We’re committed to putting people first – if you need an accommodation as you go through the job searching, application, and interviewing process, please click here for more information.
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Reinforce best practices in documentation, reserving and communication, contributing to improved QA outcomes and consistent execution across the team. Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews. Performs other duties as assigned. Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required. Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively. Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the state`s tort laws as normally acquired through a bachelor`s degree (or equivalent training) plus 3 to 5 years directly related work experience. 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Utilizes CMS to document claims and to diary future events or follow-up. Within prescribed settlement authority for line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level. Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting. Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. Pro-actively manages the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority. Participates in the claims audit process. Provides claims marketing services by meeting with brokers, risk managers and reinsurers, as necessary. Bachelors' and/or advanced degree. 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Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conduct 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. BS/BA degree or equivalent work experience. Minimum of 2 years' experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain all applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). 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Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (injured workers, customers, witnesses, etc.) to gather information regarding injuries or loss refers tasks to auxiliary units as necessary and posts file accordingly. Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources. Manages an inventory of worker's compensation claims, evaluates compensability/liability and losses, and negotiates settlements within prescribed limits. Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols. Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action. Responsible for review, analysis, and disposition of assigned claims within authority limits and state compliance. Updates file, strategizes and executes plans to mitigate exposure and increase disposal. Effective interpersonal, analytical and negotiation abilities required. Ability to provide information in a clear, concise manner with an appropriate level of detail. Demonstrated ability to build and maintain effective relationships. Demonstrated success in a professional environment; success in a customer service/retail environment preferred. Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent. Knowledge of legal liability, insurance coverage and medical terminology are helpful, but not mandatory. 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Creative Problem Solving: Apply critical thinking and innovative approaches to resolve a wide variety of claims challenges and customer concerns. Accuracy & Compliance: Maintain high standards for documentation accuracy, confidentiality, and compliance. Meet or exceed service level goals for call handling and transaction quality. Logistical Coordination: Arrange support services such as rental cars and towing with care and efficiency, ensuring customers receive timely assistance. Minimum of 1-2 years of experience in a customer-facing or consultative role, preferably within insurance, financial services, healthcare, hospitality, or retail. Demonstrated success in roles requiring high attention to detail, problem-solving, and decision-making under time-sensitive conditions. Experience using claims systems, CRM platforms, or workflow tools to manage documentation and customer interactions a plus. Proven ability to deliver accurate, empathetic, and efficient service in a fast-paced environment. High school diploma or equivalent required. Bachelor's degree in Business, Communications, Insurance, or a related field preferred. 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This may include accessing roofs by ladder, inspecting attics, crawl spaces and basements in search of damage. Handle moderate to complex claims independently while managing your workload, from first notice of loss to final closure. Be expected to work in a vehicle in the field daily while occasionally handling assignments from the desk. Explain coverage of loss, assist policyholders with itemization of damages, emergency repairs and additional living arrangements. Work with and coordinate a few vendor services such as contractors, emergency repair, cleaning services and various replacement services. May be called upon for catastrophe duty. Working knowledge of claims handling procedures and operations. Proven ability to provide exceptional customer service. Effective negotiation skills. Ability to effectively and independently manage workload while exhibiting good judgment. Strong written/oral communication and interpersonal skills. 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