Investigate multiple sources of health insurance data to identify potential accidents and physical injuries, determining recoverability of claims.
Communicate and negotiate with healthcare plan members, insurance adjusters, and attorneys to recover funds from at-fault parties.
Utilize computer systems for documentation, apply analytical skills to manage workflows, and create medical expense spreadsheets for payment processing.
Plans and conducts investigations of claims to analyze coverage and determine liability, compensability, and damages.
Assesses policy coverage, establishes reserve requirements, and negotiates settlements within assigned authority limits.
Mentors new team members, participates in quality reviews, and coordinates litigation activities for timely resolution.
Liberty Mutual is a fast-growing insurance company that consistently outpaces the industry in year-over-year growth. It has a large workforce and fosters an inclusive culture with comprehensive benefits and professional development opportunities.
Analyze and process workers compensation lost-time claims, investigating to determine benefits and exposure.
Negotiate settlement of claims within designated authority and communicate with claimants and clients.
Report claims to excess carrier and respond to requests in a professional and timely manner.
Sedgwick is the world’s leading risk and claims administration partner, helping clients navigate the unexpected with advanced AI-enabled technology. With over 33,000 colleagues and 10,000 clients across 80 countries, it offers a caring culture that values work-life balance and professional growth.
Manage a caseload of complex workers' compensation cases including litigation and disability.
Investigate claims to determine compensability, establish reserves, and manage medical treatment.
Collaborate with clients, legal counsel, and healthcare professionals to resolve claims.
Berkley Risk provides program administration and insurance services for self-insured entities. It is a member company of W. R. Berkley Corporation, a Fortune 500 firm, offering a competitive compensation and robust benefits package.
Initiate investigation of new claims and evaluate coverage to make appropriate policy decisions.
Evaluate and negotiate settlements of property, collision, and transportation losses while managing outside adjusters.
Ensure compliance with state laws, maintain licenses, and handle small claim suits as needed.
ClaimsPro LP, part of SCM Insurance Services, is a Third Party Administrator handling claims across the US and Puerto Rico. SCM is Canada's largest privately owned insurance services provider, known for a culture of continuous learning and recently winning a Culture Innovator Award.
Investigate and evaluate auto claims, determine coverage and liability.
Negotiate and settle claims with empathy and professionalism.
Manage claim inventory independently and ensure compliance with state regulations.
Horace Mann is an insurance and financial services company focused on educators. The company serves over 4,100 school districts, has over $12 billion in assets, and is publicly traded on the NYSE.
Investigate and adjudicate workers' compensation claims, including medical-only and indemnity claims in MN, as well as Federal and State Black Lung claims.
Conduct claimant, employer, and provider outreach, set reserves, deny non-compensable claims, and ensure timely, accurate medical payments.
Manage a diary, complete tasks to resolve cases timely, and prepare reports for file documentation.
Argo Group is an underwriter of specialty insurance products in the property and casualty market, offering a full line of products and services for businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc., and the company fosters a collaborative, inclusive work environment that values innovation.
Investigate, evaluate, and adjust commercial auto and property claims from assignment through resolution while ensuring compliance with standards and regulations.
Conduct thorough liability investigations, establish reserves, and negotiate settlements within authority limits in alignment with client expectations.
Maintain accurate claim documentation, communicate effectively with clients and claimants, and identify subrogation opportunities where applicable.
CCMSI is the largest privately-owned Third Party Administrator (TPA) that partners with global clients to solve complex risk management challenges through advanced technology and collaborative problem-solving. As a certified Great Place to Work®, the company is employee-owned and empowers its staff to grow, collaborate, and make meaningful contributions every day.
Serves as a subject matter expert for the entire ceded reinsurance process within Claims, reviewing all reinsurance claims completed by team members.
Manages reinsurance inquiries by triaging, assigning, and tracking responses to ensure timely resolution and communication with brokers.
Leads and monitors workload in the coding and closeout process, including reviewing claims with newly established reserves for accuracy and exposure alignment.
EMC Insurance provides insurance products and services with over 105 years of financial strength and stability. The company is a five-star insurance carrier with multiple locations recognized as Top Workplaces, fostering a culture that engages and empowers team members.
Lead Auto Claims operations with accountability for performance, customer outcomes, compliance, expense management, and talent results.
Oversee the handling strategy and operational execution for Low Touch Claims, Coverage Investigations, Subrogation, Rental, Med Pay, and Theft/Fire.
Partner cross-functionally to support portfolio management, product implementation, growth, and business profitability.
Mercury Insurance helps people reduce risk and overcome unexpected events. They have been in business for over 60 years and foster a team culture focused on growth, fun, and inclusion.
Investigate, evaluate, and adjust assigned multi-line claims in accordance with corporate standards, client guidelines, and jurisdictional requirements.
Manage claims cradle to grave across all jurisdictions, including licensed states such as NY and FL.
Negotiate settlements with claimants, attorneys, and vendors in alignment with client expectations and authority levels.
CCMSI partners with global clients to solve complex risk management challenges through advanced technology and collaborative problem-solving. As the largest privately-owned Third Party Administrator, CCMSI is a certified Great Place to Work® with employee-owners empowered to grow and make meaningful contributions.
Process inbound claim contacts from dealers, repair facilities, sales agents, and contract holders.
Manage queue contacts via phone, email, and chat channels.
Correspond with vendors and assist with claim estimation and cost comparison.
Protective helps protect customers against life's uncertainties by providing insurance and claims services. The company offers comprehensive benefits and promotes work/life balance with a focus on employee wellbeing.
Investigate and manage complex, high-exposure multi-line claims from assignment through resolution, including coverage analysis and litigation strategy.
Lead claim strategy on heavily litigated files, working closely with defense counsel and negotiating high-value settlements.
Provide strategic communication and reporting to clients, manage reserves, and ensure compliance with corporate standards.
CCMSI partners with global clients to solve complex risk management challenges through advanced technology and collaborative problem-solving. As the largest privately-owned Third Party Administrator, we deliver customized claim solutions; we are a certified Great Place to Work® with employee-owners empowered to grow and make meaningful contributions.
Investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis and interviews.
Analyze information, report findings, and recommend settlements or denials while supporting legal proceedings.
Conduct training on fraud detection and maintain knowledge of relevant laws and regulations.
Cotiviti is a healthcare analytics company that helps clients reduce costs and improve outcomes through data-driven insights. As a global leader in payment accuracy and network performance, Cotiviti fosters a collaborative and inclusive culture.
Handle high-exposure and complex workers' compensation claims in multiple jurisdictions as a technical Subject Matter Expert.
Serve as primary liaison for key business partnerships and lead claims-related account management for large clients.
Investigate, evaluate, and resolve litigated claims while maintaining compliance with jurisdictional regulations.
BerkleyNet is an innovative workers compensation insurance provider that operates entirely online. The company is part of W.R. Berkley Corporation, a Fortune 500 company known for its fast and easy service culture.
Serve as the main point of contact for providers, resolving escalated issues and maintaining positive relationships.
Manage internal projects to improve provider experience, including education on best practices and policies.
Use data analysis and tools like Excel and Salesforce to investigate issues and reduce provider abrasion.
Clover Health provides high-quality, affordable healthcare plans for America's seniors by leveraging data and technology through the Clover Assistant. The company is a mission-driven, remote-first organization with a focus on diversity and inclusion, employing a team of passionate professionals.
Conduct thorough investigations of potentially fraudulent insurance claims, analyzing evidence and documenting findings.
Interview claimants, witnesses, and relevant parties to gather accurate information and support case resolutions.
Collaborate with claims professionals and vendors to manage complex investigations from review through resolution.
Our partner company specializes in fraud investigation and insurance claim integrity. The organization offers a collaborative remote work environment focused on innovation, accuracy, and customer protection.
Conduct virtual or in-person property inspections to identify covered damage.
Interpret insurance policies and provide exceptional customer service.
Fill out paperwork to process claims and drive business growth.
Metro Public Adjustment helps homeowners get maximum insurance claim payouts. They are a 30-year-old company that provides training and flexible opportunities.
Evaluate SIU referrals to identify suspicious fraud indicators and create investigative plans.
Conduct data analysis and manage vendor assignments while collaborating with law enforcement.
Prepare detailed investigative reports and referrals to NICB and Departments of Insurance.
Core Specialty is a multi-state commercial insurance carrier offering property and casualty insurance for small to mid-sized businesses. The company has underwriting offices across the U.S. and emphasizes niche markets and local distribution.
Review and investigate vehicle service contract claims to determine coverage and eligibility.
Collaborate with repair facilities to evaluate repair needs and authorize covered work.
Calculate repair costs, negotiate fair pricing, and maintain clear documentation of claim decisions.
APCO Holdings partners with dealerships across North America to deliver innovative vehicle protection products and services. The company fosters a collaborative, results-driven culture with teams across operations, technology, risk, finance, marketing, and sales.
Assist clients in initiating auto insurance claims and provide guidance through the initial reporting process.
Follow up with insurance companies to check claim status and troubleshoot any blockers in processing.
Serve as a primary point of contact for clients, insurance providers, and third parties to maintain clear communication.
Lendbuzz develops innovative technologies to provide underserved and overlooked borrowers with better access to credit. They value diversity and have built a company culture around independent and critical thinking.