Claims Specialist

• The position of Care Advocate will play a leading role in developing an innovative digital product strategy based off your deep expertise and knowledge of the long-term care needs of the aging in your market.
• You will be part of a team delivering concierge services care-seekers and care-managers including but not limited to Caregiver support and Education.
• Conducting consultations with older adults and caregivers on aging services and supports providing support and guidance on the caregiving journey.
• Unlike other traditional Care Advocacy roles, your responsibilities will not stop there but will extend to working with digital product teams to help infuse your patient-centered knowledge into the design process and provide feedback that will help create incredible digital user experiences for millions of care-seekers and care-managers at a tremendous scale.
• This role will provide Subject Matter expertise on the local and state level programming and resources for aging adults and their caregivers.
• This role will provide education and resources to aging individuals seeking assistance with care options and navigating challenges.
• Intensive case management experience and crisis intervention.
• Approach problem-solving with a human-centered lens.
• Regular document key and frequent needs of users and report qualitative data (such as quotes and anecdotal stories that representative of user needs) and quantitative data (such as frequency of user needs and trends in gaps in local care environments and resources) to the digital product and design teams.
• Bring deep understanding of landscape and individual aging and long-term resources, facilities, organizations, agencies, and referral sources to help marketing team reach key partnerships and potential consumers who would benefit from our digital products.
• Report back to product and design teams opportunities for improvement of the digital products based off of user feedback.
• Review new product features before they are released to consumers to identify improvements or potential issues to proactively improve user experience.

Associate Claims Clinical, Care Advocacy

• Investigate and resolve Homeowners claims of moderate complexity in a prompt and efficient manner.
• Document with photographs, measurements, recorded interviews as needed, write a repair estimate to capture damages, and complete thorough file notes.
• Ability to use imagery and advanced video technology to collaborate with onsite vendors and insureds to identify damage and write damage estimates from a virtual setting.
• Compare facts gathered during the investigation against the policy to determine coverage of claim; extend or deny coverage as appropriate.
• Establishes reserve amounts within prescribed settlement authority limit and negotiates settlement of claims; recommends claims which exceed personal authority limit to supervisor for approval.
• Responsible for effectively and timely communicating with insureds and /or their representatives to resolve issues and ensure customer satisfaction.

Property Claims Examiner II – Wind/Hail

• Determine, evaluate, investigate, negotiate and resolve quota share and single insurer property claims
• Verify coverage under the applicable Commercial Property insurance policy
• Coordinate with field adjusters and experts for inspections or further investigation
• Review supporting documentation submitted for the claims and properly note the details of the review within the file
• Analyze damage estimates and repair costs as well as review vendor invoices for accuracy
• Identify potential issues such as fraud, duplicate claims, or policy exclusions
• Communicate with policyholders, adjusters, contractors, and other stakeholders regularly to ensure constant claim progression and keep all involved parties updated
• Prepare written status and large loss reports for clients, including Reservation of Rights and Coverage Position Letters
• Handle appeals or disputes related to claim decisions
• Attend mediations and settlement conferences as necessary
• Direct and monitor defense counsel to settle litigated claims
• Provide monetary authority and strategy to counsel to ensure client’s money and claims are protected
• Present and explain claim overviews to business partners on a monthly basis
• Participate in audits and quality control reviews
• Stay updated on industry trends, policy changes, and best practices

Commercial Property Claims Adjuster

• Investigate first party physical damage and third party liability claims to determine coverage, liability, and damages
• Review accident reports, witness statements, repair estimates, and related claim materials
• Conduct interviews with claimants, insureds, witnesses, and other involved parties
• Analyze policy provisions and coverage details to determine claim applicability
• Complete damages investigations including repair estimates, loss of use, diminished value, etc
• Issue payments in accordance with coverage, liability, and damages investigation, company policies, and client service standards
• Identify subrogation, or other risk transfer opportunities, and refer the file to the subrogation unit
• Manage assigned claims from initial report through resolution
• Establish and maintain appropriate claim reserves based on claim exposure
• Establish and maintain appropriate plan of action and file diary
• Evaluate damages including bodily injury, liability exposure, and property damage
• Negotiate settlements with claimants, attorneys, and other involved parties
• Process form letters
• Maintain regular communication with clients, insureds, claimants, and other involved parties
• Provide updates regarding claim status, strategy, and resolution progress
• Deliver high-quality customer service
• Maintain accurate and detailed claim documentation within the claims management system
• Ensure claim handling complies with company guidelines, regulatory requirements, and client service standards
• Identify potential fraud indicators and escalate concerns when appropriate

Claims Specialist jobs in Alabama

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Associate Claims Clinical, Care Advocacy

Property Claims Examiner II – Wind/Hail

Commercial Property Claims Adjuster

Liability Associate, Claims Adjuster