<p>We are looking for an experienced and meticulous Claims Adjuster to assist with our client with handling New York based Workers Compensation Claims. </p><p>This is a fully remote, temporary-to-permanent opportunity. </p><p>To be considered, candidates must possess a valid NY Adjusters License and have experience working workers compensation specific claims.</p><p>Responsibilities include:</p><ul><li>Conduct in-depth investigations and evaluations of complex workers' compensation claims, applying strong analytical skills to drive informed decision-making and achieve timely resolution.</li><li>Collaborate closely with clients to develop innovative strategies and continuously improve the claims management process.</li><li>Utilize critical thinking and problem-solving abilities to effectively plan, prioritize, and manage tasks that support both client and claimant needs.</li><li>Leverage claims management expertise to assess exposure, determine appropriate action plans, and drive timely and effective claim resolutions.</li><li>Maintain thorough and timely documentation of all claim activities, ensuring transparency and supporting claim outcomes.</li><li>New York Adjusters License is required.</li></ul><p><br></p><p><br></p>
<ul><li><strong>Position: Claims Examiner - Lost Time (Contract Role)</strong></li><li><strong>Location: 555 Long Wharf Drive New Haven CT USA 06511-5941</strong></li><li><strong>Type: 100% Onsite</strong></li><li><strong>Hourly Pay Range: $30-33/per hour</strong></li><li><strong>Interview Process: Virtual interview 1-2 round of 30 minute interview</strong></li></ul><p> </p><p><strong>Job Description: </strong></p><p>Job Schedule-100% ONSITE</p><p>Job hours-8:30am-5:00pm EST</p><p> </p><p>3 years of Workers Compensation Lost Time Claim Examiner or Commensurate Experience </p><p> </p><p>Duties and Responsibilities:</p><p>- Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.</p><p>- Reviews claim and policy information to provide background for investigation.</p><p>- Conducts 3-part ongoing investigations obtaining facts and taking statements as necessary with insured claimant and medical providers.</p><p>- Evaluates the facts gathered through the investigation to determine compensability of the claim.</p><p>- Informs insureds claimants and attorneys of claim denials when applicable.</p><p>- Prepares reports on investigation settlements denials of claims and evaluations of involved parties etc.</p><p>- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.</p><p>- Sets reserves within authority limits for medical indemnity and expenses and recommends reserve changes to Team</p><p>Leader throughout the life of the claim.</p><p>- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.</p><p>- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.</p><p>- Works with attorneys to manage hearings and litigation</p><p>- Controls and directs vendors nurse case managers telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.</p><p>- Complies with customer service requests including Special Claims Handling procedures file status notes and claim reviews.</p><p>- Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.</p><p>- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.</p><p>- Works with in-house Technical Assistants Special Investigators Nurse</p><p>Consultants Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.</p>
We are looking for a skilled Claims Examiner specializing in lost time claims to join our team on a contract basis in Jersey City, New Jersey. In this role, you will oversee the full lifecycle of workers' compensation claims, ensuring compliance with regulations while maintaining strong relationships with all involved parties. This position requires someone with excellent attention to detail, capable of managing complex claims processes and delivering high-quality service.<br><br>Responsibilities:<br>• Manage workers' compensation lost time claims from initial setup to closure, maintaining excellent customer relationships throughout the process.<br>• Conduct thorough investigations by reviewing policy details, collecting statements, and gathering facts from claimants, insured parties, and medical providers.<br>• Evaluate gathered information to determine claim compensability and communicate decisions regarding claim approvals or denials to all relevant parties.<br>• Administer statutory medical and indemnity benefits in a timely manner, ensuring compliance with applicable regulations.<br>• Set and adjust claim reserves for medical, indemnity, and related expenses, recommending changes to the Team Leader as necessary.<br>• Partner with attorneys to oversee litigation processes, including hearings, and manage legal documentation.<br>• Direct and coordinate efforts with vendors, nurse case managers, and rehabilitation managers to support medical management and return-to-work initiatives.<br>• Prepare and submit reports on claim settlements, denials, evaluations, and potential exposures to the Team Leader.<br>• Ensure compliance with state regulations by filing workers' compensation forms and electronic data accurately and on time.<br>• Identify subrogation opportunities and work to recover claim-related costs effectively.
<p>We are looking for a dedicated Case Manager to join a stable team in Sherman Oaks looking to add a new member of the team. This firm specializes in personal injury cases, and this role is crucial to ensuring clients receive the support and advocacy they need throughout the claims process. The ideal candidate will thrive in a collaborative and focused environment while demonstrating exceptional organizational and communication skills.</p><p><br></p><p>Responsibilities:</p><p>• Manage claims processing with various insurance carriers, including health insurance providers, Medicare, and MediCal.</p><p>• Resolve property damage and loss of use claims efficiently and effectively.</p><p>• Coordinate with healthcare providers to schedule medical appointments for injury treatment.</p><p>• Advocate for clients by monitoring medical treatments and organizing care based on provider recommendations.</p><p>• Review, analyze, and interpret medical records, surgical reports, and medical bills.</p><p>• Prepare comprehensive case files for submission to the demands department.</p><p>• Maintain clear and precise communication with clients, healthcare providers, and internal staff.</p><p>• Collaborate with team members to ensure seamless case management and support.</p><p>• Utilize case management software and tools to maintain accurate and organized documentation.</p>
<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 4-5 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>
<p>Reputable personal injury firm is seeking an experienced and compassionate Case Manager to join their team. This position is ideal for someone with a strong background in personal injury law who thrives in a fast-paced environment and is committed to delivering exceptional client service. As a key member of our legal team, you will play a vital role in managing cases, communicating with clients, and supporting attorneys to ensure successful outcomes.</p><p><br></p><p>Responsibilities:</p><p>• Conduct initial interviews with prospective clients to gather relevant case information.</p><p>• Request, review, and organize medical records related to client cases.</p><p>• Maintain consistent communication with insurance companies, medical providers, and clients to provide updates and address inquiries.</p><p>• Draft and send correspondence letters to clients, insurance companies, and healthcare providers.</p><p>• Collaborate closely with attorneys to review case status and develop strategies.</p><p>• Perform investigative tasks related to claims and pre-litigation case work.</p><p>• Manage administrative duties such as faxing, filing, and copying to support case management.</p><p>• Oversee and prioritize a substantial caseload while ensuring accuracy and timeliness.</p><p>• Assist staff and team members with various tasks, ensuring seamless workflow and collaboration.</p><p>• Utilize software tools, including Microsoft Word and Excel, to maintain organized records and documentation.</p>
<p><strong>Firm seeks Coverage Opinion Writing Attorney (No Litigation)</strong></p><p><br></p><p>This Attorney opening involves working closely with insurers to provide expert advice and analysis on insurance coverage matters. The ideal attorney will have a deep understanding of various insurance policies and be adept at drafting comprehensive coverage opinions.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Collaborate with insurers to provide advice on insurance coverage and interpret policies.</li><li>Analyze various types of insurance policies across an array of industries.</li><li>Draft detailed coverage opinions based on policy analysis and contract interpretation.</li><li>Maintain effective communication with clients and internal team members.</li></ul><p><br></p><p>Billable hour target: 1850/year</p><p><br></p><p>Can work 100% remote in US (PST work hours)</p><p><br></p><p><u>Perks of Firm</u>:</p><ol><li>Established for over 30 years</li><li>Multiple offices with large firm resources</li><li>Women-owned firm</li></ol><p><br></p>
<p>We are looking for a dedicated Claims Admin Support Specialist to join our client's team in Oxford, MS. In this role, you will handle a variety of clerical tasks, ensuring smooth office operations and providing support to internal teams. This is a long-term contract position, offering an excellent opportunity to utilize your organizational skills and attention to detail.</p><p><br></p><p>Responsibilities:</p><p>• Manage and maintain office supplies to ensure adequate inventory levels.</p><p>• Operate and oversee office equipment, including fax machines, printers, and copiers, ensuring functionality and addressing issues as needed.</p><p>• Coordinate document shredding services with external vendors to maintain compliance with company policies.</p><p>• Organize, retrieve, and deliver files while performing document scanning and copying as required.</p><p>• Draft and send routine correspondence, ensuring professionalism and accuracy.</p><p>• Welcome visitors and address routine inquiries or direct them to the appropriate department.</p><p>• Sort, open, and distribute incoming mail and packages, including FedEx and other courier services.</p><p>• Assist with scheduling meetings, maintaining records, and organizing retention processes.</p><p>• Perform additional research, reporting, and administrative tasks as requested by leadership.</p><p>• Travel occasionally to fulfill job-related responsibilities.</p>
We are looking for a Claims Admin Support Specialist to join our team in Maitland, Florida. This role involves performing a variety of administrative and clerical tasks, ensuring office operations run smoothly under direct supervision. As this is a long-term contract position, it offers stability and an opportunity to contribute to a dynamic work environment.<br><br>Responsibilities:<br>• Maintain and manage the inventory of office supplies to ensure availability for daily operations.<br>• Operate and oversee office equipment such as fax machines, printers, and copiers, ensuring proper functionality.<br>• Coordinate document shredding services with external vendors to uphold confidentiality standards.<br>• Handle document management tasks, including retrieving files, making copies, and delivering documents as needed.<br>• Draft routine correspondence and respond to visitor inquiries with professionalism and efficiency.<br>• Open, sort, and distribute incoming mail and packages, including deliveries from FedEx and other couriers.<br>• Assist in organizing meetings, coordinating record retention, and performing additional clerical support as requested.<br>• Conduct research and compile reports based on leadership requests to support decision-making processes.<br>• Occasionally travel to fulfill job-related duties and meet organizational needs.
<p>We are seeking a highly organized and detail-oriented <strong>Insurance Authorization Specialist</strong> with proven <strong>Microsoft Excel expertise</strong> to join our team. In this critical role, you will be responsible for securing insurance authorizations and ensuring compliance with pre-approval requirements for medical services and procedures. If you thrive in fast-paced environments and are motivated by efficiency and accuracy, we want to hear from you!</p><p><strong>Key Responsibilities</strong></p><ul><li>Obtain and manage authorizations from insurance providers for medical services and procedures.</li><li>Track and document authorization statuses in systems, spreadsheets, and other databases.</li><li>Maintain organized records in <strong>Microsoft Excel</strong> for tracking deadlines, approvals, and patient-specific insurance requirements.</li><li>Collaborate with medical staff and billing departments to ensure insurance approvals align with patient care plans.</li><li>Communicate with patients and insurance companies to address issues, verify coverage requirements, or request additional documentation.</li><li>Proactively follow up on pending authorizations to avoid delays in medical services.</li><li>Ensure compliance with HIPAA regulations and insurance provider-specific policies.</li></ul><p><br></p>
We are looking for an experienced Insurance Service Associate to join our team on a long-term contract basis in Rochester, New York. In this role, you will provide exceptional customer service to clients in the Paychex Property and Casualty Insurance division, ensuring that all claims and inquiries are managed efficiently and in alignment with company policies. This position offers an opportunity to work in a fast-paced environment, where attention to detail and effective communication are essential.<br><br>Responsibilities:<br>• Deliver outstanding customer service to clients by addressing inquiries, resolving complaints, and processing claims in adherence to company policies.<br>• Develop and maintain a solid understanding of the Paychex Property and Casualty Insurance product offerings.<br>• Utilize various software systems, including Salesforce and Adobe Flex, to manage client interactions and maintain accurate records.<br>• Perform data entry tasks with precision, ensuring timely and organized completion of assignments.<br>• Document all client interactions and service activities to maintain detailed and accessible records.<br>• Collaborate with team members and other departments to ensure seamless customer service delivery.<br>• Prioritize and organize tasks effectively to meet deadlines and support operational efficiency.<br>• Stay updated on industry procedures and policies to enhance service quality and compliance.<br>• Assist with administrative tasks such as photocopying, scanning, and preparing documents.<br>• Provide support for HRIS systems and other tools integral to operations.
<p>We are looking for a detail-oriented Personal Injury Plaintiff Case Manager to join our team in Los Angeles, California. In this role, you will oversee personal injury cases, ensuring efficient claim processing, effective communication, and timely management of client needs. The ideal candidate will have a strong background in case management and a commitment to delivering exceptional client service.</p><p><br></p><p>Responsibilities:</p><p>• Process and open health insurance claims with accuracy and attention to detail.</p><p>• Upload and organize critical documents into the company’s case management software.</p><p>• Schedule and coordinate medical appointments while maintaining an up-to-date calendar.</p><p>• Serve as the primary point of contact for clients, addressing their concerns promptly and professionally.</p><p>• Ensure proper documentation and tracking of case details to support smooth claim administration.</p><p>• Collaborate with internal teams to streamline workflows and maintain case progress.</p><p>• Utilize CRM tools to manage client interactions and maintain detailed records.</p><p>• Monitor case timelines and ensure all deadlines are met.</p><p>• Stay informed about personal injury law and regulations to provide informed support.</p><p>• Maintain confidentiality and adhere to legal compliance standards.</p>
<p>We are looking for a skilled Insurance Authorization Coordinator to join our client's team on a short-term contract basis. This position is based in Knoxville, Tennessee, and will primarily involve remote work within the Eastern Time Zone, with occasional on-site visits as needed. In this role, you will collaborate with the Chief Compliance Officer and internal insurance teams to address operational issues, complaints, and the development of policy and procedure manuals.</p><p><br></p><p>Responsibilities:</p><p>• Partner with the Chief Compliance Officer to support the insurance policy project.</p><p>• Collaborate with internal insurance staff to identify and address operational complaints and issues.</p><p>• Develop and refine procedure manuals and policies to ensure compliance and operational efficiency.</p><p>• Conduct thorough reviews of existing documentation and recommend improvements.</p><p>• Facilitate communication among stakeholders to gather insights and feedback.</p><p>• Conduct occasional on-site visits to support project needs.</p><p>• Ensure all documentation aligns with industry standards and regulatory requirements.</p><p>• Maintain accurate records and version control for all policy documents.</p><p>• Provide expertise in property and casualty insurance to guide policy development.</p><p>For immediate consideration please contact: Brenda Rodriguez at 865-370-2206</p>
