About This Role
This role is responsible for resolving claims of average complexity and low to mid exposure. The primary purpose of this job is to investigate, evaluate, negotiate, and settle assigned claims by collecting and analyzing data according to policy application and contract provisions. The position involves decision-making within authority and works under the general direction of a manager.
Responsibilities
- Confirm coverage of claims by reviewing policies and documents submitted in support of claims
- Analyze coverage and communicate coverage positions
- Conduct, coordinate, and direct investigation into loss facts and extent of damages
- Direct and monitor assignments to experts and outside counsel
- Evaluate information on coverage, compensability, and medical management to determine the extent of insured's exposure
- Set reserves within authority or make claim recommendations concerning reserve changes to manager
- Focus on driving claims to a resolution with a focus on returning the injured back to work
- Evaluate, negotiate, and settle claim when appropriate
- Prepare reports by collecting and summarizing information
- Adhere to Fair Claims Practices regulations and internal Claims Quality Performance Objectives
- Participate in special projects or assist other team members as requested
- Attend all state-specific trainings as scheduled
- Travel to mediations, trials, and conferences as required
Requirements
- Bachelor's degree in a business-related field preferred; equivalent insurance industry experience may be substituted
- 2+ years of claims handling or relevant work experience
- California Claims Examiner Certification
- Excellent written and verbal communication skills
- Strong analytical, problem-solving, organizational, and time management skills
- Ability to deliver outstanding customer service and work effectively in a team environment
- Strong understanding of medical terminology preferred
- Intermediate proficiency in Microsoft Office applications, including Excel, Outlook, and Word
- Demonstrated commitment to continuous improvement and professional development
- Ability to analyze complex coverage, liability, compensability, and medical management issues and make sound claim decisions
- Strong negotiation and decision-making skills
- US Work Authorization required
Benefits
- Competitive benefit programs that help meet diverse and changing environments as well as support employees
- Option to select from multiple health, dental, and vision insurance plan options
