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

• Utilize in-depth knowledge of vehicle mechanics to evaluate, investigate, and process mechanical claims accurately and efficiently.
• Communicate via telephone and email with vehicle contract holders, repair facilities, and other parties.
• Actively listen to callers’ questions and concerns, demonstrating empathy and compassion.
• Adhere to all established department processes and utilize company-specific computer systems.
• Collaborate with leaders and other claim analysts to consistently uphold the company’s reputation.

Bilingual Automotive Claims Specialist – Spanish/English

• 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

• 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.

Property Claims Adjuster

• Independently handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
• Ensure compliance with multiple state workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
• Negotiate settlements of claims within designated authority to reach claim resolution.
• Provide clear and effective communication with the claimant and client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
• Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing 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

• Support the Clinical Research billing and account review needs of the Providence Health System
• Review charges, processing and tracking of ongoing research-related clinical billing
• Regularly review research-related billing process for accuracy and compliance

• 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 Specialist jobs in Montana

See all jobs on JobTailor

Associate Claims Clinical, Care Advocacy

Bilingual Automotive Claims Specialist – Spanish/English

Claims Processor – Part-Time

Property Claims Adjuster

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing Required

Property Claims Examiner II – Wind/Hail

Lost Time Claims Adjuster – Workers' Compensation

Claims Specialist

Claims Representative – Personal Property

Field Property Claims Adjuster

Field Property Claims Adjuster

Field Property Claims Adjuster

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

Claims Analyst

Claims Analyst II