service logs within a 5 day turnaround time
• Maintaining HR logs within a 2 day turnaround time
• Complying with state laws, policy, company procedures, and plan documentation
• Entering codes, and verifying data for computer processing
• Meeting or exceeding daily claim production goals.
• Providingservice to claimants, providers, and clients with problems or questions regarding their claims and/or policies via telephone or correspondence.
• Maintaining customer service logs and HR logs as stated above, plus meeting or exceeding customer service quality standards
• Completingspecial projects as assigned

• Ability to interpret and apply provisions of the manuals, SPDs, medical terminology and insurance claims preferred.
• Excellent verbal and written communication skills.
• Knowledge of Microsoft Office products and COREclaims system preferred.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of instructions.
• Courteous telephone communication skills to provide backup customer service to clientele when needed.

• Generous Paid Time Off & paid Holidays
• Work/Life Balance
• Medical, Dental, and Vision
• Healthcare spending or reimbursement accounts such as HSA or FSA
• Employer paid Core Benefits - Life Insurance, Short & Long Term Disability, EAP
• 401k with Company match
• Many Company sponsored employee events
• Career advancement possible

Join to apply for the Claims Adjuster role at Aspire General Insurance

Join to apply for the Claims Adjuster role at Aspire General Insurance

Description

Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service.

Description

Aspire General Insurance Company and its affiliated general agent, Aspire General Insurance Services, are on a mission to deliver affordable specialty auto coverage to drivers without compromising outstanding service.

Our company values can best be described with ABLE : to always do the right thing, be yourself, learn and evolve, and execute. Join our team where every individual takes pride in driving their role for shared success.

What You'll Do

Under the close supervision of the Training Supervisor, the Claims Adjuster Trainee performs essential functions to develop the skills and knowledge required to investigate, evaluate, and resolve automobile claims. This entry-level position involves comprehensive training in a classroom setting and practical, on-the-job experience to ensure proficiency in all aspects of claims adjudication.

Responsibilities

• Successfully complete all assigned claims training programs in a classroom setting
• Engage actively in learning sessions, demonstrating a clear understanding of the material covered.
• Investigate automobile claims thoroughly to gather relevant information;
• Evaluate claims to determine their validity and potential payout based on policy terms and conditions.
• Resolve automobile claims efficiently and in a timely manner, ensuring customer satisfaction
• Ensure ongoing adjudication of claims within company standards, industry best practices and all state and federal regulations;
• Stay updated on changes in regulations and company policies
• Document all investigations, evaluations, recommendations, and action plans accurately
• Maintain detailed and organized records in the claims management system
• Produce grammatically correct and clearly written correspondence including letters, memos, reports and claim file documentation;
• Communicate effectively with claimants, policyholders, and other stakeholders through written and verbal means
• Regular and predictable punctuality and attendance;
• Perform other duties as necessary to support the claims department and organizational goals
  
  

• A 4 year college degree or at least 1 year industry experience;
• Must have strong communication skills;
• Must have strong written communication skills;
• Must be able to multi-task;
• Must be able to pass a background check;
• Must have a disciplined approach to all job-related activities;
• Must have a solid foundation of personal organization, sound decision making and analytical skills, strong interpersonal and customer service skills;
• Ability to work in a fast paced environment while managing multiple priorities simultaneously;
• Ability to achieve targeted performance goals.
• Ability to develop excellent working relationships with staff, clients, Partners and outside agencies;
• Ability to communicate with others in an effective and friendly manner, one that is conducive to being a conscientious team member, fostering a spirit of good will, indicative of a professional environment and atmosphere;
• Ability to be a team player and work cohesively with other Company Partners and Companies staff to achieve company goals;
• Able to represent the company in a professional manner and contribute to the corporate image;
• Able to consistently provide excellent client service.
  
  

• This is a non-exempt position which complies with alternative work schedule when applicable;
• This position may require mandatory overtime as deemed appropriate by management;
• The office is that of a highly technical company supporting a paperless environment;
• Travel may be required;
• This work environment is fast-paced and accuracy is essential to successful task completion;
• Travel may be required;
• Requires extended periods of computer use and sitting
  
  

• dependent on plan(s) selected

• Seniority level Internship

• Employment type Full-time

• Job function Finance and Sales
• Industries Insurance

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• Verify information set-up on claims, to determine if the customer's complaint, the diagnosis, the failed parts are documented and justified the approved repair.
• Verify repair costs are performed within industry standards.
• Verify repair information to determine if coverage was within the limits of the service contract.
• Interface with customers, agents, dealers to complete all investigations of claims.
• Complete a fair settlement of the claim.
• Contribute to team effort by accomplishing related results as needed.
• Verify claims are processed following the policy and procedure established by Smart Autocare

• Proven work experience as a team leader or supervisor
• 1 to 2 years of Claims processing experience
• 2-3 years leadership experience
• Spanish fluency/Bilingual a plus
• Current or previous ASE Certification preferred.
• Minimum 3 years of hands-on automotive repair and diagnosis experience.
• Parts and Labor Guide familiarity.
• Intermediate knowledge of Windows-based computer programs.
• Exceptional customer service and communication skills.
• Ability to read, analyze and interpret general business correspondence or technical procedures.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists

• 401(k) matching
• Company parties
• Competitive salary
• Dental insurance
• Free food & snacks
• Health insurance
• Opportunity for advancement
• Paid time off
• Vision insurance

• 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 insureds 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 insureds 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

• 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

• 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

• 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

Walnut Creek, California

Claims Adjusting Northern CA / Non-Exempt / Hybrid

Are you searching for a unique opportunity that offers exceptional training and career growth with a dynamic and growing organization? Are you a Spanish speaker looking to apply those skills in a professional environment? Berkshire Hathaway Homestate Companies is searching for bright individuals looking to begin a challenging, yet rewarding career path as a Workers' Compensation Claims Adjuster.

Upon successful completion of the Claims Training program, the Claims Adjuster Trainee will be responsible for management of a caseload of workers compensation claims from inception to resolution. Responsibilities include initial investigation and analysis, strategic planning, management of medical care and legal process, and client relations. This individual will continue to build on claims knowledge and claims will increase in number and complexity.

• Completes classroom training introducing workers' compensation claims handling strategies, medical terminology, and legal concepts.
• Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
• Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
• Reduces fraud through early identification and escalation.
• Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

• Minimum of High School Diploma or equivalent certificate required; Bachelor's degree from four-year college or university is preferred
• Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred
• Exceptional interpersonal and customer service skills
• Ability to manage and prioritize multiple assignments in a fast-paced environment
• Strong organization skills to ensure tasks are completed within hard deadlines
• Basic mathematical skills to calculate monetary reserves
• Knowledge of Microsoft Word, Powerpoint, Excel, Outlook

• Unparalleled financial strength and stability
• Fantastic growth and advancement opportunities
• WFH Hybrid schedule
• Free gym in building
• Generous Paid Time Off and Holidays
• Excellent Benefits (Medical, Dental, Vision, 401k, etc)
• Health and Wellness Reimbursement
• Tuition Assistance Reimbursement
• Discounts across companies such as GEICO, See's Candies, etc.

In accordance with the California Equal Pay Act, the starting hourly wage for this job is $ . This hourly wage is what the employer reasonably expects to pay for the position based on potential employee qualifications, operational needs and other considerations consistent with applicable law. The pay scale applies only to this position and only if it is filled in California. The pay scale may be different for other positions or in other locations.

We are looking for an experienced and meticulous Claims Adjuster to assist with our client with handling New York based Workers Compensation Claims. This is a fully remote, temporary-to-permanent opportunity. To be considered, candidates must possess a valid NY Adjusters License and have experience working with workers compensation specific claims.

Responsibilities include:

• Conduct in-depth investigations and evaluations of complex workers' compensation claims, applying strong analytical skills to drive informed decision-making and achieve timely resolution.
• Collaborate closely with clients to develop innovative strategies and continuously improve the claims management process.
• Utilize critical thinking and problem-solving abilities to effectively plan, prioritize, and manage tasks that support both client and claimant needs.
• Leverage claims management expertise to assess exposure, determine appropriate action plans, and drive timely and effective claim resolutions.
• Maintain thorough and timely documentation of all claim activities, ensuring transparency and supporting claim outcomes.

Requirements:

• New York Adjusters License is required.
• Conduct in-depth investigations and evaluations of complex workers' compensation claims, applying strong analytical skills to drive informed decision-making and achieve timely resolution.
• Collaborate closely with clients to develop innovative strategies and continuously improve the claims management process.
• Utilize critical thinking and problem-solving abilities to effectively plan, prioritize, and manage tasks that support both client and claimant needs.
• Leverage claims management expertise to assess exposure, determine appropriate action plans, and drive timely and effective claim resolutions.
• Maintain thorough and timely documentation of all claim activities, ensuring transparency and supporting claim outcomes.

The salary range for this position is $30.00 to $45.00. Benefits available to contract/temporary professionals include medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan.

Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Network Adjusters is seekingskilled insurance claims adjusters with experience in General Liability and/or Construction Defect for a third-party liability Construction Defect Claims Adjuster position.

Become a part of a dynamic, energetic workforce in which you can make a difference. We are committed to encouraging your professional growth through a variety of training and development opportunities.

CONSTRUCTION DEFECT ADJUSTER JOB DESCRIPTION:

Handle 3rd party Construction Property Damage & Liability Insurance claims with varying degrees of complexity and severity in construction development and subcontractor programs.

CONSTRUCTION DEFECT ADJUSTER RESPONSIBILITES:

Knowledge of General Liability and Construction Defect claims.

Provide superior customer service to meet the needs of the insured, claimant, all internal and external customers, including carrier clients.

Fulfill specific client requirements including reporting of claim details and analysis.

Review and analyze coverage and apply policy conditions, provisions, exclusions and endorsements.

Recognize and apply jurisdictional issues that impact the claim (i.e.: negligence laws, financial responsibility limits, immunity, etc.)

Investigate facts to determine liability, other sources of recovery as appropriate by contacting and interviewing appropriate parties.

Manage 3rd party property damages, bodily injury and other claims requiring specialized investigation and utilization of external experts in accordance with local laws.

Effectively manage litigated claims & assigned defense or coverage counsel.

Establish and maintain appropriate claim and expense reserves in a timely fashion.

Develop and continually update a plan of action for file resolution including maintaining an effective diary.

Document claim file activities in accordance with established procedures.

Write denial letters, reservation of rights, tenders and other routine and complex correspondence to insureds and claimants.

Confer with higher level technical claim personnel for guidance and direction to ensure files are handled properly.

Determine settlement amounts based on independent judgment, application of applicable limits and deductibles.

Negotiate settlements within authority limits.

Identify subrogation opportunities.

Meet all quality standards and expectations based on Best Practices.

Assure compliance with state specific regulations.

Effectively manage multiple competing priorities to ensure timely payment, follow-up and claim resolution.

CONSTRUCTION DEFECT ADJUSTER QUALIFICATIONS:

2-5 years of experience in claims handling (preferably 3rd party - general liability).

College/Technical degree or equivalent business experience.

Obtain Adjusters licenses as required to meet business need.

Complete continuing education to maintain licenses.

Strong verbal and written communication skills.

General software skills including MS Word, Outlook and Excel.

Customer service and empathy skills.

Solid analytical and decision-making skills in order to evaluate claims and make sound decisions.

Excellent negotiation skills and ability to effectively handle conflict.

Strong organization and time management skills.

Ability to multi-task and adapt to a changing environment.

Attention to detail, ensuring accuracy.

Strong investigative skills and creativity to achieve optimal results.

Ability to maintain confidentiality.

We are proud to provide comprehensive, high quality employee programs to meet employees' needs now and in the future, including a competitive financial package. Explore what we have to offer.

CONSTRUCTION DEFECT ADJUSTER BENEFITS:

Training/Development and growth opportunities

401(k) with company match / Retirement planning

Paid time off / Company paid holidays

Comprehensive health plans including dental and vision coverage

Flex spending account

Company paid life insurance

Company paid long term disability

Supplemental life insurance

Opportunity to buy into short term disability

Strong work/family and employee assistance programs

About Network Adjusters, Inc.

Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All of our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable resultsthe proof is in our extensive track record of settled claims and unmatched recovery abilities.

Our available roles are located in Farmingdale, NY, Denver, Co., and Covington KY, however, if you meet expected criteria there is opportunity for experienced candidates to work remotely.

The starting salary for this position is $75,000 - $100,000; factors such as licensing, certifications, work, and relative experience will be taken into consideration.

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.