Inside Claims Representative
Columbus, OH
Division or Field Office: Claims Division Zone Operations Dept Work from: Columbus Branch- Remote Salary Range: $44,055.00 - $70,372.00 * salary range is for this level and may vary based on actual level of role hired for * This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.
At Erie Insurance, you're not just part of a Fortune 500 company; you're also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.
Benefits That Go Beyond The Basics
We strive to be Above all in Service to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including:
* Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
* Low contributions to medical and prescription premiums. We currently pay up to 97% of employees' monthly premium costs.
* Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
* 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
* Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave.
* Career development. Including a tuition reimbursement program for higher education and industry designations.
Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.
Position Summary
Under close supervision, handles liability and property claims within designated authority. Resolves coverage and/or liability issues in accordance with applicable state insurance laws, regulations, and procedures.
Candidate must reside within 50 miles of ERIE's Columbus Branch Office. Schedule is 8:00 - 4:30 Monday - Friday with the requirement to work rotating evening and Saturday shifts. Schedule is subject to change based on business and service level needs.
Duties and Responsibilities
* Investigates and adjudicates claims within designated authority, ensuring compliance with appropriate statutory laws. Verifies coverage, establishes and maintains reserves, secures recorded statements, drafts and processes correspondence, reports and records. Obtains additional information as required to determine liability. Documents claim files and facilitates processing of claims in collaboration with other departments. Assigns outside experts when necessary to assist in investigation and in support of potential recovery.
* Establishes contact with all parties involved in the claim in accordance with ERIE's expectations.
* Evaluates and negotiates claims, recognizes subrogation opportunities, and initiates action. Sets up and/or issues payment using ERIE's approved payment methods for settlement; or declines payment within designated authority.
* Responds to inquiries from Policyholders, Agents, insurance carriers, claimants, assigned experts and others.
* Learns and maintains knowledge of liability laws for each state. Learns and maintains knowledge of motor vehicle codes.
* Learns and maintains knowledge of no fault/medical management/FPB laws for each state, including recognition of bodily injury claims.
* With supervisor guidance, responds to intercompany arbitration applications. Files contentions and supporting documents on behalf of the insured/driver.
* Conducts research, attends industry-related training programs and other training sessions to stay current on policy changes, interpretation, or new legislation.
* Provides support for property claims during periods of heavy volume.
The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.
This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear.
Capabilities
* Self-Development
* Collaborates
* Cultivates Innovation
* Instills Trust
* Decision Quality
* Values Diversity
* Nimble Learning
* Customer Focus
* Optimizes Work Processes
* Ensures Accountability
* Detail Orientation
* Information Management Skills
* Job-Specific Knowledge
Qualifications
Minimum Educational and Experience Requirements
* High school diploma or GED and two years of related claims handling or customer service experience, or equivalent educational experience required.
* Bachelor's or Associate's degree preferred.
Designations and/or Licenses
* Successful completion of Introduction to Insurance (INTRO) and Introduction to Claims (AIC 30) preferred.
* Obtain appropriate licenses as required by state within 45 days of employment in the role for external applicants and 90 days of employment in the role for internal applicants.
Physical Requirements
* Manual Keying/Data Entry/inputting information/computer use; Frequent (50-80%)
* Climbing/accessing heights; Rarely
* Ability to move over 50 lbs using lifting aide equipment; Rarely
* Driving; Never
* Lifting/Moving 0-20 lbs; Rarely
* Lifting/Moving 20-50 lbs; Rarely
* Pushing/Pulling/moving objects, equipment with wheels; Rarely
Nearest Major Market: Columbus
Represented Bodily Injury Adjuster (NE/OH)
Ohio
At Allstate, great things happen when our people work together to protect families and their belongings from life's uncertainties. And for more than 90 years our innovative drive has kept us a step ahead of our customers' evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection.
Job Description
A day in the life of a Represented Bodily Injury Adjuster, and what it takes to do the job!
As a Represented Bodily Injury Adjuster, your main focus will be investigating automobile accidents involving single or multiple vehicles, which result in property damage and/or bodily injury with attorney/litigation involved. You will have the convenience of working remotely from your home while efficiently handling your responsibilities. You will assess coverage, liability, and damages while providing exceptional customer service throughout your day. Customer and attorney communication will take place through different channels, including voice calls, email, and text messages. Through the utilization of innovative platforms and tools, you will engage in negotiation processes to reach fair injury settlements with all parties involved.
You may be eligible for a $1000 Licensing Sign on Bonus if you have the applicable active licenses needed for this role. This could include Home Resident Property & Casualty License, Designated Home State (DHS) Florida or Texas License, and/or applicable Appraiser License.
**Candidates who have previously worked for and are seeking to be rehired at Allstate and its family of companies are not eligible for this sign-on bonus.
**
Allstate Benefits:
Being a part of Allstate means you receive a benefits package from Day 1 of employment. This includes time off, healthcare, retirement, and more. That is why as an Allstater, you'll enjoy a Total Rewards package that includes:
Competitive pay with needed support for continuous development and career advancement.
Flexibility in scheduling and a time off policy that helps support your work/life balance.
Initial and ongoing training to get you proficient in your new role
Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life. Visit ************************ to learn more.
It is likely that this position will mainly handle represented claims, with litigated claims handling at times.
You'll wear a few hats to fill a few roles throughout your day that all require a level of experience:
The Customer Service Expert- you'll live into Allstate's Claims Culture by caring, empowering, and restoring, and you will accomplish that by being compassionate, clear, and a committed partner in each Casualty claim. You lead with empathy, always.
The Investigator - you'll confidently and independently investigate casualty claims by performing detailed reviews of damage and interpreting policies to determine coverage.
The Effective Communicator - you'll use phone, emails and sometimes even video chat with customers to help them through a fast, fair, and easy claims process. You'll also incorporate a specific approach to claim handling to offer the customer their preference of communication to efficiently discuss their claim needs and keep them updated on the claim progress.
The Negotiator- You will evaluate and negotiate claims settlements with customers, vendors, third party carriers and claimants, in accordance with all legal and business standard methodologies. With negotiations, you will incorporate tactics in handling challenging and complex situations.
The Problem Solver - you'll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills.
The Recorder - you'll protect the company financially by executing policies along policy agreements, and you keep a clear record of your work in a claims system that you will be trained on. You'll accomplish this by ensuring timely and accurate documentation is completed as you work on each claim.
Preferred Qualifications:
Prior represented casualty claim handling experience is preferred
New England states and Ohio claims experience preferred
2-5 years of BI claim handling experience is preferred
Proficient communication skills, especially over the phone, to establish rapport and assess claims accurately.
Ability to work independently and remotely, while managing time efficiently.
Familiarity with insurance policies, coverage, and liability determination.
Strong critical thinking and problem-solving skills to evaluate and negotiate injury claims successfully.
Knowledge of innovative tools and platforms for effective claims evaluation.
Notice of Licensing Requirement:
As a condition of employment, your office/area may require you to obtain an adjuster and/or an appraiser license. If applicable, you will be required to secure license(s) within 60 days of hire.
If required, the Hiring Manager will work with you along with the Centralized Licensing team to ensure that you are properly licensed.
It is likely that this position will mainly handle represented claims with litigation pending claims handled at times, for the following states: all New England states, OH.
Candidates on the Eastern time zone are preferred
however, those on Central time zone will also be considered.
Remote Work:
This position is a permanent remote home-based role. Your home office does not need to be near an Allstate office, but it does need to be in the United States. This position is not available for California, Alaska, and Hawaii residents.
When you work from home full time, you'll need:
a dedicated workspace in your residence that is private and free from distractions
a minimum internet bandwidth of 50 MB down/5 MB up
appropriate work surface and seating
What will Allstate provide?
A technology bundle that includes all equipment needed to perform your work from home (laptop, monitors, headset, keyboard, mouse)
Connectivity reimbursement of $80 per month to offset some of the cost of internet
#LI-AK1
Skills
Business Communications, Critical Thinking, Customer Centricity, Digital Literacy, Fraud Investigations, Inclusive Leadership, Information Collection, Learning Agility, Results-Oriented, Time Management
Compensation
Compensation offered for this role is $56,500.00 - 99,962.50 annually and is based on experience and qualifications.
The candidate(s) offered this position will be required to submit to a background investigation.
Joining our team isn't just a job - it's an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. And one where you can impact the future for the greater good.
You'll do all this in a flexible environment that embraces connection and belonging. And with the recognition of several inclusivity and diversity awards, we've proven that Allstate empowers everyone to lead, drive change and give back where they work and live.
Good Hands. Greater Together.
Allstate generally does not sponsor individuals for employment-based visas for this position.
Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.
For jobs in San Francisco, please click “here” for information regarding the San Francisco Fair Chance Ordinance.
For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.
To view the “EEO is the Law” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs
To view the FMLA poster, click “here”. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint.
It is the Company's policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee's ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.
Claims Manager, Commercial Lines
Columbus, OH
Overmyer Hall Associates is seeking to add a Claims Manager to their Commercial Lines Service team! The Claims Manager will be primarily responsible for advocating for our clients throughout the claims process and acting as a liaison between our clients and the carrier. The ideal candidate for this role will bring a level of expertise to the team to ensure that claims are handled proactively, timely, professionally, and accurately. The Claims Manager is a hybrid full-time opportunity based in our Columbus office, and will report to our Claims Leader, Property & Casualty.
ABOUT HUB INTERNATIONAL:
Overmyer Hall Associates, a Hub International company, is one of the largest property & casualty insurance agencies in Central Ohio, specializing in commercial insurance, risk management, surety and personal lines. Hub International is a leading full-service global insurance broker and financial services firm providing risk management, insurance, employee benefits, retirement and wealth management products and services. With more than 18,000 employees in offices located throughout North America, Hub's vast network of specialists brings clarity to a changing world with tailored solutions and unrelenting advocacy, so clients are ready for tomorrow.
Do you have a passion for success and a desire to grow? Do you want to be part of a diverse, professional team who will always have your back? Overmyer Hall Associates leads the insurance industry because of our expert team members and their access to continuing education. A career at Overmyer Hall Associates means colleagues continue to grow, client relationships continue to strengthen, and the endless opportunity to thrive in a meaningful culture.
WHAT WE OFFER YOU:
At HUB we believe in investing in the future of our employees. Our entrepreneurial culture fosters an environment of open feedback and improvement that empowers our people to make the best decisions for our customers and organization. We offer:
Competitive salaries and benefits offerings
Medical/dental/vision insurance and voluntary insurance options
Health Savings Account funding
401k matching program
Company paid Life and Short-Term Disability Plans
Supplemental Life and Long-Term Disability Options
Comprehensive Wellness Program
Paid Parental Leave
Generous PTO Package - Vacation, Holiday, Sick, and Personal Time Off
Great work/life balance, because that's important for all of us!
Focus on creating a meaningful environment through employee engagement events
The ability to be a part of a motivated, winning team with the opportunity to learn from colleagues who are amongst the top talent in the industry!
Growth potential - HUB is constantly growing and so can your career!
A rewarding career that helps local businesses in the community
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Review and evaluate claims information, consult on relevant coverages and policy information, and liaise with clients on strategy for communicating and reporting claims.
Responsible for filing Property & Casualty claims on behalf of clients with the appropriate carrier in a timely manner and in accordance with agency and insurance carriers' policies.
Comfortably and proactively collaborate with clients, claim professionals, carriers, and OHA associates throughout the life of a claim to ensure all efforts are coordinated and communicated to the client.
Gain in-depth knowledge of the claim by effectively interacting with the client for accurate information and reviewing policy documents to make preliminary determinations of coverage
Thorough understanding of Commercial and Personal Property & Casualty coverages and ability to interpret policies
Monitors adjustor performance in accordance with agency standards.
Initiates a status or a follow-up on all open or unsettled claims in accordance with agency procedures.
Compile, evaluate, and present claims data and claims trends
Maintain claims files in accordance with best claims handling expectations and first-in-class experience for our clients
The essential duties contained in this job description reflect general details as necessary to describe the principal functions of this job, the level of knowledge and skill typically required and the scope of responsibility. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas to cover absences, equalize peak work periods or otherwise to balance the workload.
REQUIREMENTS:
5+ years of experience in personal and commercial insurance claims is required
Experience handling claims across multiple commercial lines policy types and client industries
Bachelor's degree OR equivalent relevant working experience is required
Active Ohio Property & Casualty License or ability to obtain one within 90 days of employment is required
Professional insurance designations are highly preferred
Strong understanding and comfort using Microsoft Office tools (Word, Excel, Outlook, PowerPoint)
Strong customer service, organization and time management skills
Strong decision making and problem-solving skills
Department Account Management & ServiceRequired Experience: 5-7 years of relevant experience Required Travel: NegligibleRequired Education: Bachelor's degree (4-year degree)
HUB International Limited is an equal opportunity and affirmative action employer that does not discriminate on the basis of race/ethnicity, national origin, religion, age, color, sex, sexual orientation, gender identity, disability or veteran's status, or any other characteristic protected by local, state or federal laws, rules or regulations. The EEO is the Law poster and its supplement is available here at ************************************************************* .
EEOAA Policy
E-Verify Program
We endeavor to make this website accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the US Recruiting Team toll-free at ************** or *********************************. This contact information is for accommodation requests only; do not use this contact information to inquire about the status of applications.
RCIS Crop Claims Field Adjuster I
Columbus, OH
117097 Zurich is currently looking for a RCIS Crop Claims Field Adjuster I to join our Rural Community Insurance Services (RCIS) team. RCIS is one of the leading crop insurance providers in the U.S. RCIS offers insurance protection in all 50 states through a national network of about 3,600 licensed agents. RCIS offers a wide range of private product coverages, including a diverse selection of named-peril options, supplemental and stand-alone insurance products as well as federal crop insurance plans through the United States Department of Agriculture's Risk Management Agency. Together with RCIS agents, we protect America's farmers and ranchers.
Zurich/RCIS is currently looking for a Crop Adjuster to work out of the state of Ohio. This incumbent will work from a home-based office. This position is scheduled to work 40 hours per week. Approximately 50% travel is expected to cover the territory.
**The ideal candidate will need to live and service within the following counties in Ohio: Clermont, Brown, Adams.**
RCIS provides insurance and superior services through leading agents to protect America's farmers and ranchers. It's been an innovator in crop insurance since the crop insurance business was privatized by the federal government in 1980. Today it's one of the nation's largest crop insurance providers, offering risk management protection in all 50 states through a national network of about 4,000 professionally trained and licensed agents.
This is a great opportunity to serve the agricultural community.
As a Crop Adjuster, your primary responsibilities will include:
+ With minimal supervision, completes field inspections and related responsibilities such as reading maps and aerial photos, measuring fields, storage bins, and discussing findings of crop loss with farmers on the most complex non-routine, problematic claims including controversial claims.
+ Ability to convey complex regulations and interpretations to claimants, agents, and industry people on claim situations.
+ Performs fact finding regarding crop damage, records information and transmits loss information to accurately determine potential indemnities.
+ Gather relevant facts, utilizing applicable law and establishing basic principles of negligence.
+ Complete claim reviews and audits on lower-level adjusters as assigned.
+ Ensure legal compliance by maintaining a strong working knowledge of regulatory and company policies and procedures.
+ Contribute to the team effort by accomplishing related results and participating on projects as needed.
Basic Qualifications:
+ High School Diploma or Equivalent and 6 or more months of experience in the agricultural area
+ Crop Adjuster Proficiency Program Certification (CAPP) must be obtained with 180 days of hire date
+ Reliable personal transportation and travel within territory
+ Valid Driver's License
+ RCIS Crop Adjuster Physical Requirements: walk in agricultural fields up to 3 miles, climb agricultural storage bins up to 25 feet, lift 25 lbs. to 50 lbs., work outdoors in varying temperatures/weather conditions
Preferred Qualifications:
+ Excellent verbal, written and interpersonal communication skills
+ Strong organization and prioritization skills
+ Experience as a Crop Claims Field Adjuster
+ Intermediate Microsoft Office skills
As an insurance company, Zurich is subject to 18 U.S. Code § 1033.
As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ( ************************************ ).
A future with Zurich. What can go right when you apply at Zurich?
Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500 . Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here (********************************* to learn more.
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers' expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.
Location(s):
Remote Working: Yes
Schedule: Full Time
Employment Sponsorship Offered: No
Linkedin Recruiter Tag: #LI-MM1 #LI-REMOTE
Unemployment Claim Specialist
Columbus, OH
Equifax is where you can power your possible. If you want to achieve your true potential, chart new paths, develop new skills, collaborate with bright minds, and make a meaningful impact, we want to hear from you.
As an Unemployment Claims Specialist you will be tasked with receiving, analyzing and building claims for states and Unemployment Insurance Consultants.
What you'll do
Analyze unemployment claims and questionnaires via SIDES, state websites, and scanned mail copy.
Determine best course of response to send to client for request based on SLA's with clients, state instructed deadlines and internal practices.
Consult with state adjudicators to provide timely and accurate information on claims and questionnaires.
Answer phone calls and provide responses to state agencies on needed information regarding claims filed.
Construct information requests from state agencies to go directly to clients.
Adhere to all state regulations and guidelines.
Address questions, concerns or issues with internal teams and escalate as needed.
Work as a team with Unemployment Insurance Consultants to ensure accurate and necessary information is provided to states on behalf of clients and documented properly for auditing purposes.
Testify in unemployment hearings regarding timeliness of claim responses.
Ensures work is accurate and complete, processed timely and free from errors for auditing purposes.
What experience you need
Associate's degree (A.A.) or equivalent from two-year college or technical school; or two years customer service related experience and/or training; or equivalent combination of education and experience.
Proficiency with Google applications such as Gmail and Chat.
Able to handle a high volume of work, follow policies and procedures, and complete administrative tasks while adhering to strict deadlines.
Wearing a headset throughout the entire shift is required to access the Noble application
What could set you apart
Previous experience with Unemployment Insurance and the Unemployment Claims process is a plus
We offer comprehensive compensation and healthcare packages, 401k matching, paid time off, and organizational growth potential through our online learning platform with guided career tracks.
Are you ready to power your possible? Apply today, and get started on a path toward an exciting new career at Equifax, where you can make a difference!
Primary Location:
USA-OH-Columbus-Mill Run Drive
Function:
Function - Fulfillment / Operations
Schedule:
Full time
Claims Investigator - Part Time
Columbus, OH
Claims Investigator (Part-Time)
Columbus, OH area
Immediate need for a PT Claims Investigator within the largest worldwide investigative solutions company. Join CoventBridge Group as it continues its expansion into all areas of investigations, allowing continual growth for its employees.
Responsibilities/ Requirements
Responsibilities:
Duties and responsibilities include essential functions of positions assigned to this classification. Depending on assignment, the employee may perform a combination of some or all the following duties:
Ability to conduct multiple types of complex claims investigations
Daily submission of updates regarding work performed on each case
Ability to manage time
Maintain a sufficient level of client billable hours
Write and record detailed statements
Conduct scene investigations
Submit professional and client ready investigative reports
Conduct background/activity checks and courthouse research
Due to driving, constant state of alertness in a safe manner is an essential function of this position
Requirements:
Licensed or eligible to be licensed as a Private Investigator in Ohio and in surrounding states
1 year or more of full time report writing experience on field investigations cases
Field investigations experience - face to face statements
Ability and willingness to travel within a multi-state coverage area (as necessary)
Experienced in investigation of product/auto/general liability claims, Workers Compensation, disability claims, life insurance and contestable death claims
Flexibility to work varied/irregular hours and days including nights, weekends
Reliable and fuel efficient vehicle with minimum of auto liability insurance
Possess or is willing to purchase: digital recording device and laptop computer with Windows Operating System with access to Microsoft Word and other necessary equipment for position
Educational/Experience Qualifications:
Associate or Bachelor's Degree in Criminal Justice or related field
Experience as a Private Investigator or detective
Military or Law Enforcement background
Comprehensive knowledge of insurance law and underwriting
Self-starter who holds themselves accountable for results and performance
Strong attention to detail with commitment to accuracy and quality
Ability to adapt and work under stressful and sensitive situations
Can type 50 words or more a minute
Benefits
CoventBridge offers the most premiere compensation package in the industry.
Flexibility to self-schedule
Ability to work from home-based office
Competitive pay
Monthly vehicle allowance
Company fuel card
Company cell phone
Company matching 401(k)
Travel and report writing compensation
Company paid investigator licensing fees
Paid ongoing career advancement training
Timely expense reimbursement with very minimal out-of-pocket expenses
About Us:
CoventBridge Group is the global leader in full-service investigations providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; ************; *******************************
IND123
Claims Representative - Occupational Accident
Cincinnati, OH
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.
Great American's Trucking Division is a leading provider of insurance products for the long-haul trucking industry and specializes in service to Owner-Operators. Our focus on trucking started in the early 1990s with the development of a trucking Physical Damage policy. Since then, it has evolved to include a complete suite of products and services supporting the independent contractor including Physical Damage, Non-Trucking Liability, Occupational Accident, Contingent Liability, our signature Rig Ready repair service, Deductible Buyback and TruXpro, which includes downtime and rental reimbursement. Our experienced team is dedicated entirely to trucking, all day, every day. This niche expertise allows us to provide the products drivers need and the service they deserve to get them back on the road faster.
*****************************************************************************************
The Trucking Division is looking for a Claims Representative to join the Occupational Accident Claims team in our Cincinnati, OH office. Candidates with previous claims experience are encouraged to apply!
Essential Job Functions and Responsibilities
* Manages an inventory of claims to evaluate compensability/liability.
* Conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
* Determines and may negotiate appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
* Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
* May authorize payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
* Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
* Performs other duties as assigned.
Job Requirements
* Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.
* Generally, a minimum of 6 months of experience in property and casualty claims handling. Continuing progress toward and/or the completion of a professional designation preferred, such as Associate in Claims (AIC).
* Works within specific limits and authority on assignments of moderate technical complexity and coordination.
* Demonstrates functional analytical, negotiation, and problem-solving skills.
* Demonstrates knowledge of insurance policies, coverage, and claims handling procedures.
* Develops and maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims.
* Strong interpersonal and communication skills with the ability to build relationships and handle negotiations. Proven ability to handle confidential information with discretion.
This job is non-exempt in California and Washington
Business Unit:
Trucking
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
Cambridge - WC Claims Specialist - PN: 20069746 & 20069097
Cambridge, OH
Cambridge - WC Claims Specialist - PN: 20069746 & 20069097 (250001R1) Organization: Workers' CompensationAgency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: ************************ Unposting Date: Mar 11, 2025, 3:59:00 AMWork Location: Cambridge Service Office 61501 Southgate Parkway Cambridge 43725-9114Primary Location: United States of America-OHIO-Guernsey County-Cambridge Compensation: $24.66 - $32.08Schedule: Full-time Work Hours: 40Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Claims ExaminationTechnical Skills: Claims Examination, Customer ServiceProfessional Skills: Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication Agency Overview
A Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.
Our Vision:To transform BWC into an agile organization driven by customer success.
Our Mission:To deliver consistently excellent experiences for each BWC customer every day.
Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.Job DescriptionBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.
What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:
BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
I have worked at several state agencies and BWC is the best place to work.
Best place to work in the state and with a sense of family and support.
I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.
I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.
If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!
What You'll Be Doing:
Communicate, coordinate and collaborate with internal and external stakeholders to set return to work expectations.
Perform initial/subsequent claims investigation and determination within prescribed timeframes.
Evaluate information and issue orders, make claim allowance decisions in regard to Worker's Compensation law and/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs.
Address subsequent requests by parties to claim via due process notification, investigation, BWC orders and referrals to the Industrial Commission of Ohio.
Maintain the various claims management systems correct claims information including claim reserve data elements.
Reviews medical documentation and legal documentation and take appropriate action.
Attends statewide, local meetings, team huddles; complete required BWC specific and State of Ohio trainings throughout the year.
Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
Medical Coverage
Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
Childbirth, Adoption, and Foster Care leave
Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.Qualifications36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law). -Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits). -Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation). -Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers' Compensation Employer Service Representative, 63521. -Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination
Major Worker Characteristics:
Knowledge of: workers' compensation laws, policies & procedures*; eligibility criteria & procedures used for processing workers' compensation claims*; English grammar & spelling; oral & written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals & percentages; interviewing techniques; internet search engines & navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*;
Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers' Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;
Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.
The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact ADA Coordinator Kathleen Bourke at ************ or by email to: ***********************.
BWC OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check:
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.
Senior Claim Specialist
Ohio
The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one.
If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to
Accessibility
(accommodation requests only; other inquiries won't receive a response).
Regular or Temporary:
Regular
Language Fluency: English (Required)
Work Shift:
1st Shift (United States of America)
Please review the following job description:
Analyzes and processes claims by gathering information and drawing conclusions. Acts as a liaison between insured and insurance carrier to report, track and manage claims process. Provides leadership to all employees within the claims department.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
1. Supervise a multi-person team ensuring all pertinent information is communicated.
2. Evaluate claims, reporting forms and cancellations and initiate necessary corrections to ensure accuracy of dates, coverage, signature, commission, premium, attachments, etc.
3. Authenticate all relevant activity on assigned files and makes recommendation for additional activity as appropriate.
4. Determine where new loss claims should be reported.
5. Manage all claim documentation.
6. Use discretion to submit the necessary information and/or correspondence to the Agent or Insurer to process claims appropriately.
7. Analyze claim coverage with insurance carriers to ensure claims are paid accurately.
8. Assess eligibility status of denied claims.
9. Anticipate and meets all customer needs (both internal and external).
10. Maintain claims and suspense system ensuring follow-up for receipt of policies, endorsements, inspections reports, correspondence, claims, etc. from outside sources.
11. Process all departmental claims in a timely manner according to company policy.
12. Facilitate the training of new employees in the department.
13. Provide supervision to Claims Assistants.
14. Perform other duties as assigned.
QUALIFICATIONS
Required Qualifications:
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Bachelor's degree with a concentration in business or equivalent work experience
2. Three years of Claims handling experience and commercial and multi-line knowledge
3. Ability to critically review a claim file for relevant information, accurately access the information and make necessary recommendations
4. Ability to make independent decisions following CRC guidelines with minimal or no supervision
5. Good organizational, time management, and detail skills
6. Extensive knowledge of insurance and CRC processes
7. Ability to maintain a high level of tact and professionalism
8. Good leadership skills to influence all departmental employees in a positive manner
9. Possess strong interpersonal skills
10. Strong verbal and written communication skills
11. Strong computer and office skills
12. Ability to work extended hours when necessary
Preferred Qualifications:
1. Adjusting experience
General Description of Available Benefits for Eligible Employees of TIH Insurance: All regular teammates (not temporary or contingent workers) working 20 hours or more per week are eligible for benefits, though eligibility for specific benefits may be determined by the division of TIH Insurance offering the position. TIH offers medical, dental, vision, life insurance, disability, accidental death and dismemberment, tax-preferred savings accounts, and a 401k plan to teammates. Teammates also receive no less than 10 days of vacation (prorated based on date of hire and by full-time or part-time status) during their first year of employment, along with 10 sick days (also prorated), and paid holidays. For more details on TIH's generous benefit plans, please visit our site. Depending on the position and division, this job may also be eligible for TIH's defined benefit pension plan, restricted stock units, and/or a deferred compensation plan. As you advance through the hiring process, you will also learn more about the specific benefits available for any non-temporary position for which you apply, based on full-time or part-time status, position, and division of work.
CRC supports a diverse workforce and is an Equal Opportunity Employer that does not discriminate against individuals on the basis of race, gender, color, religion, citizenship or national origin, age, sexual orientation, gender identity, disability, veteran status or other classification protected by law. CRC is a Drug Free Workplace.
EEO is the Law Pay Transparency Nondiscrimination Provision E-Verify
Claims Specialist
Columbus, OH
Job Details Columbus Office - Columbus, OH Full TimeDescription
Job Purpose:
Process provider forms, claims and adjustments for early childhood nutrition programs.
Job Duties and Responsibilities:
Process new and existing provider forms, claims payments and adjustments, including data entry, scanning, imaging, and ensuring accuracy.
Ensure databases are current and complete for all audit inquiries.
Process claims and related paperwork for reimbursement in compliance with federal, state, and organizational regulations.
Provide administrative support for department including maintaining and sorting documents, answering phones, incoming and outgoing mail, etc.
Provide excellent communication and customer service to providers, internal staff, vendors, and others by responding to questions and requests, including problem-solving, and/or training on departmental processes and procedures.
Other duties as assigned.
Qualifications
Job Qualifications:
High school diploma or equivalent
Three years related or similar office experience
Proficiency with Microsoft Office Suite, specifically Microsoft Excel
Aptitude for learning new software applications
Ability to work with diverse individuals
Strong technical and mathematical skills
Proficiency with office equipment including fax machine, copier, scanner, computer, etc.
Highly attentive to details; demonstrates excellent organization and time management skills
Ability to work both independently and within a team setting
Strong oral and written communication skills
Requires minimal supervision to complete job responsibilities
Shows initiative in taking on new tasks and meeting departmental goals
Unflappable, resilient, and positive
Knowledge of the Child and Adult Care Food Programs a plus.
Job Working Condition:
Typical office environment
Property Field Claims Adjuster (Southwest Cleveland/Lorain, OH)
Cleveland, OH
You will investigate and maintain property claims, secure information, review coverages, complete field inspections, and settle claims. You will handle moderately complex homeowner property field claims, typically within 1-2 hours of Southwest Cleveland/Lorain Ohio (you must be located in this market). You will also occasionally handle desk claims.
This is a fully remote/work from home role where you will spend 80% of your time in the field. On occasion you may be asked to travel to an office location for in person engagement activities such as team meetings, training and culture events. You will report to the Property Claim Manager. A company fleet vehicle is provided with the position and there's an option to use the vehicle for personal use.
Position Compensation Range:
$56,000.00 - $92,000.00
Pay Rate Type:
Salary
Compensation may vary based on the job level and your geographic work location.
Relocation support is offered for eligible candidates.
Primary Accountabilities
Investigate origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel.
Identify complex issues and seek assistance. Handle claims on a good faith basis.
Handle both 1st party and 3rd party claims under multiple policy types and numerous endorsements.
Conduct on-site inspections when needed, evaluates damages, and handles claim negotiations with insureds, claimants, attorneys, public adjusters.
Respond to customer inquiries, make appropriate decisions and close file as needed.
Interpret and determine policies, leases, by-laws, declarations, articles and contract coverages and apply to all parties for assigned losses.
Provides all parties with claim process and status; answer questions or redirect to other areas.
May complete other assignments, job duties, or participate in projects based upon skills, achievements, or experience.
Specialized Knowledge & Skills Requirements
Demonstrated experience providing customer-driven solutions or support.
Demonstrated experience handling 1st and 3rd party, multi-line claims across our operating territories, or other equivalent experience.
Demonstrated experience handling moderately complex claims, or other equivalent experience.
Solid knowledge of policies and endorsements related to casualty coverages, or other equivalent knowledge.
Solid knowledge and understanding of each phase of the claim handling process, or other equivalent knowledge.
Licenses
Valid driver's license required plus an acceptable driving record.
Obtain state specific property casualty claims licensing.
Travel Requirements
Up to 50%.
Catastrophe duty up to 75% as applicable.
Physical Requirements
Ascend or descend ladders, stairs, scaffolding, ramps, poles and the like. We may ask you for employees to visit areas that have a higher hazard than a typical office such as customer homes, body shops, or other locations.
Move self in different positions to accomplish tasks in various environments including tight and confined spaces.
Adjust or move objects up to 50 pounds in all directions.
Working Conditions
Low/High temperatures.
Outdoor elements such as precipitation and wind.
Noisy environments.
Hazardous conditions.
Poor ventilation.
Small and/or enclosed spaces.
Your offer will be made contingent on the results of applicable background checks and signing a non-disclosure agreement for proprietary information, trade secrets, and inventions
Our policy restricts consideration of applicants needing employment sponsorship (visa) to specialty occupations. Sponsorship will not be considered for this position
#LI-Remote
We encourage you to apply even if you do not meet all of the requirements listed above. Skills can be used in many different ways, and your life and professional experience may be relevant beyond what a list of requirements will capture. We encourage those who are passionate about what we do to apply!
We provide benefits that support your physical, emotional, and financial wellbeing. You will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health. We also offer a competitive 401(k) contribution, a pension plan, an annual incentive, 9 paid holidays and a paid time off program (23 days accrued annually for full-time employees). In addition, our student loan repayment program and paid-family leave are available to support our employees and their families. Interns and contingent workers are not eligible for American Family Insurance Group benefits.
We are an equal opportunity employer. It is our policy to comply with all applicable federal, state and local laws pertaining to non-discrimination, non-harassment and equal opportunity. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.
#LI-JA2
PAR - Claims Representative II
Toledo, OH
Processes claims in accordance with benefit contracts, plan policies and production/quality goal requirements. Performs administrative duties as requested by management. Responsibilities:
Processes claims edits from receipt to completion and adheres to quality standards to meet Company and departmental goals.
Utilizes claims and ancillary systems and adheres to processing procedures resulting in the finalization of basic claims edits.
Maintains working knowledge of policies and procedures and attends additional training as needed.
Performs routine claim adjustments.
Performs other duties as assigned.
Qualifications Qualifications
Education and Experience:
High School diploma or GED
2 years of experience as a Claims Representative in health insurance operation or equivalent experience with professional, institutional and non-standard claims.
Successful completion of required training (within 4 months of hire).
Technical Skills and Knowledge:
Knowledge of data entry and standard office procedures
Knowledge of health insurance claims processing and provider coding
Alpha-numeric keyboarding skills at a minimum of 6,000 ksph
Proficiency with claims processing systems and basic Microsoft Office Skills.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
Discounts at many places in and around town, just for being a Medical Mutual team member.
The opportunity to earn cash rewards for shopping with our customers.
Business casual attire, including jeans.
Excellent Benefits and Compensation:
Employee bonus program.
401(k) with company match up to 4% and an additional company contribution.
Health Savings Account with a company matching contribution.
Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
Career development programs and classes.
Mentoring and coaching to help you advance in your career.
Tuition reimbursement up to $5,250 per year, the IRS maximum.
Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing. Primary Location: US-OH-ToledoJob: 7 - General StaffOrganization: ParamountSchedule: RegularShift: StandardEmployee Status: Individual ContributorJob Type: Full-time Job Level: Day JobJob Posting: Feb 27, 2025, 6:58:12 PM
Sr Casualty Claim Rep
Ohio
Employee Status: Regular Schedule: Full -time
You're ready to make your mark where people care about each other. Where your work is meaningful. And where your unique perspectives are welcome. Think about joining Westfield, a company focused on what's most important - the people behind our policies.
Westfield was founded in 1848 by a small group of hard-working farmers who believed in the promise of the future and the power of the individual. Today, as one of the nation's leading property and casualty (P&C) companies, we remain true to their vision and are dedicated to making a positive difference in our customers' lives.
Responsibilities;
Coverage/Investigation/Liability - Determines whether proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness.
Damages - Determines the value of the physical damage of property, automobiles, or injuries through use of appropriate tools. Obtains all necessary documentation to support claim evaluation. Recognizes claim file exposures and escalates appropriately.
Communication - Maintains effective and ongoing communications with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel.
Customer Service - Ensures customer service excellence. Responsible for the customer and agent experience associated with assigned claims.
Reserving/Reporting - Establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. Completes appropriate reports so that the current status of the claim is clearly documented at all times.
Negotiation/Settlement - Within decision making authority, negotiates timely and appropriate settlements with insureds, claimants, vendors, attorneys, and other insurance companies. Refers claims exceeding authority to appropriate leader or complex claims specialist with recommendations.
Leader Assistance - May assist and direct office staff at Unit Leader direction.
Coach/Mentor - May provide technical guidance and assistance to lower-level associates and other functional areas.
Travel - Travels occasionally to participate in special assignments, training, storm duty and/or travel between office locations.
Qualifications;
5 or more years' experience adjusting casualty claims.
Experience negotiating claims and handling conflict.
Experience using a claims management system e.g. Guidewire or diary management system to accurately document file activities.
Strong verbal, written, and interpersonal communication skills with the ability to interact with all levels of the company.
Experience with Microsoft Windows, Outlook, and Excel or transferable software packages.
Holds and maintains appropriate adjuster licensing and certification(s) in assigned territories and will obtain additional licensing based upon business needs.
Insurance industry designation such as AIC, SCLA, CPCU, etc.
Ability to travel, including overnight business trips as needed.
Bachelor's Degree or commensurate experience.
Physical essential functions: ability to work 40 hours in an office environment (sitting, standing, on a computer, etc.), operate office related technology (computer, phone, etc.), travel as required.
Westfield offers a Total Rewards program that focuses on compensation, benefits and wellness, and includes perks like 401(k), pension plan, annual incentive, education reimbursement, onsite fitness center and casual dress. Work/life balance, recognition, and learning and career development are all part of a rewarding career with Westfield.
Westfield cares about relationships. We pay attention to the details and embrace what each employee brings to the mix. If you are talented in your profession but also care about people - whether you're just starting out or have decades of experience - we want to talk with you. Learn more about current opportunities at ***********************************
We are an equal opportunity employer/minority/female/disability/protected veteran.
#LI-PB1 #LI-Remote
Financial Products Claims Representative
Cincinnati, OH
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.
Great American entered the Surety market 90 years ago, bringing a history of strong performance, secure resources and a broad appetite for business opportunity to this important industry segment.
Agents and customers rely on the expert underwriting, solid financial strength, market leadership and personal service they receive from the Bond Division. With a highly diverse product line that includes both Commercial and Contract solutions, the division is one of the leading surety companies in the United States with loss results that are well below the industry average.
While the Division continues to be one of the largest writers of Contract bonding, they are also a leading provider of Commercial Surety bonds with an emphasis on Miscellaneous, License & Permit, Court, Fiduciary and Public Official bonds.
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The Surety Bond Claims team is currently in search of a Financial Products Claims Representative/Specialist to join our team in Cincinnati, OH.
Essential Job Functions and Responsibilities
Investigates, evaluates and adjusts small to mid-sized commercial surety bond claims.
Reviews and evaluates coverage and/or liability.
Secures necessary information (i.e., reports, bonds, credit limits, policies, appraisals, releases, statements, or other documents) to assist in the investigation of claims.
Retains and directs approved consultants and outside counsel. Responsible for maintaining cost controls and overseeing the work of outside counsel.
Determines available avenues of recovery and their cost-effectiveness; coordinates approved recovery effort.
Establishes and maintains proper loss, salvage, and subrogation reserves.
Prepares periodic claims reports and financial evaluations.
Affects settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.
Ensures that claims payments are issued in a timely and accurate manner.
Ensures compliance of claims handling pursuant to all state, legal, statutory, and regulatory bodies to comply with all company procedures and requirements.
Performs other duties as assigned.
Job Requirements
Bachelor's Degree or equivalent experience. (JD or paralegal experience a plus)
Business, Liberal Arts, Finance or a related discipline
Generally, 6 months to 3 years of related experience.
Works within specific limits and authority on assignments of moderate technical complexity.
Possesses functional knowledge and skills that are reflective of a fully competent practitioner.
Performs work under moderate supervision
Business Unit:
Bond
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
Adjuster Trainee
Cleveland, OH
Position Type: Full-time Information about the Company: Cenveo is a leading North American manufacturer of envelopes with over 100 years of experience and approximately 30 billion envelopes manufactured annually. We are hiring immediately for skilled and entry level Machine Adjusters for its envelope manufacturing facility in Cleveland, OH for 8hr shift; training is on 1st shift.
Machine Adjuster Rewards & Benefits: Cenveo provides competitive pay and a comprehensive benefits package that includes a Health, Dental and Vision insurance and Paid Time Off. In addition, we provide 401K, as well as disability insurance, life insurance, as well as other benefit plans.
Machine Adjuster Rewards & Benefits Responsibilities & Daily Duties:
* Sets up and adjusts various types of converting equipment for safe and efficient operation.
* Start-up, adjustments involving close tolerances, maintenance, and troubleshooting.
* Reviews job tickets to determine parts/tool/materials necessary for changes and/or adjustments.
* Assists in adjuster/operator training.
* Examines product for defects, ensures quality process is followed.
* Performs preventative maintenance inspections and ensures consistent quality production.
* Minimizes waste to ensure it is weighed, recorded and stored according to guidelines.
* Change window rolls (overhead).
* Provides coverage for machine operator (packer) if needed.
* Notifies Supervisor of recurring equipment problems and corrective action taken.
* Willingness to work overtime as needed.
* Compliance with company policy including safety rules and regulations.
* Maintains clean machine and work area (sweeps, removes waste, etc).
* Other duties and assignments as required.
Machine Adjuster Physical Requirements & Work Environment:
* Requires regularly standing, walking, carrying, climbing, and reaching.
* Frequently required to reach, bend and stoop.
* Frequently required to lift and/or move up to 55 pounds with assistance.
* Exposure to high production equipment, noise, hazardous materials (inks, solvents, glue, etc.)
* Must be able to work in hot or cold weather.
* Ability to keep up with a high-speed delivery output in a standing position for a full shift.
* Mental alertness to stop equipment when jam occurs.
Cenveo is an EEO Employer
Senior Claims Rep Bodily Injury - Hybrid
Richfield, OH
National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you!
Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (******************
National Interstate is looking for a Senior Claims Representative - BI to join their team. This individual will work a hybrid schedule out of the Richfield, OH office.
Essential Job Functions and Responsibilities
Investigates and maintains claims:
Reviews and evaluates coverage and/or liability.
Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, reports, or other documents) in the investigation of claims.
Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions or trials as necessary.
May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
Conveys moderately complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
Ensures that claims payments are issued in a timely and accurate manner.
Ensures that claims handling is conducted in compliance with applicable statutes, regulations and other legal requirements, and that all applicable company procedures and policies are followed.
May provide guidance and assistance to lower level positions and other functional areas.
Performs other duties as assigned.
Job RequirementsEducation: Bachelor's Degree or equivalent experience.Field of Study: Liberal Arts, Business or a related discipline.Experience: Generally, 3 to 5 years of related experience.
This job is non-exempt in California
Company:
NIIC National Interstate Insurance Company
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
Coordinator Claims (Payments)
Mason, OH
Position:Full-Time Total Rewards: Benefits/Incentive Information At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.
Our mission is to help people see life to the fullest-and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world's vision crisis.
EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.
GENERAL FUNCTION
The Coordinator - Payments will complete payment functions to initiate payment transactions. The Coordinator will ensure all payments are processed in a timely and satisfactory manner, provide daily documentation for audits, and work to resolve issues. The Coordinator will act as a liaison to Claims Research, Call Center Supervisor, IT and other cross-functional areas in the organization.
MAJOR DUTIES AND RESPONSIBILITIES
Execute and validate the integrity of payment data in the payments system.
Ensure proper controls are being met in the fulfillment of EyeMed payments.
Assist in driving payment issue resolution and working with cross-functional areas and IT to identify concerns, create plans to solve, and ensure the team is meeting the needs of our constituents (plans, members, and providers).
Complete payment related requests from various applications within agreed upon service level agreements (SLAs).
Identify and communicate issue status and resolution with the goal of improving the effectiveness of the Payments Team.
Log and reprocess bank rejections.
Sort, log, process and resolve returned payment related correspondence.
Maintain effective, on-going communication with key internal stakeholders.
Maintain payment processing standards, policies and desk level procedures to ensure appropriate controls and key compliance requirements are met.
Proactively identify opportunities and process improvement initiatives.
BASIC QUALIFICATIONS
High school diploma
3+ year of experience in data processing
Knowledge of PCs and Microsoft products (excel, word, etc.)
Knowledge of mid-range computer applications and query reporting
Ability to effectively communicate both verbally and in writing
PREFERRED QUALIFICATIONS
Bachelor's degree
2 years of process management
Previous experience with ERP systems
Working knowledge of Facets, SAP, Business Objects
Highly effective oral and written communication skills
Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.
Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at ************ (be sure to provide your name and contact information so that we may follow up in a timely manner) or email ********************************.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.
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Nearest Major Market: Cincinnati
Job Segment:
Business Process, Social Media, Management, Marketing
CLAIMS ANALYST 2
Canton, OH
The primary purpose of the Claims Analyst II is to independently evaluate and correctly adjudicate medical, vision and/or dental claims received from clients. These claims must be input in a timely manner, ensuring prompt turn-around time for clients. A Claims Analyst II must be knowledgeable regarding unique variances that can affect health insurance policies. They must be able to recognize problem situations while processing; initiating steps to resolve the problem(s). This position entails meticulous attention to detail.
RESPONSIBILITIES & EXPECTATIONS:
* Reviews, analyzes and inputs complex claims into the system, paying close attention to information provided by the system; such as, duplicate bill prompts, coordination of benefits information, precertification notes, reasonable and customary schedules, and benefit calculations.
* Adjusts voids and reopens claims on line, within guideline, to ensure proper adjudication.
* Understands and applies CPT, ICD9 & 10, HCPCS and Medical Terminology as it applies to a submitted claim for consideration.
* Can be pulled between units to assist for high volumes, PTO, etc.
* Demonstrates understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits and healthcare terminology.
* Displays excellent knowledge of the various operations of the organization, products, and services.
* Researches and analyzes claims issues and whenever possible makes phone calls to eliminate the need for pended claims.
* Responds to customer/client contacts in person, via telephone or via email
* Meets quality and performance metrics.
* Recognizes the need for additional information and requests promptly through pended letters.
* Whenever possible, makes phone calls, to eliminate the need for pended claims.
* Updates employee and dependent notes as needed in an understandable format.
* Refers questionable claim situations to supervisor and/or appropriate department for review.
* Keeps an accurate mail count.
* Displays good work habits and organizational skills by working in date order and prioritizing daily work flow; i.e., claims, referrals, questions, and possibly special projects.
* Promptly responds to phone sheets and refund requests.
* Insures the accuracy of the data input into the system; being to not only claim being processed but to claims previously processed in history.
* Displays a positive attitude and willingness to work as a team.
* Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
* Seeks supervisory guidance/approval as appropriate.
* Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
* Promotes and demonstrates professional standards to enhance the development of the department.
* Practices ethical conduct.
* Meets acceptable attendance and punctuality expectations (excluding FMLA)
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
QUALIFICATIONS:
* Education: High school diploma or GED required.
* Minimum one year experience as Claims Analyst I,
* Able to type a minimum of 40 wpm.
* Understanding of HMO, PPO and Medicare plans/benefits.
* Knowledge of medical terminology.
* Knowledge of ICD10 Coding.
* Previous experience with Microsoft Word, Excel and Outlook.
* Available to work 40 hours per week anytime within the operating hours of the department, Monday through Friday, 6:00am-8:00pm, which may include weekends and holidays.
PREFERRED QUALIFICATIONS
* Education: Associate's degree preferred.
* Two years' experience as Claims Analyst in health insurance organization.
WORKING CONDITIONS
* Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
* Office environment with minimal noise level due to computers, printers and floor activity.
Claims Representative - Occupational Accident
Cincinnati, OH
Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.
At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.
Great American's Trucking Division is a leading provider of insurance products for the long-haul trucking industry and specializes in service to Owner-Operators. Our focus on trucking started in the early 1990s with the development of a trucking Physical Damage policy. Since then, it has evolved to include a complete suite of products and services supporting the independent contractor including Physical Damage, Non-Trucking Liability, Occupational Accident, Contingent Liability, our signature Rig Ready repair service, Deductible Buyback and TruXpro , which includes downtime and rental reimbursement. Our experienced team is dedicated entirely to trucking, all day, every day. This niche expertise allows us to provide the products drivers need and the service they deserve to get them back on the road faster.
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The Trucking Division is looking for a Claims Representative to join the Occupational Accident Claims team in our Cincinnati, OH office. Candidates with previous claims experience are encouraged to apply!
Essential Job Functions and Responsibilities
Manages an inventory of claims to evaluate compensability/liability.
Conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
Determines and may negotiate appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
May authorize payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
Performs other duties as assigned.
Job Requirements
Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.
Generally, a minimum of 6 months of experience in property and casualty claims handling. Continuing progress toward and/or the completion of a professional designation preferred, such as Associate in Claims (AIC).
Works within specific limits and authority on assignments of moderate technical complexity and coordination.
Demonstrates functional analytical, negotiation, and problem-solving skills.
Demonstrates knowledge of insurance policies, coverage, and claims handling procedures.
Develops and maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims.
Strong interpersonal and communication skills with the ability to build relationships and handle negotiations. Proven ability to handle confidential information with discretion.
This job is non-exempt in California and Washington
Business Unit:
Trucking
Benefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.
Canton - WC Claims Specialist - PN: 20068464
North Canton, OH
Canton - WC Claims Specialist - PN: 20068464 (250001QC) Organization: Workers' CompensationAgency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: ************************ Unposting Date: Mar 11, 2025, 3:59:00 AMWork Location: Canton Service Office 339 East Maple Street Suite 200 North Canton 44720-2593Primary Location: United States of America-OHIO-Stark County-North Canton Compensation: $24.66 - $32.08Schedule: Full-time Work Hours: 40Classified Indicator: ClassifiedUnion: OCSEA Primary Job Skill: Claims ExaminationTechnical Skills: Claims Examination, Customer ServiceProfessional Skills: Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication Agency Overview
A Little About Us:With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
Our Culture:BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.
Our Vision:To transform BWC into an agile organization driven by customer success.
Our Mission:To deliver consistently excellent experiences for each BWC customer every day.
Our Core Values:One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.Job DescriptionBWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.
What our employees have to say:BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:
BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
I have worked at several state agencies and BWC is the best place to work.
Best place to work in the state and with a sense of family and support.
I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.
I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.
If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!
What You'll Be Doing:
Communicate, coordinate and collaborate with internal and external stakeholders to set return to work expectations.
Perform initial/subsequent claims investigation and determination within prescribed timeframes.
Evaluate information and issue orders, make claim allowance decisions in regard to Worker's Compensation law and/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs.
Address subsequent requests by parties to claim via due process notification, investigation, BWC orders and referrals to the Industrial Commission of Ohio.
Maintain the various claims management systems correct claims information including claim reserve data elements.
Reviews medical documentation and legal documentation and take appropriate action.
Attends statewide, local meetings, team huddles; complete required BWC specific and State of Ohio trainings throughout the year.
Why Work for the State of OhioAt the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
Medical Coverage
Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
Childbirth, Adoption, and Foster Care leave
Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.Qualifications36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute. -Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law). -Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits). -Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation). -Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers' Compensation Employer Service Representative, 63521. -Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment. Job Skills: Claims Examination
Major Worker Characteristics:
Knowledge of: workers' compensation laws, policies & procedures*; eligibility criteria & procedures used for processing workers' compensation claims*; English grammar & spelling; oral & written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals & percentages; interviewing techniques; internet search engines & navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*;
Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers' Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;
Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.Supplemental InformationEEO & ADA Statement:The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.
The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact ADA Coordinator Kathleen Bourke at ************ or by email to: ***********************.
BWC OCSEA Selection Rights:This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Salary Information:Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
Educational Transcripts:For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check:
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.ADA StatementOhio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.Drug-Free WorkplaceThe State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.