Claims Specialist

• 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.
• Report incidents involving theft, fraud, or arson to appropriate state and industry agencies.
• Perform duties independently, with work directly impacting management outcomes.
• Act as a company representative in public interactions, maintaining a professional demeanor consistent with management standards.
• Engage 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.
• Perform additional duties as assigned.
• Promote safety at all times and comply 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.

Field Property Claims Adjuster

• Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission
• Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues
• Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate
• Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines
• Perform payer research and communicate directly with insurance carriers to resolve claim processing issues
• Monitor assigned work queues and ensure timely resolution of outstanding claims
• Escalate complex reimbursement, coding, or compliance issues to senior team members
• Partner with A/R and Denials Management teams to resolve denied and underpaid claims
• Assist in preparing appeal documentation and supporting materials for denied claims
• Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator
• Maintain accurate documentation of denial resolution activities and payer communications
• Support efforts to reduce preventable denials and improve reimbursement outcomes
• Work closely with the pre-billing team to identify and correct claim issues prior to submission
• Review claims for completeness and compliance with payer billing requirements
• Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage
• Collaborate with coding and clinical teams to obtain information needed for claim resolution
• Assist with reducing claim holds and billing delays
• Participate in routine claim quality reviews and internal audit activities
• Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines
• Support Revenue Integrity initiatives through accurate claim review and documentation
• Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements
• Adhere to HIPAA, CMS, and organizational compliance standards
• Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities
• Track assigned workloads and resolution outcomes
• Assist with compiling information for denial trend reporting and operational reviews
• Provide feedback regarding workflow issues contributing to claim errors or payment delays
• Assumes other responsibilities as appropriate to the position and organizational needs

Claims Resolution Specialist

• 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

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Claims Examiner – Workers Compensation I

• 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

• Investigate and confirm the facts of loss for automobile accidents.
• Determine coverage, liability, damages and adjust and negotiate claims within limit of authority.
• Handle investigation regarding auto claims (coverage, liability and damages).
• Review, evaluate, and negotiate basic injury claims if handled.
• Recognize and identify body parts of a vehicle and understand other potential property damage.
• Identify customer needs and work to meet those needs using appropriate customer service skills.
• Determine subrogation or fraud potential and how to handle.

MD Claims Adjuster

• Responsible for working with repair facilities to validate, adjudicate, and approve payment for diagnostics and repair recommendations for pre-sale repairs as well as customer vehicles under warranty.
• Properly adjudicates claims within approval limit and in accordance with department & industry standards.
• Accurately notates all actions taken and interactions with shops and customers within internal systems ensuring proper documentation of interactions.
• Effectively navigates department resources in order ensure adherence to department process flows and policies.
• Manages list of assigned pending claims and provides timely follow up with repair facilities to decision claims.
• Other duties as assigned.

Claims Specialist jobs in Nevada

See all jobs on JobTailor