Claims Specialist

• Initiate the investigation of new claims
• Make coverage decisions based on the Named Peril Policies
• Evaluate settlements of personal property damage as appropriate
• Establish contact with the insured and storage facility within established protocol
• Recognize coverage issues and bring them to the attention of the supervisor
• Develop basic understanding of all entities under this program and their corresponding certificates and policies
• Recognize state specific laws and claims regulations throughout the United States to ensure proper compliance in claims investigation including sending and securing proper documentation
• Respond to time sensitive material including but not limited to department of insurance complaints
• Manage a diary system to systematically review and resolve claims within the specified state and client compliance guidelines
• Maintain state license by completing continuing education coursework and/or work towards a claims designation
• Other duties as assigned by the claims supervisor.

Claims Representative – Personal Property

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements.
• Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment.
• Evaluate and report on potential subrogation opportunities.
• Reports incidents involving theft, fraud, or arson to appropriate state and industry agencies.
• Perform duties independently, with work directly impacting management outcomes.
• Acts as a company representative in public interactions, maintaining a professional demeanor consistent with management standards.
• Engages regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties.
• Use strong customer service skills to negotiate with policyholders to settle the claim.
• Performs additional duties as assigned.

Field Property Claims Adjuster

• Conduct both virtual and on-site investigations by visiting policyholders’ residences.
• Assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements.
• Use claims handling software, a company car, and a laptop to determine claims-related damage.
• Evaluate and report on potential subrogation opportunities.
• Reports incidents involving theft, fraud, or arson to appropriate state and industry agencies.
• Perform duties independently, with work directly impacting management outcomes.
• Acts as a company representative in public interactions.
• Engages regularly with various stakeholders.
• Use strong customer service skills to negotiate with policyholders to settle the claim.

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements
• Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment
• Evaluate and report on potential subrogation opportunities
• Reports incidents involving theft, fraud, or arson to appropriate state and industry agencies
• Perform duties independently, with work directly impacting management outcomes
• Acts as a company representative in public interactions, maintaining a professional demeanor consistent with management standards
• Engages regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties
• Use strong customer service skills to negotiate with policyholders to settle the claim
• Performs additional duties as assigned
• Promotes safety at all times and complies with safety/ergonomic standards as outlined in relevant company published manuals
• Employees assigned to the Catastrophe team will be required to travel away from their residence for a specified period of time, usually consisting of 2-3 days
• Although this is not a CAT-specific role, hires will be expected to commit to 1–3 CAT deployments per year

• Work in the field and report to the Property Claim Manager
• Handle homeowner property field claims in Central Missouri (Jefferson City or Columbia) area
• Spend 80% of time working in the field, directly interacting with customers
• 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 for assigned losses

Property Field Claims Adjuster, Central Missouri – Jefferson City/Columbia

• Ensure timely processing of pending medical claims
• Verify and update information on the submitted claims
• Review work processes to determine reimbursement eligibility
• Ensure payments and/or denials are made in accordance with company protocols and procedures
• Process first time claims
• Apply policy and provider contract provisions to determine if claim is payable
• Research and determine status of medical related claims
• Maintain records, files, and documentation as appropriate
• Meet and maintain department production and quality standards
• Successfully complete additional progressive claims training programs as required
• Performs other duties as assigned
• Complies with all policies and standards

Claims Analyst

• Ensure timely processing of complex pending medical claims
• Verify and update information on the submitted claims
• Review work processes to determine reimbursement eligibility
• Process first time claims with added complexity
• Communicate with stakeholders important information needed for successful processing
• Maintain appropriate records, files, documentation, etc.
• Meet and maintain department production and quality standards
• Performs other duties as assigned

Claims Analyst II

• 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

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property losses and damages.
• Effectively communicate and negotiate with policyholders, agents, public adjusters, attorneys, and service providers via phone, email, and internal systems to accurately document claim details.
• Successfully manage a pending claim load at varying stages of the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Interpret and apply computer generated loss estimates, engineer’s reports, and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.
• Mentor our mid and associate level claims representatives.

Complex Claims Representative

• 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

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

Claims Specialist – Large Loss

• Research and resolve all claims and authorizations exceptions using internal resources.
• Provide communication to providers as necessary regarding the status of a claim or authorization.
• Follow up with providers on all financial implications of reprocessed claims or authorizations.
• Transport all claims entered by processors from image software to proprietary software for review.
• Utilizing knowledge of system, research current queues of work to find claims requiring further research and correction.
• Research and resolve any claim and authorization issues to determine best resolution.
• Work with internal departments to resolve issues involving authorization or claim handling.
• Recoup any overpayments to providers resulting from changes to a claim or authorization processing by posting to the provider account.
• Log all claims and authorizations that cannot be resolved and send rejection letters to providers.
• Using knowledge of authorizations, hold certain payments pending the outcome of client review.
• Adjudicate claims and send for payments ensuring that all proper documentation is attached.
• Complete daily audit of claims entered by Claim Intake representative.
• Take any incoming calls from providers or members regarding authorizations, benefits, or claim status.
• Provide backup to Accounts Receivable Assistant or Authorization Representative as needed.
• Develop and/or communicate methods to improve productivity and efficiency.
• Assist with gathering data for client audits.
• Contribute to the team effort by accomplishing additional responsibilities as needed.
• Assist with training of new staff members.

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Claims Specialist II

• Engage with Pure adjusters and homeowners or property managers to assess project scope and build trust during the sales process
• Develop accurate estimates using Xactimate or other relevant software
• Present estimates and proposals to clients, ensuring clear understanding of project scope, cost, and timelines
• Collaborate with internal teams to transition projects from sale to production
• Train new hires and existing team members in company estimating standards by performing quality reviews
• Create and maintain training content, including job aids, videos, and SOPs
• Provide coaching to our sales team to evaluate and support estimators and sales reps
• Conduct one-on-one mentoring for process improvement and skill-building
• Identify performance gaps and recommend strategies to improve team efficiency and accuracy

MRP Estimator, Claims Specialist

• Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary, as well as review coverage counsel's opinion letters and analysis
• Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care
• Develop and implement timely and accurate resolution strategies to ensure mitigation of indemnity and expense exposures
• Maintain contact with any/all associated claims carrier(s)’ claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes as necessary
• Investigate claims and review the insureds' materials, pleadings, and other relevant documents
• Identify and review each jurisdiction's applicable statutes, rules, and case law
• Review litigation materials including depositions and expert's reports
• Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues
• Retain counsel when necessary and direct counsel in accordance with resolution strategy
• Analyze coverage, liability and damages for purposes of assessing and recommending reserves
• Prepare and present written/oral reports to senior management setting forth all issues influencing evaluations and recommending reserves
• Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter
• Negotiate resolution of claims
• Select and utilize structure brokers
• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from the insured, counsel, underwriters, brokers, and senior management regarding claims

Claims Examiner – General Liability

• Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability and pay or deny losses.
• Become familiar with insurance coverage by studying insurance policies, endorsements and forms.
• Work towards the resolution of claims, and may attend arbitrations, mediations, depositions, or trials as necessary.
• Ensure that claims payments are issued in a timely and accurate manner.
• Service the needs of agents, policyholders and others.
• Handle investigations by phone, mail and on-site investigations.

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