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

• 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 the origin and cause of claims by contacting the appropriate parties including insureds, claimants, agents, attorneys, contractors, experts, special investigation unit, other adjusters, public personnel, etc.
• Identify complex issues and seek assistance as needed.
• Handle both 1st party and 3rd party claims under multiple policy types and numerous endorsements.
• Conduct on-site inspections when needed, evaluate damages, and handle claim negotiations with insureds, claimants, attorneys, and public adjusters.
• 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.
• Proactively provide all parties with the claim process and status as appropriate; answer questions or redirect to other areas.

Property Field Claims Adjuster

• Efficient claim management and documentation of declaratory judgment new loss assignments
• Clear understanding of coverage issues and complex coverage decisions
• Develop and enforce litigation management strategy on each claim
• Review and analyze file materials, policies, motions, and pleadings
• Collaborate with other claim adjusters to evaluate litigated claims
• Stay informed on industry trends and utilize AI tools

Declaratory Relief Action Claims Adjuster III

• Communicating directly and following up with insureds to perform loss adjustments, pre-acceptance or quality control inspections to gather facts involved with the settlement of reported claims or inspections
• Fostering and maintaining positive customer relationships by providing prompt and accurate support throughout the claims process
• Staying abreast of crop insurance industry procedures relating to proper adjustment of claims
• Analyzing and making recommendations for enhancements for company software products to assure compliance with company and RMA procedures

Crop Insurance Claims Adjuster

• The Investigative Specialist reviews complex and often unique claims to assess their validity and ensure accurate outcomes.
• In this role, you will investigate and verify the facts of loss for a range of automobile claims, from basic to advanced scenarios.
• Leveraging your auto claims adjusting experience, you will evaluate coverage, determine liability, and assess damages.
• You will also take ownership of the claims process by making informed decisions and effectively negotiating settlements.
• Every claim presents a new challenge.

Claims Investigative Specialist

• Responsible for processing health insurance claims submitted via paper or electronically by providers and members
• Validates health insurance claims with an understanding of health insurance cost sharing, limitations, and exclusions
• Reviews claims for completeness and accuracy
• Releases health insurance claims for payment according to the defined workflows
• Works assigned pend and error reports
• Determines benefit level to be paid according to the summary plan language
• Responds promptly to requests for information from other Sanford Health Plan departments
• Refers complex claims to Senior and/or Lead Claims Representatives.

Associate Claims Representative

• Manage a caseload of General Liability Claims (premises and construction defect) in multiple states
• Manage new loss assignments, reassignments and proper, timely reserve setting
• Perform coverage analysis, responsibilities to defend and/or indemnify, and choice of law
• Identify issues that need to be investigated and resolved, focusing on risk transfer and resolutions
• Familiarity with drafting of complex coverage position letters, which include reservation of rights, disclaimers and responses to rebuttal letters
• Develop legal strategy with counsel and manage General Liability litigation
• Identify appropriate cases for trial and complete pre-trial reports and trial activities
• Utilization of artificial intelligence tools and resources

GL Claims Adjuster III

• 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

• Investigating and confirming the facts of loss for basic automobile accidents.
• Applying analytical thinking to determine coverage, liability, damages, and adjusting claims.
• Handling investigation regarding most aspects of auto claims (coverage, liability, damages).
• Recognizing and identifying body parts of a vehicle and understanding potential property damage.
• Determining subrogation or fraud potential and how to handle.

Auto Claims Adjuster

• 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

• 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

Claims Specialist jobs in Minnesota

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