Claims Specialist

• Analyze complex coverage issues, conduct detailed investigations, and evaluate damages and liability to determine the validity of moderate to highly complex commercial property and casualty claims
• Handle high-exposure property losses, including large commercial building, business personal property, business interruption, inland marine, equipment breakdown, crime, and bond claims
• Investigate and evaluate third-party casualty claims, including general liability, premises liability, product liability, contractual liability, and bodily injury/property damage claims
• Formulate and issue formal coverage position letters and liability determinations based on policy language, facts, and applicable legal principles
• Conduct comprehensive investigations, including interviews of insureds, claimants, witnesses, and other involved parties to determine coverage, liability, causation, and damages
• Coordinate and manage field investigations, site inspections, scene examinations, and independent adjuster assignments as necessary
• Identify, retain, and manage experts including engineers, building consultants, forensic accountants, cause-and-origin specialists, medical professionals, accident reconstructionists, and defense counsel to support claim resolution
• Review and analyze repair estimates, contractor bids, engineering reports, medical records, litigation documents, and expert evaluations to determine the extent of damages, liability exposure, and appropriate claim disposition
• Assess comparative negligence, liability defenses, subrogation opportunities, and risk-transfer provisions where applicable
• Establish, monitor, and recommend appropriate reserves based on claim complexity, damages, liability exposure, and settlement potential
• Develop and execute claim resolution strategies for large-loss and high-severity claims, including those with significant litigation potential
• Collaborate with defense counsel and litigation management teams on litigated matters, monitoring case strategy, budgets, exposure assessments, and settlement opportunities
• Prepare detailed large loss and management reports summarizing coverage positions, liability assessments, damage evaluations, reserve adequacy, and settlement recommendations
• Present claim evaluations and settlement recommendations to management for claims exceeding assigned authority limits
• Negotiate fair and timely settlements with insureds, claimants, attorneys, contractors, and other parties within delegated authority
• Communicate effectively with insureds, agents, brokers, claimants, attorneys, and internal business partners to provide superior customer service and ensure transparency throughout the claims process
• Manage a high-volume and complex caseload while maintaining proactive diary management and meeting all regulatory and company service standards
• Maintain complete, accurate, and organized claim files in accordance with company policies, best practices, audit standards, and regulatory requirements
• Identify trends, emerging risks, and exposure concerns and provide recommendations to management regarding claim handling strategies and risk mitigation opportunities

Senior Claims Adjuster, Property and Casualty

• 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

• Analyze information/documentation received to determine how to proceed with a review of a claim and determine methods of obtaining additional information from alternative sources.
• Manage the review of a claim and outside sources used in the review.
• Document correspondence and conversations.
• Correspond verbally and in writing with claimants, medical providers, medical examiners, and law enforcement.
• Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims.
• Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team or conducting additional research.
• Maintain compliance with regulations.
• May testify in depositions, hearings and trials; communicate the Company’s position regarding the claim.
• Assist peers with processing questions in the absence of higher level staff.
• May serve as a back up to review and authorize pending payments calculated by peers, within approval authority.

Senior Claims Examiner

• 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

• Investigate, evaluate, and settle entry-level insurance claims
• Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products
• Learn and comply with Company claim handling procedures
• Develop entry-level claim negotiation and settlement skills
• Build skills to effectively serve the needs of agents, insureds, and others
• Meet and communicate with claimants, legal counsel, and third-parties
• Develop specialized skills including estimating and use of designated computer-based programs for loss adjustment
• Study, obtain, and maintain an adjuster’s license(s), if required by statute within the timeline established by the Company or legal requirements

Branch Claims Representative

• Work in a fast-paced and exciting position from home.
• Handle auto liability claims with a focus on bodily injury.
• Use problem-solving skills to manage claims effectively.
• Collaborate with team members for support and training.

Commercial Auto Liability Claims Adjuster, Bodily Injury

• Investigate and resolve litigated claims in an efficient and accurate manner.
• Negotiate settlements and communicate effectively with policyholders, vendors, and other stakeholders.
• Verify coverages through investigation and reviewing policy terms, conditions, and language.
• Evaluate liability by taking recorded statements from involved parties and witnesses and reviewing police reports, accident scene photos, and other pertinent evidence.
• Negotiate claims settlements with claimants and their legal representation within assigned authority limits.
• Comply with industry regulations, legal requirements, and internal policies through thorough documentation of all decisions, correspondence, and discussions that occur throughout the life cycle of the claim.
• Work with and mentor other associates.

Claims Representative Specialist – Litigation

• 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

• Provide a high-quality customer service experience characterized by educating customers, keeping customers informed of next steps and answering customer questions.
• Maintain a compassionate and empathetic approach when interacting with claimants, ensuring their concerns are heard and addressed with professionalism and care.
• Review claim information to determine steps needed to complete the settlement of a claim.
• Initiate and complete claim settlement transactions.
• Actively engage in an inclusive team environment by providing guidance to other team members, participating in team meetings and team projects.
• Continuous improvement is a focus.
• Follow documented department claim procedures and requirements defined by claims good faith claim handling guidelines.
• Document phone calls and claim information accurately and proficiently.
• Identify opportunities to improve team performance and contribute to process enhancements.
• May be required to obtain and maintain relevant examinations and licensing.

Lending Claims Specialist, Level II

• Investigate and resolve claims within assigned authority
• Determine coverage and liability
• Negotiate settlements with insureds, claimants, and attorneys
• Maintain accurate documentation and reserving
• Communicate promptly and professionally with all stakeholders
• Collaborate with internal teams and external partners
• Adhere to audit and compliance standards
• Participate in training and team initiatives

Senior Claims Representative

• Complete field inspections, reviews and adjustments accurately and efficiently to administer crop insurance policies.
• Ensure compliance with insurance statutes and regulations to apply crop policies cost-effectively.
• Build and maintain customer relationships through timely and accurate policy service.
• Document and process loss information accurately to assess potential damages.
• Participate in quality control tasks, audits, risk assessments, and field reviews.
• Contribute to a positive work environment by demonstrating cultural expectations and influencing others positively.
• Support business objectives through quality control tasks, audits, and risk assessments.

Senior Claims Adjuster – Crop

• Gain knowledge to verify coverage, compensability, and reasonable payments by thoroughly reviewing the policy, reviewing accident details, and other pertinent information related to the claim.
• Develop investigative claims skills by taking and reviewing recorded statements from involved parties and witnesses, reviewing police reports, and other pertinent evidence.
• Build knowledge to evaluate claims exposure appropriately, establishing timely reserves.
• Comply with industry regulations, legal requirements, and internal company policies through thorough documentation of all decisions, correspondence, and discussions that occur throughout the life cycle of the claim.
• Support customers with empathy and understanding, assisting them through difficult situations and effectively communicating the claims process, ongoing claim status, and decisions, including the reasoning behind them.
• Ability to obtain and maintain state licensing requirements.

Claims Specialist jobs in Iowa

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