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Actuarial Analyst CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Actuarial Analyst and help shape the future of healthcare where you'll be an integral part of our Financial Analysis team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 The Actuarial Analyst will provide analytical and actuarial support to more senior team members for the month-end Incurred But Not Reported (IBNR) reserve, semi-annual Chronic Illness and Disability Payment System (CDPS) risk score and annual rate development template. You will also support the Manager Actuary and other departments throughout CalOptima Health and may participate in ad-hoc projects. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists in preparing, analyzing and reporting the monthly IBNR reserve estimate.</li>
<li>Assists in preparing and analyzing the semi-annual CDPS risk score and reporting the financial impact for the risk score adjusted capitation rate.</li>
<li>Reconciles the monthly paid claim between Facets reports and the data warehouse.</li>
<li>Reconciles and analyzes the weekly pharmacy invoices with the data warehouse.</li>
<li>Assists in preparing standard reports related to claims data and/or reserve estimation for internal and external auditors. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in actuarial science, mathematics, finance, economics, business administration or related field PLUS 1 year of experience with spreadsheets and databases required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in actuarial science, mathematics, finance, economics, business administration or related field. </li>
<li>Minimum of 1 actuarial exam with a passing score. </li>
<li>Actuarial experience or equivalent. </li>
<li>Experience with managed health care programs and financial modeling.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
</ul>
 *This position will be from 7:30 am to 4:00 pm daily, with in-office attendance required three (3) days a week on Tuesdays, Wednesdays, and Thursdays. **The first week of every month the position will be in the office Monday - Friday from 7:30 am to 4:00 pm daily. 
<ul>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6856022&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is January 27, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6856022" target="_blank">https://jobs.caloptima.org/jobs/actuarial-analyst-505-city-parkway-west-california-united-states-418e20e6-bd07-4ee7-a698-193cf111cc74</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-da28fcda5590e247a59a2cc227a41cbc

Actuarial Analyst

MONTSHIRE MUSEUM OF SCIENCE
POSITION DESCRIPTION - Director of Finance
&nbsp;
DEPARTMENT:&nbsp;Administration
SUPERVISOR:&nbsp;Executive Director
&nbsp;
OVERVIEW&nbsp;
The Montshire Museum of Science (Norwich, VT) seeks a broadly experienced individual with strong nonprofit finance experience to serve as Director of Finance. This position serves as a member of the Montshire’s senior management team and as an advisor to the Executive Director in the areas of strategic financial planning, internal controls, compliance, and safeguarding of museum assets. This position is responsible for general, grants and capital accounting, budgeting, financial reporting, audit preparation, risk management, investment tracking and reporting, administration of employee benefit plans, and coordination of select HR processes.&nbsp;
&nbsp;
RESPONSIBILITIES&nbsp;
Primary responsibilities include maintenance of general ledger and accounts; effective coordination of billing, fund allocation and annual audit; budget and reporting; payroll; accounts; insurance and deposits. This position also oversees payroll processing and staff enrollment into health, retirement and other benefits plans; coordinates insurance processing, workers’ compensation, disability and other insurance claims; and assists with general HR processes.&nbsp;
Specific responsibilities include:&nbsp;
Strategic Financial Planning – In collaboration with the Executive Director, develops and executes long-term financial strategies to ensure the Museum’s profitability and sustainability.&nbsp;
General Accounting and Finance Operations – Maintains general ledger and accounts. Monitors operational cash flow. Ensures timely deposits into accounts. Prepares invoices for payment. Oversees billing. Processes and monitors credit card activities. Reconciles, and creates invoices and reports for active grants. Oversees and reconciles museum accounts. Ensures timely and accurate use of restricted funds, including grants and endowment funds.&nbsp;
Budgeting and Financial Forecasting – Oversees development of the Museum’s annual operating, project and capital budgets. Assists with grant budget creation. Produces financial forecasts for operations and capital needs. Updates five-year capital investment plan. Tracks income and expenses for museum operations, grant-funded and capital projects.&nbsp;
Financial Reporting – Generates monthly, quarterly and annual reports on revenue, expenses, and overall financial performance for key stakeholders.&nbsp;
Grants – Maintains SAM and grants.gov registrations. Completes contracting, insurance and certifications for new awards. Performs quarterly invoicing for active grants. Creates quarterly, annual and final financial reports for federal, state and foundation grants.&nbsp;
Audit Coordination and Support – Prepares required materials and oversees annual audit. Serves as liaison with external auditor. Facilitates annual tax return filing.&nbsp;
Payroll&nbsp;– Oversees smooth operation of payroll processing, taxes, retirement contributions, and accounting of staff time and attendance. Reconciles staff time and attendance data with grant time tracking.&nbsp;
Administration of Employee Benefits and General HR-&nbsp;
<ul>
<li>Ensures new hire employment eligibility. Coordinates new hire background checks.&nbsp;</li>
<li>Oversees new hire and annual enrollments into health, retirement and other benefits.&nbsp;</li>
<li>Maintains personnel records.&nbsp;</li>
<li>Assists with insurance processing, including workers compensation, disability and other insurance claims.&nbsp;</li>
<li>Ensures 403(b) compliance and annual Form 5500 filing.&nbsp;</li>
<li>Assists with employment termination and offboarding, as needed&nbsp;</li>
</ul>
Risk Management – Identifies and manages financial risks associated with business operations and investments. Serve as liaison with insurance agencies and carriers for policy updates and claim processing.&nbsp;
Investment Oversight – Monitors and reports on investment performance to Investment Committee of the Board of Trustees. Executes transactions and transfers between investment, endowment and operations accounts.&nbsp;
Staff Liaison – Serves as staff liaison to Finance and Investment Committees of the Montshire Board of Trustees. Prepares quarterly board finance and investment reports. Attends select committee and board meetings.&nbsp;
Staff Supervision and Departmental Management - Hiring, training, and overseeing staff in the finance office. Coordinates administration of internships and work study programs.&nbsp;
&nbsp;
SUPERVISION OF OTHERS&nbsp;
Supervises Finance and Grants Assistant.&nbsp;
&nbsp;
EXPERIENCE, KNOWLEDGE &amp; SKILLS REQUIREMENTS&nbsp;
Collaborative team player with a passion for the mission of the Montshire Museum of Science&nbsp;
Four-year college degree in finance, accounting or business administration; advanced degree (MBA) and/or certification (CPA) preferred&nbsp;
Minimum of 5-7 years of experience in senior-level nonprofit finance / accounting of mid-sized organization required (minimum $2M annual budget) with strong understanding of cost control principles and GAAP, and demonstrated experience negotiating contracts, tracking investment, and creating financial reports&nbsp;
Minimum 3 years of employee benefits administration experience (including health, retirement, STD/LTD, flex accounts, FMLA, workers compensation)&nbsp;
Minimum 3 years supervisory experience of finance office and bookkeeping and/or accounting staff&nbsp;
Able to analyze and interpret financial data and prepare clear, concise, accurate, and timely financial reports, statements and projections&nbsp;
Strong computer skills, particularly:&nbsp;
<ul>
<li>Microsoft Office (Word, PowerPoint, and Excel - including formatting, formulas and calculated fields)&nbsp;</li>
<li>Google Workspace (Gmail, Google Drive, Docs, Sheets, Calendar)&nbsp;</li>
<li>CRM/ relational databases (FileMaker or similar)&nbsp;</li>
<li>Accounting databases (QuickBooks online or similar)&nbsp;</li>
<li>Payroll platforms (Paychex or similar)&nbsp;</li>
<li>Grant portals (federal, state, private foundations)&nbsp;</li>
<li>Electronic fund transfer platforms&nbsp;</li>
</ul>
Detail-oriented and adept at developing and modernizing systems for organizing work, time and physical workspace&nbsp;
Proactive, appropriate and articulate in both written and oral communication&nbsp;
Highly ethical and mature in dealing with others, and able to handle confidential information appropriately&nbsp;
Embraces a growth mindset with a strong desire to learn new things and expand abilities&nbsp;
Able to work collaboratively as part of a team, as well as independently&nbsp;
Able to work, prioritize and focus amid frequent interruptions&nbsp;
Flexible thinking and ability to adjust expectations as needed&nbsp;
Clean driving record with reliable transportation&nbsp;
&nbsp;
WORKING CONDITIONS&nbsp;
In-person position, in congenial, fast-paced non-profit office environment&nbsp;
Must work well in both individual and team settings&nbsp;
Long periods of sitting at a desk and working on a computer&nbsp;
Frequent use of private vehicle required for bank runs and other museum business&nbsp;
All Montshire employees must provide proof of COVID-19 vaccination&nbsp;
All Montshire employees are subject to a criminal background check&nbsp;
&nbsp;
TIME COMMITMENT&nbsp;
Full-time, exempt position (37.5 hours/week)&nbsp;
General work schedule is Monday to Friday 8:00 – 4:00 pm, with occasional after-hours work required to attend and prepare for meetings, staff museum-wide events, and ensure smooth annual budget and audit preparation.&nbsp;
&nbsp;
SALARY AND BENEFITS&nbsp;
Salary: $96,000 - $105,000 annually depending on education, experience, skills, and certifications. Full Montshire benefits, including health insurance, 403(b) retirement savings, generous paid personal time and sick leave, life insurance, and short- and long-term disability insurance.&nbsp;
&nbsp;
The Montshire Museum of Science is an Equal Opportunity Employer.
&nbsp;
TO APPLY:
Please provide the following in your application:&nbsp;
<ul>
<li>1-page cover letter&nbsp;</li>
<li>Resume&nbsp;</li>
<li>Bulleted list of how your experience and skills apply to the position (no more than 2 pages)&nbsp;</li>
<li>3 references with emails and phone numbers&nbsp;</li>
<li>Copies of relevant certifications&nbsp;</li>
</ul>
Please email your application as a single document (PDF or Word) to <a href="mailto:jobs@montshire.org" target="_blank">jobs@montshire.org</a> by February 14, 2026

Montshire Museum of Science

Director of Finance

<h3>Job Description</h3>
Job Description
Job Posting: Claims Adjuster – Remote
Join our team to support a leading pet insurance organization as a Claims Adjuster. This is a fully remote role offering the opportunity to help pet parents by efficiently managing, adjudicating, and finalizing insurance claims. We are looking for detail-oriented individuals who value accuracy, organization, and clear communication.
 
Key Responsibilities:
<ul>
<li>Adjudicate insurance claims in a timely and compliant manner, adhering to standard operating procedures.</li>
<li>Consistently meet or exceed daily claims targets.</li>
<li>Provide guidance, oversight, and final approval authority to non-licensed claims processors (GenPact, AdStrat, or Healthy Paws).</li>
<li>Maintain active adjuster licenses as required by state and municipal regulations.</li>
<li>Identify and recommend process improvements to enhance the claims workflow.</li>
<li>Ensure all claims are processed according to compliance and quality standards.</li>
</ul>
 
Required Skills:
<ul>
<li>Active Property &amp; Casualty Adjuster License, or the experience and aspiration to obtain licensing within six months.</li>
<li>Experience in claims review and adjudication.</li>
<li>Ability to clearly communicate with pet owners in writing and over the phone.</li>
<li>Strong decision-making and problem-solving abilities.</li>
<li>Excellent organizational and time management skills.</li>
<li>Confidence with basic IT tasks in a remote environment: attaching files to emails, editing documents, screensharing, and escalating technical issues as needed.</li>
<li>Experience with Microsoft Outlook, Word, Access, PowerPoint (primarily using existing slides).</li>
<li>Familiarity with ERP or CRM systems is a plus.</li>
</ul>
Preferred Education &amp; Experience:
<ul>
<li>High school diploma or equivalent work background.</li>
<li>Two years of experience in customer service or a call center environment.</li>
<li>Veterinary knowledge or experience evaluating medical records is a plus.</li>
</ul>

Claims Adjuster

<h3>Job Description</h3>
Job Description
Job Description
Insight Global is seeking an insurance Claims Adjuster I with multiple years of property and casualty claims experience to join our client's team in Snellville, GA. Our client is a regional insurance agency specializing in insurance and lending services for financial institutions. For 50 years, our client has delivered innovative risk management solutions with exceptional customer service. The Claims Adjuster I supports operations for the Creditor Placed Insurance (CPI) department. The ideal candidate will be resourceful, flexible, and able to maintain quality performance in a fast-paced office environment. This is an exciting opportunity for the right individual to join an energetic and seasoned team, with an established and expanding agency.
 
The essential functions of the Claims Adjuster I are listed below but are not limited to:
• Set up new claims, requesting necessary documentation from lenders and insureds
• Assign claims to adjusters and recovery specialists
• Adjudicate designated claims
• Prepare claim documentation for settlement
• Prepare claim payments for approval
• Record claim payment details in proprietary software
• Provide ongoing customer service via telephone and e-mail in a prompt, professional manner
• Maintain organized policy files and records
• Perform additional administrative duties as assigned
 
This is a permanent position with a salary of $60,000-$70,000 per year.
 
Required Skills &amp; Experience
• High school diploma or equivalent
• 5+ years of experience in property and casualty insurance claims adjudication
• Previous experience in an office setting
• Demonstrates intermediate skills with Microsoft Excel, Word and Outlook
• Typing speed of 45-50 wpm with accuracy
 
Nice to Have Skills &amp; Experience
• Associate Degree
• Three or more years’ experience in an insurance or financial institution environment
• Insurance claims adjuster’s license in Georgia and other states

<h3>Job Description</h3>
Job DescriptionDescription:
POSITION SUMMARY: The Claims Adjuster is responsible for managing workers compensation claims and assisting the process of determining benefits due the injured worker, ensure ongoing adjudication of claims within company standards and industry best practices and comply with all statutory and regulatory requirements for the administration of workers compensation benefits on behalf of the Company.
 
KEY RESPONSIBILITIES AND ESSENTIAL FUNCTIONS:
<ul>
<li>New Claims: All new lost time claims require an initial contact with the employer, the injured worker and the medical provider. This must be done within 24 hours of receipt of the claim or notification of a claim. </li>
<li>Ensure that all claim determinations and payments are completed timely including but not limited to, acceptance/denial letters, wage determination letters including required enclosures and appeal forms. In jurisdictions requiring the letters be provided in Spanish and English the adjuster is responsible to make sure all letters are completed.</li>
<li>The initial payment of TTD is to be completed within 14 days from the receipt of an accepted claim. Wage information is to be solicited from the employer and either an average weekly wage or average monthly (jurisdiction dependent) be established. In the event actual payroll documentation cannot be obtained from the employer an “estimated wage” is established and a payment reconciliation is done when the verified wage is secured. Initial compensation benefits should NOT be delayed due to the failure of the employer to provide wage documentation.</li>
<li>Timely claims determinations for all services including but not limited to: acceptance, denials, authorizations for treatment, benefit payment start, termination are to be included within the statutory or regulatory time frames of the jurisdiction. Denials requiring certified mailing are to be completed timely with appropriate tracking.</li>
<li>Regulatory notices are to be completed timely when required by jurisdictions.</li>
<li>Approvals and denials of medical bills should be completed within 24 hours of receipt so bills can be repriced and paid timely.</li>
<li>Identify the medical providers and medical treatment plan and ensure timely and appropriate medical care is provided to the injured worker. In cases requiring complex or unusual medical care a nurse case manager is to be assigned to facilitate the timely and appropriate care.</li>
<li>All communications with all parties and reference to all determinations and correspondence are to be included in the claim notes. Each office is “paperless” offices, and all documents need to be scanned and added to the claim claims system and a claim note generated. </li>
<li>Manage the legal aspects of the claim and appropriately assign and direct designated attorneys. </li>
<li>Assign claims for investigations, including surveillance, medical surveys and social media checks when required and seek supervisor support on related questions.</li>
<li>Ensure that all bills for various expenses, including legal bills, managed care bills and similar expenses are paid timely or direct claims assistants to pay such when appropriate.</li>
<li>Answer phone calls immediately when in the office. Return all calls and voice mail messages within 24 hrs. Respond to all e-mails when required within 24 hrs.</li>
<li>Direct claims assistants to facilitate adjuster assignments as required. This includes directing clerical staff in duties such as copying documents, scheduling medical appointments for injured workers and filing of documents. Coordinate assignments with the supervisor of the assistants.</li>
<li>Monitor claims for reinsurance/excess insurance reporting and provide initial reports and quarterly updates on all claims meeting reporting requirements.</li>
<li>Performs other activities, assignments and duties as assigned.</li>
</ul>
Requirements:
QUALIFICATIONS:
<ul>
<li>High school diploma or GED required</li>
<li>Bachelor’s degree or equivalent experience preferred</li>
<li>2-3 years’ claims experience preferred</li>
<li>Insurance industry knowledge preferred</li>
<li>Excellent analytical skills and verbal and written communication skills</li>
<li>Strong organizational skills</li>
<li>Strong oral and written communication skills</li>
</ul>

<h3>Job Description</h3>
Job DescriptionJob Title: Claims AdjusterLocation: USAHire Type: ContingentPay Range: $35.00/hourWork Type: Full-timeWork Model: OnsiteWork Schedule: Monday – Friday, 8:30am – 4:30pm Recruiter Contact: Sean Craft, <a href="mailto:sean@marykraft.com" target="_blank">sean@marykraft.com</a>Nature &amp; Scope:Positional OverviewWe are seeking an experienced Workers’ Compensation Claims Adjuster to manage mid- to high-level lost-time workers’ compensation claims. This role is responsible for determining compensability and benefits due, managing reserves, coordinating return-to-work efforts, identifying subrogation opportunities, and negotiating settlements. The ideal candidate will have proven experience handling Pennsylvania and New Jersey lost-time claims and will ensure claims are adjudicated in compliance with company standards, state regulations, and industry best practices.Role &amp; Responsibility:Tasks That Will Lead to Your Success
<ul>
<li>Manage end-to-end handling of mid- and higher-level workers’ compensation lost-time claims, including investigation, compensability determination, and ongoing claim administration.</li>
<li>Develop and execute claim-specific action plans to drive timely and appropriate resolutions.</li>
<li>Monitor and maintain reserve adequacy throughout the life of the claim.</li>
<li>Approve and issue indemnity and medical payments in accordance with statutory and contractual requirements.</li>
<li>Prepare and submit required documentation and filings with applicable state agencies.</li>
<li>Ensure claim files are thoroughly documented and claims coding is accurate.</li>
<li>Apply in-depth knowledge of Pennsylvania and New Jersey workers’ compensation statutes, regulations, and case law.</li>
<li>Prepare and file state-specific forms, including PA LIBC forms and NJ WC filings.</li>
<li>Manage EDI submissions and resolve filing errors as needed.</li>
<li>Accurately calculate Average Weekly Wage (AWW) and Temporary Total Disability (TTD) benefits.</li>
<li>Apply jurisdiction-specific rules, including PA’s 7-day waiting period and NJ’s 7-day retroactive provisions.</li>
<li>Coordinate medical treatment plans, utilization review, and compliance with state medical fee schedules.</li>
<li>Apply NJ authorized provider rules and PA panel provider requirements.</li>
<li>Manage litigated claims by working closely with defense counsel, attending hearings, and preparing testimony as needed.</li>
<li>Demonstrate knowledge of PA’s Supersedeas process and NJ’s informal and formal hearing procedures.</li>
<li>Handle complex lifetime medical and defined-period medical claims, including physician and state filings.</li>
<li>Collaborate with employers to develop modified duty programs and facilitate early return-to-work.</li>
<li>Identify and manage subrogation opportunities.</li>
<li>Negotiate lump-sum settlements, including Compromise &amp; Release (PA) and Section 32 agreements (NJ).</li>
<li>Prepare settlement evaluations and manage Medicare compliance requirements when applicable.</li>
<li>Maintain regular communication with injured workers, employers, medical providers, and attorneys.</li>
<li>Provide superior customer service and professional phone etiquette.</li>
<li>Clearly and timely document all claim activities and correspondence.</li>
</ul>
Skills &amp; ExperienceQualifications That Will Help You Thrive
<ul>
<li>Minimum five (5) years of direct experience managing lost-time workers’ compensation claims in both Pennsylvania and New Jersey required.</li>
<li>Experience handling additional jurisdictions is a plus.</li>
<li>Workers’ compensation adjuster licenses preferred but not required.</li>
<li>Strong technical expertise in lost-time indemnity claim management.</li>
<li>Excellent analytical, organizational, and negotiation skills.</li>
<li>Strong written and verbal communication abilities.</li>
<li>Ability to manage a high-volume caseload independently in a remote environment.</li>
<li>Proficient in claims management systems, EDI processing, and Microsoft Office.</li>
</ul>

<h3>Job Description</h3>
Job DescriptionBenefits/Perks:
<ul>
<li>Competitive Pay</li>
<li>Professional Development</li>
<li>Job Stability in a Growing Industry</li>
</ul>
Job Summary:PLS Claims is seeking an experienced Senior Property Field Adjuster with five (5) or more years of property field adjusting experience to support our growing New Jersey operations. This is a permanent position offering a strong long-term growth opportunity for the right professional&nbsp; The ideal candidate is highly organized with strong analytical and writing skills. About PLS Claims Founded in 1997, PLS Claims is an Independent Adjusting and Third-Party/Delegated Claims Administration firm headquartered in Georgia. We proudly represent a diverse client base that includes domestic insurance carriers, select Underwriters at Lloyd’s, self-insured entities, and other third-party administrators. We are committed to fostering a collaborative, positive, and professional work environment where team members are supported, mentored, and held accountable, allowing every team member to grow and succeed.&nbsp; We offer a competitive salary with quarterly bonus potential, mileage reimbursement, reimbursement for approved continuing education, and contribution towards employer sponsored group medical insurance with an HSA option, company paid Life/AD&amp;D /STD &amp; LTD insurance, paid Personal Time Off, and a SIMPLE IRA plan. &nbsp; Position Overview This role will cover all areas of New Jersey and will initially involve working alongside our current New Jersey General Adjuster, who will be transitioning out of the role. The successful candidate will assume responsibility for handling claims for our existing clients, as well as supporting future client growth.&nbsp; This is a high-visibility position with direct client interaction.&nbsp; The Senior Property Adjuster will be responsible for full-cycle adjustment of both personal and commercial property claims, including complex losses. Key Responsibilities
<ul>
<li>Conduct full property adjustments for personal and commercial lines claims, including:
<ul>
<li>Building</li>
<li>Personal property</li>
<li>Business income / Loss of Use (LOU)</li>
</ul>
</li>
<li>Perform thorough claim investigations and evaluations from first notice through resolution</li>
<li>Accurately track time and expenses; claims are billed on a Time &amp; Expense basis</li>
<li>Prepare clear, professional, and well-documented reports and claim correspondence</li>
<li>Identify coverage issues, liability considerations, and subrogation opportunities</li>
<li>Navigate claims efficiently toward fair and timely resolution using sound judgment and situational awareness</li>
</ul>
Required Qualifications
<ul>
<li>Minimum of 5 years of property field adjusting experience (required)</li>
<li>Strong knowledge of:
<ul>
<li>&nbsp;Residential and commercial building construction&nbsp;</li>
<li>General building valuation&nbsp;</li>
<li>Personal property and time element losses&nbsp;</li>
</ul>
</li>
<li>Ability to review and interpret policy coverages from a wide range of insurers, including non-standard and manuscript forms</li>
<li>Proficiency with Xactimate</li>
<li>Proficiency in Microsoft Word and Excel</li>
<li>Strong organizational and time management skills with the ability to consistently meet deadlines</li>
<li>Excellent written communication skills, including the ability to clearly and concisely document events, damages, and conclusions using proper grammar and punctuation</li>
<li>Experience preparing:&nbsp;
<ul>
<li>Requests for Information (RFIs)&nbsp;</li>
<li>Reservation of Rights letters&nbsp;</li>
<li>Full and partial denial letters&nbsp;</li>
<li>Sworn Statements in Proof of Loss&nbsp;</li>
<li>Subrogation receipts and related claim documentation&nbsp;</li>
</ul>
</li>
<li>Strong investigative, evaluation, and negotiation skills</li>
<li>Inquisitive mindset with a natural curiosity and attention to detail</li>
<li>Ability to work effectively with a wide variety of people and personalities</li>
<li>Valid driver’s license with a good driving record</li>
</ul>
Preferred (Not Required)
<ul>
<li>AIC and/or CPCU designations</li>
</ul>

<h3>Job Description</h3>
Job DescriptionSalary: 70,000-80,000 

TITLE: Liability Claims Adjuster
FLSA: Exempt, Full Time
DEPARTMENT: Claims
WORKSITE: 6 West Colony Place, Durham, NC REPORTS TO: Director, Claims
 
OCCUPATIONALSUMMARY:
Responsible for the management of commercial general and professional liability claims from first notice of loss through final resolution. This position conducts thorough investigations, evaluates coverage and liability exposure, establishes and maintains reserves, and ensures fair, timely, and compliant claim outcomes in accordance with program standards, regulatory requirements, and industry best practices.

DUTIES/RESPONSIBILITIES:
<ul>
<li>Ensure that claims processing procedures and time frames are consistent with contracts, with a quarterly report on any specific shortfalls.</li>
<li>Document all claim activity, communications, and decisions in accordance with program standards.</li>
<li>Review policy coverage, endorsements, and eligibility specific to dive professionals and operators.</li>
<li>Serve as point of contact for insureds providing clear and timely communication regarding claim processes, requirements, status updates, and outcomes.</li>
<li>Establish, maintain, and manage complete electronic claim files from first notice of loss through closure.</li>
<li>Support leadership with claims reporting, loss trend analysis, reserve reviews, litigation oversight support, and participation in special projects to improve program performance.</li>
<li>Prepare and submit required reports, including status reports, loss reports, and management updates.</li>
<li>Ensure timely assignment and coordination of external services such as independent adjusters, investigators, defense counsel, medical reviewers, or expert consultants, and monitor performance.</li>
<li>Ensure compliance with regulatory requirements, claims handling standards, carrier or program guidelines, and best practices.</li>
<li>Other duties as assigned.</li>
</ul>
 
EDUCATION
<ul>
<li>Bachelors degree or higher</li>
<li>5+ years of relevant claims experience</li>
<li>Claims adjuster license or the ability to obtain required</li>
</ul>
REQUIRED KNOWLEDGE, SKILLS &amp; ABILITIES
<ul>
<li>Knowledge of the scuba diving industry</li>
<li>Excellent interpersonal communication, organization, and management skills</li>
<li>Superior project management skills with proven ability to plan, lead and track projects from concept through implementation</li>
<li>Ability to manage timelines and milestones to ensure timely reporting and closures</li>
<li>Self-motivated with strong attention to details and problem-solving skills</li>
<li>Familiarity with captive insurance companies, risk retention groups, accident and health and trip/travel programs</li>
<li>Proficient with Microsoft Office Suite and experienced or adaptable to claims management platforms</li>
</ul>

Liability Claims Adjuster

<h3>Job Description</h3>
Job Description
Claims Adjuster
Company Overview
Allegro Home Delivery is a nationwide third-party logistics company specializing in the final mile delivery and installation of big and bulky items including furniture and appliances. We partner with major retail clients to provide comprehensive delivery solutions ranging from standard delivery to white-glove installation services. 
Position Summary
The Claims Adjuster will manage all aspects of damage and loss claims for our final mile delivery and installation operations. This role requires a detail-oriented professional who can investigate claims, determine liability, negotiate settlements, and work cross-functionally to reduce future claim occurrences. The ideal candidate will balance customer satisfaction with cost control while maintaining strong relationships with retail partners and delivery teams. 
Key Responsibilities
Claims/Licensure Management
<ul>
<li>Review, investigate, and adjudicate damage and loss claims from customers, retail partners, and delivery teams </li>
<li>Evaluate claim validity by analyzing delivery documentation, photos, customer statements, and driver reports </li>
<li>Determine liability and appropriate settlement amounts based on contract terms and claim circumstances </li>
<li>Process approved claims efficiently while maintaining accurate documentation in company systems </li>
<li>Manage claim communications with customers, retail partners, insurance carriers, and internal teams </li>
<li>Track claims from initial report through final resolution and payment</li>
<li>Oversee the full lifecycle of state, federal, and trade licenses required for company operations</li>
<li>Verify that employees and contractors hold required trade licenses for assigned work</li>
<li>Coordinate with regulatory agencies to submit applications, updates, and renewals</li>
<li>Monitor changing state and federal regulations to ensure ongoing compliance</li>
<li>Maintain accurate records of all regulatory licenses and ensure timely renewal</li>
<li>Provide leadership with regular reports on licensure status, risks, and upcoming deadlines</li>
</ul>
Analysis &amp; Investigation
<ul>
<li>Conduct thorough investigations of high-value or complex claims </li>
<li>Identify patterns in damage types, locations, or delivery partners to inform operational improvements </li>
<li>Analyze root causes of damages occurring during delivery, unpacking, assembly, or installation </li>
<li>Coordinate with delivery partners and installation teams to gather evidence and statements </li>
<li>Review driver training and handling procedures when patterns emerge </li>
</ul>
Financial Management
<ul>
<li>Negotiate settlements within established authority limits </li>
<li>Manage claims budget and track expenses against targets </li>
<li>Prepare regular reports on claim volumes, costs, and trends by client, region, and service type </li>
<li>Identify opportunities for cost savings through process improvements or training </li>
<li>Work with finance team on proper accounting and reserve management </li>
</ul>
Process Improvement
<ul>
<li>Collaborate with operations teams to implement claim prevention strategies </li>
<li>Recommend changes to packaging, handling procedures, or installation protocols </li>
<li>Develop and update claims handling procedures and documentation requirements </li>
<li>Create training materials for delivery partners on proper damage reporting </li>
<li>Support implementation of quality control measures to reduce claim frequency </li>
</ul>
Partner &amp; Customer Relations
<ul>
<li>Maintain professional communication with retail partners regarding their customer claims </li>
<li>Manage expectations and provide timely updates throughout the claims process </li>
<li>Handle escalated customer situations with empathy and problem-solving </li>
<li>Build collaborative relationships with delivery partner teams </li>
<li>Represent the company professionally in all claim-related interactions </li>
</ul>
Required Qualifications
Education &amp; Experience
<ul>
<li>Bachelor's degree in Business, Risk Management, or related field, or equivalent experience </li>
<li>3+ years of claims adjusting experience, preferably in logistics, transportation, or retail </li>
<li>Experience with final mile delivery, furniture, appliances, or high-value goods preferred </li>
<li>Knowledge of liability determination and insurance principles </li>
</ul>
Technical Skills
<ul>
<li>Proficient in claims management software and Microsoft Office Suite, Mercury Gate </li>
<li>Experience with photo documentation and digital evidence review </li>
<li>Strong data analysis skills with ability to create meaningful reports </li>
<li>Comfortable learning new technology systems and tools </li>
<li>Experience with Salesforce or similar CRM systems preferred </li>
</ul>
Core Competencies
<ul>
<li>Excellent investigative and analytical skills </li>
<li>Strong negotiation abilities with balanced approach to settlements </li>
<li>Detail-oriented with exceptional organizational skills </li>
<li>Effective written and verbal communication </li>
<li>Ability to make sound decisions under pressure </li>
<li>Customer service mindset with professional demeanor </li>
<li>Understanding of logistics operations and supply chain </li>
</ul>
Key Performance Indicators
<ul>
<li>Average claim resolution time </li>
<li>Claim settlement accuracy rate </li>
<li>Cost per claim and total claims expense management </li>
<li>Customer and partner satisfaction scores </li>
<li>Claim volume trends and reduction initiatives </li>
<li>Documentation quality and compliance rates </li>
</ul>
Physical Requirements &amp; Working Conditions
<ul>
<li>Office environment with standard computer workstation setup </li>
<li>Occasional travel to distribution centers or client locations may be required </li>
<li>Ability to review and analyze photographic evidence of damaged goods </li>
<li>Standard business hours with occasional flexibility needed for urgent escalations </li>
<li>May require occasional weekend or evening work during peak seasons </li>
</ul>
Compensation &amp; Benefits
<ul>
<li>Competitive salary commensurate with experience </li>
<li>Comprehensive health, dental, and vision insurance </li>
<li>401(k) retirement plan with company match </li>
<li>Paid time off and holidays </li>
<li>Professional development opportunities </li>
</ul>
About Allegro Home Delivery:
We are a fast-growing nationwide logistics and transportation company with a focus in the middle and final mile home delivery market. Our methodology is taking ownership of the product from origination until it is in the customer’s home. Retailers, distributors, and manufacturers rely on us to orchestrate the fastest deliveries, with the most comprehensive in-home experience.
AllegroHome Delivery provides equal employment opportunities to all employees andapplicants for employment and prohibits discrimination and harassment of anytype without regard to race, color, religion, age, sex, national origin,disability status, genetics, protected veteran status, sexual orientation,gender identity or expression, or any other characteristic protected byfederal, state or local laws.
Thispolicy applies to all terms and conditions of employment, including recruiting,hiring, placement, promotion, termination, layoff, recall, transfer, leaves ofabsence, compensation and training.

<h3>Job Description</h3>
Job DescriptionBenefits: 
<ul>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Opportunity for advancement</li>
<li>Paid time off</li>
</ul>
 Company Overview Alfa Insurance is an A-rated insurance carrier that offers an excellent array of auto, home, life, farm and business insurance products. Alfa is known for its superior customer service and boasts 94% claims satisfaction. Since its humble beginnings in 1946, Alfa and its affiliates now serve more than 1 million customers across 14 states. Working as a Claims Adjuster for Alfa Insurance offers a remarkable opportunity that extends beyond the mere tasks of handling property and casualty clams. It entails joining a revered company built on principles of faith, family, community, and unwavering integrity. By becoming a member of the Alfa family, you can uncover your true purpose and actively contribute to enhancing the lives of our valued policyholders and making a positive impact in your community. Job Summary Do you have a keen eye for details, have excellent time management skills and thrive in a fast-paced working environment? Do you enjoy working with a team of professionals who are committed to customer service excellence? If you answered yes, then you might be the perfect fit for the Claims Adjuster position at Alfa Insurance. As a Claims Adjuster, you will be responsible for handling all assigned company property and casualty and/or subrogation claims in an efficient and accurate manner. At Alfa Insurance, we pride ourselves on delivering on our promise to our customers. Our Claims department has a 94% satisfaction rating, and we work hard to help our customers get back on their feet as quickly as possible. Responsibilities 
<ul>
<li>This position is responsible for handling all company property and casualty and/or subrogation claims assigned to the position in an efficient and accurate manner.</li>
<li>During the period that the incumbent is an Adjuster Trainee they will be expected to successfully complete the Alfa Adjuster training and other departmentally provided training to move to an Adjuster position.</li>
<li>Maintain the company standard of professional claims handling by providing fast, fair claims service with a minimum of customer complaints.</li>
<li>Contribute to the financial planning of the company by adequate reserving and controlling expenses.</li>
<li>Assure control of claimants and insured to avoid lawsuits.</li>
</ul>
Qualifications 
<ul>
<li>4-year bachelors degree. In lieu of degree, must have 2 years as an Adjuster -OR- 3 years in automobile repair, home and/or commercial construction, law enforcement, auto and/or property estimating.</li>
<li>Computer skills with Excel and Word are preferred.</li>
<li>AIC certification preferred.</li>
<li>Valid driver's license and satisfactory driving record.</li>
<li>Ability to lift and carry approximately 50 pounds, such as a ladder.</li>
<li>Physical agility to ascend/descend stairs/ladders, walk on roofs, crawl under houses/cars and maneuver over and around small barriers. Sit for long periods of time doing sedentary work such as paperwork and computer work.</li>
<li>Must be able to work in adverse weather and working conditions, with some extended stay away from home.</li>
</ul>
 Benefits/Perks 
<ul>
<li>Opportunity for annual performance bonus</li>
<li>Discounts on your auto insurance (underwriting approval required)</li>
<li>Benefits include: Health, dental, supplemental cancer, vision insurance and 401(k) plan</li>
<li>Paid Time Off Bank to include 3 days PTO available after first 80 hours worked for New Hires</li>
<li>Short-term and long-term disability</li>
<li>Flexible Healthcare and Childcare spending accounts for tax savings</li>
<li>Opportunities for advancement</li>
<li>Continuous training and support throughout your career with Alfa</li>
<li>College tuition discounts at various colleges in Alabama</li>
</ul>

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