Claims Specialist

• Reviewing and processing claims
• Identifying irregularities and reviewing for accuracy
• Complying with policy provisions and appropriate state and federal laws
• Managing high volume of semi-routine claims and phone calls
• Explaining basic contract definitions to insureds verbally and in writing
• Processing claim operational activities including tax reporting, journal vouchers, and overpayments

Senior Claims Analyst

• Responsible for the resolution of moderate to high complexity ocean marine bodily injury and property damage claims
• Handle claims from coverage enquiry through legal liability assessment and quantum analysis
• Communicating developments and outcomes to all internal and external stakeholders
• Training and providing referral support for other team members
• Analyze coverage and communicates coverage positions
• Prepare coverage position letters
• Conduct investigations into loss facts and damages
• Initiating timely contact to appropriate parties throughout the claim's lifecycle
• Evaluating information on coverage, liability, and damage
• Negotiate and settle claims directly or indirectly
• Present at roundtables to senior claims leaders and underwriters

Senior Claims Examiner, Ocean Marine Claims

• To analyze mid- and higher-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.

Claims Adjuster – Workers Compensation

• 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

• Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level
• Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution
• Review and analyze supporting damage documentation
• Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions
• Establish appropriate loss and expense reserves with documented rationale
• Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines
• Communicate effectively and timely with internal (such as underwriting) and external customers on claims and account issues
• Maintain and manage diary system to efficiently manage and resolve assigned pending
• Identify and communicate trends with senior claims and underwriting management
• Effectively draft written communications to Insureds and Claimants regarding status of claim i.e. request for information, confirmation of investigatory details and/or coverage position letters
• Mitigate claim expenses as economically as possible
• Summarize claims in excess of authority and submit rationale to manager for approval
• Negotiate settlements within approved authority level, issue settlement payments and document all activities
• Identify potential subrogation and fraud opportunities and make appropriate referrals
• Support claims workflow efficiency by accurately documenting claim progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
• Use multiple systems to gather, enter and analyze claim metric data to ensure targets are achieved.

Senior DRC Claims Examiner

• Prepare and file medical stop loss claims for reimbursement with stop loss carriers for aggregate coverage
• Follow up with the various carriers to ensure reimbursements are received in time and in full
• Appeals of denied and reduced claim reimbursements
• Retain the appropriate documentation needed to support the reimbursement request
• Compile and submit claim reports and the necessary documentation to file a stop loss claim
• Frequently monitor the status of claims assigned and follow up with stop loss carriers
• Answer questions and requests from stop loss carriers for additional information
• Communicate with other internal departments to resolve claim issues
• Manage time to file aggregate accommodation, level funded and/or final claim submissions per contract stipulations
• Audit the aggregate positions, tracking the funding balance and updated reporting monthly
• Prepare both the year end and monthly accommodation aggregate claim filings upon reconciliation of the claim activity

Stop Loss Claims Specialist I – Aggregate

• Responsible for programming and implementing Enterprise claims auditing logic under the direction of the Manager Professional Reimbursement Programs
• Assists in the implementation, updates, and maintenance of code auditing software.

Claims Reimbursement Analyst

• Handle Commercial General Liability (CGL) and Business Owners Policy (BOP) claims from initial investigation through resolution
• Manage litigated and in-suit claims, partnering with defense counsel, experts and vendors throughout the litigation process
• Review policy language and determine coverage, liability, damages, and litigation strategy
• Develop and execute claim resolution plans that support timely and cost-effective outcomes
• Negotiate settlements with claimants, attorneys, and other involved parties
• Maintain accurate claim documentation in accordance with company and regulatory requirements
• Communicate with insureds, claimants, attorneys, vendors, and internal stakeholders

Complex Liability Adjuster – Litigated CGL, BOP Claims

• Investigate, evaluate, and adjust multi‑line liability claims (property damage & bodily injury) in accordance with CCMSI standards and state requirements.
• Manage claims involving commercial vehicles, trucking exposures, and third‑party liability.
• Determine coverage, assess liability, and develop defensible claim strategies.
• Review medical, legal, and vendor invoices for accuracy and reasonableness; negotiate discrepancies as needed.
• Establish, monitor, and adjust reserves in alignment with exposure and authority guidelines.
• Negotiate settlements with claimants, attorneys, and representatives in accordance with client expectations.
• Engage, coordinate, and manage defense counsel or other external vendors when appropriate.
• Identify and pursue subrogation opportunities.
• Maintain detailed and timely claim documentation, diary management, and financial reporting.
• Support excess reporting requirements and client communication needs.
• Deliver consistent, high‑quality service with professionalism and integrity.

Multi-Line Claims Adjuster – Commercial Auto, GL/BI

• Investigates, evaluates, negotiates, and resolves assigned claims
• Handles the most complex claims with minimal manager oversight
• Establishes and maintains positive relationships with customers
• Assists in building business relationships with agents, insureds and partners
• Develops and mentors other associates
• Assists leadership in training and resources development
• Maintains proper reserving through proactive investigation
• Assists other departments with investigations as required

Claims Representative, Casualty Large Loss, Auto Injury

• Manage an inventory of moderate to high complexity and exposure commercial claims
• Provides exceptional customer service by interacting professionally with insureds and claimants
• Verifies coverage and establishes timely reserves by reviewing policy language
• Conducts investigations to determine compensability, liability, and covered damages
• Establishes working relationships with internal and external partners
• Authorizes claim disbursements and negotiates settlements
• Contributes to expense management by timely resolving claims and delivering high quality service
• Identifies and addresses potential fraud occurrences
• Maintains compliance with state/local regulatory requirements

General Liability Claims Specialist

• Manages an inventory of low to moderate complexity and exposure commercial claims.
• Investigates, evaluates, and resolves claims in accordance with company protocols.
• Verifies coverage and establishes timely and adequate reserves.
• Conducts investigations to gather pertinent information.
• Negotiates settlements and escalates to manager as appropriate.
• Maintains compliance with state/local regulatory requirements.

Commercial General Liability Claims Representative

• Investigate, inspect, evaluate, and pay Federal Crop and Crop Hail Claims
• Review the client's policy and determine coverage levels
• Make contact with the client within 24 hours and explain claims procedures
• Set inspection date/time and inspect the damage
• Determine cause of loss and evaluate the damages
• Calculate the amount of damages and issue payment
• Communicate and negotiate with individuals regarding investigation and settlement of claims
• Adjust all federal crop claims in the American Farm Bureau Insurance Services CAP estimating system

Claims Representative – Crop

• Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
• Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
• Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols.
• Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, injured workers, witnesses, and working with experts, or other parties, as necessary to verify the facts of the claim.
• Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
• Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
• Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
• Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
• Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
• Maintains compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations or trends for line of business.
• May serve as a mentor/coach to less experienced claim professionals
• May perform additional duties as assigned.

Complex Claims Specialist – Professional Liability, Real Estate

• Accountable for the full handling and control of all claim matters assigned from inception to resolution including: timely coverage analysis and letter writing; investigation; incident response, evaluation; reserve adequacy and timeliness; diary maintenance; management of defense and coverage counsel; reinsurance reporting; and claim disposition.
• The handling of these claims may require the occasional in-person attendance at mediations, settlement conferences and trials nationwide.
• Consistent prompt evaluation of potential exposure present as to all claims assigned as well as an ability to adapt to changing circumstances as claims develop.
• An ability to segregate potentially significant claims possessing considerable exposure from straightforward claims.
• Ability to consider and formulate a possible resolution strategy at the earliest possible opportunity, including setting appropriate and timely reserves and communicating with defense counsel, insureds, coverage counsel or others to successfully achieve such strategy.
• Claim presentations, both written and oral, will be required on a regular and timely basis to bring management up to speed, obtain authority and/or formulate appropriate action plans on claims that present the risk for considerable exposure.
• Superior customer service to all co-employees, agents, policyholders and others encountered during the claims handling process is expected.
• When needed, the Executive Specialist is expected to market claim services, update underwriting department personnel on claims trends, and coordinate and participate in presentations to industry personnel, including brokers and insureds.

Executive Specialist, Claims

• The Investigative Specialist reviews complex and often unique claims to assess their validity and ensure accurate outcomes.
• In this role, you will investigate and verify the facts of loss for a range of automobile claims, from basic to advanced scenarios.
• Leveraging your auto claims adjusting experience, you will evaluate coverage, determine liability, and assess damages.
• You will also take ownership of the claims process by making informed decisions and effectively negotiating settlements.
• Every claim presents a new challenge.

Claims Investigative 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

• Works closely with veterinary hospitals, and policyholders to evaluate and review a pet’s medical history to determine a baseline of health.
• Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy.
• Updates Explanation of Benefits (EOB), pays and closes claim.
• May order medical records from providers.
• May communicate with clients and providers during treatment.
• Performs other duties and responsibilities as assigned.

Claims Specialist jobs in Illinois

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