Claims Trainer Jobs

Location: Remote ERGO NEXT's mission is to help entrepreneurs thrive. We’re doing that by building the only technology-led, full-stack provider of small business insurance in the industry, taking on the entire value chain and transforming the customer experience. Simply put, wherever you find small businesses, you’ll find ERGO NEXT. Since 2016, we’ve helped hundreds of thousands of small business customers across the United States get fast, customized and affordable coverage. We’re backed by industry leaders in insurance and tech, and we still have room to grow — that’s where you come in. As a Claims Advocate, you’ll manage a portfolio of new claims, utilizing your growing expertise to identify third-party negligence early in the process. Your role is to interpret policy language and analyze initial loss reports to ensure that liability is accurately assessed from day one. You’ll collaborate with adjusters and site experts to build a solid foundation for every claim, developing the investigative rigor needed to thrive in a fast-paced commercial environment. What You’ll Do Investigate and Assess Liability: Conduct thorough investigations to identify liable third parties and assess the liability and Claims: Initiate, document, and manage all aspects of general liability cases from identification through final resolution Negotiate Settlements: negotiate and process denials per the policy. Evaluation: Establish the precise financial and legal merit of a loss Collaborate with Our Claims Team: Work alongside claims adjusters, legal partners, and vendors to determine coverage and proper claim practices. Documentation: Per our best practice claim handling and legal requirements. Policy Analysis and Compliance: Review and interpret policy language to align with company policies and relevant legal requirements External Vendor Management: Engage and coordinate with outside vendors, specialists, attorneys, an

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers.. How You’ll Do It Claims Technical Management: Independently handle all aspects of the workers’ compensation claims from set-up to closure. Evaluate and handle high dollar, high exposure, complex claims. Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. Mitigate the complex exposure while achieving the best outcome. Determine timely and accurate compensability decisions within statutory requirements. Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. Ability to present claims to senior management, internal and external stakeholders. Timely administration of statutory medical and indemnity benefits throughout the life of the claim. Comply with all applicable statutory guidelines, rules, and regulations. Control legal activity with defense counsel through the litigation process while managing legal fees and costs. Prioritize early resolution opportunities, evaluate claim exposure and negotiate settleme

Why Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career. MiniCo has nearly 50 years of experience in program management, underwriting, binding authority, and claims, offering a portfolio of exclusive programs to address even the most unique risk exposures. Our dedicated program teams provide niche underwriting process and flexibility, industry specialization, and unparalleled customer service. Today, MiniCo is a member of the Jencap Program Administrators division, offering multiple specialty property and casualty insurance products for a variety of unique industries and exposures. The Claims Assistant will work a hybrid schedule from our Phoenix AZ, office. Responsibilities Take incoming new and existing claim calls. Ability to communicate effectively with the public. Ability to analyze information received when a new claim is submitted Ability to enter check requests and reserves from the adjuster Do monthly reporting as requested Pay and track vendor invoices Generate letters and other correspondence based on claim type Follow appropriate claims procedures for the reserving, and payment of loss or expense. Review coverage questions with claims Manager and/or appropriate personnel of the principal. Perform other duties as assigned. Qualifications 1 - 2 years of Insurance experience preferred. Understanding of business line of products, policy language, exclusions, forms/endorsements, and effective claims handling practices. Attention to detail ensuring accuracy. The base salary of

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. As the Vice President of Claims Adjudication, reporting to the Chief Claims Officer, your purpose will be to collaborate in the design and execution of Pie's claims strategy and programs. In this role, you will lead Pie's claims adjudication function, ensuring the delivery of optimal claim outcomes and exceptional customer experiences. You are responsible for strategically building and leading a claims adjudication organization that executes on the overall claims strategies. You will be fostering relationships at every level both internally with team members and other senior leaders, as well as externally, working to build relationships with key partners in the industry. How You'll Do It Claims Adjudication Leadership Lead and oversee Pie's claims adjudication function across all jurisdictions. Plan and direct all aspects of claims adjudication operations, overseeing daily and long-term activities. Responsible for implementing claims programs for workers' compensation. Serve as the lead claims adjudication authority, bringing expert claims experience to the Pie Executive Team. Direct the quarterly review and settlement of large loss and catastrophe claims. Develop and guide claims adjudication procedures and policies to enhance the processing, investigation, and settlement of claims. Claims Strategy Collaboration Collaborate with the Chief Claims Officer in the design and execution of Pie's overall claims strategy. Contribute claims adjudication expertise and insights to inform enterprise-wide claims initiatives. Partner with Claims leadership on strat

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. How You’ll Do It Claims Technical Management: Independently handle all aspects of the workers’ compensation claims from set-up to closure. Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. Mitigate claim exposure while achieving the best outcome. Determine timely and accurate compensability decisions within statutory requirements. Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. Timely administration of statutory medical and indemnity benefits throughout the life of the claim. Comply with all applicable statutory guidelines, rules, and regulations. Control legal activity with defense counsel through the litigation process while managing legal fees and costs. Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement. Claims Customer Service: Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations. Ass

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. How You’ll Do It Claims Technical Management: Independently handle all aspects of the workers’ compensation claims from set-up to closure. Evaluate and handle high dollar, high exposure, complex claims. Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. Mitigate the complex exposure while achieving the best outcome. Determine timely and accurate compensability decisions within statutory requirements. Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices. Ability to present claims to senior management, internal and external stakeholders. Timely administration of statutory medical and indemnity benefits throughout the life of the claim. Comply with all applicable statutory guidelines, rules, and regulations. Control legal activity with defense counsel through the litigation process while managing legal fees and costs. Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlemen

Opportunity Overview: We are seeking a versatile and highly skilled Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends, and

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Lead Director, Technology Product Management for Medicare Claims is accountable for shaping the strategy, roadmap, performance, and modernization of the technology products and platforms that support claims administration for more than 4 million Medicare members. As the organization transitions to a product operating model, this leader will help establish and mature the product structure, practices, accountabilities, and cross-functional ways of working needed to improve claims accuracy, automation, timeliness, reliability, compliance, and operating efficiency. The Lead Director will partner closely with business, engineering, data, architecture, operations, and delivery leaders, as well as strategic software vendor partners, to translate claims, regulatory, operational, and technology needs into prioritized investments, aligned roadmaps, and measurable outcomes across a complex enterprise ecosystem. Given the significant role of vendor-provided platforms in the claims product, this leader will influence vendor roadmaps, align modernization priorities, manage critical dependencies, partner with release management on complex releases, and hold internal and external partners accountable for product performance and business outcomes. This role also leads and develops product management colleagues, strengthens product capabilities, and helps teams evolv

About the Team DoorDash's Risk & Insurance team protects and strengthens our business by developing innovative insurance programs and operational strategies that support millions of deliveries worldwide. We partner across Product, Engineering, Legal, Finance, Data Science, and Operations to manage risk, improve customer outcomes, and enable the continued growth of one of the world's largest local commerce platforms. As DoorDash continues to scale globally, Insurance Claims Operations is evolving through artificial intelligence, automation, and digital transformation. Our organization is reimagining how claims are managed by leveraging technology to automate routine work, enhance operational decision-making, and create scalable solutions that improve efficiency while maintaining exceptional customer experiences. About the Role DoorDash is seeking an Insurance Claims Operations Associate to join our Claims Operations team. In this role, you will manage the intake, documentation, and follow-up work that keeps cases moving efficiently from first report through resolution. You will work closely with internal systems, AI-assisted tools, and cross-functional partners to ensure every case is accurately created, updated, and progressed. Your work directly supports the team's ability to deliver timely, high-quality outcomes for the people we serve. This role is well suited to someone who is detail-oriented, organized, and comfortable managing a high volume of work in a fast-paced environment. This position will report to a Supervisor, Insurance Claims Operations and is fully remote. Onboarding will take place over the first 4–6 weeks, Monday through Friday. After onboarding, schedules may be assigned on any day Monday through Sunday based on business needs. You're excited about this opportunity because you will Execute high-volume intake and case processing across multiple channels Prepare and submit FNOL details for claim establishment Review, organize, and accurately in

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

At Lyft, our purpose is to serve and connect. We aim to achieve this by cultivating a work environment where all team members belong and have the opportunity to thrive. Lyft is looking to add a Claims Operations Specialists to its growing Risk Team. The Operations Specialist position is an integral role assisting with the processing of claims and responding to inquiries to expedite the handling of claims. The focus of these roles will be cross-functional collaboration and enhanced customer communication focused on the best claims experience for our users. You’ll balance day-to-day responsibilities between independent claims processing and working with our cross-functional teams with a focus on customer obsession and operational excellence. Responsibilities: Create initial loss reports and assist with overall processes for Lyft Healthcare, as well as Lyft Bikes and Scooters Respond and assist with customer inquiries relating to claims Requests additional information, where necessary, for completion of claim processing Manages and coordinates next steps for Accidents; including missing claim searches, adjuster contacts, and enhanced customer experience Coordinate with cross functional teams regarding claims processes, system updates, and customer experience Gathers investigative material and general support to assist adjusters and internal claims teams Develops and delivers effective written and oral communications/reports to management Supports various Risk, Safety, Bikes & Scooters, Express Drive, Legal, Lyft Rentals, and Finance Teams regarding all aspects of insurance claims Supports and facilitates a team environment of continuous feedback and idea sharing with all team members and stakeholders Assist with special projects, including and not limited to auditing and data reconciliation Seeks out opportunities to gain broader insurance knowledge and cross-training Experience: 2+ years experience handling and solving customer support issues - ideally in a

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

About THG Ingenuity THG Ingenuity is a fully integrated digital commerce ecosystem, designed to power brands without limits. Our global end-to-end tech platform is comprised of three products: THG Commerce, THG Studios, THG Fulfilment. Each represents a single, unified solution, overcoming challenges and taking brands direct-to-consumer. Our client portfolio includes globally recognised brands such as Coca-Cola, Nestle, Elemis, Homebase, and Proctor & Gamble. What’s the role? Job Title: CX Apprentice - Claims, Post Dispatch & Returns Reports to: Head of CX - Courier & Fulfilment Apprenticeship: Business Administrator Level 3 Duration: 12-18 months, subject to learner progress + End Point Assessment Role Purpose To support the Post Dispatch Communications, Carrier Claims and Returns functions, helping deliver a seamless end-to-end delivery and returns experience for customers and clients, from order dispatch through to resolution of any delivery, claims or return issues. Key Responsibilities Post Dispatch Communications Act as the voice of the customer for delivery excellence, helping improve touchpoints across the order-to-delivery journey for outbound and inbound shipments. Support the day-to-day relationship with our Post Dispatch Communications 3rd party provider (parcelLab), and help manage courier delays to reduce their impact on contact rates. Assist with onboarding new couriers, clients, sites and carrier services, setting up parcelLab/STS configurations and appropriate communication flows and brand tone. Support regular performance reviews of Post Dispatch Communications, maintaining metrics and reporting and helping communicate results and recommendations to stakeholders and clients. Collaborate with cross-functional teams across Ingenuity and PLC to support a seamless experience and identify revenue opportunities. Carrier Claims Support timely, accurate submission of claims to carriers, including requi

Why Jencap? We are one of the largest wholesale insurance intermediaries in the United States with expertise in wholesale brokerage, binding authority, and program management. The common thread woven throughout our success story is our collaborative and driven team of people. Our teams are empowered and work together to find solutions. We have a passion culture – with teamwork, collaboration and a focus on growing individuals and giving them the tools & development opportunities to have a successful career. MiniCo has nearly 50 years of experience in program management, underwriting, binding authority, and claims, offering a portfolio of exclusive programs to address even the most unique risk exposures. Our dedicated program teams provide niche underwriting process and flexibility, industry specialization, and unparalleled customer service. Today, MiniCo is a member of the Jencap Program Administrators division, offering multiple specialty property and casualty insurance products for a variety of unique industries and exposures. MiniCo is looking for a dynamic and customer-driven individual to join our team! MiniCo offers a hybrid work environment. Under General supervision, the position is responsible for evaluating and resolving routine property damage claims for the Tenant Protection Plan Program within assigned authority limits. This role will provide exceptional customer service through coverage analysis and damage assessment. The Property Damage Claims Adjuster will work a hybrid schedule from our Phoenix AZ. Responsibilities : Review coverage and handle routine personal property damage of tenant property stored in storage facility. Review tenant protection plan agreement and determine damage eligibility and settlement recommendations Examine photographs, estimates, repair invoices and other damage-related documents Maintain regular communication with customers regarding status and next steps Settle damages within assigned autho

Associate - Insurance - P&C Claims 5A — TOWER -4, JHARSA. Apply via Workday.