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Custom Senior Liability Claims Account Examiner Property & Casualty Insurance Industry The role involves managing a custom claims portfolio and various designated accounts from start to finish. It is essential to ensure effective control over reserves and expenses. The main focus should be on resolving cases fairly and efficiently from the beginning. Collaboration with defense attorneys is necessary to guarantee all cases are adequately prepared for potential trials. Support for underwriting and loss control during account evaluations will also be required. Regular communication with insured parties and brokers will be crucial as needed. Responsibilities • Claims handling for designated special accounts includes overseeing cases across multiple states, guiding each claim from initiation to resolution., • Each claim must be thoroughly examined for coverage by reviewing policies and aligning them with the claims made by the claimant., • Timely coverage position letters should be issued to all relevant parties., • Conduct factual investigations, either directly or with investigator assistance., • Analyze various documents, such as contracts, leases, governing documents for condos/co-ops, the insured’s business records, and medical or property damage reports, among others., • Establish accurate reserves promptly, resulting in fair and quick settlement decisions., • Negotiate settlements effectively., • Adhere to all company and department guidelines., • Supervise defense counsel and manage the discovery process., • A minimum of four years of experience in handling premises liability claims is required., • In-depth knowledge of New York Labor Law is essential, with an additional two years in labor law claims preferred., • Applicants should also possess experience with complex claims, including wrongful death, mold issues, drownings, and negligent security cases., • The ability to direct defense counsel effectively and think independently is a must., • Holding CPCU, AIC, SCLA, or other insurance industry credentials is preferred., • Familiarity with systems like ImageRight and Guidewire is considered advantageous. Remote - CANDIDATES MUST BE ABLE TO TRAVEL TO NYC ON A REGULAR BASIS

The Office of Chief Medical Examiner investigates cases of persons who die within New York City from criminal violence, by accident, by suicide, suddenly when in apparent health, when unattended by a physician, in a correctional facility or in any suspicious or unusual manner or where an application

Join PNC as a Business Credit Field Examiner, where our people are our greatest asset. PNC provides a comprehensive benefits package, including medical coverage, retirement plans, paid time off, and professional development opportunities.

The office of chief medical examiner investigates cases of persons who die within new york city from criminal violence, by accident, by suicide, suddenly when in apparent health, when unattended by a physician, in a correctional facility or in any suspicious or unusual manner or where an application

Flexible 1-day-per-week schedule with no call or weekends Outpatient independent medical examinations, approximately 10 minutes per case Workers' compensation and accident case evaluations, no prescribing required Board-certified neurologist position focused on head, neck, and back assessments New Y

Job Description Job Summary: We are currently seeking a New York Labor Law Examiner to join our growing team. This position may be located at our Rutherford, New Jersey headquarters or Remote based. The work of our examiners directly impacts the success of our organization. You will have the ability to make a meaningful impact by leveraging your claim handling skills, industry expertise, customer service skills, and ability to execute with a high degree of professionalism. This is the perfect opportunity for a self-motivated and skilled adjuster to apply their knowledge and grow with a forward-thinking organization! Responsibilities • Manage complex New York Labor Law general liability claims and third-party property and bodily injury., • Maintain a current understanding of relevant statutes and case law., • Expertise in admitted and non-admitted policy coverages., • Knowledge of New York Labor Law: 200, 240(1), 241(6), • Investigate claims and determine coverage. Identify coverage issues and draft coverage position letters. When necessary, retain coverage counsel and implement recommendations., • Participate in litigation activities including assignment of defense panel counsel, monitoring of defense counsel work., • Provide internal and external stakeholders with regular updates including reserve recommendations, coverage and contractual issues, determination of liability., • Manage litigation and negotiate settlements., • Determine reserves and monitor for accuracy., • Manage litigation and defense., • Manage all claims in accordance with industry best practices.Qualifications, • At least 5+ years of relevant experience., • Must maintain current and valid adjuster license(s)., • Strong project management skills and ability to work independently., • Strong working knowledge of insurance law(s) and construction safety regulation., • Strong verbal and written communication skills., • Excellent customer service skills., • Experience working for a Third-Party Administrator (TPA) company is a plus.About Raphael and Associates Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for exceptional service. We understand the importance of adapting to the demands of a dynamic market and we tailor our services to our client’s specific needs. As a claim’s organization, what we do is complex. Our mission is simple: to provide outstanding service, retain extraordinary professionals, and utilize the best technology in the industry! As a leading organization in the industry, we offer dynamic and challenging opportunities to individuals who want to make a difference. We value camaraderie, vision, a passion for excellence, creativity, and self-reliant professionals. Benefits and Perks We are an organization that recognizes and appreciates hard work! We offer a competitive compensation package commensurate with experience, including salary, bonus, paid time off, medical/dental/vision/life insurance and 401k (with matching!). Most importantly, you will have the opportunity to work directly alongside an extraordinary and dedicated team to grow a critical function within a dynamic, growing company. Powered by JazzHR zQpuarPUas

Job Description Hi, we're Oscar. We're hiring a SIU Coding Auditor to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role The Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations. You will report to the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: The base pay for this role in the states of New Jersey and New York is: $65,412 - $85,853 per year. The base pay for this role is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities • Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements., • Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar., • Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders., • Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews., • Help draft written communications to providers to convey audit findings., • Participate in educational calls with providers., • Help train new team members., • Develop and document processes to improve the effectiveness of the team., • Compliance with all applicable laws and regulations, • Other duties as assignedQualifications, • 2+ years of coding or auditing experience across multiple specialties is required, • Bachelor's degree or 4+ years of work experience, • Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification, • Experience working in production-based environment, • Experience of both outpatient and inpatient auditingBonus Points, • Certified Professional Medical Auditor (CPMA), • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar, • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity, • Demonstrated experience translating technical jargon to non-technical end users., • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting., • Experience with HIPAA, data privacy, and/or data security processes At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionWe are currently seeking a First Party Physical Damage Cargo Claims Examiner to join our growing team. This position may be located at our Rutherford, New Jersey headquarters or our Lake Mary, Florida office. We will consider remote based candidates. The work of our examiners directly impacts the success of our organization. You will have the ability to make a meaningful impact by leveraging your claim handling skills, industry expertise, customer service skills, and ability to execute with a high degree of professionalism. This is the perfect opportunity for a self-motivated and skilled adjuster to apply their knowledge and grow with a forward-thinking organization! Responsibilities • Provide superior claim management for first party physical damage cargo business throughout the entire claim life cycle inclusive of customer service, technical expertise, coverage analysis and claim analysis and evaluation., • Provide recommendations for loss reserving and claim negotiation and resolution., • Maintain compliance with internal and external quality standards, best practices, and statutory regulations., • Identify additional resources required to investigate claims including technical experts, subrogation, salvage, risk control, fraud, or other experts., • Confirm the extent of property damage by reviewing all appropriate records and damage documents., • Maintain claim files, documentation, diary system in accordance with best practices., • Provide timely updates when needed to appropriate internal and external leadership.Key Requirements, • At least 5+ years of relevant experience, • Must maintain current and valid adjuster license(es) in Florida, Texas, and New York, • Experienced working on cargo claims, • Must maintain a valid driver’s license., • Strong project management skills and ability to work independently., • Strong working knowledge of insurance laws, • Strong verbal and written communication skills, • Excellent customer service skills, • Commitment to superior performance that adds value., • An aptitude for evaluating, analyzing, and interpreting technical information., • Sound critical thinking and decision-making skills., • Experience at a Third-Party Administrator (TPA) company is a plus.About Raphael and Associates Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for exceptional service. We understand the importance of adapting to the demands of a dynamic market and we tailor our services to our client’s specific needs. As a claim’s organization, what we do is complex. Our mission is simple: to provide outstanding service, retain extraordinary professionals, and utilize the best technology in the industry! As a leading organization in the industry, we offer dynamic and challenging opportunities to individuals who want to make a difference. We value camaraderie, vision, a passion for excellence, creativity, and self-reliant professionals. Benefits and Perks We are an organization that recognizes and appreciates hard work! We offer a competitive compensation package commensurate with experience, including salary, bonus, paid time off, medical/dental/vision/life insurance and 401k (with matching!). Most importantly, you will have the opportunity to work directly alongside an extraordinary and dedicated team to grow a critical function within a dynamic, growing company. Powered by JazzHR 20g7ombzmt

Job DescriptionSenior AuditorEmployment Type: Full Time, Mid-levelDepartment: Financial Services CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success- Analyze complex personal and business financial records for purposes to include identifying payments and kickbacks, tracing money flows, identifying assets, identifying sources and uses of cash, and quantifying damages.- Analyze and calculate ability to pay settlements and judgments, including analyzing debt covenants, borrowing capacity, adjusted earnings and earnings per share, financial ratios, accounts receivable and accounts payable, aging schedules, tax considerations, assessing collectability, and developing payment terms and schedules.- Identify, quantify, and understand related party transactions.- Analyze healthcare claims and other data.- Create financial damage models for use in litigation.- Conduct asset valuation.- Conduct records reconstruction.- Develop computerized models to assist in the presentation of financial evidence.- Report on financial data and evidence.- Communicate findings to attorneys and investigators.- Review defense presentations, expert reports, and arguments.- Work with independent experts.- Prepare expert reports for litigation.- Participate in negotiations as requested.- Testify as required.- Perform training and give presentations on data analysis tools and experience. Qualifications- Minimum of 5 years of experience in forensic financial accounting, litigation consulting, and/or health care fraud analysis required.- The resume must demonstrate experience that illustrates a clear understanding of the rules of evidence and civil procedures, the admissibility and inadmissibility of evidence, the elements of the violation(s) under investigation, and other applicable policies required to support criminal and civil investigations. Ideally, you will also have- Experience preparing expert reports and other trial preparation preferred. CPA preferred.- Certified Fraud Examiner preferred. Our CommitmentContact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package.- Health, Dental, and Vision- Life Insurance- 401k- Flexible Spending Account (Health, Dependent Care, and Commuter)- Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of meaningful government innovation! Explore additional job opportunities with CGS on our Job Board: For more information about CGS please visit or contact:Email: #CJ We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

A Veteran service organization in Newark, NJ, seeks an Examiner Physician Assistant to conduct medical evaluations for Veterans seeking disability compensation.The role emphasizes clinical insights and documentation while ensuring quality care.Candidates must possess a valid PA license and at least

Job Description Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Senior Analyst, SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Identify and conduct investigations into suspected FWA with high autonomy, • Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation, • Met metrics to align with caseload, turn around times, and other unit-wide goals, • Continue to monitor providers with substantiated findings to track behavior change, • Participate in the development and presentation of FWA-related education for Oscar teams, • Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies, • Compliance with all applicable laws and regulations, • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies, • Bachelor's degree in Criminal Justice or a related field, • Experience with HIPAA, data privacy, and/or data security processes, • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description Job Description: We are seeking a skilled and board-certified Orthopedic Surgeon to join our team in Brooklyn, NY, for Independent Medical Examinations (IMEs). This role offers flexible scheduling, allowing you to select or decline assignments based on your availability. Key Responsibilities: • Review Medical Records: Thoroughly review and analyze patient medical documents related to orthopedic conditions., • Conduct Physical Exams: Perform in-person evaluations of patients with orthopedic issues., • Address Clinical Questions: Respond to clinical queries from insurance carriers regarding orthopedic matters., • Flexibility: Choose the cases you want to accept or decline based on your schedule., • Compensation: Competitive rates based on your individual fee schedule., • Organized Documentation: All necessary medical documents will be provided in an organized manner., • Board Certification: Must be a board-certified Orthopedic Surgeon., • Experience: Previous experience in performing IMEs is a plus but not required.