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Claims Examiner CalOptima CalOptima Health is seeking a highly motivated Claims Examiner to join our team. The Claims Examiner will be responsible for analyzing and validating claim data elements and claims processing. The incumbent will be responsible for adhering to the regulatory and internal processing guidelines in conjunction with CalOptima Health policies and procedures related to claims adjudication. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Claims Support
<ul>
<li>Performs thorough review of pending claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.</li>
<li>Processes non-institutional claim types.</li>
<li>Corrects system generated errors manually prior to final claims adjudication.</li>
<li>Processes claims based upon CalOptima Health contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health policies and procedures.</li>
<li>Analyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, including International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference.</li>
<li>Validates eligibility and other possible health insurance coverage on the claim.</li>
<li>Alerts manager or supervisor of more complex issues that arise.</li>
<li>Processes claim exception reports as assigned. </li>
</ul>
</li>
<li>10% - Administrative 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>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of related claims processing experience 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>
 Preferred Qualifications: 
<ul>
<li>Experience processing online claims in a managed care environment. </li>
<li>Experience processing Medi-Cal claims.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6329575&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 11, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6329575" target="_blank">https://jobs.caloptima.org/jobs/claims-examiner-505-city-parkway-west-california-united-states-fd7ed77a-73a4-4bd2-9f12-47d82ac1ed30</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-a4cc42329aeb0d40b1127d796b9ce31e

Claims Examiner

Financial Analyst IV (Decision Support) CalOptima CalOptima Health is seeking a highly motivated Financial Analyst IV (Decision Support) to join our team. The Financial Analyst IV (Decision Support) will be responsible for providing analysis, guidance and expert knowledge on health care finance for various departments within CalOptima Health. Working independently, the incumbent will lead large-scale analytical initiatives and develop report suites and financial models used to forecast medical cost trends. The incumbent will provide support for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions, provide ad-hoc analytic support as needed and act as a resource to staff and other consultants within the department. The incumbent will evaluate various complex issues, perform detailed analysis and communicate well reasoned solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, enrollment and provider data. Position Information: 
<ul>
<li>Department: Financial Analysis </li>
<li>Salary Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<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>Researches, assesses and develops advanced tools, models, reports and approaches to increase the accuracy and timeliness of data-driven work projects.</li>
<li>Develops medical expense, revenue and enrollment projections to support the budget process.</li>
<li>Develops financial models and reports to support provider contract negotiations.</li>
<li>Develops return on investment and business case analyses for program initiatives under consideration by management.</li>
<li>Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima Health members.</li>
<li>Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse.</li>
<li>Provides support and analyses around risk adjustment.</li>
<li>Mentors, trains and serves as a lead for analytical staff.</li>
<li>Designs, develops, implements and maintains report suites and dashboards for all levels of CalOptima Health management.</li>
<li>Serves as a subject matter expert around one or more of the following areas: Medi-Cal provider rate methodology, Medicare provider rate methodology, Department of Health Care Services (DHCS) revenue, Centers for Medicare &amp; Medicaid Services-Medicare Advantage (CMS-MA) revenue, population health member cohort identification, industry standard approaches to health care cost service categorization and metrics. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, finance, economics, actuarial sciences or related field PLUS 6 years of experience working with health care finance reporting and analytics in a medical group, hospital or health plan setting 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>
<li>3 years of experience in Provider Contract Modeling required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience working with commercial, Medi-Cal and Medicare large payer data sets and related pricing information that is publicly available. </li>
<li>Experience developing annual organizational budgets, forecasts and financial modeling. </li>
<li>Experience using Tableau and/or Microsoft SQL Server.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6299502&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 26, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6299502" target="_blank">https://jobs.caloptima.org/jobs/financial-analyst-iv-decision-support-505-city-parkway-west-california-united-states</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-f3569a1ca984034796c2553e8b161065

Financial Analyst IV (Decision Support)

<h3>Job Description</h3>
Job Description &nbsp;Benefits/Perks:
<ul>
<li>Competitive Pay</li>
<li>Professional Development</li>
<li>Job Stability in a growing industry </li>
</ul>
Job Summary:We are seeking a professional and knowledgeable Claims Adjuster to join our team. In this role, you will examine property damage and physical injuries, process claim reports, and negotiate payments. You will interview relevant parties and gather information to assist you in the claims process. The ideal candidate is highly organized with strong analytical and writing skills.&nbsp; Responsibilities
<ul>
<li>Inspect the property for damage</li>
<li>Interview claimants and witnesses</li>
<li>Gather information from a variety of sources, including police reports and surveillance cameras</li>
<li>Write claim reports</li>
<li>Consult with other professionals</li>
<li>Negotiate settlements</li>
</ul>
 Qualifications
<ul>
<li>High school diploma/GED required, bachelor’s degree preferred</li>
<li>Previous experience as a claims adjuster is preferred</li>
<li>Experience using industry-specific software</li>
<li>Strong problem-solving and analytical skills</li>
<li>Excellent written and verbal communication skills</li>
<li>Experience writing detailed reports</li>
</ul>

Claims Adjuster

<h3>Job Description</h3>
Job DescriptionSalary: $55-60K 
A well-established, employee-focused company is currently seeking a Licensed Claims Adjuster to join our team in an on-site role based in the North Valley. This position involves handling low-complexity property claims from start to finishno field work required. This is not a remote opportunity. This position follows a standard schedule of Monday through Friday, 9 a.m. to 5 p.m. Candidate must be located in the Phoenix area.
 
What Youll Do
<ul>
<li>Investigate, evaluate, and resolve low-complexity property claims</li>
<li>Review submitted claims and documentation for accuracy and completeness</li>
<li>Determine appropriate settlements, denials, or payments</li>
<li>Answer claim-related phone calls professionally and empathetically</li>
<li>Prepare monthly reports for financial and risk analysis</li>
<li>Assist in onboarding clients to our proprietary claims platform</li>
<li>Support internal training initiatives as needed</li>
</ul>
 
Requirements:
<ul>
<li>Active Arizona Adjuster License</li>
<li>13 years of experience handling property claims preferred</li>
<li>Excellent communication and customer service skills</li>
<li>Strong analytical and organizational abilities</li>
<li>Proficiency in Microsoft Excel, Word, Outlook, and Teams</li>
<li>Ability to work independently and in a fast-paced team environment</li>
</ul>
 
What We Offer
<ul>
<li>Competitive base salary ($55,000$60,000)</li>
<li>Generous PTO, paid sick leave, and holiday time</li>
<li>100% employer-paid medical insurance for employees</li>
<li>401(k) with company match</li>
<li>Opportunities for professional growth and advancement</li>
<li>Supportive, team-oriented culture</li>
<li>Dog friendly environment</li>
</ul>
 
We are an Equal Opportunity Employer
 We prohibit discrimination and harassment of any kind. Our hiring decisions are guided by merit, qualifications, and business needs.

<h3>Job Description</h3>
Job DescriptionSalary: $55,000-$90,000 annual salary 
JOB DESCRIPTION
The Claims Adjuster with SteadPoint Risk Management Solutions is responsible for maintaining and handling workers' compensation claims by determining compensability, investigating with specific focus on acquisition of recorded statements of claimant or witnesses, coordinating medical care, assigning legal counsel if deemed necessary, and directing or coordinating workers' compensation benefits. The Claims Adjuster will focus on reserve practices, medical terminology, communication, organization, and directing claim development from onset to conclusion or settlement. Prefer candidate to have experience handling multiple jurisdictions, including GA and TN. Candidate must be comfortable working in a fast paced environment.
 
JOB FUNCTIONS AND RESPONSIBILITIES
<ul>
<li>Receipt, review, and analyze incoming claims. </li>
<li>Produce necessary documentation for justification of compensability and/or denial of claim. </li>
<li>Must be able to answer, service, and document calls pertaining to policy benefits and determine whether the call needs to be referred to a supervisor. </li>
<li>Follow up and complete work that originates from the calls received if applicable. </li>
<li>Maintaining caseload by managing lost time claims.</li>
<li>Take statements of injured worker, insured, potential witnesses, as necessary, in the scope of investigative duties of the claim. </li>
<li>Process lost time benefits and coordinate meds, assign nurse case management, assign legal counsel if deemed necessary, and/or surveillance when appropriate. </li>
<li>Solicit PPI from physician, calculate awards, and initiate settlements to resolve claim.</li>
<li> </li>
</ul>
REQUIREMENTS
<ul>
<li>Some college preferred or equivalent insurance claims handling experience of at least 5 years.</li>
<li>Appropriate ICA continuing education coursework. </li>
<li>State claims adjuster license.</li>
</ul>
Why SteadPoint?
BENEFITS
<ul>
<li>HEALTH &amp; DENTAL BCBS </li>
<li>LONG-TERM DISABILITY </li>
<li>TERM LIFE INSURANCE </li>
<li>FITNESS REIMBURSEMENT </li>
<li>GROWTH OPPORTUNITIES</li>
<li>VSP VISION </li>
<li>SHORT-TERM DISABILITY </li>
<li>401K MATCHTING </li>
<li>COMPETITIVE PTO</li>
</ul>
 remote work

<h3>Job Description</h3>
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 &amp; 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 &amp; 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 results—the 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.

<h3>Job Description</h3>
Job Description
We are seeking a Claims Adjuster to become a part of our firm!
Key Responsibilities:
Claim Intake and Evaluation:
- Review accident reports, medical records, and other documentation to assess the validity and potential value of personal injury claims arising from auto accidents.
- Contact clients and insurance companies to gather information and initiate the claims process.
- Analyze liability issues and determine the best course of action based on applicable laws and case precedents.
Investigation and Communication:
- Conduct thorough investigations by contacting witnesses, obtaining police reports, and visiting accident sites when necessary.
- Communicate with insurance adjusters to negotiate settlements and advocate for the client's interests.
- Maintain detailed case files and documentation to track claim progress and important deadlines.
Medical Record Review:
- Analyze medical records to evaluate the extent of injuries, treatment plans, and potential future medical needs.
- Consult with medical experts when necessary to assess the validity of medical claims.
Litigation Support:
- Assist the legal team in preparing for potential litigation by gathering evidence, identifying key witnesses, and drafting legal documents.
Required Skills and Qualifications:
- Strong understanding of personal injury law, insurance policies, and legal procedures related to auto accidents.
- Excellent communication and negotiation skills to effectively interact with clients, insurance adjusters, and other parties involved in the claims process.
- Detail-oriented with the ability to manage multiple cases simultaneously, prioritize tasks, and meet deadlines.
- Analytical skills to assess the merits of a case and determine appropriate settlement strategies.
- Proficiency in utilizing case management software and other relevant technology.
- 3 to 5 years experience handling automotive and premise claims.
Company DescriptionWell established personal injury law firm represent clients throughout the New York and New Jersey metro area with offices conveniently located in Manhattan, Queens, Newark, Union City, Elizabeth, Clifton, New Brunswick and Perth Amboy. Our team of 35 attorneys concentrates on a variety of legal matters, including personal injury, construction accidents, workers compensation, car accidents, truck accidents, premises cases, medical malpractice and Social Security Disability. With this wide skill-set, and years of experience backing us, we are equipped to provide you with the knowledgeable and professional legal advice you need. 
<h3>Company Description</h3>
Well established personal injury law firm represent clients throughout the New York and New Jersey metro area with offices conveniently located in Manhattan, Queens, Newark, Union City, Elizabeth, Clifton, New Brunswick and Perth Amboy. Our team of 35 attorneys concentrates on a variety of legal matters, including personal injury, construction accidents, workers compensation, car accidents, truck accidents, premises cases, medical malpractice and Social Security Disability. With this wide skill-set, and years of experience backing us, we are equipped to provide you with the knowledgeable and professional legal advice you need.

<h3>Job Description</h3>
Job Description
Position: Mechanical Claims Adjuster
Location: Earth City, MO
Duration:&nbsp;Long Term Contract with potential of conversion&nbsp;
Hourly Rate: 24/hr to 27/hr&nbsp;
Exact compensation may vary based on several factors, including skills, experience, and education.
Employees in this role will enjoy a comprehensive benefits package starting on day one of
employment, including options for medical, dental, and vision insurance. Eligibility to enroll in
the 401(k) retirement plan begins after 90 days of employment. Additionally, employees in this
role will have access to paid sick leave and other paid time off benefits as required under the
applicable law of the worksite location.
Qualifications:
<ul>
<li>At least 3 years of proven experience as an automotive mechanic or in a related mechanical field.</li>
<li>Prior success in a customer service role including experience resolving complex requests and ensuring outstanding customer satisfaction</li>
<li>Technology proficient in Microsoft Office applications (Email, Teams, Outlook, etc.) and programs used for&nbsp;claims&nbsp;processing, as well as the ability to navigate multiple software systems and monitors while assisting customers on the phone.</li>
<li>Bilingual (Spanish &amp; English) candidates.</li>
<li>High school diploma or GED required.&nbsp;</li>
<li>ASE certification</li>
<li>Automotive degree&nbsp;</li>
</ul>
Additional Considerations:
<ul>
<li>Must be willing to work Saturdays occasionally.</li>
<li>A high-speed home internet connection and a quiet at-home workspace is required for remote and hybrid schedules.&nbsp;</li>
<li>Must be able to pass background check&nbsp;</li>
<li>Must have reliable transportation to and from work&nbsp;</li>
</ul>

Automotive Claims Adjuster

<h3>Job Description</h3>
Automotive Claims Adjuster $50-60K 
Will train Mechanical/Diesel background, trade the shop for the office!
60
SNI Companies has partnered with an amazing north Austin third party Automotive Warranty firm with an outstanding reputation and established client base across the country to add new fulltime addition to the team!
 
Hybrid work schedule, Competitive Salary, Bonuses and Benefits package 
 
Are you the Ideal candidate?
 
Minimum Qualifications
• Minimum 4-5 years of Mechanical/Diesel hands-on experience with Engines/Transmissions
OR Mechanical Claims experience in Call Center environment
• Individuals should possess basic to intermediate skills using MS Outlook and Excel
• Must have great verbal and written communication skills
• Ability to read and understand contractual language
• Willing to continue to take continued education courses and keep us any ASE or Automotive Certifications
 
The Mechanical Claims examiner specializes in the adjudication of mechanical automobile claims. They possess
extensive mechanical knowledge in order to investigate the cause of the failure reported, determine coverage, and
negotiate fair costs for repairs.
 
Essential Job Functions
• Complete and finalize initial claim reports submitted by service writers/advisors, their representatives, or directly from
contract owners to complete the adjudication process.
• Properly, efficiently, and accurately document loss report by establishing part and labor costs by utilizing approved pricing
standards and/or labor and parts guides
• Properly manage and maintain claim loss reports to ensure files are being settled and closed
• Provide claim information/status to existing open or pending claims and communicate updates to service advisors or
customers and other stakeholders.
• Refer disputed claims to appropriate parties for the next steps
• Dispatch third-party inspections per department/company requirements and evaluate correctly
• Properly document and manage open claims via the Open Diary process
• Use resources such as technical bulletins, recalls and system comments, and other requirements during the adjudication
process

Mechanical Claims Adjuster

<h3>Job Description</h3>
Job Description
The Hospital Claims Adjuster is responsible for the adjusting of hospital risk claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospitals/IPAs. Research, reviews, and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.
Duties and Responsibilities
· Accurately review all incoming adjustment requests to verify necessary information is available.
· Meets production and accuracy standards established by claims management.
· Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims.
· Coordinate resolution of claims issues with other Departments.
· Assist Providers and other Departments in claims research.
· Review and adjudicate web portal inquiries.
· Assist in training claims personnel when issues are identified.
· Promote a spirit of cooperation and understanding among all personnel.
· Attend organizational meetings as required
· Adhere to organizational policies and procedures.
· Performs other tasks as assigned by Claims Leadership.
· Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation &amp; Collaboration
Minimum Job Requirements
· High School Graduate
· Minimum 1 year experience as a Claims Examiner II
· One year experience with Hospital/Facility risk claims
Skill and Abilities
· Knowledge of DOFR interpretation and the adjudication of hospital risk claims.
· Ability to get work done efficiently and within timeliness guidelines.
· Experience in a managed care environment preferred.
· ICD-9 and ICD-10 and CPT-4 coding knowledge preferred.
· Must be detail oriented and can work independently

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