<p>We are looking for a dedicated Claims Representative to join our team in Napoleon, Ohio. This position involves adjusting and settling claims across various lines of business. As a Contract to permanent role, it offers the opportunity to transition to a long-term position based on performance and company needs. The ideal candidate will have strong communication skills, a commitment to customer service, and the ability to work effectively within company systems.</p><p><br></p><p>Responsibilities:</p><p>• Manage claims in accordance with company policies and the Unfair Claims Practices Act.</p><p>• Verify coverage for assigned claims to ensure proper handling.</p><p>• Conduct investigations and evaluations to determine appropriate settlements.</p><p>• Coordinate with independent adjusters and appraisers when necessary.</p><p>• Handle subrogation, salvage, and third-party liability contributions.</p><p>• Notify supervisors about claims exceeding settlement authority limits.</p><p>• Set accurate reserves for claims and monitor their status.</p><p>• Report potential fraud, complaints, or questionable submissions to the Claims Supervisor.</p><p>• Participate in training seminars and relevant associations to enhance skills.</p><p>• Complete additional tasks assigned by the Claims Supervisor or Manager.</p>
We are looking for an experienced Workers’ Compensation Senior Claim Representative to join our team in Los Angeles, California. In this role, you will oversee the management of workers’ compensation lost time claims, ensuring compliance with statutory regulations and delivering exceptional customer service throughout the claims process. This is a Long-term Contract position requiring strong analytical, communication, and organizational skills.<br><br>Responsibilities:<br>• Manage all aspects of workers’ compensation lost time claims from initial setup to resolution, maintaining high standards of customer service.<br>• Conduct thorough investigations to gather facts, obtain statements, and assess compensability of claims.<br>• Administer statutory medical and indemnity benefits promptly and accurately throughout the duration of each claim.<br>• Collaborate with attorneys to oversee hearings and manage litigation processes effectively.<br>• Establish and adjust reserve amounts for medical, indemnity, and related expenses within authority limits.<br>• Coordinate with vendors, nurse case managers, and rehabilitation managers to ensure optimal medical management and return-to-work initiatives.<br>• Prepare detailed reports documenting investigation outcomes, claim settlements, denials, and evaluations.<br>• Ensure compliance with state regulations by accurately filing workers’ compensation forms and electronic data.<br>• Refer claims for subrogation and facilitate recovery opportunities by securing necessary documentation.<br>• Work closely with internal teams, including Technical Assistants and Special Investigators, to exceed customer expectations and deliver superior claims handling.
<p>A prominent Michigan-based organization in the insurance sector is looking for a dynamic <strong>Claims Director</strong>. This position is ideal for an experienced leader with expertise in claims management, litigation oversight, and operational strategy.</p><p><br></p><p><strong><u>*This is a hybrid position- in-office 2-3 days per month; however, candidates must currently reside in Michigan to be considered.*</u></strong></p><p><br></p><p><strong>Responsibilities: </strong></p><p>Responsible for overseeing all operations of the Assigned Claims Program and related organizational tasks. Serves as a member of the senior leadership team, providing strategic and day-to-day oversight of claims functions, litigation, servicing insurers, third-party administrators (TPAs), vendors, and staff. Manages multi-million-dollar budgets, ensures compliance with regulations, and supports the executive team with personnel, technology, and policy initiatives. This role involves managing litigation processes, supervising claims activities, and ensuring compliance with industry regulations and organizational standards. The ideal candidate will possess strong leadership skills, a deep understanding of insurance claims, and expertise in litigation management.</p><p><br></p><ul><li>Direct daily operations of the assigned claims unit, including staff management, workflow, and quality control.</li><li>Develop and manage program budgets, expenses, and financial reporting.</li><li>Oversee litigation strategy, appeal processes, and counsel/vendor partnerships.</li><li>Monitor servicing insurers and TPAs to ensure compliance, performance, and effective claims handling.</li><li>Lead committees, task forces, and organizational initiatives, including No-Fault Reform strategy.</li><li>Provide training, coaching, performance management, and employee engagement initiatives for staff.</li><li>Oversee technology and IT projects supporting claims operations.</li><li>Represent the organization in litigation, industry groups, and external committees as needed.</li><li>Ensure policies, procedures, and statutory requirements are up to date and enforced.</li><li>Review vendor contracts, legal billing, and claims documents to ensure accuracy and compliance.</li><li>Support the executive director and collaborate with leadership on organizational strategy and initiatives.</li></ul>
We are looking for a skilled Claims Examiner specializing in lost time workers' compensation claims to join our team in Jersey City, New Jersey. This is a contract position requiring expertise in managing claims processes from initiation to resolution. The role involves handling complex cases, ensuring compliance with statutory regulations, and delivering exceptional customer service.<br><br>Responsibilities:<br>• Manage the full lifecycle of workers' compensation lost time claims, from initial setup to closure, ensuring a seamless process.<br>• Conduct detailed investigations, including gathering facts, taking statements, and reviewing policy details to assess claim validity.<br>• Evaluate claim compensability based on investigation findings and communicate decisions to claimants, insured parties, and attorneys.<br>• Prepare comprehensive reports on claim statuses, settlements, denials, and evaluations of involved parties.<br>• Administer statutory medical and indemnity benefits promptly throughout the duration of the claim.<br>• Set and adjust reserves for medical, indemnity, and expenses within established authority limits.<br>• Collaborate with attorneys to manage hearings and litigation effectively.<br>• Oversee vendors, rehabilitation managers, and case managers to support medical management and return-to-work initiatives.<br>• Ensure compliance with state regulations by filing necessary workers' compensation forms and electronic data.<br>• Identify subrogation opportunities and secure required information to maximize recovery potential.
We are looking for a dedicated Claims Adjustor to join our team on a contract basis in Des Moines, Iowa. In this role, you will handle medical-only workers' compensation claims, ensuring accuracy and prompt processing. This position requires excellent customer service skills and attention to detail to effectively manage a low volume of daily calls and claims.<br><br>Responsibilities:<br>• Review workers' compensation claims to ensure compliance with medical and insurance standards.<br>• Process medical-only claims accurately and in a timely manner.<br>• Communicate with customers to address inquiries and provide exceptional service.<br>• Collaborate with team members to maintain organized and efficient claim workflows.<br>• Handle medical billing and insurance claim documentation with precision.<br>• Monitor and manage medical denials and appeals to resolve issues.<br>• Support hospital billing processes and ensure proper claim handling.<br>• Maintain detailed records for claims and related communications.<br>• Identify discrepancies in claim submissions and take corrective actions.<br>• Provide regular updates and reports on claim processing activities.
We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal for someone with extensive experience in medical claims processing and a strong ability to manage repetitive clerical tasks effectively. The role requires a collaborative team player who is dependable, punctual, and committed to delivering high-quality results.<br><br>Responsibilities:<br>• Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date.<br>• Resubmit denied or rejected claims, following proper protocols to secure approvals.<br>• Post payments accurately into multiple systems, maintaining consistency and precision.<br>• Utilize payer portals to manage claims and track progress effectively.<br>• Perform clerical tasks such as data entry and filing with a focus on accuracy and attention to detail.<br>• Collaborate with a team of professionals to ensure smooth workflows and timely completion of tasks.<br>• Monitor claim statuses to identify and resolve discrepancies proactively.<br>• Maintain compliance with relevant policies and regulations in the healthcare industry.<br>• Provide support in behavioral health payment posting processes.<br>• Communicate effectively with team members and external parties regarding claim-related issues.
<p>We are looking for a Medical Claims Supervisor to lead a dynamic team in Winston-Salem, North Carolina. This role requires a skilled leader with a strong background in healthcare claims and a commitment to driving performance while maintaining a supportive team environment. The ideal candidate will bring both industry expertise and leadership experience to help the department achieve its goals. This is an onsite position. </p><p><br></p><p>Responsibilities:</p><p>• Oversee the daily operations of a team handling healthcare claims inquiries and adjudications.</p><p>• Monitor performance metrics, including KPIs, to ensure the department meets its objectives.</p><p>• Provide guidance and support to team members, fostering growth and accountability.</p><p>• Address escalated claims-related issues and ensure timely resolution.</p><p>• Collaborate with team leads to implement strategies that enhance efficiency and service quality.</p><p>• Develop and maintain workflows for processing claims and customer service inquiries.</p><p>• Train and onboard new hires, ensuring they understand company policies and procedures.</p><p>• Maintain a cohesive team environment, balancing empathy with performance-driven management.</p><p>• Evaluate and improve processes related to CRM systems to optimize customer interactions.</p><p>• Coordinate with upper management to align departmental goals with organizational priorities.</p>
<p>We are looking for an experienced Workers’ Compensation Senior Claim Representative to join our team in Los Angeles, California. In this role, you will oversee the management of workers’ compensation lost time claims, ensuring compliance with statutory regulations and delivering exceptional customer service throughout the claims process. This is a Long-term Contract position requiring strong analytical, communication, and organizational skills.</p><p><br></p><p>Responsibilities:</p><p>• Manage all aspects of workers’ compensation lost time claims from initial setup to resolution, maintaining high standards of customer service.</p><p>• Conduct thorough investigations to gather facts, obtain statements, and assess compensability of claims.</p><p>• Administer statutory medical and indemnity benefits promptly and accurately throughout the duration of each claim.</p><p>• Collaborate with attorneys to oversee hearings and manage litigation processes effectively.</p><p>• Establish and adjust reserve amounts for medical, indemnity, and related expenses within authority limits.</p><p>• Coordinate with vendors, nurse case managers, and rehabilitation managers to ensure optimal medical management and return-to-work initiatives.</p><p>• Prepare detailed reports documenting investigation outcomes, claim settlements, denials, and evaluations.</p><p>• Ensure compliance with state regulations by accurately filing workers’ compensation forms and electronic data.</p><p>• Refer claims for subrogation and facilitate recovery opportunities by securing necessary documentation.</p><p>• Work closely with internal teams, including Technical Assistants and Special Investigators, to exceed customer expectations and deliver superior claims handling.</p>
We are looking for a dedicated and detail-oriented Case Manager to join a dynamic plaintiff litigation law firm in Santa Barbara, California. This permanent position offers the opportunity to grow into a leadership role, blending case management expertise with office oversight responsibilities. If you are motivated, organized, and eager to become a key part of a thriving legal team, this role is designed for you.<br><br>Responsibilities:<br>• Assist with legal administrative tasks and learn case processes from intake to settlement.<br>• Support case managers by gaining hands-on experience with file management and workflow.<br>• Take on a manageable caseload as a Senior Case Manager, providing strategic guidance and ensuring timely case progression.<br>• Oversee staff workflows and productivity, stepping into an Office Manager role over time.<br>• Conduct twice-daily team check-ins to monitor task completion and file movement.<br>• Lead hiring, onboarding, and training initiatives for new case managers.<br>• Manage HR-related duties, including tracking time-off requests, conducting employee reviews, and maintaining payroll records.<br>• Organize and improve internal systems to enhance team efficiency and accountability.<br>• Serve as the point of contact for case strategy discussions and file reviews.
<p>We are looking for a compassionate and thorough Bilingual Case Manager to join our team in Los Angeles, California. In this long-term contract position, you will play a vital role in providing support to individuals by connecting them with essential resources and services. This is a great opportunity for someone with strong organizational skills and a passion for helping others thrive in challenging circumstances.</p><p><br></p><p>Responsibilities:</p><p>• Conduct comprehensive intake assessments to understand clients' needs and develop personalized service plans.</p><p>• Provide ongoing case management, including crisis intervention and support for clients.</p><p>• Facilitate access to community resources such as housing, healthcare, employment, and mental health services.</p><p>• Maintain accurate and up-to-date documentation of case notes and ensure compliance with program guidelines.</p><p>• Collaborate with internal team members and external social service providers to coordinate effective client care.</p><p>• Participate in regular team meetings, training sessions, and development opportunities.</p><p>• Monitor client progress and adjust service plans as necessary to meet evolving needs.</p><p>• Advocate for clients to ensure they receive appropriate services and support.</p><p>• Stay informed about local community programs and resources to enhance service delivery.</p>
