Claims Specialist

• Investigate automobile accidents involving bodily injury
• Assess coverage, liability, and damages
• Provide exceptional customer service through calls, emails, and texts
• Engage in negotiation processes to reach fair settlements
• Support claimants throughout the vehicle restoration process

Claims Resolution Adjuster

• To process low level workers compensation claims to determine benefits due;
• To ensure ongoing adjudication of claims within company standards and industry best practices;
• To identify subrogation of claims and negotiate settlements with general supervision.
• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims.
• Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

Claims Representative – Workers Compensation

• 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

• Support the Clinical Research billing and account review needs of the Providence Health System
• Review charges, processing and tracking of ongoing research-related clinical billing
• Regularly review research-related billing process for accuracy and compliance

• Resolve client, employee/member, or provider issues regarding escalated or complex claims.
• Review and release over-authority claims up to limit specified by corporate policy.
• Handle claim referrals, including pre-determinations, using internal and external resources as needed.
• Advise Claim Analysts and/or vendor regarding claim processing.
• Handle network referrals as well as PPO repricing disputes.
• Review, analyze and interpret claim forms and related documents.
• Determine benefit coverage based on clinical edits, plan documents/booklets, benefit reference documents, Claim Reference Manuals and claims-related memoranda, and reports.
• Appropriately investigate, pend and refer claims based on claim procedures and guidelines.
• Accurately handle correspondence, claims, and referrals in the established timeframes and/or performance guarantees.
• Support the Claims reinsurance team, in the research and resolution of claims as assigned.
• Handle complex or technical claim adjudication using internal and external resources as needed, e.g. transplants, experimental & investigational, chemotherapy, etc.
• Research and respond to vendor reconciliation requests.
• Mentor and assist with onboarding new Analysts, including the oversight of work.
• Support the management, monitoring, and tracking of performance in collaboration with the Supervisor.
• Provide mentoring and coaching.
• Assist Supervisor in documenting processes for analysts.
• Other duties as needed/assigned

Claims Specialist jobs in Alaska

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Claims Resolution Adjuster

Claims Representative – Workers Compensation

Property Claims Examiner II – Wind/Hail

Claims Specialist

Senior Claims Analyst