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 analyze reported lower-level 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/HI Licensing Preferred

• To process low level general/product 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 with general supervision.
• Processes low level general/product liability claims by gathering information to determine liability exposure.
• Develops and coordinates low level general liability claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.

Claims Representative – Liability, General Liability, Multi State Jurisdiction, Licensing Reciprocal 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

• 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 Hawaii

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Claims Resolution Adjuster

Liability Claims Associate, NY/HI Licensing Preferred

Claims Representative – Liability, General Liability, Multi State Jurisdiction, Licensing Reciprocal Required

Property Claims Examiner II – Wind/Hail

Senior Claims Analyst