Title: Claims Examiner, Commercial Auto Location: Morristown, NJ United States of America New York, NY United States of America Jersey City, NJ United States of America Alpharetta, GA United States of America Philadelphia, PA United States of America Job Description: With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential. Our work is the catalyst that helps others achieve their goals. In short, We Enable Possibility℠. Position Summary The Auto Claims Examiner – Property Damage is responsible for the investigation, evaluation and resolution of commercial automobile claims involving property damage. You will be Arch’s point of contact with customers – directing and making decisions regarding the repair process from beginning to end. Managing your own inventory while working independently, you’ll work closely with body shops and others to negotiate repair pricing and assess liability. Ideal candidates will possess leadership and conflict management skills, along with strong attention to detail and a passion for providing excellent customer service. The ideal candidate is customer and technically focused to ensure we’re achieving industry best outcomes all while making sure we’re delivering on our promise to our customers Responsibilities - Investigate, evaluate, and resolve commercial auto claims nationwide that involve an inventory of physical damage claims, salvage, rental and other related claims. - Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis - Execute on claims strategies to achieve claims quality, customer service and operational objectives - Coordinate vehicle inspections, review estimates, determine total loss evaluations, manage rental and salvage and set clear expectations and timelines - Document information related to the claim and make decisions consistent with claims standards and local laws - Evaluate and handle claim payments - Review and determine validity of any supplement requests - Serve as a mentor to less-experienced claims professionals. - Support the strategy and operations of Auto claims. - Assists in industry analysis and benchmarking studies - Prepare and present written/oral reports to senior management setting forth all issues influencing evaluation and recommending reserves - Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims - Other duties as assigned. Experience & Required Skills - Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines - Strong time management and organizational skills - Creative, out of the box thinker who refuses to accept the status quo. - Ability to take part in active strategic discussions - Ability to work well independently and in a team environment - Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word - This role is a hybrid role, 3 days a week in office - Willing and able to travel 10% Education - One to three (1-3) years of working experience at a commercial auto carrier handling material damage claims nationally. Claims experience with Commercial Middle Market Customers a plus. - Bachelor's degree - Proper adjuster licensing in all applicable states #LI-SW1 #LI-HYBRID For individuals assigned or hired to work in the location(s) indicated below, the base salary range is provided. Range is as of the time of posting. Position is incentive eligible. For NY/NJ: $75,000 - $85,000/year For Alpharetta, O'Fallon: $60,000 - $70,000/year - Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs. The above pay range may be modified in the future. - Arch is committed to helping employees succeed through our comprehensive benefits package that includes multiple medical plans plus dental, vision and prescription drug coverage; a competitive 401k with generous matching; PTO beginning at 20 days per year; up to 12 paid company holidays per year plus 2 paid days of Volunteer Time Offer; basic Life and AD&D Insurance as well as Short and Long-Term Disability; Paid Parental Leave of up to 10 weeks; Student Loan Assistance and Tuition Reimbursement, Backup Child and Elder Care; and more. Click here to learn more on available benefits. Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn’t the right fit but you’re interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. 14400 Arch Insurance Group Inc.

Role Description The Claims Coordinator ensures accuracy and timely filing for all dental claims for assigned office and reports problems and issues on follow up report to dental office. Reviews Accounts Receivable reports on assigned rotation for all offices, following up on outstanding insurance claims and balances; working problem EOBs, denials, and processing appeals as needed. Responsibilities - Reviews clinical note, x-rays, and account ledger for cohesion of information - Creates and submits e-claims and paper claims attaching any necessary x-rays, notes, narratives, charting, etc. This includes ortho claims - Sends claims through clearing house and manages all invalid and rejected claims - Claims should be sent out within 48 hours of the date of service - Any account or claim issues are included on a Follow Up report to the dental office or assigned to the designated DO team member within PMS with the expectation that answers and corrections will be made within 48 hours of sending the report - If accounts are unresolved from the dental office from the follow up report, an Urgent Weekly Report goes to the dental office - Files corrected claims triaged from the AR Specialist based on returned problem EOBs - Manages Accounts Receivable report on an assigned schedule, reviewing accounts for outstanding insurance claims and balances - Calls and follows up with insurance companies on claims issues and non-payments - Maintains and completes all appeals and requests from insurance companies - Reviews returned EOBs: - Denials - manages info needed for appealing claims - Denials - manages info needed for missing information or attachments - Corrected claims and/or retractions - Tracks all outstanding insurance balances by category and reporting to OM when completed Administrative Responsibilities - Participates in special projects and tasks as assigned - Fills in for other Claims/AR Coordinators as needed - Assists and conducts training of new CBO team members - Attends and contributes to monthly meetings - Reports to CBO-RCM with any grievances or issues Qualifications - Previous experience in dental office administration, dental billing, or insurance claims processing is highly beneficial - Candidates with experience in medical claims processing may also be considered - Familiarity with dental terminology and procedures is essential for accurately processing claims and communicating with dental providers and insurance companies - A good understanding of dental insurance policies, coverage limitations, and claim submission procedures is necessary, including knowledge of common insurance codes (e.g., CDT codes) and claim forms (e.g., ADA dental claim form) - Detail-oriented to accurately review claims, ensure all necessary information is included, and identify any discrepancies or errors - Strong communication skills for interacting with patients, dental providers, insurance companies, and other staff members, including both verbal and written communication skills - Ability to effectively manage and prioritize multiple tasks, such as processing claims, following up on outstanding payments, and resolving claim disputes - Proficiency with dental practice management software and other computer applications used for claim processing and administrative tasks is typically required - Good customer service skills for addressing inquiries and concerns in a professional and empathetic manner - Ability to troubleshoot issues related to claim processing, billing errors, or insurance coverage discrepancies - Knowledge of and adherence to legal and ethical guidelines related to patient privacy (HIPAA) and billing practices is essential Benefits - Health and dental benefits - 401(k) - Holiday pay - Paid time off

Role Description The Institutional Claims Examiner is responsible for the accurate, timely, and compliant adjudication of institutional (hospital/facility) medical claims in accordance with applicable HMO, Medi-Cal, Medicare, and Commercial contracts. This role ensures proper determination of financial responsibility among health plans, providers, and delegated entities, while adhering to California and federal regulatory requirements applicable to a healthcare Management Services Organization (MSO). Qualifications - Minimum: High School Diploma or equivalent. - Preferred: Additional coursework or training in healthcare administration, medical billing, or managed care. Requirements - Minimum: Five years of managed care claims processing experience. - Preferred: Two – three years of recent institutional/hospital claims experience involving Medicare, Medi-Cal, HMO, PPO, and Commercial products. - Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. - Professional claims or medical billing certifications preferred. - Advanced knowledge of institutional claims processing, including UB-04 and CMS-1500 claim forms. - Strong understanding of DRG, OPPS/APC, Ambulatory Surgery, and RBRVS reimbursement methodologies. - Working knowledge of Medi-Cal, Medicare, and California managed care regulations, including prompt payment requirements. - Proficiency with claims processing systems, third-party pricing software, and standard office applications (Microsoft Office). - Strong analytical, problem-solving, and decision-making abilities. - Excellent written and verbal communication skills; ability to read, write, and communicate effectively in English. - Ability to manage multiple priorities in a fast-paced, deadline-driven environment. - Demonstrated attention to detail and commitment to accuracy and compliance. Benefits - Light physical activity, including the ability to lift up to 10 pounds and to bend, stoop, reach, and file materials as needed. - Ability to frequently use a computer, keyboard, and standard office equipment. - Maintain focus, manage workload pressures, and meet deadlines in a professional healthcare office or remote work environment. Pay Range $31.00 - $36.00 / hourly

Role Description As a Claims Resolution Adjuster II, your main focus will be investigating automobile accidents involving single or multiple vehicles which result in property damage and/or bodily injury. You will have the convenience of working remotely from your home while efficiently handling your responsibilities. You will assess coverage, liability, and damages while providing exceptional customer service throughout your day. Customer communication will take place through different channels, including voice calls, email, and text messages. Through the utilization of innovative platforms and tools, you will engage in negotiation processes to reach fair injury settlements with all parties involved. - The Customer Service Expert: You’ll live into Allstate’s Claims Culture by caring, empowering, and restoring, and you will accomplish that by being compassionate, clear, and a committed partner in each Casualty claim. You lead with empathy, always. - The Investigator: You’ll confidently and independently investigate casualty claims by performing detailed reviews of damage and interpreting policies to determine coverage. - The Effective Communicator: You’ll use phone, emails, and sometimes even video chat with customers to help them through a fast, fair, and easy claims process. You’ll also incorporate a specific approach to claim handling to offer the customer their preference of communication to efficiently discuss their claim needs and keep them updated on the claim progress. - The Negotiator: You will evaluate and negotiate claims settlements with customers, vendors, third party carriers, and claimants, in accordance with all legal and business standard methodologies. With negotiations, you will incorporate tactics in handling challenging and complex situations. - The Problem Solver: You’ll utilize multiple tools to get the job done in a fast-paced environment, including estimate tools, job aids, and additional settlement platforms, all while using your sharp critical thinking skills. - The Recorder: You’ll protect the company financially by executing policies along policy agreements, and you keep a clear record of your work in a claims system that you will be trained on. You’ll accomplish this by ensuring timely and accurate documentation is completed as you work on each claim. Qualifications - 2+ years claims adjusting experience determining liability. - Claims investigation and negotiation experience is preferred. - Experience with liability investigations, investigating coverage, property damage coverage, set method of inspection, rental, and resolving liability a plus. - Proficient communication skills, especially over the phone, to establish rapport and assess claims accurately. - Strong critical thinking and problem-solving skills to evaluate and negotiate injury claims successfully. Requirements - This position is a permanent remote home-based role. Your home office does not need to be near an Allstate office, but it does need to be in the United States. - 8 hours shift between the hours of 8:00am - 6:00pm EST or CST zone. This will be Monday – Friday with potential Saturday duty rotation. - A dedicated workspace in your residence that is private and free from distractions. - A minimum internet bandwidth of 50 MB down/5 MB up. - Appropriate work surface and seating. Benefits - A technology bundle that includes all equipment needed to perform your work from home (laptop, monitors, headset, keyboard, mouse). - Connectivity reimbursement of $80 per month to offset some of the cost of internet. - Being a part of Allstate means you receive a benefits package from Day 1 of employment, including time off, healthcare, retirement, and more. - Competitive pay with needed support for continuous development and career advancement. - Flexibility in scheduling and a time off policy that helps support your work/life balance. - Initial and ongoing training to get you proficient in your new role. - Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life.