Claims Specialist

• 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

• Manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage
• Handles litigated files and works with delegated authority
• Receives claims, confirms policy coverage and acknowledgment of the claim
• Determines validity and compensability of the claim
• Investigates claims and handles Auto and/or General Liability claims
• Establishes reserves and authorizes payments within reserving authority limits
• Communicates claim status with the customer, claimant, and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Collaborates with team members on more complex or problematic claims as necessary
• Additional duties as assigned

Senior Liability Claims Specialist

• To ensure agency clients receive timely and equitable claims service.
• Investigates, negotiates, and aids in settling personal lines claims.
• Receives notification of claims, reviews policy, account instructions and process claim to conclusion in accordance with agency and insurance carrier policies.
• First Reports – upon receipt of claim, responsible for completing claim file, which includes policy verification and making preliminary or tentative determinations of coverage.
• Input claims acknowledgments, direct reports, and claim payments into the computer system.
• Process claims mail.
• Act as a liaison between clients and third-party companies to resolve claim issues - process claims that are designated for internal claim handling, assigning the others to an outside claims adjuster.
• Check status of claims – every 30 days, initiate a follow up on all open or unsettled claims.
• Service and assist clients as necessary – process, record, monitor, and analyze all claims for personal lines clients as assigned, keeps Producer and Personal Lines Account Manager apprised of claims status.
• Follow DII procedures and workflows within Applied Epic.
• Exercise discretion and judgment in prioritizing workload.
• This role exists to serve as an advocate for our clients, explaining policy coverage to clients and third parties and ensuring claims are resolved in a prompt, fair and courteous manner.

Claims Associate

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, to include CEO's, claimants, providers offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster, Northeast Jurisdictions

• 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

• Handle homeowner property field claims in Baltimore, MD
• Investigate origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, and other adjusters
• Identify complex issues and seek assistance as needed
• Handle claims on a good faith basis
• Conduct on-site inspections when needed, evaluate damages, and handle claim negotiations
• Respond to customer inquiries, make appropriate decisions, and close files as needed
• Interpret and determine policies, leases, by-laws, declarations, articles and contract coverages and apply to all parties for assigned losses

Property Field Claims Adjuster

• To analyze Medical Only & Lost-Times Workers Compensation claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution.
• Investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Claims Specialist jobs in Maryland

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