Claims Specialist

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements.
• Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment.
• Evaluate and report on potential subrogation opportunities.
• Reports incidents involving theft, fraud, or arson to appropriate state and industry agencies.
• Perform duties independently, with work directly impacting management outcomes.
• Acts as a company representative in public interactions, maintaining a professional demeanor consistent with management standards.
• Engages regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties.
• Use strong customer service skills to negotiate with policyholders to settle the claim.
• Performs additional duties as assigned.
• Promotes safety at all times and complies with safety/ergonomic standards as outlined in relevant company published manuals.

Field Property Claims Adjuster

• Investigating and confirming facts of loss for automobile accidents
• Determining coverage, liability, damages, and adjusting claims
• Working Monday through Friday, 8 am to 5 pm Pacific Time

Claims Adjuster, Trainee

• Manage claim intake, review, and communication across both digital and paper channels.
• Verify eligibility, analyze coverage details, and adjudicate supplemental insurance claims.
• Complete the full payment process, including distribution, authorization, and lost‑check resolution.
• Apply claim management strategies to ensure accurate payments and appropriate financial outcomes.
• Participate in continuous improvement efforts by identifying issues, sharing customer insights, and supporting workflow enhancements.

Claims Examiner

• Review, validate, and process NEMT claims in accordance with Medicaid policies, GOBHI program guidelines, and contractual requirements.
• Perform accurate billing and coding for NEMT claims using appropriate HCPCS/CPT codes.
• Verify member eligibility, trip authorization, and service documentation prior to submission.
• Ensure claims are submitted within required timelines and track adjudication through final payment.
• Identify and resolve claim errors, discrepancies, and denials in coordination with providers and program staff.
• Maintain current knowledge of Medicaid billing codes, guidelines, and NEMT-specific requirements.
• Conduct regular audits of NEMT claims to detect and prevent errors, overpayments, or potential fraud.
• Support corrective action plans and recommend process improvements to strengthen billing integrity.
• Accurately code trips and services in compliance with Medicaid and NEMT guidelines.
• Prepare, review and submit billing batches to Medicaid and other payers.
• Reconcile claims against payments, identifying variances or unpaid balances.
• Collaborate with GOBHI finance staff to support accurate accounting and reporting.
• Generate and maintain reports on claims activity, denial rates, and reimbursement trends.
• Provide data analysis to identify cost drivers, claim patterns, and areas for improvement.
• Serve as a resource for NEMT providers regarding Medicaid billing procedures, documentation, and claim resolution.
• Upon supervisor’s approval and direction, update and maintain provider rate contracts.
• Provide training and technical assistance to providers on coding, billing, and submission processes.
• Other duties as assigned.

Medicaid Claims Analyst

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property losses and damages.
• Effectively communicate and negotiate with policyholders, agents, public adjusters, attorneys, and service providers via phone, email, and internal systems to accurately document claim details.
• Successfully manage a pending claim load at varying stages of the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Interpret and apply computer generated loss estimates, engineer’s reports, and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.
• Mentor our mid and associate level claims representatives.

Complex Claims Representative

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim;
• negotiates settlement of claims within designated authority;
• calculates and assigns timely and appropriate reserves to claims;
• manages reserve adequacy throughout the life of the claim;
• calculates and pays benefits due; approves and makes timely claim payments and adjustments;
• manages the litigation process; ensures timely and cost effective claims resolution;
• communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

Claims Examiner – Workers Compensation, Licensing Required

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

Claims Specialist – Large Loss

• Interact with policyholders, agents, claimants, witnesses, attorneys, contractors, public adjusters and other vendors/partners to facilitate accurate, prompt claims resolution.
• Effectively manage fluctuating workload, with low to moderate supervision, while maintaining focus on claims quality and customer experience.
• Conduct physical inspections at the scene of loss to determine scope of damage and control estimates provided by vendors.
• Collaborate with other internal departments in recognizing and referring claims involving SIU, subrogation, auto physical damage, and total loss.
• Build rapport with policyholders, customers, agents, carriers, attorneys and vendors to facilitate prompt and accurate claim resolution.
• Apply case and statutory law in the proactive adjustment of moderate to complex property claims located in Washington and Oregon.
• Accurately interpret coverage using experienced level contract, regulatory and compliance knowledge, following company file handling procedures.
• Issue timely claims payments with a moderate level of claims payment authority; present files outside of authority level for review and approval.
• Direct and coordinate vendors and experts in order to achieve restoration project timeline goals while keeping insured apprised, ensuring remarkable customer experience.
• Occasional CAT duty as needed.
• Demonstrate behaviors consistent with PEMCO's policies, values, code of ethics, and business conduct.
• Authentically support the PEMCO Brand and are constantly on the lookout for top talent to join us to achieve our Mission to Worry Less and Live More.
• Other duties as assigned.

Senior Property Claims Adjuster

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