Workers’ Compensation Claims Adjuster II - California | 100% Remote Opportunity General Summary The Work comp Claims Adjuster II is responsible for timely and accurate management of workers’ compensation claims with moderate medical and indemnity benefit exposure, including litigation. This opportunity will require working west coast hours (M-F 8am-5pm PDT) Essential Duties and Responsibilities - Completes initial contacts to obtain necessary additional information, verify coverage, determine compensability and develop of plan of action. Completes and maintains accurate claim system data as it pertains to work comp insurance claims. - Analyzes case facts to establish timely and accurate case reserves using knowledge of medical disabilities and related costs, as well as judgment of extent of disability. - Provides timely and appropriate customer service within established best practices. Maintains ongoing professional communications with all internal and external customers. - Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. Files appropriate state forms, as needed. - Proactively coordinates and monitors medical treatment to continue to move the claim forward. Uses resources, internal and external, to contain costs and manage exposure. - Reviews and analyzes legal exposures. Collaborates with defense attorneys to manage legal issues. Proactively mitigates exposure to litigation, prices up claims for settlement and works within authority to resolve claims. - Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. - Other duties as assigned. Requirements - 2 - 5 years’ work comp claims adjusting or insurance experience. - Excellent communication and customer service skills and knowledge of an imaged environment. - Demonstrated knowledge of workers’ compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. - Self-motivated with excellent analytical, problem solving and decision-making skills. Strong ability to multi-task and prioritize. - High school diploma or equivalent required. - Equivalent combinations of education and experience may be considered. Certification - If state certification or license is required, must meet requirements and obtain certification within state mandated timeframe and maintain any required license through continuing education. - WCCP, AIC, ARM, CPCU or other insurance certification preferred. Education - Bachelor’s degree or equivalent business experience preferred. Work Environment - Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship. - It requires a suitable space that provides a private and quiet workplace. - Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. - Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $50,000-$75,000 and a strong comprehensive benefits package, don't forget to follow the link to our benefits page for details, too many benefits to list! https://www.employers.com/careers/our-benefits-and-perks/ About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

Senior Work Comp Claims Adjuster II - California| 100% Remote (WFH) Opportunity General Summary With minimal oversight, the Senior Workers Compensation Claims Adjuster II is responsible for timely and accurate management of workers’ compensation claims with high or catastrophic medical and indemnity benefits, involving litigation and complex issues and exposures. Must have 10+years of experience adjusting CALIFORNIA work comp claims Essential Duties and Responsibilities - Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action as it pertains to work comp claims. - Completes and maintains workers' compensation claim data integrity. - Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability. - Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure, serious or catastrophic workers' compensation losses. - Provides timely and appropriate customer service within established best practices. - Maintains ongoing professional communications with all internal and external customers. - Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines. - Files appropriate state forms, as needed. - Proactively manages or coordinates medical treatment to continue to move the claim forward. - Uses internal and external resources to contain costs and manage exposure. - Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation. - Collaborates with defense attorney to move claims to resolution. - Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate workers’ compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable. - Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions. - Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs. May handle supervisory duties, as needed. Requirements - 10 or more years of workers’ compensation insurance claims experience including complex claims handling. - Superior communication and customer service skills and proficiency in an imaged environment. - Demonstrated knowledge of workers’ compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. - Self-motivated with the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly. - Excellent analytical, problem solving and decision-making skills. Certification - If state insurance certification or license is required, must meet certification within state mandated timeframe and maintain any required license through continuing education. - WCCP, AIC, ARM, CPCU or other insurance designation is preferred. Education - Bachelor’s degree or equivalent business experience preferred. Work Environment: - Remote: This role is a remote (work from home (WFH) opportunity, and only open to candidates currently located in the United States and able to work without sponsorship. - It requires a suitable space that provides a private and quiet workplace. - Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. - Travel: May be required to travel to off-site location(s) to attend meetings, as necessary Salary Range: $80,000 - $110,000 and a comprehensive benefits package, please follow the link to our benefits page for details! https://www.employers.com/careers/our-benefits-and-perks/ About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote

Stop Loss Claims Analysts Work from home within Oregon, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of Stop Loss Claims Analysts is living our mission to make health care easier and lives better. As a member of the Stop Loss team, this position adjudicates all stop loss claims by developing policies and procedures to ensure consistent claim practices and adherence to policy and contract terms, appropriate laws and regulations – all in service of creating a person-focused health care experience. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: Stop Loss Claims Analyst would have a/an High School Diploma or GED and 5 years of professional claims processing experience or equivalent combination of education and experience. Skills and Attributes: - Knowledge of when to utilize legal and clinical resources to comprehend legal and medical terminology in order to make final determinations on whether to approve or further investigate a claim. - Possess strong knowledge of Policy and Contract terms, lasering, aggregating deductibles and eligibility to ensure correct processing of all eligible claim reimbursements. - Advanced knowledge of claim reserving and settlement. - Excellent communication skills for both external and internal customers - Demonstrate understanding of medical terminology and ICD-10/CPT coding. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired. - Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at Cambia: - Accurately apply contract benefits within guidelines and recognize incomplete or inappropriate claims. Recognize all policies and procedures that apply to claim and be able to quickly reference documentation for details. - Make informed decisions regarding the disposition of claim; may include payment or denial of claim, or requests for further information. - Lead the process to measure, track, and report all aggregate claims. - Audit all aggregate claims onsite and off-site when needed based on set dollar threshold. Provide client audit reporting as needed. - Manage inventory of claims while ensuring best practices and claim standards are met. - Identify new opportunities to track and process claims more efficiently. Thoroughly document claims throughout the adjudication process so they can be understood by the team and for audit purposes. - Analyze and investigate all claims, request supplementary documentation as necessary, in order to process or reprocess claims in a timely and accurate manner. Work Environment - No unusual working conditions. - Work is primarily performed in an office environment. The expected hiring range for a Stop Loss Claims Analyst is $68,900.00 - $93,150.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 6.25%.  The current full salary range for this role is $64,000.00 to $106,000.00. #LI-remote About Cambia Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. Why Join the Cambia Team? At Cambia, you can: - Work alongside diverse teams building cutting-edge solutions to transform health care. - Earn a competitive salary and enjoy generous benefits while doing work that changes lives. - Grow your career with a company committed to helping you succeed. - Give back to your community by participating in Cambia-supported outreach programs. - Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: - Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. - Annual employer contribution to a health savings account. - Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. - Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). - Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). - Award-winning wellness programs that reward you for participation. - Employee Assistance Fund for those in need. - Commute and parking benefits. Learn more about our benefits. We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Type of Requisition: Regular Clearance Level Must Currently Possess: None Clearance Level Must Be Able to Obtain: None Public Trust/Other Required: MBI (T2) Job Family: Ancillary Health Job Qualifications: Skills: CMS 1500 Claim Forms, Communication, Healthcare Claims Processing, Health Care Systems, ICD-10 Procedure Coding SystemCertifications: NoneExperience: 5 + years of related experienceUS Citizenship Required: No Job Description: GDIT is seeking a highly skilled Claims Processing Lead to oversee the adjudication and processing workflows for the World Trade Center (WTC) Health Program. This role is pivotal in ensuring that WTC responders and survivors receive timely and accurate medical benefits. You will lead a team of processors, serve as the primary subject matter expert for complex federal claim regulations, and ensure all activities meet the strict compliance standards of the WTC Health Program. The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania. HOW YOU WILL MAKE AN IMPACT - Supervise a team of claims processors, providing daily technical guidance, performance feedback, and training on WTC-specific adjudication rules. - Act as the final point of escalation for complex or high-dollar claims requiring manual review and clinical alignment with WTC-covered conditions. - Implement and monitor rigorous Quality Assurance (QA) protocols to ensure 99%+ accuracy in claim payments and adherence to HIPAA and federal regulations. - Identify bottlenecks in the claims lifecycle and collaborate with the IT and Codebook teams to automate manual processes and improve "clean claim" rates. - Generate and present weekly production metrics to leadership, tracking turn-around times (TAT), error rates, and inventory levels. - Coordinate with medical providers and federal program representatives to resolve billing disputes and clarify policy interpretations. WHAT YOU’LL NEED TO SUCCEED Minimum Qualifications - Minimum of a Bachelor of Arts (BA) or Bachelor of Science (BS) degree. - 5+ years of experience in healthcare claims processing, with at least 2 years in a lead, supervisory, or senior auditing capacity. - Must have mastery of claims platforms experience (e.g., CareSuite, QNXT, Facets) and advanced Microsoft Excel skills. - Must have a comprehensive understanding of CMS-1500 and UB-04 forms, ICD-10/CPT coding, and federal reimbursement methodologies. - Must have experience managing a claims team. - Exceptional written and verbal communication skills for presenting data and managing internal and external relationships. Preferred Qualifications: - Prior experience supporting the World Trade Center Health Program or other federal government health contracts. - Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst). - Strong analytical mindset with the ability to translate complex clinical rules into technical system requirements GDIT IS YOUR PLACE: - 401K with company match - Comprehensive health and wellness packages - Internal mobility team dedicated to helping you own your career - Professional scientific growth opportunities, including journal subscriptions, conference attendance, and supporting publication journey - Cutting-edge technology you can learn from - Rest and recharge with paid vacation and holidays OWN YOUR OPPORTUNITY: Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference. #GDITFedHealth #GDITWTCJobs The likely salary range for this position is $97,968 - $100,050. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range. Scheduled Weekly Hours: 40 Travel Required: 10-25% Telecommuting Options: Remote Work Location: Any Location / Remote Additional Work Locations: Total Rewards at GDIT: Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most. We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology. Join our Talent Community to stay up to date on our career opportunities and events atgdit.com/tc. Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans