Claims Specialist

• Handle Property and Casualty Claims, including structural damage and casualty claims such as auto and workers’ compensation.
• Manage and supervise Third-Party Administrator (TPA) adjusters, outside vendors, field adjusters, and consultants, including CPAs.
• Assess and determine policy coverage for reported claims.
• Evaluate damages to determine appropriate compensation amounts.
• Consult with accountants, architects, engineers, and other experts for specialized evaluations.
• Respond promptly and professionally to claims calls and emails from agents and claimants.
• Negotiate fair claim settlements while maintaining compliance with policies and regulations.

Claims Examiner

• To analyze reported lower-level level general liability claims to determine benefits due.
• Ensure ongoing adjudication of claims within company standards and industry best practices.
• Handles lower-level liability and/or physical damage claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes general liability claims determining compensability and benefits due.
• Monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.

Liability Claims Associate

• To analyze reported lower-level general liability claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.
• Handles lower-level liability and/or physical damage claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes general liability claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships

Liability Claims Associate, NY or HI Licensing Required

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Claims Specialist II

• Investigating basic and occasionally moderately complex auto insurance claims.
• Evaluating coverage, determining liability, and negotiating settlements.
• Working directly with claimants, insureds, and other involved parties to ensure timely, accurate, and customer-focused claim resolution.
• Ensuring compliance with all regulatory requirements and company standards throughout the claim lifecycle.
• Preparing clear, concise claim summaries.
• Conducting recorded statements with claimants, insureds, and witnesses.
• Maintaining detailed and well-documented claim files, including notes, summaries, and decision rationale.
• Collaborating with internal teams to support efficient and customer-centric claim handling.

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Liability Claims Associate, NY or HI Licensing Required

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