Claims Specialist

• Streamlined Processing: Ensure claims accuracy and timely submission, minimizing disruptions for patients and practices.
• Issue Resolution: Address rejected or denied claims promptly, resolving challenges with finesse and professionalism.
• Account Integrity: Conduct thorough audits and manage escalation cases, safeguarding the integrity of every account.
• Financial Recovery: Track and recover missing payments efficiently, optimizing revenue streams for our practices.
• Technological Mastery: Utilize cutting-edge platforms like sFax, Adobe, PureCloud, and JIRA with proficiency, enhancing workflow efficiency and collaboration.
• Professional Growth: Take ownership of your development journey, embracing opportunities for advancement and skill enhancement.
• Cross-Functional Collaboration: Foster strong relationships across OrthoFi departments, understanding their functions and enhancing synergy for maximum impact.

Claims Coordinator

• Contact, Face, and Voice for all things Damage Claims for all of NAM for not only Aggreko but its customers, patrons, insurances, and suppliers.
• Provide case by case guidance and feedback to all parties involved.
• Attend all meetings needing Damage Claim representation.
• Manage all First Report of Loss (FROL) data and processes.
• Oversee the Damage Claims SharePoint site (Initiated development project).
• Create and communicate Damage Claim notifications to responsible party.
• Obtain hard cost and prepare marked up repair estimates.
• Obtain root cause analyst, reports, and investigation.
• Contact Sales, Customers, Insurances, or Patrons to Negotiate.
• Provide all requested documents, set up inspections with adjusters and manage all negotiations.
• Provide guidance for all Aggreko parties involved through the claim process.

Damage Claims Specialist

• 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)
• Travels as required

Claims Representative, Auto – Property Damage

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

Claims Examiner – Workers Compensation, TX preferred

• Receives and processes claims including entering/verifying claims data
• Resolves claim edits and determines benefit eligibility
• Reviews payment levels and elevates issues to supervision as necessary
• Meets production and quality standards, ensuring timely and accurate work
• Maintains accurate records including timekeeping
• Attends all required training classes

Associate Claims Processor

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property losses and damages.
• Effectively communicate and negotiate with policyholders, agents, public adjusters, attorneys, and service providers via phone, email, and internal systems to accurately document claim details.
• Successfully manage a pending claim load at varying stages of the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Interpret and apply computer generated loss estimates, engineer’s reports, and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.
• Mentor our mid and associate level claims representatives.

Complex Claims Representative

• Analyzes and processes complex claims, works with high exposure claims involving litigation, and ensures ongoing claims within service expectations, industry best practices and specific client service requirements.
• Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims across all jurisdictions.
• Manages high-exposure, complex, multi-jurisdictional claims with a focus on identifying and pursuing third-party subrogation opportunities.

Claims Examiner – Recovery

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

Claims Specialist – Large Loss

• Receives and processes claims including entering/verifying claims data; determines if claim information is complete and correct.
• Resolves claim edits, reviews history records and determines benefit eligibility for service.
• Reviews payment levels to arrive at final payment determination; elevates issues to next level of supervision, as appropriate.
• Meets all production and quality standards, ensuring timeliness and accuracy of all work.
• Maintains accurate records including timekeeping records.
• Attends all required training classes.

Claims Processor

• Responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims
• Provide excellent customer service and interact on a regular basis with employees, employers, health care providers and other specialized internal resources
• Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life
• Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge
• Produce objective, clear documentation and technical rationale for all claim determinations
• Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation
• Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business

Associate VB Claims Specialist

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