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

• The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS.

Oncology Claims Analyst

• Independently handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
• Ensure compliance with multiple state workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
• Negotiate settlements of claims within designated authority to reach claim resolution.
• Provide clear and effective communication with the claimant and client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
• Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing 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

• To analyze and process low to mid-level auto and transportation claims
• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution
• Identifies and pursues subrogation opportunities; secures and disposes of salvage
• Communicates claim action/processing with insured, client, and agent or broker when appropriate
• Maintains professional client relations
• Performs coverage, liability, and damage analysis on all claims assignments
• Performs other duties as assigned
• Supports the organization's quality program(s)

Claims Specialist jobs in Louisiana

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Senior Claims Adjuster, Property and Casualty

Associate Claims Clinical, Care Advocacy

Oncology Claims Analyst

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing Required

Property Claims Examiner II – Wind/Hail

Claims Representative – Auto