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

• Demonstrate the ability to independently and timely manage all aspects of the most complex, high-value claims while exhibiting a detailed knowledge of the claim, a well-reasoned analytical focus and a clear strategy for resolution
• Provide proactive communications to customers and business partners in the management and resolution of claims
• Respond to inquiries from customers and provide superior customer service
• Review and analyze multiple complex policies and coverage parts (including general liability and umbrella/excess liability)
• Write and articulate clear, concise and accurate coverage positions
• Conduct investigations regarding claims and/or lawsuits
• Effectively manage litigation and counsel, inclusive of litigation planning/budgeting, and proactively position claims for resolution
• Develop and persuasively articulate complex coverage, liability and damage assessments
• Provide detailed impactful recommendations to leadership
• Pursue and finalize coverage and liability risk transfer against other liable parties and insurance carriers
• Conduct complex negotiations and articulate coverage/liability positions
• Attend mediations and trials as necessary
• Proactively manage accurate expense, reserve and financial transactions
• Consistently maintain up-to-date claims metrics

Claims Specialist – Latent Bodily Injury

• Independently and timely manage all aspects of the most complex, high-value claims
• Provide proactive communications to customers and business partners in the management and resolution of claims
• Review and analyze multiple complex policies and coverage parts (including general liability, contractors professional liability and wrap-up policies)
• Write and articulate clear, concise and accurate coverage positions
• Conduct investigations regarding claims and/or lawsuits
• Effectively manage litigation and counsel, inclusive of litigation planning and budgeting
• Develop complex coverage, liability and damage assessments and persuasively articulate them to leadership
• Pursue and finalize coverage and liability risk transfer against other liable parties and insurance carriers
• Attend mediations and trials as necessary
• Proactively manage accurate expense, reserve and financial transactions
• Consistently maintain up to date claims metrics

Construction Defect Claims Specialist

• Actively managing commercial general liability claims for medium severity, and general liability, as well as the associated excess and umbrella policies
• Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel
• Develop and implement strategy relative to coverage issues
• Maintain contact with associated claims carrier(s)’ claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes
• Investigate claims and review the insureds' materials, pleadings, and other relevant documents
• Review litigation materials including depositions and expert's reports
• Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues
• Retain counsel when necessary and direct counsel in accordance with resolution strategy
• Analyze coverage, liability and damages for purposes of assessing and recommending reserves
• Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves
• Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter
• Negotiate resolution of claims
• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries.

Claims Examiner, Casualty

• Investigate and manage all aspects of a medical only claim, maintaining phone/written contact with all necessary parties
• Verify coverage, investigate, manage, and resolve medical only claims promptly and accurately
• Authority to approve or deny payment of medical invoices, and determine case reserves, with up to $10,000 in reserve approval authority
• Required to handle medical only claims in Maryland, New Jersey, and Pennsylvania with the largest volume of claims being Pennsylvania

Senior Medical Claims Representative – Workers Compensation

• Manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage
• Handles litigated files and works with delegated authority
• Receives claims, confirms policy coverage and acknowledgment of the claim
• Determines validity and compensability of the claim
• Investigates claims and handles Auto and/or General Liability claims
• Establishes reserves and authorizes payments within reserving authority limits
• Communicates claim status with the customer, claimant, and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Collaborates with team members on more complex or problematic claims as necessary
• Additional duties as assigned

Senior Liability Claims Specialist

• Investigate, evaluate and settle more complex first and third-party commercial insurance property claims.
• Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
• Communicates with all relevant parties and documents communication as well as results of investigation.
• Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
• Travel is required to attend customer service calls, mediations, and other legal proceedings.

Claims Specialist – Professional Liability

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, including CEOs, claimants, providers' offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster – Northeast Jurisdictions

• Independently analyze liability claim submissions for potential coverage
• Set adequate case reserves
• Promptly and professionally respond to inquiries from clients and their brokers
• Proactively drive early resolution of claims arising from General Liability products
• Manage a full pending of General Liability Claims
• Provide thought leadership in multiple forums within and outside the company
• Engage in business development, product innovation, and market/customer insight
• Develop strong working relationships with underwriting leadership

Complex Claims Specialist

• The Senior Claims Examiner-Miscellaneous Professional Liability adjudicates assigned claims within given authority and according to Hiscox Claims Best Practices.
• Adjusts and resolves low to moderate professional liability claims that include litigated matters
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Heavy customer facing role. Must have confident communication skills.
• Communicates effectively to resolve matters directly with claimants, and or claimant attorneys
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Reviews and analyzes claims in order to determine appropriate and timely reserving per Hiscox Claims Best Practices
• Identifies emerging exposures and claims trends
• Manages defense counsel as necessary in defending litigated matters
• Identifies suspected fraudulent claims and tracks with Special Investigations Unit
• Participates in Claims Projects, as needed

Senior Claims Examiner – MPL

• To perform all core aspects of in-house claims management, including but not limited to: Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses
• Strategizing and maximizing early settlement opportunities
• Monitoring litigation and managing local defense counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Smartly managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
• Liaising directly on daily basis with insureds and brokers
• Maintaining timely and accurate file documentation/information in our claims management system

Complex Claims Specialist – A&E

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Claims Examiner I, Workers Compensation, NE Jurisdiction Experience Required

• 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

• Manage lost time and medical only Workers' Compensation claims.
• Evaluates and establishes an action plan to manage medical and indemnity benefits associated with injury and occupational disease claims.
• Decides the outcome of the claim using sound judgment by applying established policy, procedures, regulations and guidelines.
• Gathers facts by conducting interviews with all involved parties and considers all the elements of the claim prior to issuing a decision.
• Determines eligibility of indemnity and medical benefits once salary information and medical treatment plans have been secured and processed.
• Utilize proactive reserving behaviors to ensure adequate case reserves.
• Consults with assigned claim director, return to work specialists, nurse case managers, and internal/external medical professionals.
• Works collaboratively with the injured worker, employer, outside counsel, and health and rehabilitation professionals to manage the claims costs.

Lost Time Claims Adjuster – Workers' Compensation

• Adjusts and resolves complex mid to severity claims that include all phases of litigation
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and provides analysis of claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors team members
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
• Identifies emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities

Complex Claims Specialist – MPL

• The Claims Examiner adjudicates assigned claims within given authority and provides operational support to the claims team.
• Adjusts and resolves moderate claims that includes all phases 1st Party commercial claims for our Property Team
• Accurately reviews and assesses coverage for all losses
• Completes full in depth investigations to confirm how coverage is relevant and applies it to the loss
• Manages smaller business income losses and the period of restoration
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Accurately assesses reserves for indemnity and expense payments
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Drives 1st Party Best Practices to manage expense and exposure on losses
• Has a high level of customer service
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Participates in Claims projects as needed

Claims Examiner – Property

Workers Compensation Claims Examiner – CT, MA, NH, RI, VT Jurisdictional Knowledge

• Analyzing liability claim submissions for potential coverage
• Setting adequate case reserves
• Promptly and professionally responding to inquiries from customers and their brokers
• Proactively driving early resolution of claims arising from the Cyber, Tech PL, Media and/or Crime professional liability lines of business
• Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses for tech E&O, first and third party cyber claims
• Strategizing and maximizing early resolution opportunities
• Monitoring litigation and managing local defense and breach counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves

Complex Claims Specialist – Cyber Tech E&O, Media & Crime

• This position will be accountable for successfully investigating, reserving, assigning and settling first party property losses while delivering superior customer service.
• The ideal candidate will operate in the full file model and handle all claims by selecting the proper estimating resource to adjudicate the claim.
• Ensure quality standards are met with vendors utilized to adjudicate the claim.
• Claim File Management: Handle claim files in a manner consistent with Claim quality standards and goals.
• Negotiate skillfully in challenging situations with internal and external groups.
• Make independent business decisions to move claims forward as needed.
• Consistently provide high-quality customer service Meet or exceed expectations and requirements of internal and external customers.
• Properly assess the exposure of assigned claims.
• Utilize organization and communication skills to effectively resolve assignments, manage claim deadlines, and appropriately manage vendors.
• Develop technical and jurisdictional expertise, including knowledge of independent adjusters, contractors, vendors, etc.
• Set appropriate and timely file reserves.
• Identify and properly manage subrogation, salvage and other recovery opportunities.
• Identify fraud indicators and initiate investigation.
• Always demonstrate professionalism and establish credibility when interacting with customers; personally enhance The Hartford’s reputation in the marketplace.

Property Claims Adjuster

• Manages complex primary and excess financial lines claims under claims‑made policies
• Applies strong technical expertise and sound judgment to evaluate, manage, and resolve claims in accordance with company standards and regulatory requirements
• Plan, recommend, reserve, and execute file strategies including investigation, valuation, disposition, and settlement of assigned claims
• Draft and issue timely reservation of rights letters on all files and independently draft denials for management review
• Properly assesses the exposure of assigned claims
• Establish priorities and communicate the status of assignments
• Maintain current knowledge of claim loss cost management initiatives
• Obtain first-hand customer information and use it for improvements in products and services

Claims Specialist jobs in Connecticut

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