Company : Highmark Inc.Job Description : JOB SUMMARY This job reviews inquiries to determine if they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals; initiates a case file for each grievance and appeal; ensures compliance with organizational and regulatory requirements for member or provider issues; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties involved in the case the investigation results. ESSENTIAL RESPONSIBILITIES - Review inquiries to determine if they meet definition of appeal/grievance. - Request and review all related relevant documentation and assemble case file. - Coordinate resolution results and relay investigative results with all involved parties. - Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional teams to reduce trends. - May support the Quality Assurance, Appeal and other quality committees. - Other duties as assigned or requested. EDUCATION Required - High School Diploma or GED Substitutions - None Preferred - None EXPERIENCE Required - 3-5 years of relevant, progressive experience in the area of specialization. Exempted experience requirements effective August 2016. Preferred - Experience in Customer Service or a related field LICENSES or CERTIFICATIONS Required - None Preferred - None SKILLS - Knowledge of multiple processing systems and workflows - Knowledge of claims processing methodologies - Ability to interpret all government regulations - Knowledge of company products - Excellent organizational skills - Strong verbal and written communication skills Languages (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Occasionally Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $21.53 Pay Range Maximum: $32.95 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

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 Adjuster PRIMARY PURPOSE: Handles losses and claims valued up to $15,000 for property and casualty insurers through the thorough examination of documents, records, loss reports, and other relevant documentation. Efficiently manages a case load using technology for efficient claim processing. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Evaluates insurance policies, claims forms, policies, endorsements, carrier instructions, and other records to determine insurance coverage. - Conducts thorough investigations, gathers official reports as needed, consults police and hospital records and inspects physical damage or written estimates for damages based on a conducted inspection to determine extent of company's liability and varying methods of investigation, according to type of insurance. - Interviews, telephones, and/or corresponds with claimant and witnesses regarding claim. - Estimates cost of repair, replacement, or compensation. - Prepares report of findings and negotiates claim settlements by adhering to carrier instructions and obtaining necessary information. Issues settlement checks, files regulatory documents, and handles salvage and subrogation as applicable. - Recommends litigation by legal department when settlement cannot be negotiated. - Attends litigation hearings and participates in depositions as necessary. - Revises case reserves in assigned claims files to cover probable costs. - Maintains an expected caseload efficiently. - Utilizes technology and automation tools for efficient claim handling. - Sends claims exceeding $15,000 gross loss amount to leadership for authority approval. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Must obtain IIA-AIC designation within 12 to 18 months in the role. Appropriate state adjuster license is required. Experience Three (3) year of related experience or equivalent combination of education and experience required. Prior experience handling property and casualty claims a plus but not required. Skills & Knowledge - Empathetic claims handling demeanor - Strong communication, analytical, organizational, and interpersonal skills - PC literate, including Microsoft Office products - Analytical and interpretive skills - Negotiating skills - Ability to create and complete comprehensive, accurate and constructive written reports - Ability to work in a team environment - Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking 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.

Overview Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good! Grow Your Skills, Grow Your Potential Responsibilities Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accident and weather-related claims for homeowners, commercial properties, and large losses. We are looking for an experienced and highly skilled professional to contribute to our dynamic team. You will be the first point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process while providing Remarkable service. Key Responsibilities: - Conduct on-site inspections and assessments of property damages for both residential and commercial claims - Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently - May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions - Provide exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally - Gather necessary evidence, document findings, and prepare detailed reports to support the claims handling process - Investigate and adjust both personal and commercial property claims with exposures up to $500,000 - Evaluate coverage and policy terms to determine the validity of claims and ensure compliance with local regulations - Negotiate and settle claims within the authorized limits, considering policy provisions, industry standards, and company guidelines Where you'll work: This position is located in Swedesboro, NJ. Competitive candidates should reside within one of the listed zip codes and will service this same territory: 08001 08014 08020 08027 08028 08032 08038 08039 08051 08056 08061 08062 08066 08067 08069 08070 08071 08072 08079 08080 08085 08090 08094 08097 08098 08310 08312 08318 08322 08326 08328 08341 08343 08344 08360. This is a Remote-Field position in which you will work from home and utilize a mobile office/vehicle for in-person appointments. Although the primary work location is in the field, with a commutable distance from home, there will be opportunities for virtual work to be completed at home. Additionally, there may be occasions where you will be required to travel outside your assigned area to assist in other territories. Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible schedules and may be asked to work overtime and/or irregular hours. Qualifications Competitive candidates must demonstrate: - Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims - Strong knowledge of property insurance policies, coverage and claim handling practices - Knowledge of both residential and commercial building construction - Familiarity with local regulations and compliance requirements in your assigned territory - Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders - Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus - Proven ability to assess damages, estimate repair costs, and negotiate settlements - Detail-oriented with strong organizational and analytical skills - Proficient in using claims management software and other relevant tools - Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces - May be required to complete Rope and Harness Safety Training. - A valid driver's license is required Preferred: - Bachelor's Degree in a related field or equivalent work experience - Experience in handling complex or high-value claims - Construction background - Water mitigation inspection experience - Xactimate, XactContents Additional Details: - Employees must successfully complete all required training, including applicable licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s). - State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing Our Benefits Because work-life balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! - Potential starting salary range: $64,965.62 - $99,000.00 annually - Starting salary will be based on skills, background, and experience - High end of the range limited to applicants with significant relevant experience - Potential yearly incentive pay up to 15% of base salary At State Farm, we offer more than just a paycheck. Check out our suite of benefits designed to give you the flexibility you need to take care of you and your family! - Get Paid! On top of our competitive pay, you are eligible for an annual raise and bonus. - Stay Well! Focus on you and your family’s health with our robust health and wellbeing programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare plan options, including a high deductible plan. All medical plans provide 100% coverage for in-network preventative care, AND you and your family have access to vision, dental, telemedicine, 24/7 mental health professionals, and much more! - Develop and Grow! Take advantage of educational benefits like industry leading training programs, top-notch tuition assistance programs, employee resource groups, and mentoring. - Plan Ahead! Plan for those big moments in life with benefits like fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and more. You can also start a savings account or consider financing through our State Farm Federal Credit Union! - Take a Little “You” Time! You will have access to our generous time off policies designed so you can plan around holidays, family events, volunteering, or just to take a relaxing day off. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! - Give Back! We offer several ways to give back through our Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund. - Finish Strong! Plan for retirement using free financial advisors and a 401(k) plan with company contributions of up to 7% of your salary. Visit our State Farm Careers page for more information on our benefits, locations, and the hiring process of joining the State Farm team!

Overview Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good! Grow Your Skills, Grow Your Potential Responsibilities Join our team as a Property Field Inspection Claim Specialist and showcase your expertise in handling accident and weather-related claims for homeowners, commercial properties, and large losses. We are looking for an experienced and highly skilled professional to contribute to our dynamic team. You will be the first point of contact to meet with our insureds, explain coverage, estimate damages, and help them through the claims process while providing Remarkable service. Key Responsibilities: - Conduct on-site inspections and assessments of property damages for both residential and commercial claims - Collaborate with policyholders, insurance agents, and other involved parties to gather information and resolve claims efficiently - May occasionally require interacting with parties who express strong emotions or concerns about ongoing inspections or claim resolutions - Provide exceptional customer service throughout the claims process, addressing inquiries and concerns promptly and professionally - Gather necessary evidence, document findings, and prepare detailed reports to support the claims handling process - Investigate and adjust both personal and commercial property claims with exposures up to $500,000 - Evaluate coverage and policy terms to determine the validity of claims and ensure compliance with local regulations - Negotiate and settle claims within the authorized limits, considering policy provisions, industry standards, and company guidelines Where you'll work: This position is located in Newark, NJ. Competitive candidates should reside within one of the listed zip codes and will service this same territory: 07003 07008 07009 07011 07012 07013 07014 07016 07017 07018 07028 07033 07036 07040 07041 07042 07043 07044 07050 07052 07055 07065 07079 07083 07088 07102 07103 07104 07105 07106 07107 07108 07109 07110 07111 07112 07114 07201 07202 07203 07204 07205 07206 07208 07424 07503 07512 07513. This is a Remote-Field position in which you will work from home and utilize a mobile office/vehicle for in-person appointments. Although the primary work location is in the field, with a commutable distance from home, there will be opportunities for virtual work to be completed at home. Additionally, there may be occasions where you will be required to travel outside your assigned area to assist in other territories. Hours of operation are continually evaluated and may change based on business need. Successful candidates are able and willing to work flexible schedules and may be asked to work overtime and/or irregular hours. Qualifications Competitive candidates must demonstrate: - Experience as a Property Field Inspection Claim Specialist in the insurance industry, specifically in property claims - Strong knowledge of property insurance policies, coverage and claim handling practices - Knowledge of both residential and commercial building construction - Familiarity with local regulations and compliance requirements in your assigned territory - Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders - Proven effective communication skills to handle difficult/emotional conversations with a customer-minded focus - Proven ability to assess damages, estimate repair costs, and negotiate settlements - Detail-oriented with strong organizational and analytical skills - Proficient in using claims management software and other relevant tools - Physical agility to allow for: frequent lifting, carrying and climbing a ladder; ability to navigate roofs at various heights for inspection of both residential and commercial structures; ability to crawl in tight spaces - May be required to complete Rope and Harness Safety Training. - A valid driver's license is required Preferred: - Bachelor's Degree in a related field or equivalent work experience - Experience in handling complex or high-value claims - Construction background - Water mitigation inspection experience - Xactimate, XactContents Additional Details: - Employees must successfully complete all required training, including applicable licensing exam(s), Motor Vehicle Record (MVR) checks, and background checks required of various state(s). - State Farm recently implemented new pre-employment assessments. Candidates that have previously taken an assessment may be asked to participate in additional testing Our Benefits Because work-life balance is a priority at State Farm, compensation is based on our standard 38:45-hour work week! - Potential starting salary range: $73,824.56 - $112,500.00 annually - Starting salary will be based on skills, background, and experience - High end of the range limited to applicants with significant relevant experience - Potential yearly incentive pay up to 15% of base salary At State Farm, we offer more than just a paycheck. Check out our suite of benefits designed to give you the flexibility you need to take care of you and your family! - Get Paid! On top of our competitive pay, you are eligible for an annual raise and bonus. - Stay Well! Focus on you and your family’s health with our robust health and wellbeing programs. State Farm pays most of your healthcare premium, and we offer multiple healthcare plan options, including a high deductible plan. All medical plans provide 100% coverage for in-network preventative care, AND you and your family have access to vision, dental, telemedicine, 24/7 mental health professionals, and much more! - Develop and Grow! Take advantage of educational benefits like industry leading training programs, top-notch tuition assistance programs, employee resource groups, and mentoring. - Plan Ahead! Plan for those big moments in life with benefits like fertility/IVF/adoption assistance, college coaching, national discount programs, interactive monthly financial workshops, free financial coaching, and more. You can also start a savings account or consider financing through our State Farm Federal Credit Union! - Take a Little “You” Time! You will have access to our generous time off policies designed so you can plan around holidays, family events, volunteering, or just to take a relaxing day off. With the opportunity to initially earn up to 20 days annually plus parental leave, paid holidays, celebration day, life leave (40 hours/year), bereavement leave, and community service/education support days, there will be plenty of time for you! - Give Back! We offer several ways to give back through our Matching Gift Program, Good Neighbor Grant Program, and the Employee Assistance Fund. - Finish Strong! Plan for retirement using free financial advisors and a 401(k) plan with company contributions of up to 7% of your salary. Visit our State Farm Careers page for more information on our benefits, locations, and the hiring process of joining the State Farm team!