• Review and manage Life, Disability, and Waiver of Premium claims, ensuring compliance with company policies and regulatory standards. • Evaluate waiting periods, verify medical providers and treatment institutions, and assess the reasonableness of fees. • Determine claim applicability, conduct investigations, and evaluate allowable benefits under policies or certificates. • Approve claims within assigned authority limits, escalating complex or high value claims as necessary. • Accurately enter and maintain claims data within the claims management system. • Gather and verify documentation to ensure timely and accurate claim processing. • Conduct detailed reviews to validate claim accuracy and identify discrepancies or potentially fraudulent activity. • Provide prompt, courteous, and professional service to clients, employers, broker partners, and internal stakeholders. • Communicate effectively with claimants and beneficiaries to resolve inquiries and ensure clarity throughout the claims process. • Maintain organized, audit-ready claim files that support transparency and compliance. • Partner with legal, compliance, underwriting, and SIU teams on complex, disputed, or potentially fraudulent claims. • Ensure adherence to all regulatory requirements, company policies, and service standards. • Support a consistent and compliant claims handling approach across all lines of business. • Analyze claims data to identify trends, patterns, and opportunities for improvement. • Prepare reports and summaries for leadership to support data-driven decision-making. • Partner with internal teams to improve workflows, reduce cycle times, and enhance claim outcomes. • Support implementation of new tools, systems, and best practices to improve efficiency and customer satisfaction. • Stay current on industry regulations, product updates, and compliance requirements.

Role Description If you're looking for the stability of a profitable, growing company with the entrepreneurial spirit of a startup, we’re hiring. SageSure, a leader in catastrophe-exposed property insurance, is seeking a Property Claims Adjuster II. A qualified candidate will have estimating skills, can comfortably and independently handle moderate severity losses, and distill complex information for customers. You’ll be able to effectively communicate and negotiate across multiple parties, including customers, contractors, and public adjusters. This is a desk-based adjusting position. If you're interested in joining our growing Claims team, we'd love to hear from you. - Investigate and document property claims, including policy review, recorded statements, assigning inspections, updating reserves, preparing or reviewing estimates, and negotiating settlements. - Communicate claim updates and decisions verbally and in writing. - Handle claims in compliance with all applicable regulations and internal processes. - Act as a resource for less experienced staff. - Support catastrophe response as needed, to include potential overtime and deployment. - Any other duties needed to help drive our purpose and fulfill our values. Qualifications - 3+ years of property claims experience. - Estimating skills. - Excellent written and verbal communication skills. - Strong organizational abilities. - Empathetic interpersonal skills. - Adjuster licensed in home state or holds a non-resident license if license not required; meets requirements for licensing in additional states as needed. Requirements - Field claims experience (highly preferred). - Experience in catastrophe-focused environments (highly preferred). - Professional designations (highly preferred). Benefits - Named among the Best Places to Work in Insurance by Business Insurance for four years in a row (2020-2023). - One of the largest managing general underwriters (MGU) focused on catastrophe-exposed property in the US. - Exceptional growth while generating underwriting profits for carrier partners through hurricanes, wildfires, and hail. - Available in 16 states with more than 110 home, flood, and commercial products. - Manages more than $3.2 billion of inforce premium and helps protect more than 970,000 policyholders. - More than 1,000 employees in a distributed workforce environment across 12 offices.

• Manages an inventory of claims to evaluate compensability/liability. • Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages. • Determines and negotiates appropriate claim settlements/reserves within prescribed authority. • May attend arbitrations, mediations, depositions, or trials. • Conveys moderately 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. • Performs other duties as assigned.

Role Description Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. The Leave Specialist provides administrative and transactional support services for employees' leave of absence requests. - Advises employees, employee's family members, managers, and HR Professionals on leave policies and processes. - Tracks employee absences as reported via web, fax, phone, and e-mail. - Responsible for resolving issues by interacting with employee's manager, Human Resources, payroll, or disability specialists. - Coordinates the leave process; verifies eligibility, determines leave approval, calculates leave length, and monitors maximum duration of leave allowed under federal/state and/or client policy. - Supports in-bound and outbound employee leave related calls. - Applies concepts and rules as mandated by guidelines for FMLA and other federally or state mandated or company specific leaves. - Responsible for all communications with the employee, the employee's manager, Human Resources, and all integrated partners throughout the duration of the leave. - Utilizes HR information system [Peoplesoft], payroll system [Kronos], and web-based vendor software as needed to input and update leave data and generate reports. - Assists in the identification of recommendations to positively impact the efficiency and quality of service delivery. Qualifications - Bachelor's degree and 1 year of leave of absence processing or Human Resources experience, OR High School and 3 years of leave of absence processing or Human Resources experience. - Minimum of 1 year of Absence processing required. - Ability to use and navigate web-based software programs and Microsoft Office products [Outlook, Word, Excel etc]. - Ability to communicate effectively both verbally and in writing. - Knowledge of client leave policies, federal and state leave laws pertaining to leave of absence. Requirements - Certified Leave Management Specialist (CLMS) designation required within 12 months of hire. - To maintain designation, 20 hours of continuing education credits are required every two years. Benefits - This position is work-from-home anywhere in the Continental US. - Despite the pay range listed, the current budget for this position is $25.40 - $27/hr. - In the event that there is a high volume of applications received, we will only be able to consider the first 100 applications.