Claims Adjusters, Examiners, and Investigators

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

Workers Compensation Claims Adjuster | Remote (Must be able to work Pacific Time Zone hours) | WA License required

**JURISDICTIONAL KNOWLEDGE: WA**

**LICENSING: WA license preferred**

**At least 2 years of Workers Compensation experience**

**Basic knowledge of excel/computations**

**Time Management skills: multi-tasking & prioritizing**

**Pacific Time Zone hours**

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

+ Apply your adjuster knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

+ Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

+ Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.

+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.

+ Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

**ARE YOU AN IDEAL CANDIDATE?** To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

**PRIMARY PURPOSE OF THE ROLE:** We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

**ESSENTIAL RESPONSIBLITIES MAY INCLUDE**

+ Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

+ Negotiating settlement of claims within designated authority.

+ Communicating claim activity and processing with the claimant and the client.

+ Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

**QUALIFICATIONS**

Education & Licensing: 2 years of claims management experience or equivalent combination of education and experience required.

High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.

Professional certification as applicable to line of business preferred.

**TAKING CARE OF YOU**

+ Flexible work schedule.

+ Referral incentive program.

+ Career development and promotional growth opportunities.

+ A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Work environment requirements for entry-level opportunities include:

Physical: Computer keyboarding

Auditory/visual: Hearing, vision and talking

Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

\#claims #claimsexaminer #remote

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (48,200 - 67,480/yr). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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)

APD Claims Representative - CH10IN

We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

A new role can expand your knowledge and your network, and help you learn more about our business. If you think this opportunity is a fit for your career you should apply. If you are not sure you can have a conversation with your manager.

The Total Loss department is seeking Auto Total Loss Claims Representatives to join a dynamic team. At The Hartford, we respect our employees for their unique perspectives, ideas, and solutions. We empower individuals and teams to invent faster, smarter ways of meeting customers’ needs while improving our performance. Goals are important, but so is the way we reach them. Character and customer value are just as vital to our reputation as financial performance – leading to behaviors that put the customer at the center of everything we do. In recognition of successful completion of training you will be eligible for a proficiency increase at or around 6 months from your date of hire. Projected Start Date: March 24, 2025 Location: Hybrid Training Hours: Monday - Friday 8:00am - 5:00pm (all time zones) Regular Hours: Monday - Friday Core Business Hours, no weekends As a Total Loss Auto Claim Representative, you will: • Plan, recommend, reserve and execute the investigation, control, valuation and final disposition of small to medium dollar total loss (majority) with the occasional high end or specialty vehicle total loss • Properly assess the indemnity and expense exposure, along with settling total loss claims in line with state jurisdictions. • Support other team members to enhance overall team productivity. • Handle other duties as assigned by your manager. Qualifications: • 2+ years of auto claim handling experience required. • Proven negotiation \ dispute resolution skills • Ability to efficiently manage the auto rental process. • Proven track record of providing excellent customer service. • Bachelor's degree preferred, and/or 1+ years of equivalent experience. Additional details: This role can have a Hybrid or Remote work arrangement. Candidates who live near a local office will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise. For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, MiFi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$49,920 - $74,880

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories) | Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity) | Benefits (https://www.thehartford.com/careers/benefits)

Privacy Policy | Legal Notice (https://www.thehartford.com/legal-notice) | Accessibility Statement (https://www.thehartford.com/accessibility-statement) | Producer Compensation (https://www.thehartford.com/producer-compensation) | EEO (https://www.thehartford.com/eeo-statement)

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$49,920 - $74,880

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us (https://www.thehartford.com/about-us) | Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories) | Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity) | Benefits (https://www.thehartford.com/careers/benefits)

Human achievement is at the heart of what we do.

We believe that with the right encouragement and support, people are capable of achieving amazing things.

We put our belief into action by ensuring individuals and businesses are well protected, and by going even further – making an impact in ways that go beyond an insurance policy.

Nearly 19,000 employees use their unique talents in careers that span a variety of disciplines – from developing the latest technology to creating and promoting our products to evaluating future financial risks.

We’re also committed to programs that drive education and support volunteerism, which put human beings first. We do it because it’s the right thing to do, and because when our customers, communities and employees succeed, we all do.

About Us (https://www.thehartford.com/about-us)

Culture & Employee Insights (https://www.thehartford.com/careers/employee-stories)

Diversity, Equity and Inclusion (https://www.thehartford.com/about-us/corporate-diversity)

Benefits (https://www.thehartford.com/careers/benefits)

Legal Notice (https://www.thehartford.com/legal-notice)

Accessibility StatementProducer Compensation (https://www.thehartford.com/producer-compensation)

EEO

Privacy Policy (https://www.thehartford.com/online-privacy-policy)

California Privacy Policy

Your California Privacy Choices (https://www.thehartford.com/data-privacy-opt-out-form)

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Canadian Privacy Policy (https://www.thehartford.com/canadian-privacy-policy)

Unincorporated Areas of LA County, CA (Applicant Information)

**Why USAA?**

At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.

Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.

**The Opportunity**

**It is all about learning and growing.** Our Customer Service Claims Representative role may be a new career for you. There’s a lot to learn, but the pathway is mapped out and USAA is willing to invest in you! Our comprehensive, fully paid four-month training program includes all training materials, licensing costs, class discussions, hands-on training, e-learning modules, and the instructor led guidance will help you to support our members independently. We have new training classes starting every month.

Our in-office development program provides the training you need and the reassurance to create a proactive and independent support style to service our membership. **After six months in-office, you’ll have the opportunity to work offsite 2 days a week.** Military veterans and spouses are highly encouraged to apply. Relocation assistance **is not** available for this position.

Work schedules will vary and may include some **nights and weekends** . Schedules are assigned based on business need. Regularly scheduled shift hours that fall between 6 p.m. and 7 a.m. during the week, or between 6 p.m. Friday and 7 a.m. Monday are eligible for **shift premium pay.**

We are currently seeking dedicated professionals to **work in our Phoenix office** **(1 Norterra Drive, Phoenix, AZ 85085)** as a Customer Service Claims Representative. You will be part of an outstanding contact service center, where you will focus on providing claims service to members regarding the initial contact on all **auto OR property** First Notice of Loss (FNOL) claims. In addition, you will respond to status inquiries from various parties, document reported losses, set appropriate expectations, provide proactive communications, advice, and empathy to our members.

**What you'll do:**

+ Document First Notice of Loss by acquiring relevant information for effective claim investigation. Set up appropriate services, as needed, to proactively move claims forward to the furthest point in the process within scope of role and expectation.

+ Build loss reports, describe or verify coverage as appropriate, and initiate the most effective method of damage assessment to assign for file handling.

+ Assist with questions regarding the claims process and set expectations for next steps to help ensure claims are optimally resolved and accurately documented.

+ Resolve status inquiries and, when appropriate, route to handling adjuster.

+ Effectively operate in a fast-paced, high-volume, contact center environment taking back-to-back calls and navigating multiple systems and programs while maintaining an engaging member interaction that occurs across multiple communication channels.

+ Apply strong time management skills by closely adhering to assigned work schedule.

+ Adopt continuous improvement and development through coaching and collaboration with manager and team members.

+ Use strong call management skills by assisting members within a timely manner and limiting non-productive time.

+ May assign or initiate emergency services when required on specific claims.

+ Support workload surges and catastrophe (CAT) response operations as needed which may include potential weekends, and/or holiday work outside normal work hours.

+ Work various types of claim loss notices and inquiries, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.

+ Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

**What you have:**

+ High School Diploma or GED

+ Ability to provide exceptional customer service for our members by using active listening, verbal, and written communication skills to communicate clearly, professionally, and empathetically.

+ Highly developed interpersonal skills to collaborate effectively in a fast-paced team environment.

+ Ability to prioritize and multi-task while navigating through multiple business applications.

+ Successful completion of a job-related assessment is required.

+ May require acquisition and maintenance of insurance adjuster license within 90 days. (USAA provides all materials and licensing fees.)

**What sets you apart:**

+ US military experience through military service or a military spouse/domestic partner

**Compensation range:** The hiring range for this position is: $43,750 to $45,750

**Compensation:** USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.

Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.

The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.

**Benefits:** At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

For more details on our outstanding benefits, visit our benefits page on USAAjobs.com

_Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting._

_USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran._

**If you are an existing USAA employee, please use the internal career site in OneSource to apply.**

**Please do not type your first and last name in all caps.**

**_Find your purpose. Join our mission._**

USAA is unlike any other financial services organization. The mission of the association is to facilitate the financial security of its members, associates and their families through provision of a full range of highly competitive financial products and services; in so doing, USAA seeks to be the provider of choice for the military community. We do this by upholding the highest standards and ensuring that our corporate business activities and individual employee conduct reflect good judgment and common sense, and are consistent with our core values of service, loyalty, honesty and integrity.

USAA attributes its long-standing success to its most valuable resource: our 35,000 employees. They are the heart and soul of our member-service culture. When you join us, you'll become part of a thriving community committed to going above for those who have gone beyond: the men and women of the U.S. military, their associates and their families. In order to play a role on our team, you don't have to be connected to the military yourself – you just need to share our passion for serving our more than 13 million members.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

California applicants, please review our HR CCPA - Notice at Collection (https://statmcstg.usaa.com/mcontent/static\_assets/Media/enterprise\_hr\_cpra\_notice\_at\_collection.pdf) here.

USAA is an EEO/AA Employer - applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, gender identity or expression, pregnancy, protected veteran status or other status protected by law.

Location(s)

Remote-AZ

**Details**

Kemper is one of the nation’s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper’s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises.

**Position Summary** :

Looking for that next opportunity to use your advanced negotiation skills? Kemper is looking for experienced Represented Bodily Injury Claims Adjusters for our growing teams! This specialized position focuses solely on the analysis & negotiation of bodily injury claims that are ordinarily assigned after the initial coverage determination, property damage handling, and investigation are completed. Claim inventories primarily involve attorney-represented files with varying degrees of complexity.

**Position Responsibilities** :

+ Initiate thorough coverage and liability investigations

+ Draft coverage letters as appropriate

+ Evaluate and resolve moderate to severe, including fatal, bodily injury claims with prompt review and respond to all demands, including time limit demands

+ Obtain and thoroughly analyze complex medical records and data

+ Research and apply applicable laws in multiple states

+ Submit timely large loss reports and referrals to home office when appropriate

+ Prepare for and deliver quality presentations of high exposure cases to upper claims management

+ Timely reserve losses and continue to monitor reserve adequacy

+ Skillfully and professionally negotiate settlements with claimants and attorneys

+ Adjust insurance policies for UM/UIM claims

**Position Qualifications** :

+ High School Diploma or GED required

+ 3 plus years of claims adjusting experience handling complex and severe first party and bodily injury claims with high exposures

+ Must be detail oriented and show a high level of accuracy

+ Excellent verbal and written communication skills

+ Exercise decisiveness and execution within authority

+ Ability to work independently and as a team

+ Strong problem-solving skills

+ Strong time management and organizational ability

+ Must have the ability to deal with conflict in an effective manner

+ Proficient in MS Office

+ Experience with Guidewire claims system is a plus

+ This position is a remote role and must be located in the state of Arizona.

The range for this position is $53,200.00 to $88,600.00. When determining candidate offers, we consider experience, skills, education, certifications, and geographic location among other factors. This job is also eligible for our Kemper benefits package (Medical, Dental, Vision, PTO, 401k, etc.)

Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination.

Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.

_Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it._

**Kemper at a Glance**

The Kemper family of companies is one of the nation’s leading specialized insurers. With approximately $13 billion in assets, Kemper is improving the world of insurance by providing affordable and easy-to-use personalized solutions to individuals, families and businesses through its Kemper Auto and Kemper Life brands. Kemper serves over 4.8 million policies, is represented by approximately 22,200 agents and brokers, and has approximately 7,500 associates dedicated to meeting the ever-changing needs of its customers. Learn more at Kemper.com .

*Alliance United Insurance Company is not rated.

_We value diversity and strive to be an employer of choice. An Equal Opportunity Employer, M/F/D/V_

**Our employees enjoy great benefits:**

• Qualify for your choice of health and dental plans within your first month.

• Save for your future with robust 401(k) match, Health Spending Accounts and various retirement plans.

• Learn and Grow with our Tuition Assistance Program, paid certifications and continuing education programs.

• Contribute to your community through United Way and volunteer programs.

• Balance your life with generous paid time off and business casual dress.

• Get employee discounts for shopping, dining and travel through Kemper Perks.

**Become a part of our caring community and help us put health first**

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.

The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana’s Bold Goal mission, throughout all activities.

**Use your skills to make an impact**

**Required Qualifications**

+ MD or DO degree

+ 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

+ Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.

+ A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.

+ No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

+ Excellent verbal and written communication skills.

+ Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation) **Preferred Qualifications**

+ **Understands Medicare Inpatient Guidelines**

+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

+ Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

+ Experience with national guidelines such as MCG® or InterQual

+ Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization

+ Advanced degree such as an MBA, MHA, or MPH

+ Exposure to Public Health principles, Population Health, analytics, and use of business metrics.

+ Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

+ The curiosity to learn, the flexibility to adapt and the courage to innovate

+ **Additional Information** Typically reports to a Director of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

+ Satellite, cellular and microwave connection can be used only if approved by leadership

+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

+ This is a remote position\#LI-Remote

**Scheduled Weekly Hours**

40

**Pay Range**

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

**Description of Benefits**

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 02-27-2025

**About us**

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

**Equal Opportunity Employer**

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

**Come join our amazing team and work remote from home!**

The Default FHA MI Claims Specialist I will, under moderate supervision, responsible for preparing, filing, and following up on FHA claims timely and accurately according to insurer/investor guidelines. Perform all duties in accordance with the company’s policies and procedures and all US state and federal laws and regulations wherein the company operates. The target pay range for this position is $21.00/hr - $24.50/hr.

**What you’ll do:**

+ Prepare and file claims for one primary loan type timely and accurately; primary loan types are FHA Conveyance Part A, Part B, Non-Conveyance CWCOT, Pre-Foreclosure Sale, as assigned.

+ Document system(s) with appropriate tasking and comments.

+ Ensure required documentation is included in the Claim File and uploaded to agency system as applicable.

+ Submit claim for quality review; complete corrections timely and accurately.

+ Finalize and submit claim to agency for payment; follow up with agency for claim payment if applicable.

+ Perform other duties and special projects as assigned.

+ Moderate knowledge of default claims processes for insurers and investors.

+ Understanding of the default servicing processes, to include Foreclosure, Bankruptcy, Loss Mitigation and Claims processes.

+ Moderate understanding of Agency and investor guidelines.

+ Strong interpersonal skills with a focus on teamwork and quality.

+ Excellent written and oral communication, organizational and time management skills.

+ Ability to communicate effectively with all levels of staff and management both internally and externally.

+ Ability to manage work in order to meet strict deadlines.

+ Ability to handle multiple tasks under pressure and changing priorities.

**What you’ll need:**

+ High School diploma required; some college preferred.

+ One (1) or more years’ mortgage servicing default experience, preferred

**Our Company:**

Carrington Mortgage Services is part of The Carrington Companies, which provide integrated, full-lifecycle mortgage loan servicing assistance to borrowers and investors, delivering exceptional customer care and programs that support borrowers and their homeownership experience. We hope you’ll consider joining our growing team of uniquely talented professionals as we transform residential real estate. To read more visit: www.carringtonmortgage.com .

**What We Offer:**

+ Comprehensive healthcare plans for you and your family. Plus, a discretionary 401(k) match of 50% of the first 4% of pay contributed.

+ Access to several fitness, restaurant, retail (and more!) discounts through our employee portal.

+ Customized training programs to help you advance your career.

+ Employee referral bonuses so you’ll get paid to help Carrington and Vylla grow.

+ Educational Reimbursement.

+ Carrington Charitable Foundation contributes to the community through causes that reflect the interests of Carrington Associates. For more information about Carrington Charitable Foundation, and the organizations and programs, it supports through specific fundraising efforts, please visit: carringtoncf.org.

EEO/AAP Employer

**Notice to all applicants: Carrington does not do interviews or make offers via text or chat.**

\#LI-SY1

Carrington is an equal opportunity employer. It is the policy of the company that applicants be considered for positions for which they qualify without regard to race, color, religion, sex, gender identity, national origin, ancestry, age, marital status, sexual orientation, protected veterans status, physical or mental disability or any other legally protected category. Carrington will make reasonable accommodations for known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the company.

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com .

Our Education team offers consulting services and technology solutions to help schools, school districts, and state education agencies/ministries of education promote student success, improve programs and processes, and optimize financial resources. We work with clients to ensure all students have what they need to succeed.

Services:

+ Teaching

+ Learning Solutions

+ Data Systems

+ IT Solutions

+ Financial Solutions

+ Equity in Education

+ Equitable Education

+ Recovery Services

**Duties and Responsibilities**

+ Analyzes the development of claims assigned at each level of the adjudication process.

+ Outlines the case strategy and develop a Theory of the Case for each individual claim.

+ Writes case summaries to be sent with applications.

+ Monitors and gives direction to Claims Developer regarding specific tasks on claims.

+ Provides monthly reporting statistics.

+ Ensures adherence to claim timeliness and accuracy performance standards.

+ Prepares for and participate in various meetings, including status reports, process improvement meetings and meetings related to collection of required data.

+ Assists with quality control projects, including case reviews to ensure the integrity of claim methodology and eligibility determinations.

+ Assists with preparation of other written reports and materials for clients.

**Required Skills**

+ Ability to evaluate, coordinate and perform a complex set of planning, development and administrative tasks.

+ Ability to build and maintain working relationships with federal, state and county agency staff.

+ Strong Microsoft application skills.

+ Ability to work with a large volume of claims and effectively prioritize the workload.

+ Excellent organizational, oral presentation and written communication skills.

+ Ability to work both in a team situation and autonomously.

+ Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid), and/or cost accounting are highly advantageous.

+ Knowledge and understanding of appropriate laws and regulations and applicable government agencies

**Qualifications**

+ High School Diploma or equivalent required. A Bachelor’s Degree is preferred

+ 2+ years of Medical Claims experience

**Supervisory Responsibility**

+ None

**Working Conditions**

+ Office Setting

**The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.**

**As required by applicable law, PCG provides the following reasonable range of compensation for this role: $45,000-$55,000. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.**

**Compensation:**

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role below. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

**EEO Statement:**

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in six Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com .

Our Human Services team helps state and municipal human services and economic development agencies keep their promises—responsibly and sustainably—to the children, adults, and families they serve. Join us and use your professional skills to build stronger communities and better serve populations in need by making meaningful and lasting changes in government organizations.

Services:

+ Program Consulting

+ Finance Consulting and Billing Services

+ Applied Technology

+ Outsourcing and Operations

+ Strategy

+ Project and Grants Management

+ Assessments and Feasibility Studies

Analyzes claims for accuracy, provides client support, documents inquiries, supervises staff, prepares reports, ensures compliance, conducts training, and assists with quality control and process improvements.

**Duties and Responsibilities**

+ Analyzes and reviews claims for accuracy, completeness and eligibility.

+ Provides leadership, supervision and coaching to junior department staff.

+ Prepares and submits claims data for multiple clients within multiple states.

+ Analyzes the development of claims assigned at each level of the adjudication process.

+ Provides support and give direction to less experienced staff

+ Evaluate medical records and apply evidence to each case.

+ Provides monthly reporting statistics.

+ Ensures adherence to claim timeliness and accuracy performance standards.

+ Prepares for and participate in various meetings, including status reports, process improvement meetings and meetings related to collection of required data.

+ Conducts policy and other research.

+ Assists with quality control projects, including case reviews to ensure the integrity of claim methodology and eligibility determinations.

+ Assists with preparation of other written reports and materials for clients.

+ Assists in administration of time studies and operation of help desk lines.

+ Trains others on the function of analyzing claims.

**Required Skills**

+ Ability to evaluate, coordinate and perform a complex set of planning, development and administrative tasks.

+ Ability to build and maintain working relationships with federal, state and county agency staff.

+ Strong Microsoft application skills.

+ Ability to work with a large volume of claims and effectively prioritize the workload.

+ Excellent organizational, oral presentation and written communication skills.

+ Strong analytical skills, including the ability to analyze and organize data.

+ Ability to work both in a team situation and autonomously.

+ Existing knowledge or experience with state government, health insurance payment systems (particularly Medicaid), and/or cost accounting are highly advantageous.

+ Knowledge and understanding of appropriate laws and regulations and applicable government agencies

+ Overtime and travel might be needed at times.

**Qualifications**

+ Bachelor’s degree in a relevant field is preferred

+ 6+ years of relevant claiming experience is required. Previous leadership experience is preferred.

**Working Conditions**

+ Office Setting

**The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities or skills of personnel so classified.**

PCG provides the following reasonable range of compensation for this role: $63,600.00 - 87,000.00 - and a potential discretionary bonus of up to 10 %

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\#LI- Remote

**Compensation:**

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role below. In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

**EEO Statement:**

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

The **Team Leader, Absence Claims Management** is responsible for leading a team of Absence Management Case Managers to get results within their team and the organization. The Team Leader will serve as a primary resource and provide direction to team members by setting objectives, communicating progress, and holding the staff accountable for adhering to all quality assurance, turnaround time, operational efficiency, and best practice standards. The Team Leader is responsible for assisting staff with career development and career progression, along with encouraging candor and challenging the status quo to continuously improve the way we work. The Team Leader partners with internal cross functional areas for program direction, goal setting, service delivery and development of action plans and using bench strength.

The Team Leader will validate that all FML, STD, State, and PFL are accurately adjudicated according to plan provisions, established standard methodologies and within state and federal guidelines. The Team Leader must be able to manage and resolve issues that pertain to claim administration procedures, cost containment activities, reports, quality control and complex customer issues. The Team Leader will work with external customers/clients to enhance the overall experience for the customer. The Team Leader is responsible for the overall functioning of the team and communicating to leadership on team status and performance.

**You will:**

+ Partner with leadership to develop and communicate objectives and performance goals for the team.

+ Manage direct reports’ performance by coordinating with HR to implement coaching plans and performance improvement plans.

+ Develop employee goals to promote career growth that enhance level of knowledge for future opportunities.

+ Collaborate with internal business partners including Short Term Disability, Long Term Disability, Service, Sales and Account Management, Group Quality Management, and other areas within the Company.

+ Create regular action plans based on results from employee engagement surveys – the Team Leader owns and acts on engagement survey results.

+ Review and analyze daily, weekly, and monthly reports on team productivity 1) for operational reporting and monitoring purposes; 2) to identify trends and training opportunities; and 3) to create action plans for improvement.

+ Review processes/reports regularly for process improvement opportunities.

+ Own relationship with client and get involved, when necessary, in meetings, phone calls, and closing the loop on service issues.

+ Prioritize the customer/client experience in day-to-day interactions and processes.

+ Identify Continuous Improvement opportunities by reviewing process and eliminating unnecessary steps.

+ Empower staff to submit process improvement ideas to revise workflows and procedures.

+ Support claims initiatives by encouraging/providing relevant feedback and acting as a change leader for project rollouts.

+ Schedule and facilitate team meetings and individual touchpoints.

+ Mentor, coach, supervise and develop talent of direct reports by acting as a partner in recommending and coordinating training resources, tools, and plans for individuals to achieve personal and departmental goals and objectives.

+ Review claim staff QA/CMA assessments for training or enhancement opportunities.

+ Use data and analytics to improve or change business process/procedures and team outcomes procedures and team outcomes.

**You have:**

+ Bachelor’s degree in related field and/or equivalent relevant disability work experience; integrated absence management preferred.

+ 5+ years of disability claims experience.

+ 3+ years of demonstrated leadership experience.

+ Extensive knowledge of disability products, business rules and procedures.

+ Familiarity with mandated state and federal regulations.

+ Professional oral, written and presentation skills.

+ Proven organizational and time management skills.

+ Excellent math aptitude and analytical skills

+ Strong PC skills, including Microsoft Office applications.

**Leadership Behaviors**

Team Leadership – Hire, develop and retain top talent. Recognize and reward team members. Model leadership behavior and act as a servant leader to ensure team success. Communicate effectively with team, champion, and challenge changes with positivity. Own messaging and decision making. Lead team through ambiguity.

Problem Solving – Be creative and take calculated risks to achieve goals and deliverables. Make mistakes and learn quickly from them, model this behavior for your team.

Customer/Client Focused – Act with urgency and ownership to resolve customer issues. Proactively identify and resolve issues when possible. Work to ensure self and team prioritize the customer experience.

Results Focused – drive team to achieve results, focusing on desired outcomes. Action plan for team management despite operational challenges.

**LOCATION:**

This is a flexible remote position. Minimal travel expected into one of our office locations for leadership meetings or training.

**Salary Range:**

$57,330.00 - $94,185.00

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.

**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.

**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. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits . _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.

**Accommodations**

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. 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] .

**Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.**

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 .

Sr Claims Analyst (Debit Fraud Claims)

Phoenix, Arizona

**Job Description:**

**Class Start Date: 04/07/2025**

**Work Schedule: Monday - Friday (8:00 AM to 5:00 PM)**

At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. We do this by driving Responsible Growth and delivering for our clients, teammates, communities and shareholders every day.

Being a Great Place to Work is core to how we drive Responsible Growth. This includes our commitment to being a diverse and inclusive workplace, attracting and developing exceptional talent, supporting our teammates’ physical, emotional, and financial wellness, recognizing and rewarding performance, and how we make an impact in the communities we serve.

At Bank of America, you can build a successful career with opportunities to learn, grow, and make an impact. Join us!

**Job Description:**

This job is responsible for resolving the day-to-day complex claims and escalations including in-depth analysis for fraud and non-fraud claims, handling complex decisions based on analytical research, established policies and procedures, and judgment. Key responsibilities include following all applicable regulatory guidelines and establishing procedures while utilizing multiple systems and tools. Job expectations include interacting with multiple business partners and clients in order to educate, set appropriate expectations, or deny the claim.

**Responsibilities:**

+ Interacts with multiple business partners to appropriately investigate and decision claim

+ Follows up with clients either verbally or through written communication

+ Educates and communicates claim decisions to clients

+ Records data captured during client interactions accurately

**Required Skills: "Must" have these skills to be minimally qualified.**

+ Experience in a Customer Service or Client Facing Environment

+ Must display excellent customer service skills with the ability to diffuse difficult customer interactions

+ Must possess excellent problem solving and analytical skills

+ Customer-centric approach to problem resolution

+ Must work well in a team environment, as well as independently

+ Strong personal ownership and follow through skills

+ Must have a strong and positive work ethic and display Bank of America's Values

+ Must be flexible and adapt quickly to change

+ Ability to multi-task and meet defined performance goals

+ Must be a meets in performance results

+ Proficient PC skills in a Windows based environment

+ Excellent written and oral communication skills

**Desired Skills:**

+ Prior experience in a Fraud or Non-Fraud Claims back office investigations or Call Center role

+ Experience in claim investigations/systems

**Skills:**

+ Attention to Detail

+ Decision Making

+ Due Diligence

+ Research

+ Active Listening

+ Adaptability

+ Issue Management

+ Problem Solving

+ Business Acumen

+ Collaboration

+ Oral Communications

+ Written Communications

**LOB Specific Information:**

This role will be supporting the _Research_ function within Debit Fraud Claims.

**Shift:**

1st shift (United States of America)

**Hours Per Week:**

40

Bank of America and its affiliates consider for employment and hire qualified candidates without regard to race, religious creed, religion, color, sex, sexual orientation, genetic information, gender, gender identity, gender expression, age, national origin, ancestry, citizenship, protected veteran or disability status or any factor prohibited by law, and as such affirms in policy and practice to support and promote the concept of equal employment opportunity and affirmative action, in accordance with all applicable federal, state, provincial and municipal laws. The company also prohibits discrimination on other bases such as medical condition, marital status or any other factor that is irrelevant to the performance of our teammates.

To view the "EEO is the Law" poster, CLICK HERE (https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf) .

To view the "EEO is the Law" Supplement, CLICK HERE (https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP\_EEO\_Supplement\_Final\_JRF\_QA\_508c.pdf) .

View the LA County Fair Chance Ordinance (https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf) .

Bank of America aims to create a workplace free from the dangers and resulting consequences of illegal and illicit drug use and alcohol abuse. Our Drug-Free Workplace and Alcohol Policy (“Policy”) establishes requirements to prevent the presence or use of illegal or illicit drugs or unauthorized alcohol on Bank of America premises and to provide a safe work environment.

To view Bank of America’s Drug-free Workplace and Alcohol Policy, CLICK HERE .

This communication provides information about certain Bank of America benefits. Receipt of this document does not automatically entitle you to benefits offered by Bank of America. Every effort has been made to ensure the accuracy of this communication. However, if there are discrepancies between this communication and the official plan documents, the plan documents will always govern. Bank of America retains the discretion to interpret the terms or language used in any of its communications according to the provisions contained in the plan documents. Bank of America also reserves the right to amend or terminate any benefit plan in its sole discretion at any time for any reason.