Title: Claims Adjudicator II Location: Oak Brook, IL, US Work Type: Remote, Full Time Job ID: 1700 Job Description: UNITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries. ESSENTIAL JOB FUNCTIONS AND DUTIES - Screens claims for completeness of necessary information - Verifies participant/dependent eligibility - Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents - Codes basic information and selects codes to determine payment liability amount - Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered - Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers - Handles the end to end process of Medicare Secondary Payer (MSP) files - Processes Personal Injury Protection (PIP) claims - Requests overpayment refunds, maintains corresponding files and performs follow-up actions - Handles verbal and written inquiries received from internal and external customers - Processes Short Term Disability claims - Adjudicates claims according to established productivity and quality goals - Achieve individual established goals in order to meet or exceed departmental metrics ESSENTIAL QUALIFICATIONS - 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment - Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits - Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it's related processes - Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes - Fluency (speak and write) in Spanish, preferred Salary range for this position: Hourly $20.36 - $24.97. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH) We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP). #LIRemote

Title: Bodily Injury Claims Specialist Bodily Injury-Hybrid Location: OH Richfield-3250 Interst Full time Job Description: National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (https://natl.com/) National Interstate is looking for a Bodily Injury Claims Specialist to join their team. This individual will work a hybrid schedule out of the Richfield, OH. office National Interstate’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in‑office days are Tuesday–Thursday, with the fourth day determined by business needs. Essential Job Functions and Responsibilities - Manages a large inventory of complex claims to evaluate compensability/liability. - Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages. - Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. - Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners. - Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. - Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. - May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. - Performs other duties as assigned. Job Requirements Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience. Experience: Generally, a minimum of 9 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC). Scope of Job/Qualifications: Works within broad limits and authority on assignments of the highest technical complexity, requiring specialized knowledge. Demonstrates excellent analytical, negotiation, and problem-solving skills. Maintains strong knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Advanced ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. Viewed as a senior resource within the Claims department and/or organization. Company: NIIC National Interstate Insurance Company Salary Range: $0.00 -$0.00 Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits. Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. *Excludes seasonal employees and interns.

Title: Workers Comp Claims Specialist - Hybrid Location: OH Richfield-3250 Interst Job Description: time type Full time job requisition id R8872 National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (https://natl.com/) National Interstate is looking for a Workers Comp Claims Specialist to join their team. This individual will work a hybrid schedule out of the Richfield, OH office National Interstate’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in‑office days are Tuesday–Thursday, with the fourth day determined by business needs. Essential Job Functions and Responsibilities - Manages a large inventory of complex claims to evaluate compensability/liability. - Plans and conducts complex claims investigations to confirm coverage and to determine liability, compensability and damages. - Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials. - Conveys complex information regarding coverage and settlements to insureds, claimants, and external partners. - Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner. - Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements. - May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. - Performs other duties as assigned. Job Requirements Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience. Experience: Generally, a minimum of 9 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC). Prefer FL NC SC GA TN state handling experience Scope of Job/Qualifications: Works within broad limits and authority on assignments of the highest technical complexity, requiring specialized knowledge. Demonstrates excellent analytical, negotiation, and problem-solving skills. Maintains strong knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Advanced ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion. Viewed as a senior resource within the Claims department and/or organization. Company: NIIC National Interstate Insurance Company Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits. Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. *Excludes seasonal employees and interns.

Role Description Are you an experienced claims professional ready to take on complex cases and make a meaningful impact? MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on complex claims and contributing to workflow improvements. Essential Duties and Responsibilities - Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles. - Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes. - Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors. - Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel. - Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit. - Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances. - Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance. - Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines. - Maintain accurate system data and prepare reports for management on high-profile claims. - Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention. - Provide mentorship and training to junior adjusters, supporting professional growth and team development. Qualifications - High school diploma or equivalent required; bachelor’s degree preferred. - Associate in Claims (AIC) designation preferred. - Valid driver’s license required; Texas-All Lines license preferred. - 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred. Benefits - Health Plans: Medical, Dental, and Vision, including fertility benefits, fully paid preventative care, and adult orthodontia. - Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability. - Wellness and Recognition Program: Employer-paid incentives for employees and spouses. - Flexible Spending Account and Dependent Care options. - Health Savings Account: Generous employer contribution. - Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave. - Employee Assistance Programs. - 401k Retirement Plan: Employer match and profit sharing. - Adoption Assistance and Tuition Assistance.