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

• 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

• Timely completion of all case activities, maximizing customer service and minimizing net loss payout.
• Contacts all insureds, claimants and witnesses that may have information relating to the loss, either in person, by telephone or in writing.
• Inputs and retrieves information using the automated claims system, requests checks, form letters and other correspondence through the automated claim system.
• Evaluates case facts determining coverage, liability and reserves, and reports on settlement; maintains an effective reminder system.
• Negotiates settlements with individuals, attorneys, and other insurance carriers within their granted settlement authority level.
• Will keep management informed of activities and problems with in assigned area of responsibility.
• Pursues subrogation and may arrange for salvage to obtain the maximum recovery.
• Provides information to all interested parties, including the local agents, by answering routine questions regarding the status of the claim.
• Maintain claim files and document claim file activities in accordance with established procedures.
• Will successfully complete all required in-house training
• Manage and track all claims referred to Subrogation counsel.
• Daily navigation and management of E-Subro Hub
• Prepare well written contentions for arbitration filings when liability and damages are in dispute.

Claims Service Specialist I

• 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

• 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

• 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

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

Workers Compensation Claims Adjuster – Northeast Jurisdictions

• 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

• Independently analyze liability claim submissions for potential coverage
• Set adequate case reserves
• Promptly and professionally respond to inquiries from clients and their brokers
• Proactively drive early resolution of claims arising from General Liability products
• Manage a full pending of General Liability Claims
• Provide thought leadership in multiple forums within and outside the company
• Engage in business development, product innovation, and market/customer insight
• Develop strong working relationships with underwriting leadership

Complex Claims Specialist

• The Senior Claims Examiner-Miscellaneous Professional Liability adjudicates assigned claims within given authority and according to Hiscox Claims Best Practices.
• Adjusts and resolves low to moderate professional liability claims that include litigated matters
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Heavy customer facing role. Must have confident communication skills.
• Communicates effectively to resolve matters directly with claimants, and or claimant attorneys
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Reviews and analyzes claims in order to determine appropriate and timely reserving per Hiscox Claims Best Practices
• Identifies emerging exposures and claims trends
• Manages defense counsel as necessary in defending litigated matters
• Identifies suspected fraudulent claims and tracks with Special Investigations Unit
• Participates in Claims Projects, as needed

Senior Claims Examiner – MPL

• To perform all core aspects of in-house claims management, including but not limited to: Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses
• Strategizing and maximizing early settlement opportunities
• Monitoring litigation and managing local defense counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Smartly managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves, and escalating high exposure and/or volatile claims to line manager
• Liaising directly on daily basis with insureds and brokers
• Maintaining timely and accurate file documentation/information in our claims management system

Complex Claims Specialist – A&E

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by 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 Examiner I, Workers Compensation, NE Jurisdiction Experience 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

• 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

• Adjusts and resolves complex mid to severity claims that include all phases of litigation
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and provides analysis of claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors team members
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
• Identifies emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities

Complex Claims Specialist – MPL

• The Claims Examiner adjudicates assigned claims within given authority and provides operational support to the claims team.
• Adjusts and resolves moderate claims that includes all phases 1st Party commercial claims for our Property Team
• Accurately reviews and assesses coverage for all losses
• Completes full in depth investigations to confirm how coverage is relevant and applies it to the loss
• Manages smaller business income losses and the period of restoration
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Accurately assesses reserves for indemnity and expense payments
• With minimal supervision, drafts coverage letters, including reservation of rights and denial letters
• Drives 1st Party Best Practices to manage expense and exposure on losses
• Has a high level of customer service
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Participates in Claims projects as needed

Claims Examiner – Property

• Investigating, evaluating, and negotiating general and auto liability claims.
• Conducting thorough investigations of coverage, liability, and damages.
• Communicating effectively with internal and external customers on claims issues.
• Maintaining and managing a diary system to manage claims inventory.
• Preparing Large Loss reports and maintaining ongoing claim updates.

Claims Analyst IV – Auto and GL

• To analyze Lost-Time 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.
• 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.

Workers Compensation Claims Adjuster – DE & CT Jurisdiction Knowledge Required – PA NJ MA Preferred

Workers Compensation Claims Examiner – CT, MA, NH, RI, VT Jurisdictional Knowledge

• Analyzing liability claim submissions for potential coverage
• Setting adequate case reserves
• Promptly and professionally responding to inquiries from customers and their brokers
• Proactively driving early resolution of claims arising from the Cyber, Tech PL, Media and/or Crime professional liability lines of business
• Reviewing and analyzing claim documentation and legal filings
• Drafting coverage analyses for tech E&O, first and third party cyber claims
• Strategizing and maximizing early resolution opportunities
• Monitoring litigation and managing local defense and breach counsel
• Attending mediations and/or settlement conferences, either in person or by phone as appropriate
• Managing and tracking third-party vendor and service provider spend
• Continually assessing exposures and adequacy of claim reserves

Claims Specialist jobs in Massachusetts

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