We have other current jobs related to this field that you can find below
-
Commercial Auto Claims Field Adjuster
2 months ago
Cleveland, United States Great West Casualty Company Full timeTake your tractor trailer and estimating skills out of the shop and into the field with a career as a Commercial Auto Claims Field Adjuster. This position is fully remote and will be located in or around the Cleveland, OH area.As a Commercial Auto Claims Field Adjuster for Great West, you will investigate, negotiate, and settle claims in the field by...
-
Healthcare Claims Specialist
6 days ago
Cleveland, Ohio, United States Everstaff Full timeJob OverviewEverStaff is seeking a skilled Medical Claims Adjuster to join our team. This role involves the meticulous review, investigation, and processing of medical claims to guarantee precise payments in accordance with policy stipulations.CompensationSalary Range: $50,000 - $65,000Benefits Offered:Comprehensive Medical, Dental, and Vision insurance401K...
-
Healthcare Claims Specialist
6 days ago
Cleveland, Ohio, United States Everstaff Full timeJob OverviewEverStaff is seeking a qualified Medical Claims Adjuster to support our client in the healthcare sector. The successful candidate will be tasked with the assessment, investigation, and processing of medical claims to guarantee precise payment in accordance with policy stipulations.CompensationSalary Range: $50,000 - $65,000Benefits...
-
Claims Examiner
2 weeks ago
Cleveland, United States Core Specialty Full timeMulti-state commercial insurance carrier is seeking a qualified Claims Examiner for a position in their Mayfield Heights, Ohio claims office. Hybrid position in Mayfield Heights (Cleveland) area. Key Accountabilities/Deliverables: Investigate commercial insurance automobile property damage claims. Claims will be handled from the initial loss report through...
-
Field Adjuster
3 months ago
Cleveland, United States CCMS & Associates Full timeCCMS & Associates is looking for a 1099 Field Adjuster in Ohio, specifically the Cleveland area. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team! We are seeking a residential or commercial field adjuster with at least 1 year of field experience. Requirements: + Minimum 1 year first-party...
-
Field Adjuster
3 months ago
Cleveland, United States CCMS & Associates Full timeJob DescriptionJob DescriptionCCMS & Associates is looking for a 1099 Field Adjuster in Ohio, specifically the Cleveland area. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team!We are seeking a residential or commercial field adjuster with at least 1 year of field experience. Requirements:...
-
Insurance Claims Analyst
6 days ago
Cleveland, Ohio, United States Core Specialty Full timeCore Specialty is in search of a proficient Claims Examiner to join our dynamic team in the insurance sector. This role is pivotal in our claims office, focusing on the evaluation and management of commercial automobile property damage claims. Key Responsibilities: Conduct thorough investigations of commercial insurance automobile property damage claims,...
-
Property Field Claims Representative
2 months ago
Cleveland, Ohio, United States Celina Insurance Group Full timeIn this role you will be responsible for providing claims service to Company policy holders, third party claimants and internal customers, by accomplishing a wide variety of claims adjusting activities. This individual will provide the highest level of customer service to our agents and policyholders. This position is based in Northeast Ohio and the...
-
Claims/Customer Care Specialist
1 month ago
Cleveland, United States Medical Mutual Full timeThe Claims/Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of an Ohio Medical Mutual office. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our...
-
Claims/Cust Care Spec
1 month ago
Cleveland, United States Medical Mutual Full timeThe Claims/Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, Ohio Medical Mutual office. We are presently seeking candidates with current or previous dental experience. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance...
-
Transportation Specialist for Seniors
6 days ago
Cleveland, Ohio, United States New Perspective Senior Living LLC Full timePosition OverviewWelcome to New Perspective Senior LivingAt New Perspective, we are committed to enhancing the lives of seniors through dedicated service and support. Our organization is focused on fostering a culture of teamwork and personal growth, where every employee is a vital part of our mission.Role SummaryAre you a caring individual eager to make a...
-
Claims Assistance Coordinator
6 days ago
Cleveland, Ohio, United States Metroaccidentrepair Full timeCustomer Service AdvisorFull TimeCompany OverviewMetro Accident Repair Center is dedicated to providing top-notch collision repair services by employing innovative processes and adhering to lean manufacturing principles. Our focus is on ensuring a seamless workflow that guarantees high-quality results and timely vehicle delivery.As a certified repair center...
-
Manager Quality and Claims
3 months ago
Cleveland, United States Sheffield Metals International Full timeJob DescriptionJob DescriptionManager, Quality and ClaimsThe Quality and Claims Manager is a key member of the Sheffield Metals Team. The Quality and Claims Manager position is responsible for processing and supporting all quality and continuous improvements within the company. This includes assurance related internal audits in adherence with regulatory...
-
Senior Care Driver
2 months ago
Cleveland, United States Senior Transportation C Full timeJob DescriptionJob Description Senior Transportation Connection (STC) provides coordinated, efficient and affordable transportation to seniors and adults with disabilities throughout Cuyahoga County. We serve individuals who have mobility challenges due to age, lack of access, disability, frailty or inability to drive. More than 12,000 registered...
-
Transportation Specialist for Seniors
16 hours ago
Cleveland, Ohio, United States New Perspective Senior Living LLC Full timePosition OverviewWelcome to New Perspective Senior LivingAt New Perspective, we are committed to enhancing the lives of seniors through dedicated service and community engagement. Our mission is to support over 2,000 seniors currently, with aspirations to expand our reach significantly. We believe in fostering a culture of teamwork and personal growth, where...
-
Senior Quality Assurance Specialist
6 days ago
Cleveland, Ohio, United States Experis Full timePosition Overview:Our client in the insurance sector is looking for a Senior Quality Assurance Specialist to enhance their team. In this role, you will be an integral part of the client support unit. The ideal candidate will possess a blend of Manual Testing, Automation, and AWS expertise that aligns with the organization's objectives.Job Title:Senior...
-
Care Partner for Senior Living Night Shift
3 weeks ago
Cleveland, United States Brooklyn Pointe Senior Living Full time $15Job DescriptionJob DescriptionCare Partner for Senior Living Night Shift. Full Time position, 12 hour shifts, 6pm to 6am. Please send resume for interview.Job Posted by ApplicantPro
-
Care Partner for Senior Living Night Shift
2 months ago
Cleveland, United States Brooklyn Pointe Senior Living Full timeJob DescriptionJob DescriptionCare Partner for Senior Living Night Shift. Full Time position, 12 hour shifts, 6pm to 6am. Please send resume for interview.Job Posted by ApplicantPro
-
Full-Time Lecturer/Senior Lecturer
2 months ago
Cleveland, Ohio, United States Case Western Reserve University Full timeFull-Time Lecturer/Senior Lecturer - Jack, Joseph and Morton Mandel School of Applied Social SciencesThe Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University invites applications for a full-time (100% FTE) Lecturer or Senior Lecturer position. This position will require teaching four courses over three semesters...
-
{Westlake} Caregivers
3 months ago
Cleveland, United States ProMedica Senior Care Full timeLooking for a professional career or just to pick up a few shifts a week? You have options with a company that cares - meet ProMedica Senior Living. We are actively hiring caregivers & CNAs to work within a few miles of Westlake. Premium wages reviewed annually for market competitiveness along with Daily Pay Professional Growth: Work with people who inspire...
Senior Lost Time Claims Adjuster
2 months ago
Senior Lost Time Claims Adjuster - Workers Compensation
#4011
Multiple Locations
Apply for this job now
Job Description:
As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.
Responsibilities:
Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature
Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
Alert Supervisor and Special Investigations Unit to potentially suspect claims
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
Negotiate claims settlements with client approval
Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
Work collaboratively with PMA nurse professionals to develop and execute return to work strategies
Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome
Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced
Demonstrate technical proficiency through timely, consistent execution of best claim practices
Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues
Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions
Authorize treatment based on the practiced protocols established by statute or the PMA Managed Care department
Assist PMA clients by suggesting panel provider information in accordance with applicable state statutes.
Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work.
Requirements:
Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required
At least 3-5 years' experience handling lost time workers compensation claims required; past experience with Ohio jurisdiction is required
Associate in Claims (AIC) Designation or similar professional designation desired.
Active license required or ability to obtain license within 90 days of employment in mandated states.
Familiarity with medical terminology and/or Workers' Compensation
Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
Strong verbal, written communication skills and customer service skills
Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint.
Ability to travel for business purposes, approximately less than 10%.
Locations
BLUE BELL
Cincinnati
Cleveland
Columbus
Dayton
Toledo
#J-18808-Ljbffr