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<h3>Job Description</h3>
Job DescriptionOverview
Company Overview: 
Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.
Job Description
Allied Universal® is hiring a Claims Investigator. Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation.
<ul>
<li>Must possess a valid driver's license with at least one year of driving experience&nbsp;</li>
</ul>
<ul>
<li>Candidate must reside in state listed in job posting&nbsp;</li>
</ul>
<ul>
<li>Pay Rate: $28 - $32 / hr&nbsp;</li>
</ul>
RESPONSIBILITIES:
<ul>
<li>Investigate insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability</li>
<li>Gather information independently and in collaboration with clients and case managers through various methods such as data collection, interviews, research, and scene investigations</li>
<li>Follow guidance from the handling insurance adjuster to perform field tasks essential to the investigation</li>
<li>Develop and document information on any investigation in a professional and expert manner by writing clear, concise, and grammatically correct reports, memos, and letters</li>
<li>Run appropriate database indices if necessary and verify the accuracy of results found</li>
</ul>
QUALIFICATIONS (MUST HAVE):
<ul>
<li>Must possess one or more of the following:</li>
<ul>
<li>Bachelor's degree in Criminal Justice</li>
<li>Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims</li>
<li>High school diploma with a minimum of six (6) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims</li>
</ul>
<li>Ability to be properly licensed as a Private Investigator as required by the states in which you work</li>
<li>Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course</li>
<li>Minimum of two (2) years of demonstrated experience conducting insurance claims investigations or adjusting complex claims</li>
<li>Working knowledge and understanding of anti-fraud laws, insurance regulations, and compliance rules and standards in their home state and within their designated region of the country</li>
<li>Special Investigative Unit (SIU) Compliance knowledge</li>
<li>Ability to type 40+ words per minute with minimum error</li>
<li>Flexibility to work varied and irregular hours and days including weekends and holidays</li>
<li>Proficient in utilizing laptop computers and cell phones</li>
</ul>
PREFERRED QUALIFICATIONS (NICE TO HAVE):
<ul>
<li>Military experience</li>
<li>Law enforcement</li>
<li>Insurance administration experience</li>
<li>One or more of the following professional industry certifications</li>
<ul>
<li>Certified Fraud Investigator (CFE)</li>
<li>Certified Insurance Fraud Investigator (CIFI)</li>
<li>Fraud Claim Law Associate (FCLA)</li>
<li>Fraud Claim Law Specialist (FCLS)</li>
<li>Certified Protection Professional (CPP)</li>
<li>Associate in Claims (AIC)</li>
<li>Chartered Property Casualty Underwriter (CPCU)</li>
</ul>
</ul>
BENEFITS:
<ul>
<li>Medical, dental, vision, basic life, AD&amp;D, and disability insurance</li>
<li>Enrollment in our company's 401(k)plan, subject to eligibility requirements</li>
<li>Seven paid holidays annually, sick days available where required by law</li>
<li>Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law.</li>
</ul>
Closing
Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: <a href="http://www.aus.com" target="_blank">www.aus.com</a> 
If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: <a href="http://www.aus.com/offices" target="_blank">www.aus.com/offices</a>.
Requisition ID 2025-1465571

Claims Investigator

<h3>Job Description</h3>
Job Description
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.
 This is a remote role.
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Receives claims, confirms policy coverage and acknowledgment of the claim</li>
<li>Determines validity and compensability of the claim</li>
<li>Establishes reserves and authorizes payments within reserving authority limits</li>
<li>Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision</li>
<li>Communicates claim status with the customer, claimant and client</li>
<li>Adheres to client and carrier guidelines and participates in claims review as needed</li>
<li>Assists other claims professionals with more complex or problematic claims as necessary</li>
<li>Additional duties as assigned</li>
</ul>
KNOWLEDGE &amp; SKILLS: 
<ul>
<li>Excellent written and verbal communication skills</li>
<li>Ability to learn rapidly to develop knowledge and understanding of claims practice</li>
<li>Ability to identify, analyze and solve problems</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets</li>
<li>Strong interpersonal, time management and organizational skills</li>
<li>Ability to meet or exceed performance competencies</li>
<li>Ability to work both independently and within a team environment</li>
</ul>
EDUCATION &amp; EXPERIENCE: 
<ul>
<li>Bachelor's degree or a combination of education and related experience</li>
<li>Minimum of 1 year of industry experience and claims management preferred</li>
<li>State Certification as an Experienced Examiner</li>
</ul>
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $51,807 - $83,551
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). 
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Claims Specialist

<h3>Job Description</h3>
Job Description
 
Role: Claims Analyst
Organization: Edenbridge PACE at Skyland 
Location: Washington, DC SE
Status: Full-time
Mission: To allow frail elderly people to age in the location of their choosing and continue to lead connected, meaningful lives
JOB SUMMARY
The Claims Analyst reviews, processes and analyzes healthcare claims to determine their validity and accuracy. They assess damages, verify policy coverage and ensure compliance with regulations and company procedures. Effective communication, problem-solving and attention to detail are crucial for this role.
 
ESSENTIAL DUTIES AND RESPONSIBILITIES
 
<ul>
<li>
Reviews submitted claims for accuracy, completeness and adherence to policy terms and legal requirements. 
</li>
<li>
Analyzes claim data to identify trends, patterns, and potential irregularities. 
</li>
<li>
Communicates with stakeholders to gather information, explain decisions, and resolve issues. 
</li>
<li>
Investigates potential fraudulent claims and gathering supporting evidence. 
</li>
<li>
Makes informed decisions on claim validity and determining appropriate compensation. 
</li>
<li>
Maintains accurate and detailed records of claims processing and outcomes. 
</li>
<li>
Ensures adherence to relevant regulations and company policies. 
</li>
<li>
Develop and maintain positive relationships with the network of providers through ongoing 
</li>
</ul>
communication and by providing feedback
<ul>
<li>
Performs other duties as required.
</li>
</ul>
 
QUALIFICATIONS
Education and Experience:
<ul>
<li>
High School Diploma. Associate’s Degree preferred.
</li>
<li>
1-3 years of experience in data analysis in a customer service environment within the healthcare insurance industry preferred.
</li>
<li>
Experience analyzing data, identifying discrepancies and making informed decisions.
</li>
</ul>
Skills and Competencies:
<ul>
<li>
Able to clearly explain complex information, both verbally and in writing. 
</li>
<li>
Able to identify and resolve issues related to claims processing. 
</li>
<li>
Strong attention to detail to ensure accuracy in claim review and data entry. 
</li>
<li>
Knowledge of Insurance/Healthcare, including understanding policy terms, coverage, and relevant regulations. 
</li>
<li>
Exceptional customer service skills.
</li>
</ul>
 
 
Learn more at: 
edenbridgepace.com/dc

Claims Analyst

<h3>Job Description</h3>
Job Description
Claims Consultant Bethesda, MD 20814 SUMMARY/OBJECTIVE:
<ul>
<li>The Claims Consultant will be responsible for conducting impact analysis, analyzing risk on complex projects, and performing forensic schedule and cost analysis consisting of identifying critical path delays, schedule disruptions, evaluating labor productivity, and pricing general conditions costs</li>
</ul>
 ESSENTIAL FUNCTIONS:
<ul>
<li>Support clients in the identification, quantification, and mitigation of schedule related risks</li>
<li>Perform construction claims forensic analysis including document review and organization, key issue identification, schedule analysis, labor productivity studies, general conditions calculations, pricing, and graphic exhibits for input to expert reports</li>
<li>Have excellent written and oral communication skills that can accurately explain complex construction disputes in understandable reports and presentations</li>
<li>Analyze construction project cost reports, labor distribution reports, and other project accounting information.</li>
<li>Perform schedule assessments, including reviews of critical path, schedule content, use of relationships and lag, constraints and milestones, constructability, and general assessment based on industry knowledge</li>
<li>Work location will be remote with visits to client sites and K2 headquarters as necessary</li>
</ul>
 REQUIRED EDUCATION AND EXPERIENCE:
<ul>
<li>At least 10+ years of hands-on claims experience in the construction industry</li>
<li>Strong understanding of the Critical Path Method of scheduling theoretically and as it applies to construction projects</li>
<li>Strong understanding of schedule delay principles and techniques, including contemporaneous time impact analysis and forensic scheduling methods</li>
<li>Hands-on forensic scheduling, labor productivity analysis and time impact analysis experience</li>
<li>Ability to understand and accurately interpret construction documents (drawings, specifications, contracts/general conditions) at all levels of design, across project types, and trade disciplines</li>
<li>Expert user in Primavera P6, Microsoft Project, and Microsoft Office Suite</li>
<li>Understanding and experience in Earned Value Management</li>
<li>Mediation and testimony experience a plus</li>
</ul>
 We are an equal opportunity employer, and we are an organization that values diversity. We welcome applications from all qualified candidates, including minorities and persons with disabilities. req25-00682

Claims Consultant

<h3>Job Description</h3>
Job DescriptionAbout Us
We are a dynamic enterprise group of managed care and health insurance service companies which have become industry leaders in their diverse specialties. Headquartered in Dallas, Texas, the group has 10 offices around the world, including the United States, Canada, Panama, Ecuador, Colombia, and Dubai, and employs over 700 employees of various nationalities.
Position Summary
The Claims Adjudicator is responsible for reviewing, analyzing, and processing health insurance claims in accordance with established guidelines, contractual benefits and terms, and regulatory requirements. The claims adjudicator ensures that all claims are handled accurately, efficiently, and within specified timeframes, contributing to the overall effectiveness of the claims processing team. This role requires a detailed-oriented professional with a strong ability to follow instructions and a proactive approach to identifying and resolving discrepancies.
ESSENTIAL FUNCTIONS

<ul>
<li>Ensure all claims are processed in strict accordance with established guidelines and instructions.</li>
<li>Review and adjudicate claims in accordance with policy benefits.</li>
<li>Send claims for coverage analysis to the medical department in specific cases.</li>
<li>Regularly generate and analyze claims processing reports to identify discrepancies and ensure data accuracy.</li>
<li>Properly code procedures and diagnostics (CPT and ICD 10 coding)</li>
<li>Verify banking information.</li>
<li>Validate prescription medicines to the corresponding patient diagnosis.</li>
<li>Verify expenses with the renewal date for coverage.</li>
<li>Calculate expenses and deductible per policy year.</li>
<li>Verify waiting periods.</li>
<li>Verify pre-existing conditions and exclusions; deductible increases</li>
<li>Verify dates of service.</li>
<li>Verify currency conversions.</li>
<li>Verify general benefits of the policy according to the contracted plan.</li>
</ul>
MINIMUM QUALIFICATIONS
<ul>
<li>Minimum 2 years’ experience. </li>
<li>Bilingual (Spanish or Portugues).</li>
<li>Experience in quality customer service.</li>
<li>General knowledge and proper management of Microsoft Office </li>
<li>Proactively identify discrepancies in claims; monitor claims patterns to identify opportunities for improvement.</li>
<li>Ability to work under pressure. </li>
<li>Ability to manage interpersonal relationships.</li>
<li>Effective oral and written communication skills.</li>
<li>Strong ability to follow detailed procedures and instructions with precision to ensure accurate and compliant claims adjudication.</li>
</ul>
WORKING CONDITIONS
The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function. 
Work Environment
The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain. 
   
Physical Demands
The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to: 
<ul>
<li>exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. </li>
<li>operate standard office equipment such as copiers, computers, telephones, printers, etc. </li>
</ul>
Travel Requirements
Minimal to no travel required 
NOTE
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise. 
The Company complies with employment regulations as they apply to the location of service.

Claims Adjudicator

<h3>Job Description</h3>
Job Description
**This role is onsite at our Roslyn, NY or Rochester, NY office, with the option for a hybrid schedule after the training period. **
General Summary: A Claims Specialist will utilize their experience in medical liability claim handling to investigate, evaluate, and resolve high exposure claims while demonstrating a strong commitment to exceptional client service. 
Essential Duties &amp; Responsibilities:
<ul>
<li>Follow standard claims protocols for documentation, coverage verification, and file management</li>
<li>Maintain accurate and organized claims files, suggesting improvements as necessary</li>
<li>Assist in client relationship management, collaborate with underwriting on marketing</li>
<li>Investigate and document most significant exposures, setting appropriate indemnity and expense reserves</li>
<li>Develop resolutions strategy and participate in negotiations to bring matters to a close </li>
<li>Attend trials and mediations when necessary</li>
<li>Adhere to industry Best Practices for effective claim management</li>
<li>Mentor staff through formal and informal training and development; demonstrate strong technical knowledge to guide and support less experienced claims professionals</li>
<li>Ensure exceptional data integrity</li>
<li>Actively manage defense council and partner on litigation strategy</li>
<li>Proactive communication with insureds, other departments and claim leadership</li>
<li>Perform additional duties and responsibilities as assigned</li>
</ul>
Education &amp; Qualifications:
<ul>
<li>Bachelor’s degree or JD required </li>
<li>Five years’ claims handling experience required; medical professional liability preferred </li>
<li>NY adjusters license required within the first 6 - 12 months of employment</li>
<li>Strong analytical and problem-solving skills with attention to detail</li>
<li>Demonstrate solid and concise business writing proficiency</li>
<li>Exhibit strong oral communication skills to include presenting information clearly and effectively to diverse audiences</li>
<li>Ability to work independently as well as collaboratively within a team. Set a strong example for less experienced colleagues </li>
<li>Strong ethical judgement and a commitment to maintaining confidentiality</li>
<li>Must be able to work on site</li>
<li>Travel required as needed; may include overnight travel </li>
</ul>
The actual compensation for this position will be determined by experience and other factors permitted by law.

<h3>Job Description</h3>
Job DescriptionJoin a company that values integrity, teamwork, and exceptional service with over 100 years of service in the Pittsburgh area! As the Claims Adjuster, you’ll investigate property and cargo claims, determine validity, and reach fair, timely resolutions. You’ll work with customers, carriers, insurance companies, and internal teams to reduce claim frequency and ensure customer satisfaction. What You’ll Do:
<ul>
<li>Investigate property and cargo claims and determine equitable resolutions</li>
</ul>
<ul>
<li>Prepare and maintain reports on open claims, aging, and chargebacks</li>
</ul>
<ul>
<li>Negotiating settlements with insurance companies, shippers/customers</li>
<li>Subrogate with carriers and insurers for reimbursement</li>
</ul>
<ul>
<li>Communicate professionally with customers and co-workers</li>
</ul>
<ul>
<li>Complete all work safely, accurately, and on time</li>
</ul>
What We’re Looking For:
<ul>
<li>Detail-oriented, analytical problem solver</li>
</ul>
<ul>
<li>Excellent communication and organizational skills</li>
</ul>
<ul>
<li>Positive attitude and commitment to our Mission, Vision &amp; Values</li>
</ul>
Be part of a trusted team that keeps people moving with care and professionalism. Apply today to join South Hills Movers! Claims property cargo analyst adjuster resolution claim transportation specialist processor &nbsp;
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Claims Adjuster

<h3>Job Description</h3>
Job Description
The Property and Cargo Claim Adjuster is responsible for managing claims involving cargo loss, property damage, and auto damage across 48 states within a flatbed trucking operation. This desk-based role requires strong analytical skills, attention to detail, and the ability to resolve claims efficiently and in compliance with company policies and regulatory standards. Experience with bodily injury is a plus. The position is based in our Tulsa office.
Essential Duties and Responsibilities:
Claims Investigation &amp; Evaluation
<ul>
<li>Handle cargo, property, and auto damage claims from intake through resolution.</li>
<li>Review documentation, photographs, driver statements, and other evidence to determine liability and damages.</li>
<li>Manage the investigation process by determining what outside resources (e.g., appraisers, adjusters, forensic experts) are needed for each incident.</li>
<li>Communicate effectively with drivers, vendors, first responders, customers, and third-party claimants.</li>
</ul>
Claim Resolution
<ul>
<li>Negotiate settlements with claimants, vendors, and third parties.</li>
<li>Identify and pursue subrogation and recovery opportunities.</li>
<li>Use specific industry, company, and case knowledge to reach the best agreement for the operational success of Melton.</li>
</ul>
Documentation &amp; Compliance
<ul>
<li>Maintain accurate and detailed claim files, notes, and reports.</li>
<li>Ensure compliance with federal, state, and industry regulations, including DOT and FMCSA standards.</li>
<li>Stay current on regulatory changes and industry best practices.</li>
</ul>
Internal Collaboration
<ul>
<li>Partner with Safety, Risk Management, Dispatch, and Operations to support investigations and loss prevention.</li>
<li>Provide insights and recommendations to improve claims processes and reduce exposure.</li>
</ul>
Qualifications:
-Must have an active Claims Adjusters license and be willing to complete continuing education and training.
- Proven experience as a Claims Adjuster, property, cargo, and bodily injury experience preferred.
- Knowledge of the trucking and logistics industry, including relevant regulations and compliance requirements.
- Strong analytical and decision-making skills, with the ability to manage complex claims.
- Excellent negotiation and interpersonal skills, with the ability to communicate effectively with various stakeholders.
- Proficient in claims management software and Microsoft Office Suite.
-High school diploma required, college degree preferred.
-English/Spanish bilingual preferred but not required.
Physical Demands: It is necessary to talk, hear, sit, walk, type, and write. It is occasionally necessary to lift up to 25 lbs.

<h3>Job Description</h3>
Job Description
Looking to hire an associate attorney with 3+ years of insurance coverage and/or litigation experience. Great opportunity to work in-house with an insurance carrier handling MPL and PL claims.
$120-125k base salary, plus bonus
3 days per week in office

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