Claims Specialist

• To analyze mid- and higher-level workers compensation claims to determine benefits due.
• To ensure ongoing adjudication of claims within company standards and industry best practices.
• To identify subrogation of claims and negotiate settlements.

Claims Adjuster – Workers Compensation

• 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 and confirm facts of loss for complex automobile accidents
• Determine coverage, liability, damages and adjust claims
• Mentor junior employees
• Review and evaluate moderate to complex injury claims

Senior PIP Med/Pay Claims Associate

• Responsible for the accurate processing, adjustment and payment of claims submitted by Network180’s provider network
• This position is 40 hours a week, Monday through Friday, 8:00 am to 5:00 pm
• There are no weekends, on-call, or holiday requirements for this position
• Involves collaboration with various stakeholders for effective claims processing

Senior Claims Examiner

• Investigate and assemble facts
• Determine policy coverage
• Evaluate the amount of loss
• Pay benefits that are owed
• Review medical bills and authorize payments
• Ensure payments are issued in a timely and accurate manner in accordance with the Michigan No Fault Statute
• Work toward the resolution of claims
• Attend arbitrations, mediations, depositions, or trials as necessary
• Service the needs of agents, policyholders and others
• Handle investigations by phone and mail
• Conduct claim investigations on complex claims

Experienced PIP Claims Representative

• Your role is crucial in ensuring accurate and efficient processing of claims related to transportation services.
• You will be responsible for reviewing, investigating, and resolving 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 our 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 our proprietary systems.
• Escalate issues to leadership as they arise.

Claims Processor – Part-Time

• Provides quality investigation and analysis to adjust claims at all levels to proper resolution
• Promotes the success of the organization through development and advancement of relationships with agencies, policyholders and employees
• 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
• Determine need for, identify and engage external resources as needed to execute proper resolutions while monitoring and controlling costs
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing.

Senior Auto Physical Damage Claims Representative

• Provides quality investigation and analysis to adjust claims of medium complexity/severity
• 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, determine compensability, 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 counsel to manage litigated claims
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing

Senior Workers' Compensation Claims Adjuster

• 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

• Provide quality investigation and analysis to adjust claims of high complexity/severity, including litigated files, to proper resolution
• Promote the success of the organization through development of relationships with agencies, policyholders and employees
• Serve as the lead relationship contact for assigned agent(s) related to all claims
• Collaborate proactively with agents, policyholders and internal stakeholders on claims of highest complexity/severity and provide strategic input on book of business
• Investigate losses, identify coverage, evaluate liability and damages, review and analyze documents and legal pleadings independently
• Collaborate with counsel to manage litigated claims and leverage past experience to 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
• Address contractual indemnifications and/or additional insured coverage issues
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing
• Lead cross functional teams to identify and resolve issues and design and implement solutions to prevent future occurrence as necessary
• Mentor and train other claims adjusters

Senior Commercial Claims Specialist, GL & Auto

• 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

• 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

Claims Specialist jobs in Missouri

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