Claims Adjusters, Examiners, and Investigators

Ensures timely collection of nearly all outstanding accounts receivable from insurers by performing the following duties personally. Responsible for ensuring that all critical tasks are fulfilled on a timely basis.

+ Maintains and continually updates knowledge of insurance and government reimbursement policies and procedures while understanding causes of their payables delays and oversights.

+ Coordinates and collaborates with patient registration, coding and billing team members to resolve payment denials properly in all cases where internal enterprise errors contribute to funds owed.

+ Submits adjustment requests to management for approval when appropriate based upon underlying facts.

+ Notified management of all observed enterprise methodologies that may be contributing to receivables issues so that appropriate internal systemic corrections may be implemented.

+ Submits corrected claims or appeals when underlying facts indicate the necessity for such actions.

+ Maintains a successfully appropriate collections methodology with proper fact-based and sufficiently aggressive methodologies to reduce payment delays and payor errors.

+ Communicates with payors in pursuit of full payment on all accounts receivable via telephone and electronic means.

+ Develops, maintains and continually updates knowledge of and ability to efficiently use electronic payor interfaces and databases.

+ Takes all steps necessary to avoid write-offs.

+ Processes refund requests on a timely basis when properly requested by payors presenting underlying facts substantiating prior overpayments.

+ Accurately performs data input related to all receivables’ actions taken.

+ Manages all receivable’s data on an accurate and ethical basis without loss of data.

+ Completes appropriate adjustments in the receivables system within authority to do so. Receives necessary approval from management to do so when necessary.

+ Prepares analyses of receivable’s accounts as required.

+ Complies with all regulatory requirements regarding patient/resident personal information.

+ Assists in monthly closings.

+ Notifies all necessary executives regarding any problematic payors, and takes all actions as directed.

+ Assists with other accounts receivable and/or billing subjects and activities as necessary.

+ Demonstrates ability to regularly change priorities to accomplish all tasks despite frequent interruptions.

+ Demonstrates ability to clearly communicate, both orally and in writing, while performing all essential functions.

+ Performs other special projects and duties as assigned.

+ High School diploma or GED.

+ 1 to 4 years of accounts receivable and/or collections experience, preferably within a health care environment.

+ Recent successful experience with collections made from insurers, federal government and/or state government payors having occasionally long payables cycles.

+ Demonstrated ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures.

+ Interest in medical subjects, patient services/care, and customer service.

+ Prior medical environment work experience is preferred.

Posting Title: Claims Specialist

Department: RTH - Revenue Cycle

Job ID: 2023-9543

Street: 483 West Seed Farm Road

Post End Date: 7/1/2023

Shift: Days

Email Address: [email protected]

Performs various Customer Care Specialist activities as well as assists with special projects. As a Customer Care Support Specialist, you may be assigned to one or more of the specific jobs below and/or assist in all Specialist assignments as necessary. You will be a member of a team that provides Best in Class customer service in the Food Service industry. You will actively engage with our customers to ensure their needs are met and that their experience exceeds expectations. You will be a problem resolution expert that will partner with other cross-functional departments within the company to fulfill customer orders. Most importantly, you will see your efforts have an immediate, tangible impact every day in a well-funded and rapidly growing company.

Essential Duties:

* Order entry from internal/external customers direct or by phone and email; from non-customer sources such as fax, email and voice mail
* Customer Call Sheets and/or assignments to fulfill customer service level agreements
* Rotation of duties can vary daily/weekly, to include email communications, Inbox Management, internal and/or external customer transactions and requests
* Review reports to prevent and/or proactively make order edits and prevent lost sales
* Make product recall inquiries and timely documentation to/from customers
* Research and resolve customer delivery issues via phone and email
* Other duties may be assigned

Qualifications:

* High school diploma or General education degree (GED)
* One-year Customer Service, administrative support or restaurant experience preferred
* Must have excellent written and verbal communication skills
* Proficient in Microsoft Office suite; Word, Excel, and Outlook
* Salesforce or Customer Relationship Management (CRM) software experience preferred
* Must be flexible and willing to work the demands of the department which are subject to weekends, and holidays

Corporate Summary

At Shamrock Foods Company, people come first - our associates, our customers, and the families we serve across the nation. A privately-held, family-owned and -operated Forbes 500 company, Shamrock is an innovator in the food industry and has been since being founded in Arizona in 1922.

Our Mission

At Shamrock Foods Company, we live by our founding family's motto to "treat associates like family and customers like friends."

Why work for us?

Benefits are a major part of your overall compensation, and we believe offering them at an affordable cost is not only the right thing to do, but it helps keep you and your family healthy. That's why Shamrock Foods pays for the majority of your health insurance, allowing you to take home more of your paycheck. And it doesn't stop there - our associates also enjoy additional benefits such as 401(k) Savings Plan, Profit Sharing, Paid Time Off, as well as our incredible growth opportunities, continued education and wellness programs.

Equal Opportunity Employer

At Shamrock Foods Co all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, veteran status, sexual orientation, gender identity or any other basis protected by applicable law.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Specialist Sr Professional Liablity - Commeral Coverage Expert

**PRIMARY PURPOSE** **:** To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.

+ Negotiates claim settlement up to designated authority level.

+ Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.

+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.

+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.

+ Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.

+ Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.

+ Represents Company in depositions, mediations, and trial monitoring as needed.

+ Communicates claim activity and processing with the client; maintains professional client relationships.

+ Ensures claim files are properly documented and claims coding is correct.

+ Refers cases as appropriate to supervisor and management.

+ Delegates work and mentors assigned staff.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

**QUALIFICATIONS**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

**Experience**

Six (6) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

+ Excellent oral and written communication, including presentation skills

+ PC literate, including Microsoft Office products

+ Analytical and interpretive skills

+ Strong organizational skills

+ Excellent negotiation skills

+ Good interpersonal skills

+ Ability to work in a team environment

+ Ability to meet or exceed Performance Competencies

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical** **:** Computer keyboarding, travel as required

**Auditory/Visual** **:** Hearing, vision and talking

**NOTE** **:** Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

**Taking care of people is at the heart of everything we do. Caring counts**

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Job Description

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans, and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simply and seamless, to not only help people get well, but help them stay well in body, mind and spirit.The Pharmacy Claims Reviewer is responsible for reviewing pharmacy claims submitted through the CVS Health claims processing systems. The Pharmacy Claims Auditor will identify and rectify claim inaccuracies that would result in client over-payment.In order to be successful in this role you will contact pharmacies for proper documentation to ensure a claim was submitted correctly as well as monitor assigned clients and report status on a regular basis. In the event of an inaccurate claim submission, you will follow the appropriate policies for correction.We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays

Pay Range

The typical pay range for this role is:

Minimum: 40,560

Maximum: 83,400

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

jobs.CVSHealth.com/benefits

Required Qualifications

Valid AZ Pharmacy Technician or Pharmacy Technician Trainee License -1+ year professional pharmacy experience

Preferred Qualifications

To be successful in this role the applying candidate must have excellent time management and communication skills. The candidate will need follow up consistently and maintain excellent organizational skills.

Education

High school diploma or GED required; Bachelor's Degree preferred

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Guardian is seeking individuals with Group Disability claims experience to join our Appeals Team. The **Appeals Claims Mgr., Group Benefits** will adjudicate assigned appeals for Group Life and Disability claims. In this role, you will provide a complete and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations. This role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

**You are**

A motivated claims professional able to work with varying levels of supervision independently or collaboratively. You are detailed and a decisive decision maker who manages competing priorities at the same time with a positive demeanor.

**You have**

+ 5 years of Group Disability and/or Life claims experience.

+ 3+ years of demonstrated ability handling appeals or complex claims (preferred).

+ Bachelor’s Degree (preferred) or equivalent professional experience.

+ Demonstrated customer service with excellent verbal and written communication skills.

+ Proven problem-solving, analytical, math aptitude and information research skills.

+ Ability to manage multiple tasks in accordance with regulatory requirements.

+ Ability to remain flexible due to changing business needs.

+ Demonstrated experience with technical and persuasive writing.

**You will**

+ Apply effective claim management skills to plan, implement and complete the investigation of disputed claims while ensuring timely and compliant appeal resolution.

+ Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination.

+ Evaluate medical, financial, and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.

+ Reach out proactively providing superior customer service.

+ Identify legal and/or compliance scenarios that require additional research; facilitate resolution.

+ Maintain current knowledge of all ERISA and Department of Labor guidelines.

+ Independently workload based on individual and departmental deadlines.

+ Readily share insights and takeaways with claims colleagues.

**Location**

Remote/Flexible – This position is work primarily from home. and may be expected to come into a Guardian work location occasionally, as determined by their people leader.

**Travel**

Occasional 0-10% of the time.

**Our Promise**

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

**Salary Range**

$55,100.00 - $102,340.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

**Inspire Well-Being**

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

**Health Care**

+ Choice of medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

+ Dental plan

+ Vision plan

+ Health care accounts – flexible spending, health reimbursement, and health savings accounts

+ Critical illness insurance

**Life and Disability Insurance**

+ Company-paid Life and Disability insurance plus voluntary supplemental coverage

+ Accident insurance

**Retirement and Financial**

+ 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

+ Complimentary 1:1 financial guidance with a licensed Fidelity representative

**Time Off and Remote Work**

+ Flexible work arrangements (part in-person/part remote)

+ Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

+ Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

+ Paid parental leave and paid family and medical leave policies

**Emotional Well-being and Work-Life**

+ Emotional well-being, mental health, and work/life resources powered by Spring Health

+ Wellness programs, including fitness program and equipment reimbursement

+ Child, adult, and elder back-up care support through Bright Horizons

+ Adoption assistance

+ College planning

+ Tuition reimbursement

+ Student loan assistance

+ Commuter benefits in select metropolitan areas

**Justice, Equity, Diversity & Inclusion (J.E.D.I.)**

+ Employee Resource Groups that advocate for inclusion and diversity

+ J.E.D.I. certification and training programs

+ Matching gifts/volunteering

_Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits._

**Equal Employment Opportunity**

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. 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 [email protected] .

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .

Paylocity is a cloud-based software company that creates customized HR solutions for small to mid-sized organizations. Our workplace enhances communication and enables employees to connect, collaborate, and create from anywhere. Our award-winning culture ensures everyone has a voice and feels truly welcome. Join Paylocity as we shape the future of technology and the workplace!

We give our employees what they need to succeed, including great benefits and perks! We offer medical, dental, vision, life, disability, and a 401(k) match, as well as perks that support you, your family, and your finances. And if it’s career development you desire, we provide that, too! At Paylocity, people matter most and have always been at the heart of our business.

Help our award-winning technology company run effectively as you take on big challenges and find solutions with a position in Operations.

Use your problem-solving skills to shape the way others see Paylocity. Launch your career with us!

Position Overview

Are you a natural problem-solver? Does working with technology excite you? Do you love challenges? Do you love to learn? Excel at figuring out logic puzzles? If so, the Client Services Representative role at Paylocity may be an opportunity you would love. We offer a dynamic team environment, a modern workplace, competitive benefits, and opportunities to grow and develop new skills.

As a Client Services Representative, you represent Paylocity as the main point of contact for our clients. You communicate with clients daily to provide training, support, issue resolution, and troubleshooting related to payroll, human capital management, time and attendance, and employee engagement tools. Not an expert in the Payroll and HR world? No problem – we provide paid training to teach you. From training to your first call and beyond, you will be given the tools and support you need to make a difference for our clients.

Location: Phoenix, AZ. (Work From Home, residing within 50 miles of Phoenix, AZ)

Reports To: Client Services Team Lead

Compensation: $19.50 +DOE

Schedule: Your work schedule will be 9 a. m. to 6 p. m. PHX time until Nov 5, 2023. Your work schedule will be 10 a.m. to 7 p.m. PHX time from November 5, 2023, until March 10, 2024. Your schedule will adjust accordingly with daylight savings time. Training hours may fluctuate.

CLIENT SERVICE EXPECTATIONS:

Dependability/Follow-Up: Timely responsiveness & proactive follow up
Problem Solve: Troubleshoot and problem solve by leveraging knowledge, resources, qualitative and quantitate information
Communication: Provide professional & appropriate internal/ external communication as well as progress updates to all stakeholders
Guidance: Provide clients guidance on HR and Payroll best practices, organizational change management, and Paylocity product fit
Implement and optimize products: Ability to implement ancillary products and optimize primary HCM setup
RESPONSIBILITIES:

Issue Resolution – able to be available on a consistent basis, manage workload to maintain availability, problem solve, troubleshoot & effectively resolve issues for the client; escalate when needed
Client Focus - baseline service level is seen via Quality Assurance assessments and Team Lead and Manager feedback including (1) creating rapport (2) an appropriate sense of urgency and tone (3) understanding the question (4) and effective interactions, guides, and client instructions
Focus on the timely and successful delivery of solutions - according to client needs and objectives meet SLAs and key internal client service metrics including availability, outbound adherence, first call resolution, escalations, client retention, etc. as monitored by Leadership Team; leverages metrics to understand performance, adjust behaviors and identify where additional support is needed
System Capability – Ability to navigate w/in systems including Web Pay, Web Time, Desk, IC (phones), Service Bureau, Portal, Compass, Admin Guides and to continually build the knowledge base to best serve the client
Leverage Resources - Appropriately & effectively use resources to find and validate answers, resolve, and document issues in a way that adheres to payroll policies and ensures seamless client support. Listens to feedback, seeks to understand, and adjusts behaviors as needed
Requirements:

High School Diploma or GED
Experience in customer service or previous client interfacing role
Strong computer skills including Microsoft Office
Pass job-dependent Final Exam at training end
Preferred Skills:

Associate’s Degree
CPP, FPC, APA, and/or SHRM-CP certified
Experience in payroll and/or call center environment
Proficient in Excel
EEO and accessibility Statement Paylocity is an equal opportunity employer. Paylocity is committed to the full inclusion of all individuals. We comply with federal and state disability laws and make reasonable accommodations for applicants and employees with disabilities. To request reasonable accommodation in the job application or interview process, please contact [email protected]

As an elite Excess and Surplus Lines market, Nautilus Insurance Group offers commercial property and casualty insurance solutions to appointed wholesale surplus lines producers countrywide. We have specialized in providing these solutions for more than 35 years.

We have more flexible policy terms and premium rates on a non-admitted basis. Our focus is small to medium Property and Casualty risks on both an admitted and a non-admitted basis.

Our offerings are distributed through partnerships with appointed wholesale surplus lines producers. Our relationships are defined by mutual success, speed to market, customer-centric focus and an expanded appetite.

Coverage placed by Nautilus Insurance Group is provided by Nautilus Insurance Company and Great Divide Insurance Company, both W. R. Berkley Corporation members with A.M. Best (Superior) A+ XV ratings.

The Claims Examiner II’s primary job function includes efficiently and effectively handling primarily basic, commercial first-party property and/or third-party general liability losses in a “paperless” environment. The assigned caseload may include up to one-half intermediate-level losses. An ability to communicate both verbally and in written form in a prompt, courteous and professional manner is essential.

+ Reviews and sets up new loss assignments in a timely manner in compliance with Department guidelines and best practices.

+ Establishes appropriate initial loss and expense reserves and continues to regularly evaluate the file for adequacy, accuracy and adherence to reserving guidelines.

+ Analyzes and interprets policy language in conjunction with specific loss facts to reach appropriate coverage decisions.

+ Drafts frequent coverage correspondence, including reservation of rights and coverage disclaimers in compliance with various state statutes and regulations.

+ Composes a variety of other detailed correspondence to insureds, claimants, attorneys, agents and Regulatory agencies.

+ Proactively manages claim files from inception to closure, including identification and investigation of coverage, liability and damage issues, determination and efficient execution of an appropriate plan of action, and prompt, economical file resolution, in compliance with Department guidelines and best practices.

+ Appropriately and clearly documents all claim file activity, including current strategy, plan of action and exit plan in file notes.

+ Consistently demonstrates coverage analysis, investigation, evaluation and negotiation skills at a basic and frequently higher level.

+ Directs and controls the activities and costs of numerous outside vendors including independent adjusters, defense counsel and coverage counsel.

+ Effectively presents and discusses loss facts and issues in roundtable discussions to peers and members of management.

+ Composes and transmits in a regular and timely basis Large Loss Reports and other detailed reporting documents as appropriate.

+ Manages and monitors file caseload through the use of various resources.

+ Obtains all required state adjuster licenses and maintain them as required via compliance with mandatory continuing education requirements.

+ Demonstrated experience working with business users.

+ Other duties may be assigned.

+ Occasional participation in projects and initiatives lead by other departments and/or W. R. Berkley companies, including audits, workshops, focus groups, task forces, etc.

+ Initiates appropriate communication with members of management and other Departments.

+ Attends internal and external seminars and other training events and provide feedback to peers and/or members of management.

+ Must have at least five (5) years of insurance experience.

+ Certificates as required by states.

+ Must have intermediate knowledge of computer programs in a Windows environment, including Word, Excel and Outlook.

+ High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience. Some college preferred.

+ CPCU, AIC, AEI or completion of other insurance-related classes is preferred.

Benefit Highlights:

+ Paid Parental Leave! At Nautilus, we offer Childbirth Recovery Leave as well as Primary Caregiver Leave, for up to a maximum of 12 weeks of paid leave.

+ Nautilus offers Medical, Dental, and Vision coverage options, along with Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) choices

+ We help our employees feel secure by providing a 401(k) program, profit sharing, stock purchase plan, life insurance, and travel accident insurance options.

+ One of our core values is “Committed to Serve” and these aren’t idle words. We provide every employee one paid day off per year to volunteer at a local charity. That’s serving with a smile!

+ We take risk management excellence and your professional growth seriously by offering Tuition Assistance and Industry-Related Education and Exam programs.

+ Can you hear us now? Employees are eligible for special cell phone service discounts with Verizon and AT&T. We’ve got a plum position for you! We participate in the Plum Benefits program offering employees cost-free access to thousands of exclusive travel and entertainment discounts.

+ Flexible work arrangements, including working from home 2 days a week.

The Company is an equal employment opportunity employer.

We do not accept any unsolicited resumes from external recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Job ID: 2023-8595

Street: 7233 E Butherus Drive

Industry:

Insurance

Seniority Level:

Mid-Senior Level

Job Functions:

Other

Employment Type:

Full-Time

Additional Company Details: The Company is an equal employment opportunity employer.

We do not accept any unsolicited resumes from external recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees.

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

**Come Build Your Career Under OUR Roof**

**Job Description:**

**SUMMARY**

The goal of the Residential Claims Department is to provide solutions-based service driven by the desire to partner with our customers to assist with their issues in the most expedient and informative way. Reporting to the Residential Claims Supervisor, the Residential Claims Examiner will be responsible for overseeing the commercial claims process and providing an exceptional experience to internal and external customers.

**ESSENTIAL DUTIES:**

**Essential job responsibilities include, but are not limited to:**

+ Ability to efficiently manage the day-to-day activities related to new and existing residential claims, which includes but not limited to research and investigation, assignment of work orders, preparation of various communications throughout the life of the claim, and resolution.

+ Provide front-line support related to GAF’s residential claim process through inbound customer contact channels such as phone and email.

+ Provide the highest level of customer service addressing all customers’ general inquiries regarding guarantee coverage

+ Investigate and resolve customer concerns, complaints, and disputes in a timely and empathetic manner

+ Effectively communicate claim status and resolution with internal and external customers

+ Proactively follow up with our customers to provide a seamless experience

+ Ability to apply business reasoning and think outside the box to recommend solutions to best support our customers

+ Create and maintain close relationships with internal and external customers in an effort to align with our world class customer service model

+ Participate in ongoing training for residential products

+ Support the development and implementation of workflow, processes and system improvements

**LEVEL BASED COMPETENCIES:**

**Professional Knowledge & Skills:**

+ Requires working knowledge and skills developed through formal training or work experience

+ Ability to assess a customer's needs, to offer and recommend solutions

+ Works within established or standard operating procedures with a moderate degree of supervision

+ Works cross functionally and collaboratively to create a seamless end-to-end customer experience

**Decision Making:**

+ Ability to recommend solutions to problems that will enhance the customer experience

+ Ability to deal with change and take the initiative to move-forward with the claim resolution process

**Stress Tolerance:**

+ Organized, dependable and works towards task completion

+ Ability to manage a wide variety of tasks

+ Ability to multitask and prioritize responsibilities

**Communication:**

+ Proactive and customer friendly communication style

+ Ability to communicate in a collaborative manner

+ Strong written and verbal communications skills

**General Knowledge/Skills:**

+ Excellent listening skills to empathize with the customer

+ The ability to work effectively with a team

+ Demonstrating a dedication for supporting our customers

+ Highly self-motivated

**Education/Experience:**

+ Bachelor’s Degree preferred

+ Past customer service experience preferred

Consideration will be given based on geography, candidate experience, and qualifications.

Annual Salary Range: 50,632-64,696

We believe our employees are our greatest resource. We offer competitive salary, benefits, 401k, and vacation packages for all full time permanent positions. We are proud to be an equal opportunity workplace and GAF, Standard Logistics, SGI, and Siplast are proud to be affirmative action employers. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know. If applying for positions in the U.S., must be eligible to work in the U.S. without need for employer sponsored visa (work permit).

Privacy Policy (https://www.gaf.com/en-us/about-us/privacy-and-legal/privacy-policy) **CA Privacy** Applicant Notice (https://www.gaf.com/en-us/about-us/privacy-and-legal/applicant-privacy-notice)

With 130+ years in the industry, GAF is the leading roofing manufacturer in North America. As a member of the Standard Industries family of companies, we are also part of the largest roofing and waterproofing business in the world.

Our communities help give our work meaning and the products we manufacture help protect what matters most. The shingles help to shelter the families living in the homes in our towns. The TPO helps protect what is under that hospital’s roof. In addition to quality products, we make sure they are installed by quality craftsmen and women. The full GAF portfolio of solutions is supported by an extensive national network of factory-certified contractors.

GAF continues to be the leader in quality and offers comprehensive warranty protection on its products and systems. Our success is driven by a commitment to empowering our people to deliver advanced quality and purposeful innovation and the desire to protect what matters most.

**Come Build Your Career Under OUR Roof**

**Job Description:**

**SUMMARY**

The goal of the Residential Claims Department is to provide solutions-based service driven by the desire to partner with our customers to assist with their issues in the most expedient and informative way. Reporting to the Residential Claims Supervisor, the Residential Claims Examiner will be responsible for overseeing the commercial claims process and providing an exceptional experience to internal and external customers.

**ESSENTIAL DUTIES:**

**Essential job responsibilities include, but are not limited to:**

+ Ability to efficiently manage the day-to-day activities related to new and existing residential claims, which includes but not limited to research and investigation, assignment of work orders, preparation of various communications throughout the life of the claim, and resolution.

+ Provide front-line support related to GAF’s residential claim process through inbound customer contact channels such as phone and email.

+ Provide the highest level of customer service addressing all customers’ general inquiries regarding guarantee coverage

+ Investigate and resolve customer concerns, complaints, and disputes in a timely and empathetic manner

+ Effectively communicate claim status and resolution with internal and external customers

+ Proactively follow up with our customers to provide a seamless experience

+ Ability to apply business reasoning and think outside the box to recommend solutions to best support our customers

+ Create and maintain close relationships with internal and external customers in an effort to align with our world class customer service model

+ Participate in ongoing training for residential products

+ Support the development and implementation of workflow, processes and system improvements

**LEVEL BASED COMPETENCIES:**

**Professional Knowledge & Skills:**

+ Requires working knowledge and skills developed through formal training or work experience

+ Ability to assess a customer's needs, to offer and recommend solutions

+ Works within established or standard operating procedures with a moderate degree of supervision

+ Works cross functionally and collaboratively to create a seamless end-to-end customer experience

**Decision Making:**

+ Ability to recommend solutions to problems that will enhance the customer experience

+ Ability to deal with change and take the initiative to move-forward with the claim resolution process

**Stress Tolerance:**

+ Organized, dependable and works towards task completion

+ Ability to manage a wide variety of tasks

+ Ability to multitask and prioritize responsibilities

**Communication:**

+ Proactive and customer friendly communication style

+ Ability to communicate in a collaborative manner

+ Strong written and verbal communications skills

**General Knowledge/Skills:**

+ Excellent listening skills to empathize with the customer

+ The ability to work effectively with a team

+ Demonstrating a dedication for supporting our customers

+ Highly self-motivated

**Education/Experience:**

+ Bachelor’s Degree preferred

+ Past customer service experience preferred

Consideration will be given based on geography, candidate experience, and qualifications.

Annual Salary Range: 50,632-64,696

We believe our employees are our greatest resource. We offer competitive salary, benefits, 401k, and vacation packages for all full time permanent positions. We are proud to be an equal opportunity workplace and GAF, Standard Logistics, SGI, and Siplast are proud to be affirmative action employers. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know. If applying for positions in the U.S., must be eligible to work in the U.S. without need for employer sponsored visa (work permit).

Privacy Policy (https://www.gaf.com/en-us/about-us/privacy-and-legal/privacy-policy) **CA Privacy** Applicant Notice (https://www.gaf.com/en-us/about-us/privacy-and-legal/applicant-privacy-notice)

With 130+ years in the industry, GAF is the leading roofing manufacturer in North America. As a member of the Standard Industries family of companies, we are also part of the largest roofing and waterproofing business in the world.

Our communities help give our work meaning and the products we manufacture help protect what matters most. The shingles help to shelter the families living in the homes in our towns. The TPO helps protect what is under that hospital’s roof. In addition to quality products, we make sure they are installed by quality craftsmen and women. The full GAF portfolio of solutions is supported by an extensive national network of factory-certified contractors.

GAF continues to be the leader in quality and offers comprehensive warranty protection on its products and systems. Our success is driven by a commitment to empowering our people to deliver advanced quality and purposeful innovation and the desire to protect what matters most.

**Come Build Your Career Under OUR Roof**

**Job Description:**

**SUMMARY**

The goal of the Residential Claims Department is to provide solutions-based service driven by the desire to partner with our customers to assist with their issues in the most expedient and informative way. Reporting to the Residential Claims Supervisor, the Residential Claims Examiner will be responsible for overseeing the commercial claims process and providing an exceptional experience to internal and external customers.

**ESSENTIAL DUTIES:**

**Essential job responsibilities include, but are not limited to:**

+ Ability to efficiently manage the day-to-day activities related to new and existing residential claims, which includes but not limited to research and investigation, assignment of work orders, preparation of various communications throughout the life of the claim, and resolution.

+ Provide front-line support related to GAF’s residential claim process through inbound customer contact channels such as phone and email.

+ Provide the highest level of customer service addressing all customers’ general inquiries regarding guarantee coverage

+ Investigate and resolve customer concerns, complaints, and disputes in a timely and empathetic manner

+ Effectively communicate claim status and resolution with internal and external customers

+ Proactively follow up with our customers to provide a seamless experience

+ Ability to apply business reasoning and think outside the box to recommend solutions to best support our customers

+ Create and maintain close relationships with internal and external customers in an effort to align with our world class customer service model

+ Participate in ongoing training for residential products

+ Support the development and implementation of workflow, processes and system improvements

**LEVEL BASED COMPETENCIES:**

**Professional Knowledge & Skills:**

+ Requires working knowledge and skills developed through formal training or work experience

+ Ability to assess a customer's needs, to offer and recommend solutions

+ Works within established or standard operating procedures with a moderate degree of supervision

+ Works cross functionally and collaboratively to create a seamless end-to-end customer experience

**Decision Making:**

+ Ability to recommend solutions to problems that will enhance the customer experience

+ Ability to deal with change and take the initiative to move-forward with the claim resolution process

**Stress Tolerance:**

+ Organized, dependable and works towards task completion

+ Ability to manage a wide variety of tasks

+ Ability to multitask and prioritize responsibilities

**Communication:**

+ Proactive and customer friendly communication style

+ Ability to communicate in a collaborative manner

+ Strong written and verbal communications skills

**General Knowledge/Skills:**

+ Excellent listening skills to empathize with the customer

+ The ability to work effectively with a team

+ Demonstrating a dedication for supporting our customers

+ Highly self-motivated

**Education/Experience:**

+ Bachelor’s Degree preferred

+ Past customer service experience preferred

Consideration will be given based on geography, candidate experience, and qualifications.

Annual Salary Range: 50,632-64,696

We believe our employees are our greatest resource. We offer competitive salary, benefits, 401k, and vacation packages for all full time permanent positions. We are proud to be an equal opportunity workplace and GAF, Standard Logistics, SGI, and Siplast are proud to be affirmative action employers. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know. If applying for positions in the U.S., must be eligible to work in the U.S. without need for employer sponsored visa (work permit).

Privacy Policy (https://www.gaf.com/en-us/about-us/privacy-and-legal/privacy-policy) **CA Privacy** Applicant Notice (https://www.gaf.com/en-us/about-us/privacy-and-legal/applicant-privacy-notice)

With 130+ years in the industry, GAF is the leading roofing manufacturer in North America. As a member of the Standard Industries family of companies, we are also part of the largest roofing and waterproofing business in the world.

Our communities help give our work meaning and the products we manufacture help protect what matters most. The shingles help to shelter the families living in the homes in our towns. The TPO helps protect what is under that hospital’s roof. In addition to quality products, we make sure they are installed by quality craftsmen and women. The full GAF portfolio of solutions is supported by an extensive national network of factory-certified contractors.

GAF continues to be the leader in quality and offers comprehensive warranty protection on its products and systems. Our success is driven by a commitment to empowering our people to deliver advanced quality and purposeful innovation and the desire to protect what matters most.