Role Description The claims resolution representative plays a vital role in ensuring accuracy and adherence to the applicable guidelines. This position serves as a crucial liaison between members, providers, agencies, and the internal claims department, demonstrating leadership, collaborative skills, and commitment to achieving results. - This position is remote within the United States, but applicants can expect to work Eastern Time regular business hours with some flexibility. Responsibilities: - Independently resolve suspended claims using the resolution screens in accordance with operational procedures and process recoupments. - Determine when to use a "Forcible" disposition to override the edit and process the claim based on operational claims adjudication procedure. - Review and analyze claims and follow up on the status of claims and reimbursement. - Interpret and apply policy and reimbursement rules to support provider inquiries. - Ensure accuracy and consistency in claims processing. - Research and review submitted claims (electronic) and process them according to policies and procedures. - Possess an unwavering commitment to customer service and operational excellence. - Perform manual pricing and audit checks to ensure compliance with policies and rules. - Review and process suspended claims and submitted documentation. - Provide sufficient detail to explain claims denial reasons. - Implement workflow processes and capabilities for work queues with the ability to route workstreams. - Approve or deny requests for transportation authorization from providers, verify member transportation claims, and process approved claims. - Perform manual reviews on claims, documents, and attachments. - Release individual claims for providers on review. - Independently resubmit claims with applicable corrections. - Independently address discrepancies in charges, payments, adjustments, and demographic information. - Facilitate manual entry of claims into the system. - Review paper claims and attachments, scanning them using scanning equipment to attach the documents to corresponding transaction control numbers. - Other duties as assigned. - Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Qualifications - High School Diploma or GED - 1+ years of experience conducting research to resolve issues within the healthcare field Requirements - Ability to maneuver through various computer claims and eligibility platforms simultaneously - Outstanding customer satisfaction skills - Must be firm but professional when interacting with contacts while performing tasks - Friendly personality, tact, patience, empathy, and a helpful yet professional attitude are essential - Strong computer skills, including proficiency in MS Word and Excel - Excellent oral and written communication skills - Excellent organization and time management skills, with the ability to establish priorities effectively - Ability to read, write, and follow directions - Self-directed and capable of working without direct supervision - Ability to collaborate effectively with others - Create and maintain a positive atmosphere, demonstrating leadership qualities - Knowledgeable in claims review and analysis

Role Description Acrisure is seeking a Senior Workers' Compensation Claims Examiner to independently manage complex California workers' compensation claims from assignment through resolution. This role is responsible for: - Investigating claims and determining compensability - Managing litigation and evaluating exposure - Developing claim resolution strategies while ensuring compliance with California workers' compensation laws and regulations This is a fully remote position. Candidates must be able to support California-based claims and work business hours aligned with Mountain or Pacific Time zones. Qualifications - 5+ years of experience handling California workers' compensation claims - Experience managing indemnity claims - Experience handling litigated workers' compensation claims - Current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation - Strong knowledge of California workers' compensation laws, regulations, and claims handling practices - Experience developing claim resolution strategies and negotiating settlements - Ability to independently manage complex claims with minimal supervision - Strong analytical, decision-making, and problem-solving skills - Excellent verbal and written communication skills - Strong organizational skills with the ability to manage multiple priorities in a remote environment - Proficiency with Microsoft Office and claims management systems Requirements - High school diploma or equivalent required - Additional education beneficial - Current California Adjuster Certification, OSIP/SIP self-insured qualification, or Certified Workers' Compensation Professional (CWCP) designation required Benefits At Acrisure, we’re building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life: - Physical Wellness: - Comprehensive medical, dental, and vision insurance - Life and disability insurance - Fertility benefits - Wellness resources - Paid sick time - Mental Wellness: - Generous paid time off and holidays - Employee Assistance Program (EAP) - Complimentary Calm app subscription - Financial Wellness: - Immediate vesting in a 401(k) plan - Health Savings Account (HSA) and Flexible Spending Account (FSA) options - Commuter benefits - Employee discount programs - Family Care: - Paid maternity and paternity leave (including for adoptive parents) - Legal plan options - Pet insurance coverage This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Role Description Nous recherchons actuellement un expert en sinistres qui veut toucher à tout ! Ce poste est 100 % à distance, mais un bureau vous attend à Laval si vous préférez travailler en mode hybride. Vous pouvez résider n'importe où au Canada à condition d'être titulaire d'un permis d'expert en sinistres valide au Québec (sinistres des particuliers et des entreprises). Anglais fonctionnel est requis (oral et écrit). Résumé du rôle: Nous cherchons actuellement à ajouter un expert en dommage directs et responsabilité civile (2 à 3 années d'expérience) à notre équipe des comptes nationaux !! Pour réussir dans ce rôle, le candidat idéal doit avoir une formation/expérience dans les réclamations en dommages directs et doit être intéressé à traiter différents types de réclamations (auto, biens et responsabilité civile). Responsabilités: - Contact et suivi rapides avec les assurés et les réclamants. - Enquêter sur la cause et faire rapport aux clients avec des recommandations solides. - Tout au long du processus de réclamation, fournir un service à la clientèle de haut niveau aux clients et aux assurés. - Exécuter les tâches qui lui sont confiées conformément aux normes de travail, politiques et procédures établies. Qualifications - Proactif dans la recherche de résolutions, avec un sentiment d'urgence et de réactivité. - Compétences analytiques efficaces, y compris l'identification des dynamiques de cause à effet. - Capable de tirer des conclusions valables et de les communiquer efficacement. - Capacité à gérer la pression avec calme, en particulier lors de conflits et de situations difficiles. - Doit avoir des compétences relationnelles avec un parti pris pour établir des relations avec sa propre équipe et les parties prenantes des réclamations. - Maîtrise des ordinateurs et de la technologie actuelle. - Compétences orales efficaces, y compris l'écoute, les entretiens, la négociation, etc.; Doit être capable de fléchir le style approprié au public. - Excellentes compétences en service à la clientèle et veille à ce que toutes les demandes soient traitées efficacement et en temps opportun. - Le bilinguisme (français et anglais) est un atout majeur dans le département des comptes nationaux. Benefits - Vous ferez partie d'une équipe de plus de 700 experts en sinistre indépendants à travers le Canada. - Votre carrière peut évoluer vers d’autres genres de réclamation, vers la gestion de succursales à travers le Canada ou vers de nouveaux rôles - le ciel est la limite. - Vous travaillerez sur le logiciel de pointe EspaceRéclamations, conçu par un expert pour les experts et maintenu moderne avec notre équipe interne de programmeurs et de développeurs. - Votre charge de travail est dirigée par des cadres supérieurs et des employés chargés du développement des affaires d'un océan à l'autre. - Vous aurez droit à une multitude d'avantages tels que le remboursement des frais d'études, le remboursement des frais annuels rattachés à vos permis d’expert, des programmes de mentorat et un régime d'assurance-maladie et dentaire à prestations flexibles qui vous permet de personnaliser votre couverture. - Opportunité d’obtenir votre permis d’expert en sinistre dans toutes les provinces canadiennes. - Si vous ne désirez pas travailler de la maison à temps plein, notre bureau local vous accueillera, vous fournira un bureau agréable, des collègues sympathiques et un endroit pour développer votre carrière.

Role Description We have an existing opportunity to add a Claims Adjuster - Bodily Injury to join our growing team! You will work in a remote based environment anywhere in Alberta. The Claims Adjuster actively adjusts claims while ensuring that business development opportunities are maximized. This involves marketing and follow-up of opportunities in a timely manner. To succeed in this role, the ideal candidate should have background/experience in Liability and Bodily Injury Claims. - Prompt contact and follow up with policy holders and claimants. - Investigate the cause and report to clients with solid recommendations. - Using supplied technology (e.g., Docusketch), scope and establish quantum of damages. - Identify exposures, recommend reserves, recommend investigation required for exposure, prepare action plans, and negotiate fair and satisfactory settlements. - Provide high level of customer service to clients and the insured throughout the claims process. - Participate and share ownership and responsibility for after-hours customer service requirements when required. - Perform duties assigned in compliance with established work standards, policies and procedures. Qualifications - Completion of high school education; University degree or post-secondary education related to insurance will be given preference. - Proficient in use of Microsoft Office Products (Outlook, Word, Excel, OneDrive). - Minimum of 3 years’ experience in working with bodily injury claims. - Ongoing commitment to education and learning; currently pursuing CIP designation. - Must hold a Level 1 adjuster license in Alberta. - Effective analytical skills, including identification of cause-and-effect dynamics. - Able to draw valid conclusions and effectively communicate them. - Ability to interpret complex documents of a legal nature, perform and understand advanced numerical calculations including analysis of comparative information. - Excellent communication skills, including listening, interviewing, negotiating; must be able to flex style appropriate to audience. - Proactive and positive approach to customer service ensuring that all inquiries are effectively dealt with in a timely manner. - Strong interpersonal skills allowing you to effectively deal with conflict and difficult situations. Benefits - You will be part of a team of over 700 independent adjusters from 9 other provinces, 2 territories. - Your career can grow into other lines of claims, branch management, across Canada into other branches, or new roles - the sky is the limit. - You will work on the industry-leading iAdjust software, designed by an adjuster for adjusters and kept modern with our in-house team of programmers and developers. - You will be supported by experienced local claims support, centralized after hours support, and dictation services. - Your claims load is driven by senior executives and business development staff from coast to coast. - You are compensated for your billable hours and other costs. - Your workload is balanced to ensure you can maintain a high-quality level. Company Description We welcome and encourage applications from people with disabilities. Accommodations are available on request for candidates throughout the recruitment and assessment process. Unsolicited Outreach Statement – Recruitment Agencies: We will not accept unsolicited resume submittals from third-party recruiters and hereby request agencies not to contact our employees or managers directly to present candidates. Be advised that we will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. We welcome resumes submitted directly from candidates.