Claims Adjusters, Examiners, and Investigators

Specialist Claims - CH07DE

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.

The Claim Specialist role is crucial for handling claims within the Major Case team, specifically for Life Science claims under Hartford Global Specialty and Life Science Elite. This position, being the highest claim handling designation within the Liability Major case team, is both visible and important.

The candidate should also possess experience handling high exposure auto and general liability claims. We are seeking a motivated, initiative-taker who would enjoy a fast-paced collaborative work environment! The claims specialist will enjoy working primarily on a caseload of complex, high-exposure Life Sciences claims from inception through final disposition. This team works closely with our claims, underwriting and legal partners to ensure the best possible result for our customers! Our ideal candidate will have expertise in: product liability claims involving pharmaceuticals and medical devices. Additional areas of focus include professional liability claims, clinical trials, cyber and mass tort product liability cases, and personal and advertising injury claims. The caseload will involve primary and excess occurrence based general liability coverage as well as primary and excess claims made coverages with complex fact patterns requiring analysis of contracts between parties to determine indemnity and defense as well as risk transfer opportunities. Key responsibilities of this position include:

+ Conduct complex investigations and extensive claim file reviews on assigned cases

+ Provide coverage determinations and communicate the written position(s) to insureds, business partners and legal counsel as needed

+ Operate within prescribed authority levels to set appropriate expense and indemnity reserves

+ Regularly monitor indemnity reserves for any required adjustment

+ Present cases above authority level to leadership for expense/indemnity reserve authority

+ Develop and implement resolution strategies to achieve high quality outcomes

+ Pro-actively manage litigation and counsel throughout the case lifecycle

+ Directly oversee the litigation planning, execution, budget and bill review

+ Attending trials and mediations as necessary

+ Positively contribute to our claim and enterprise goals by participating in ad hoc audits, projects and product development initiatives

+ Prepare comprehensive reports and deliver presentations to senior claim leadership on: case developments, policy issues, industry trends, etc.

+ Collaborate with valued business partners to review and address claim trends

+ Address inquiries from agents and policyholders with a focus on providing superior customer service

+ Effectively communicating with internal constituents including billing, reinsurance accounting, finance and actuarial.

QUALIFICATIONS:

+ A bachelor’s degree required; MBA or Law degree a plus

+ Specialization in product liability, medical malpractice or mass tort insurance liability experience is preferred

+ Minimum of 5 years of experience in handling product liability claims with preference for candidates whom have handled pharmaceutical, medical device cases, professional liability claims with clinical trials, and mass tort product liability litigation

+ Prior experience handling both primary and excess policy coverages/claims

+ Prior experience handling complex auto and general liability claims

+ Working knowledge of coverage and tort laws

+ Strong coverage acumen with the ability to readily apply the terms and conditions found in manuscript policies

+ Familiarity with state specific insurance regulatory requirements

+ High level of discipline, results-orientation and ability to drive bottom line results

+ Superior analytical ability and organizational skills

+ Effective interpersonal communication skills in both verbal and written formats

+ Proven strategic reasoning and execution skills

+ Excellent negotiation and advanced technical claim handling skills

+ Full command of issues and medicals relative to high value bodily injury claims

+ Strong ability to analyze coverage and liability issues, manage time limit demands and assess extra contractual exposures and other issues of complexity

+ Ability to effectively communicate in a highly-matrixed environment

+ Readily able to influence and drive successful, collaborative claim outcomes

Core Competencies Required:

+ Strategic Thinking

+ Operational Excellence

+ Leadership

+ Business Knowledge and Decision-Making

+ Effective Relationships

+ Excellent Writing Skills

+ Strong Communication Skills

WHAT ELSE CAN YOU TELL ME?

+ Travel is required

+ Adjuster licensing is required

+ This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL) 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.

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:

$106,400 - $159,600

Equal Opportunity Employer/Sex/Race/Color/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

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

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)

International Privacy Policy

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

Unincorporated Areas of LA County, CA (Applicant Information)

Specialist Claims - CH07DE

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.

This dynamic Claim Specialist role will be part of a growing team of professionals who support the Harford Global Specialty (HGS) Claims Division. Our ideal candidate will have expertise in: primary and excess claims (including general liability, excess auto liability, products liability, and pollution liability) on integrated general liability/pollution liability policies, contractor pollution liability and site-specific pollution liability policies. We are seeking a motivated, self-starter who would enjoy a fast-paced collaborative work environment! The Claim Specialist will handle a caseload of complex, high-exposure claims on Excess General Liability and Environmental policies from inception to final resolution. This team works closely with our underwriting, actuarial and legal partners to ensure the best possible result for our customers. The claim caseload will involve both primary and excess coverages with complex fact patterns requiring some knowledge of environmental regulations and response actions as well as analysis of contracts between parties to determine liability for risk transfer opportunities.

Key responsibilities of this position include:

+ Conduct complex investigations and extensive claim file reviews on assigned cases

+ Determine coverage, draft position letters and communicate the coverage position(s) to insureds, business partners and legal counsel

+ Operate within prescribed authority levels to set appropriate expense and indemnity reserves

+ Regularly monitor indemnity reserves for any required adjustment

+ Present cases above authority level to leadership for expense/indemnity reserve and settlement authority

+ Develop and implement resolution strategies to achieve high quality outcomes

+ Pro-actively manage environmental consultants and/or litigation and counsel throughout the case lifecycle

+ Directly oversee the litigation planning, execution, budget and bill review

+ Attend trials and mediations as necessary

+ Positively contribute to our claim and enterprise goals by participating in ad hoc audits, projects and product development initiatives

+ Prepare comprehensive reports and deliver presentations to senior claim leadership on: case developments, policy issues, industry trends, etc.

+ Collaborate with valued business partners to review and address claim trends

+ Address inquiries from agents and policyholders with a focus on providing superior customer service

Qualifications:

+ Bachelor’s Degree is required

+ Candidates with a JD license and specialization within environmental or construction case experience are preferred.

+ Minimum of 7 years of claims experience with strong preference for candidates whom have handled general liability, pollution liability, site pollution, construction or product liability claims or environmental policies.

+ Prior experience handling both primary and excess policy coverages/claims

+ Working knowledge of environmental, coverage and tort laws

+ Strong coverage acumen with the ability to readily apply the terms and conditions found in manuscript policies to the facts of the claim

+ Familiarity with state specific environmental and insurance regulatory requirements

+ High level of discipline, results-orientation and ability to drive bottom line results

+ Superior analytical ability and organizational skills

+ Effective interpersonal communication skills in both verbal and written formats

+ Proven strategic reasoning and execution skills

+ Excellent negotiation and advanced technical claim handling skills

+ Full command of issues and medicals relative to high value bodily injury claims

+ Strong ability to analyze coverage and liability issues, manage time limit demands and assess extra contractual exposures and other issues of complexity

+ Ability to effectively communicate in a highly-matrixed environment

+ Readily able to influence and drive successful, collaborative claim outcomes

This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our office locations (Hartford, CT, San Antonio, TX, Lake Mary, FL, Phoenix, AZ, Naperville, IL) 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.

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:

$106,400 - $159,600

Equal Opportunity Employer/Sex/Race/Color/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

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

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)

International Privacy Policy

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

Unincorporated Areas of LA County, CA (Applicant Information)

Responsible for building a complete document package with all appropriate/applicable supporting invoices, breakdowns, ledgers, foreclosure, bankruptcy, and loss mitigation relevant documents based on a specific claim type in a timely and efficient manner. This position is responsible for adhering to all guidelines set forth by insurer, investor, and master servicing guidelines.

+ Evaluates/reconciles loan level balances (corporate and escrow advances) for expenses incurred to determine claimable vs non claimable to maximize reimbursement on behalf of the servicer and/or client

+ Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits

+ Reviews MI claim Explanation of Benefits (EOB) or Insurer Advice of Payments (AOP) and research curtailment reasons for potential rebuttal

+ Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI companies and/or Insurer.

+ Monitors pre/post conveyance processes on government loans

+ Satisfies audit requests

+ Monitors claim deadlines and exceptions reports

+ Monitors REO activity on investor claim files

+ Ensures all receivables are paid w/ no penalties or interest curtailments

+ Ensures payment to vendors in a timely manner

+ Corresponds with attorney/trustees, vendors, and agency representatives to ensure claims are processed within insurer and investor guidelines

+ Works in conjunction with attorneys, agencies, PMI companies, investors and master servicers to expedite the completion of the claim to minimize losses

+ Complies with and have working knowledge of all FNMA, FHLMC, PMI, FHA, VA, investor and master servicer rules and regulations

+ Performs regular reviews of all cases/claims on a regular basis

+ Requests UPB removal on loans from Investor Reporting Department once the claim process has been completed

+ Assists in the training of new employees

+ Performs other work and duties as assigned

Skills & Qualifications:

+ Claims analysis, claims preparation, mortgage, default, MSP, loss mitigation, default servicing

+ Must be very strong in Excel and have used Vlookup and Pivot Tables on a consistent daily basis.

+ Working knowledge of the Black Knight MSP servicing system

+ Working knowledge of MS Outlook, Word, Excel, Power Point, and ability to learn industry related systems

+ Able to work both independently and within a team environment

+ Excellent time management skills

+ Working knowledge with Microsoft Office, spreadsheets and software applications

+ Strong analytical skills

+ Excellent verbal and written communication skills

+ Detail oriented with ability to successfully manage multiple priorities

+ Able to work in fast paced environment with the ability to meet deadlines

Pay and Benefits

The pay range for this position is $26.00 - $38.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Tempe,AZ.

Application Deadline

This position is anticipated to close on May 30, 2025.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Responsible for building a complete document package with all appropriate/applicable supporting invoices, breakdowns, ledgers, foreclosure, bankruptcy, and loss mitigation relevant documents based on a specific claim type in a timely and efficient manner. This position is responsible for adhering to all guidelines set forth by insurer, investor, and master servicing guidelines.

+ Evaluates/reconciles loan level balances (corporate and escrow advances) for expenses incurred to determine claimable vs non claimable to maximize reimbursement on behalf of the servicer and/or client

+ Files respective investor/insurer initial and final claims based on the respective guidelines for allowable limits

+ Reviews MI claim Explanation of Benefits (EOB) or Insurer Advice of Payments (AOP) and research curtailment reasons for potential rebuttal

+ Files Appeal or Supplemental Claims ensuring all allowable advances and interest are recovered from the MI companies and/or Insurer.

+ Monitors pre/post conveyance processes on government loans

+ Satisfies audit requests

+ Monitors claim deadlines and exceptions reports

+ Monitors REO activity on investor claim files

+ Ensures all receivables are paid w/ no penalties or interest curtailments

+ Ensures payment to vendors in a timely manner

+ Corresponds with attorney/trustees, vendors, and agency representatives to ensure claims are processed within insurer and investor guidelines

+ Works in conjunction with attorneys, agencies, PMI companies, investors and master servicers to expedite the completion of the claim to minimize losses

+ Complies with and have working knowledge of all FNMA, FHLMC, PMI, FHA, VA, investor and master servicer rules and regulations

+ Performs regular reviews of all cases/claims on a regular basis

+ Requests UPB removal on loans from Investor Reporting Department once the claim process has been completed

+ Assists in the training of new employees

+ Performs other work and duties as assigned

Skills & Qualifications:

+ Claims analysis, claims preparation, mortgage, default, MSP, loss mitigation, default servicing

+ Must be very strong in Excel and have used Vlookup and Pivot Tables on a consistent daily basis.

+ Working knowledge of the Black Knight MSP servicing system

+ Working knowledge of MS Outlook, Word, Excel, Power Point, and ability to learn industry related systems

+ Able to work both independently and within a team environment

+ Excellent time management skills

+ Working knowledge with Microsoft Office, spreadsheets and software applications

+ Strong analytical skills

+ Excellent verbal and written communication skills

+ Detail oriented with ability to successfully manage multiple priorities

+ Able to work in fast paced environment with the ability to meet deadlines

Pay and Benefits

The pay range for this position is $26.00 - $38.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Tempe,AZ.

Application Deadline

This position is anticipated to close on May 30, 2025.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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

Job Description Summary

The Pharmacy Claims Representative assists local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients and reconcile historic billing issues.

**Location: Remote US**

**Shift: Monday-Friday 2:30pm-11pm EST. Flexibility to work alternating weekends between the hours of 9am-8pm EST. Flexibility to work 2 holidays per year.**

**Essential Duties and Responsibilities:**

• Assist in setting up and maintaining hospice/facility/pharmacy relationships under the direction of the Pharmacy Claims Team Leaders & the Pharmacy Claims (Support Services) Manager

• Assist pharmacies with claims adjudication

• Complete incoming tasks as assigned by the Pharmacy Claims Team Leaders and the Pharmacy Claims (Support Services) Manager

• Obtain all necessary information for facilities and their related pharmacies

• Assist the Call Center management team with projects to enhance the workflow and success of the Call Center

• Assist Customer Service team with claims research/resolution

*Assist with new hires training

**Billing:**

· Assist pharmacies with claims adjudication by adjusting/correcting autho rizations in dispensing systems and PBM systems

· Ensure timely adjudication of prescription claims through PBM systems

· Contact hospices for authorizations/approvals for submitted claims where necessary

· Ensure accuracy of patient profile data including related/not related status, authorization status, etc

· Research and correct pharmacy invoices from hospices

· Demonstrate basic understanding of Enclara Pharmacia standard/custom formularies

· Understand formulary and billing platform differences (PD vs. FFS) from hospice to hospice

· Assist Customer Service team with claims research/resolution via dispensing systems, PBM systems and fax systems

· Evaluate compound claims for proper ingredients/qtys/cost and ensure timely claims adjudication

· Research claims for hospice/pharmacy audits

**New Hospice Start-Ups:**

· Complete assigned facility/pharmacy spreadsheet by contacting both the facilities and pharmacies to verify accuracy of all information provided.

· Coordinate all information for facility pharmacies including verification of PBM systems.

· Update facility pharmacy spreadsheets and implementation team members on the progress with these pharmacies.

· Communicate with the facility pharmacies on proper billing procedures and contact information for rejected claims.

**New Facilities:**

· Gather partial information from Call Center on facilities not listed and obtain correct information to be entered into the database.

· Link facilities to their respective hospices once all information is obtained.

· Assist with Confirmation Fax reports to update facility and pharmacy relationships and demographic information.

**Use your skills to make an impact**

Additional Job Description

**Qualifications:**

+ Strong verbal and written communication skills, including the ability to tailor communication to audience.

+ Self-motivated, organized

+ Strong attention to detail

+ Team player

+ Problem-solving skills and ability to follow through on tasks assigned

+ Ability to handle multiple tasks, meet deadlines, and follow-up timely.

**Required Education and/or Experience:**

+ 1+ years of Pharmacy Technician experience

+ Strong knowledge working with pharmacy claims judication

+ **Must have experience with electronic claims submissions OR be a current internal Enclara Pharmacia associate**

**Preferred Experience:**

+ PBM experience

+ Dispensing system experience

+ CPhT or EXCPT

+ Drug knowledge

+ High school diploma

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

**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.

$40,000 - $52,300 per year

**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: 05-28-2025

**About us**

About Enclara: Pharmacia Enclara Pharmacia is the nation’s largest full-service hospice and palliative care Pharmacy Benefits Manager, offering compassionate and cost-effective services to our most vulnerable patients. As a wholly owned subsidiary of Humana, Enclara works closely with hospice providers to reduce pharmacy costs, improve patient care and support caregivers through digital innovations, flexible medication access, one-on-one clinical support and excellent customer service.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

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 complexand 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 $59,900.00 to $99,700.00. 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.

Location(s)

Remote-AZ, Remote-CA

**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.

At Kemper, a Major Loss Adjuster, is responsible for the investigation, evaluation, and handling of complex to claims to conclusion. This role will have advanced claim handling skills and demonstrate high quality results. This position necessitates strong analytical abilities, attention to detail, and the ability to operate independently and as part of a cohesive team.

**Position Responsibilities** :

+ Primarily handles claims with a high complexity and large injury severity.

+ Review each claim to ensure that all coverage and exposures issues have been identified and investigated.

+ Completes the investigation if warranted and adjusts exposures as needed.

+ Contacts insureds and claimants within established corporate guidelines to provide notification of reassignment of the claim and to continue the settlement process.

+ Handles questions on coverage with a reservation of rights letter and/or non-waiver agreement.

+ Advises the underwriting Department of adverse findings regarding insureds and/or coverage.

+ Conducts investigations independently and at the direction of management utilizing sound investigative procedures to establish liability as quickly as possible.

+ Evaluation, negotiation, and settlement of bodily injury claims.

**Position qualifications** :

+ 5+ years claims adjusting experience including experience with evaluation, negotiation and settlement of bodily injury claims.

+ Experience handling coverage issues, high exposure, serious injury, liability investigations and large losses.

+ Experience with injury evaluation tools a plus.

+ The ability to work closely with senior management.

+ Follow detailed and specific directions on file handling when required.

+ Excellent planning and organizing skills

+ Excellent written and verbal communication skills.

+ The ability to deal with conflict in an effective manner.

+ Workload could vary greatly based on volume. Must be able to work effectively amid constant interruptions and be able to meet deadlines.

+ Must make decisions quickly and with minimal supervision.

+ This is a remote California or remote Arizona position.

The range for this position is Hiring Range $68,000.00 to $113,400.00. 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 is focused on expanding our Diversity, Equity, and Inclusion efforts to align with our vision, mission, and guiding principles.

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.

\#LI-MV1 #LI-Remote

**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.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Bodily Injury Claims Examiner | Remote | Dedicated Client | Complex Claims & Litigation Experience Required

**Must have experience with complex bodily injury claims including litigated claims and settlement authority over $1M.**

**Commercial Trucking experience required**

**Will be required to obtain NY licensing within 6 months of hire (Sedgwick funded), and all other licensing is preferred**

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 examiner 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 Bodily Injury 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 RESPONSIBILITIES 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: 5 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.

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 (61,857.00 - 86,600). 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.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - General Liability

**PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult general liability 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.

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

+ Prepares necessary state fillings within statutory limits.

+ Manages the litigation process; ensures timely and cost effective claims resolution.

+ Coordinates vendor referrals for additional investigation and/or litigation management.

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

+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

+ Communicates claim activity and processing with the claimant and 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate 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 and Medicare 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

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**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

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.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - General Liability

**PRIMARY PURPOSE** : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ Analyzes and processes complex or technically difficult general liability 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.

+ Assesses liability and resolves claims within evaluation.

+ Negotiates settlement of claims within designated authority.

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

+ Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

+ Prepares necessary state fillings within statutory limits.

+ Manages the litigation process; ensures timely and cost effective claims resolution.

+ Coordinates vendor referrals for additional investigation and/or litigation management.

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

+ Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

+ Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

+ Communicates claim activity and processing with the claimant and 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.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

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

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

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

**Experience**

Five (5) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ Subject matter expert of appropriate 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 and Medicare 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

+ Good interpersonal skills

+ Excellent negotiation skills

+ Ability to work in a team environment

+ Ability to meet or exceed Service Expectations

**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

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.**

**Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**