Senior Claims Specialist
Everest
full-time
Posted on:
Location Type: Hybrid
Location: Warren • California • Connecticut • United States
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Salary
💰 $120,000 - $150,000 per year
Job Level
About the role
- Ensure compliance with Everest TPA Claim Handling Protocols
- Direct and report on focused claim reviews and file audits
- Maintain active diary system
- Actively manage and resolve claims when appropriate
- Participate in settlement conferences and mediation as needed
- Participate in meetings with policyholders and brokers as needed
- Analyze claims metrics including reserve accuracy, productivity, prompt communication; and expense management
- Develop and execute on action plans to address deficiencies identified within quality reviews
- Conduct regular meetings with TPA adjusters and managers to discuss trends and claim handling strategy
- Develop and maintain relationships with underwriting groups and brokers/agents.
Requirements
- 6-8 years of claims handling experience or related legal experience
- Past supervision experience
- B.A. or B.S. required
- Strong analytical and organizational skills
- Excellent verbal and written communication skills
- Strong negotiation and investigation skills
- Strong computer use skills across multiple claim system platforms
- Ability to think strategically
- Ability to influence others and resolve complex, disputed claims
- In-depth knowledge of the litigation, arbitration, and trial process
- Currently holds or readily can obtain all required adjuster licenses
- Ability to identify and use relevant data and metrics to best manage claims
- Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency
- Ability and willingness to present to senior management and to others in other group settings
- Ability to compose summary reports of quality review findings
- Ability to obtain vendor compliance to Everest claim department standards
- Knowledge of the insurance industry, claims process and legal and regulatory environment
Benefits
- Health insurance coverage
- Employee wellness program
- Life and disability insurance
- 401k match
- Retirement savings plan
- Paid holidays
- Paid time off (PTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims handlinganalytical skillsorganizational skillsnegotiation skillsinvestigation skillsdata analysisfile auditsaction plan developmentclaim metrics analysislitigation knowledge
Soft Skills
verbal communicationwritten communicationstrategic thinkinginfluencecollaborationpresentation skillsproblem-solvingrelationship managementadaptabilityleadership
Certifications
adjuster licenses