Description
The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim’s management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
Responsibilities:
Manages an inventory of claims to evaluate compensability/liability.
Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
Performs other duties as assigned.
Qualifications
Proven interpersonal, analytical and negotiation abilities required.
Ability to provide information in a clear, concise manner, ability to build effective relationships.
Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred.
Licensing may be required in some states.
Employees may apply for a new role after completing 12 months of employment in their current position.