Claims Specialist

• Provides quality investigation and analysis to adjust claims of medium complexity/severity, including litigated files, to proper resolution
• Promotes the success of the organization through development of relationships with agencies, policyholders, and employees
• Collaborate and communicate with agents, policyholders, and internal stakeholders on claims of medium complexity/severity and book of business
• Investigate losses, identify coverage, evaluate liability and damages, review and analyze documents and legal pleadings
• Develop plan of action to proactively conclude claims, timely evaluate damages, engage other parties in negotiations and settle claims pursuant to guidelines
• Establish and maintain proper reserves for each claim to accurately reflect the financial exposure
• Determine need for, identify and engage external resources as needed to execute proper resolutions while monitoring and controlling costs
• Collaborate with internal partners to address contractual indemnifications and/or additional insured coverage issues
• Collaborate with counsel to manage litigated claims
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing

Senior Auto & General Liability Claims Adjuster

• Investigate assigned casualty claims by collecting statements, physical evidence, and legal documentation
• Analyze and interpret policy coverage and determine liability and damages
• Negotiate claims settlements in accordance with company procedures and within authority limits
• Communicate claim status to all relevant stakeholders, including insureds and agents
• Maintain accurate documentation in company systems and adhere to regulatory and internal standards
• Participate in training and education programs to enhance claim-handling skills
• Travel as needed for onsite investigations or meetings
• Maintain punctual attendance according to an assigned work schedule at a Company-approved work location

Casualty Claims Representative

• Review, investigate, and resolve transportation claims in accordance with company policies and procedures
• Demonstrate comprehensive knowledge of carrier services, including tracking, reporting, and billing methods
• Utilize effective problem-solving skills to verify potential claims identified by proprietary auditing systems
• Communicate information to carriers clearly, concisely, and in an organized manner
• Meet or exceed company expectations for key performance indicators
• Prioritize daily tasks of claims to be completed using time management skills
• Provide accurate and timely updates of claims information and resolutions in proprietary systems
• Escalate issues to leadership as they arise

Claims Processor

• Review and monitor open claims files
• Provide assistance with coverage, liability, and damage determinations
• Review closed files and provide feedback to claim handlers
• Review open and closed files to ensure adherence to claim handling guidelines and state’s Fair Claims Practices
• Assist associates in identifying claims with subrogation potential
• Manage the arbitration process for subrogation files
• Assist in developing and presenting educational material to claim associates in classroom and remote settings
• Work effectively with associates and customers at all levels

Claims Examiner – Subrogation Claims

• Review and monitor open claims files
• Provide assistance with coverage, liability and damage determinations
• Review closed files provide feedback to claim handlers
• Review open and closed files to ensure adherence to claim handling guidelines and state’s Fair Claims Practices
• Assist associates in identifying claims with subrogation potential
• Manage the arbitration process for subrogation files
• Assist in developing and presenting educational material to claim associates in classroom and remote settings
• Work effectively with associates and customers at all levels

Senior Claims Examiner – Motor Carrier and Auto Liability

Senior Claims Examiner – Motor Carrier, Auto Liability

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

• Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.
• Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system.
• Complete complex coverage analysis.
• Ensure all possible policyholder benefits are identified.
• Create additional sub-claims if needed.
• Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
• Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
• Evaluate the financial value of the loss.
• Approve payments for the appropriate parties accordingly.
• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
• Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.

Property Claims Specialist

• Assist adjusters with all phases of the claim lifecycle
• Handle incoming calls and mail for the claims department
• Facilitate tasks and processes to aid the adjuster
• Respond to inquiries regarding claim status
• Obtain and verify information from relevant parties
• Assist with claim documentation
• Draft and distribute correspondence
• Maintain accurate claim records
• Coordinate external vendors
• Process payments and invoices

Claims Adjuster Associate – WC

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Claims Specialist II

• Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.
• Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system.
• Complete complex coverage analysis.
• Ensure all possible policyholder benefits are identified.
• Create additional sub-claims if needed.
• Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
• Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
• Evaluate the financial value of the loss.
• Approve payments for the appropriate parties accordingly.
• Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
• Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system.
• Utilize strong negotiating skills.

Property Desk Claims Specialist

• Collaborate proactively with agents, policyholders and internal stakeholders on claims and book of business as needed
• Investigate losses, identify coverage, evaluate liability and damages
• Develop plan of action to proactively conclude claims, timely evaluate damages, engage other parties in negotiations and settle claims pursuant to guidelines and delegated authority
• Leverage past experience to review and analyze documents
• Establish and maintain proper reserves for each claim to accurately reflect the financial exposure
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing

Senior Claims Representative

• Independently manages medical malpractice claims for assigned members
• Monitors and reviews new claims and establishes a plan of action
• Attends and facilitates member meetings and claim reviews
• Reviews and recommends appropriate case reserves
• Negotiates settlements and attends trials to provide insights and analysis
• Advocates and serves as a trusted resource for physician members
• Completes coverage analysis and develops a plan of action with counsel
• Consults with external stakeholders to optimize investigation results
• Interfaces with insured member to provide ongoing support
• Makes recommendations for assignment of litigated matters
• Partners with defense counsel for optimum outcome on all assigned cases
• Monitors and approves fees and expenses
• Evaluates facts and maintains appropriate case reserves
• Recommends resolution course to regional leadership
• Attends mediations, settlement conferences, and trials as necessary
• Supports members throughout the claim file life up to trial

Medical Malpractice Claims Specialist

• Manage a personal caseload of property claims from initial assignment through resolution.
• Investigate losses by reviewing claim details, gathering documentation, and assessing coverage.
• Evaluate damages and determine appropriate settlement outcomes within authority.
• Communicate clearly and consistently with policyholders, agents, and vendors throughout the claim process.
• Review estimates, invoices, and supporting documentation to ensure accuracy and completeness.
• Coordinate with contractors, adjusters, and other service providers as needed.
• Identify and pursue salvage and subrogation opportunities when applicable.
• Establish and maintain appropriate reserves throughout the life of each claim.
• Document all claim activity thoroughly and accurately within the claim system.
• Identify potential fraud indicators and refer as appropriate.
• Collaborate with internal partners across underwriting, loss control, and other departments.
• Participate in ongoing learning and development to build claim knowledge and expertise.

Property Claims Representative – Desk Adjuster

• Providing feedback, training and educational material to claim associates throughout our operating states from a Home Office setting
• Willingness to relocate after one or two years of training in the Home Office
• Review and monitor open claims files
• Provide assistance with coverage, liability and damage determinations
• Review open and closed files to ensure adherence to claim handling guidelines and state's Fair Claims Practices
• Assist with other duties as assigned within the regions or elsewhere on request
• Assist in developing and presenting educational material to claim associates in classroom and remote settings

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