Claims Specialist

• To analyze Auto Bodily Injury Litigation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• 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.

Auto & Bodily Injury Litigation Claims Examiner – Commercial Auto

• Review and assess workers' compensation claim files to identify viable subrogation potential
• Conduct detailed investigations to determine third-party liability through accident reports, witness statements, medical records, and other evidence
• Maintain an active pending of approximately 200+ claim files, ensuring timely and accurate file documentation, diary maintenance, email and correspondence review, and task execution
• Collaborate with clients to provide updates, recommendations, and recovery strategies in accordance with specific authority levels and settlement guidelines
• Negotiate settlements with third parties, attorneys, and carriers, while protecting client interests and ensuring compliance with applicable laws and regulations
• Work both independently and as part of a collaborative team to achieve recovery targets and meet organizational goals
• Maintain proficiency with internal systems and tracking tools to manage case progress and reporting
• Stay current on state-specific workers’ compensation and subrogation statutes, especially within Florida and any other assigned jurisdictions
• Provide guidance and support to junior team members or contribute to cross-functional projects as needed
• Support company values of *We are Dynamic, We are Innovative, We are Connected, and We Succeed Together*
• Perform other duties as assigned

Subrogation Claims Specialist

• Adjust bodily injury, personal injury, and wrongdoing claims in a timely and professional manner
• Perform all duties outlined in the Property Damage Adjuster role
• Review new claim assignments within 24 hours and develop a clear plan of action
• Establish contact with insureds and claimants within 24 hours of assignment
• Conduct thorough investigations including:
• Gathering evidence and documentation
• Obtaining recorded statements from claimants, insureds, and witnesses
• Reviewing internal client investigation reports when applicable
• Evaluate damages and determine need for appraisers or field adjusters
• Review estimates and supporting documentation for accuracy and appropriateness
• Set reserves and maintain accurate claim evaluations
• Manage claim workflow and system reminders; ensure progress within 72 hours of assigned tasks
• Coordinate with defense counsel and monitor litigation activity when applicable
• Handle claim denials in accordance with client and regulatory guidelines
• Request payment authorization in alignment with client and Davies procedures
• Maintain consistent, professional communication with clients, claimants, and partners
• Ensure accurate and timely documentation of all claim activity in the claim system
• Manage Medicare reporting and compliance where applicable
• Run ISO ClaimSearch and evaluate potential fraud indicators
• Identify and report claims to excess carriers when thresholds are met
• Respond to reservation of rights and excess carrier communications as needed
• Maintain compliance with state regulations (including PIP/No-Fault laws where applicable)
• Monitor claim progress and maintain a target 95% claim closure ratio
• Participate in continuing education to maintain adjuster licensure
• Support team members and assist leadership with additional duties as assigned

Bodily Injury Claims Adjuster

• 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.

Liability Claims Adjuster – General Liability, Bodily Injury, Property Damage

• 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

• Investigate medical necessity and determine casualty
• Consult with involved parties
• Secure medical information and review insurance contracts, associated reports and billing documentation
• Evaluate the validity of personal injury insurance claims
• Monitor case files over the course of treatment
• Provide outstanding customer service during the insurance claims process
• Deliver meaningful impact by assisting customers with auto insurance claims

Personal Injury Claims Examiner

• Investigates, evaluates and brings to timely resolution an inventory of complex construction defect claims
• Understands construction defect coverage issues and interprets construction contracts
• Manages litigation proactively and works with defense counsel and insureds
• Prepares reports detailing claim status, payments and reserves
• Engages in timely communication with relevant parties

Temporary Construction Defect Claims Specialist

• Responsible for working with repair facilities to validate, adjudicate, and approve payment for diagnostics and repair recommendations for pre-sale repairs as well as customer vehicles under warranty.
• Properly adjudicates claims within approval limit and in accordance with department & industry standards.
• Accurately notates all actions taken and interactions with shops and customers within internal systems ensuring proper documentation of interactions.
• Effectively navigates department resources in order ensure adherence to department process flows and policies.
• Manages list of assigned pending claims and provides timely follow up with repair facilities to decision claims.
• Other duties as assigned.

Mechanical 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

Senior Claims Analyst – Healthcare, Lawyers Professional Liability

• Provide customer service to our policyholders and those who may become our policyholders that exceed their expectations and deliver on the GEICO promise, communicating and guiding them through the claims process
• Assure coverage for each loss and all policy provisions before processing payments
• Investigate all aspects of the claim to determine liability percentage and legal responsibility
• Identify and evaluate claims indicators of fraud and escalate as appropriate
• Utilize all claims tools provided to properly evaluate liability and extent of damages
• Evaluate damages in accordance with investigative findings and establish value to pay only what is owed
• Negotiate claims settlements for evaluated damages with insureds, claimants and/or attorneys as assigned from letter of representation through settlement or verdict
• Authorize negotiated payment for established damages within your designated authority
• Submit requests for authority on evaluations that exceed your personal, assigned authority
• Ensure all compliance requirements are met in a timely and professional manner and in accordance with guidelines
• Adjust reserves adequately on all new and existing claims
• Participate as an active member of claims forums as required
• Communicate findings to claims management team as required or as may be needed depending on high exposure or unusual loss findings
• Perform other duties as may be assigned

• Handle commercial auto claims with a predominant focus on resolving the material damage components of the claim
• Collaborate proactively with agents, policyholders, and internal stakeholders on claims and book of business as needed
• Investigate losses, identify coverage, evaluate liability and damages
• Develop plan of action to proactively conclude claims, engage other parties in negotiations and settle claims pursuant to guidelines
• Establish and maintain proper reserves for each claim to accurately reflect the financial exposure
• Review and interpret commercial insurance policies and communicate coverage issues verbally and in writing

Senior Auto Physical Damage Claims Representative

• keying, processing health claims in accordance with claims policies and procedures
• able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology
• adjust claims
• reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement
• researches and analyzes claims issues
• responds to inquiries, may involve customer/client contact

Claims Representative II – Health & Dental

• Streamlined Processing: Ensure claims accuracy and timely submission, minimizing disruptions for patients and practices.
• Issue Resolution: Address rejected or denied claims promptly, resolving challenges with finesse and professionalism.
• Account Integrity: Conduct thorough audits and manage escalation cases, safeguarding the integrity of every account.
• Financial Recovery: Track and recover missing payments efficiently, optimizing revenue streams for our practices.
• Technological Mastery: Utilize cutting-edge platforms like sFax, Adobe, PureCloud, and JIRA with proficiency, enhancing workflow efficiency and collaboration.
• Professional Growth: Take ownership of your development journey, embracing opportunities for advancement and skill enhancement.
• Cross-Functional Collaboration: Foster strong relationships across OrthoFi departments, understanding their functions and enhancing synergy for maximum impact.

Claims Coordinator

• Make initial contacts with interest parties
• Handle moderate to high exposure construction defect claims involving residential and commercial projects.
• Analyze coverage and draft coverage position letters as needed
• Conduct liability investigations
• Comply with DOI regulations
• Retain and coordinate with defense counsel and experts to develop and execute agreed-upon litigation strategies, while managing plans and budgets to ensure effective case resolution
• Coordinate the retention of experts, subject to an agreed upon budget
• Establish timely indemnity and expense reserves based on an exposure analysis that is documented in the claim file, revisiting reserve adequacy on a continual basis
• Draft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners
• Travel up to 10% to attend mediations, settlements conferences and trials on appropriate cases
• Keep current on key changes in case law and industry trends
• Assist underwriting and other business partners

Senior Casualty Claims Examiner

• To analyze mid-level commercial auto physical damage and total loss claims to determine scope of damages.
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Receive and review new claims and maintain data integrity in the claims system.
• Conduct claim file activities including evaluations, investigations, litigation management and resolution.
• Review investigative reports, insurance policies and other pertinent records for proper coverage.
• Investigate the cause and extent of the damages, obtain appropriate documentation and issue settlement.
• Determine coverage of claims with proper limits and deductibles in accordance with policy information.
• Prepare settlement documents and requests payment for the claim and expenses.
• Work with external vendors and professionals.
• Interview and correspond with claimant and witnesses regarding claims.
• Estimate cost of repair, replacement or compensation.
• Prepare report findings and negotiate settlements with claimants.
• Recommend litigation by legal department when settlement cannot be negotiated.
• Revise case reserves in assigned claims files to cover probable costs.
• Assist in preparing loss experience report to help determine profitability and calculate adequate future rates.

Claims Adjuster - Liability, PD / TL

• Analyze mid- and higher-level workers compensation claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Identify subrogation of claims and negotiate settlements
• Manage workers compensation claims determining compensability and benefits due on long term indemnity claims
• Monitor reserve accuracy and file necessary documentation with state agency
• Develop and manage workers compensation claims' action plans to resolution
• Approve and process assigned claims and determine benefits due
• Manage subrogation of claims and negotiate settlements
• Communicate claim action with claimant and client
• Ensure claim files are properly documented and claims coding is correct
• Maintain professional client relationships

Claims Adjuster – WC

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Claims Examiner – Workers Compensation, Southeast Exp Preferred, Licensing: NC

• To analyze mid- and higher-level general liability 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.
• Manages mid-level general liability claims by gathering information to determine liability exposure.
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.

Claims Adjuster - Liability, GL and Litigation

• To analyze moderately complex Auto Bodily Injury and Property Damage claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• 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 Adjuster – Bodily Injury

• Investigating and confirming the facts of loss for basic automobile accidents
• Applies analytical thinking to determine coverage, liability, damages
• Adjusts and negotiates claims within limit of authority,
• Handles investigation regarding most aspects of auto claims

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