Hybrid Pharmacy Claims Adjudication Specialist

Senior Insurance Claims Adjuster

Our client's Senior Insurance Claims Adjuster will be responsible for handling complex insurance claims from inception to settlement, ensuring fair and timely resolution for policyholders. This role maintains the company's reputation for integrity and exceptional customer service, working in a hybrid model that blends collaborative office time with the flexibility of remote work.

Our client is seeking an experienced and detail-oriented Senior Insurance Claims Adjuster to join their dynamic team in Boston, Massachusetts. This pivotal role involves managing complex insurance claims from inception to settlement, ensuring fair and timely resolution for policyholders. You will play a crucial part in upholding the company's reputation for integrity and exceptional customer service, working within a hybrid model that blends collaborative office time with the flexibility of remote work.

• Investigate, evaluate, and negotiate complex insurance claims, including property, casualty, and liability cases.
• Gather and analyze evidence, including police reports, medical records, and witness statements, to determine coverage and liability.
• Communicate effectively with policyholders, claimants, attorneys, and other involved parties to explain coverage, settlement options, and claim status.
• Prepare detailed claim reports, settlement offers, and necessary legal documentation.
• Manage a caseload of claims, ensuring compliance with all company policies, regulatory requirements, and industry best practices.
• Mentor junior adjusters and provide guidance on complex claim investigations and resolution strategies.

• Minimum of 5 years of experience as an Insurance Claims Adjuster, with a focus on complex claims.
• Proficiency in claims management software and Microsoft Office Suite.
• Strong understanding of insurance policies, legal principles, and relevant state regulations for Massachusetts.
• Excellent negotiation, analytical, and problem-solving skills.
• Ability to work independently and manage time effectively in a hybrid work environment.
• Relevant state adjuster licenses required.

• Competitive annual salary with performance-based bonuses.
• Comprehensive health, dental, and vision insurance plans.
• Generous paid time off, including vacation, sick leave, and holidays.
• Retirement savings plan with company match.
• Professional development opportunities and support for continuing education and licensure.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity, and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.

For reasonable accommodations during the application or recruiting process, please contact us for assistance. Whether you need a modification in the interview process or a specific interview request, let us know. We aim to provide a fair and respectful experience for all applicants.