Claims Specialist

• Responsible for the resolution of moderate to high complexity ocean marine bodily injury and property damage claims
• Handle claims from coverage enquiry through legal liability assessment and quantum analysis
• Communicating developments and outcomes to all internal and external stakeholders
• Training and providing referral support for other team members
• Analyze coverage and communicates coverage positions
• Prepare coverage position letters
• Conduct investigations into loss facts and damages
• Initiating timely contact to appropriate parties throughout the claim's lifecycle
• Evaluating information on coverage, liability, and damage
• Negotiate and settle claims directly or indirectly
• Present at roundtables to senior claims leaders and underwriters

Senior Claims Examiner, Ocean Marine Claims

• 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

• To analyze Lost-Time claims on behalf of our valued clients to determine benefits due.
• Ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
• 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.

Workers Compensation Claims Examiner – DE License Preferred

• Provide and maintain exceptional customer service and ongoing communication to the appropriate stakeholders through the life of the claim including prompt contact and follow up to complete timely and accurate investigation, damage evaluation and claim resolution in accordance with regulatory, company standards, and authority level
• Conduct thorough investigation of coverage, liability and damages; must document facts and maintain evidence to support claim resolution
• Review and analyze supporting damage documentation
• Comply and stay abreast of all statutory and regulatory requirements in all applicable jurisdictions
• Establish appropriate loss and expense reserves with documented rationale
• Demonstrate technical efficiency through timely and consistent execution of best claim handling practices and guidelines
• Communicate effectively and timely with internal (such as underwriting) and external customers on claims and account issues
• Maintain and manage diary system to efficiently manage and resolve assigned pending
• Identify and communicate trends with senior claims and underwriting management
• Effectively draft written communications to Insureds and Claimants regarding status of claim i.e. request for information, confirmation of investigatory details and/or coverage position letters
• Mitigate claim expenses as economically as possible
• Summarize claims in excess of authority and submit rationale to manager for approval
• Negotiate settlements within approved authority level, issue settlement payments and document all activities
• Identify potential subrogation and fraud opportunities and make appropriate referrals
• Support claims workflow efficiency by accurately documenting claim progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
• Use multiple systems to gather, enter and analyze claim metric data to ensure targets are achieved.

Senior DRC Claims Examiner

• Handle Sompo Casualty claims (primary and/or excess) and related systems and processes
• Provide technical oversight and guidance to TPA claim handlers and supervisors
• Adherence to client-specific claim handling guidelines, providing coverage and analytical analysis of potential exposures
• Manage counsel where assigned; develop and execute strategy to control expenses and resolve litigated claims
• Establish appropriate reserves; Analyze loss and expense trends on a portfolio of claims and assist in the development and implementation of plans to improve results
• Ensure that all claim information is reviewed and accurately and timely recorded; proactively manage correspondence and claim files and maintain a current diary in compliance with company standards
• Effectively represent the company’s interests in meetings and negotiations; maintain a high level of claim and industry related expertise in order to assure technical competency and communicate to team members regarding significant issues and relevant changes
• Support underwriters and actuaries during the renewal process, communicating with and supporting underwriting and other functional groups within the organization

Senior Technical Specialist – General Liability Claims

• To analyze General Liability & Auto BI (Litigated & Non-Litigated), Premises claims.
• Determine benefits due while ensuring ongoing adjudication of claims.
• Analyzing and processing claims through well-developed action plans.
• 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.

Liability Claims Examiner – General Liability, Auto BI – License Required

• Handle Commercial General Liability (CGL) and Business Owners Policy (BOP) claims from initial investigation through resolution
• Manage litigated and in-suit claims, partnering with defense counsel, experts and vendors throughout the litigation process
• Review policy language and determine coverage, liability, damages, and litigation strategy
• Develop and execute claim resolution plans that support timely and cost-effective outcomes
• Negotiate settlements with claimants, attorneys, and other involved parties
• Maintain accurate claim documentation in accordance with company and regulatory requirements
• Communicate with insureds, claimants, attorneys, vendors, and internal stakeholders

Complex Liability Adjuster – Litigated CGL, BOP Claims

• Actively managing commercial general liability claims for medium severity, and general liability, as well as the associated excess and umbrella policies
• Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel
• Develop and implement strategy relative to coverage issues
• Maintain contact with associated claims carrier(s)’ claims staff, business line leader, underwriter, defense counsel, program manager, and broker to communicate developments and outcomes
• Investigate claims and review the insureds' materials, pleadings, and other relevant documents
• 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
• Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries.

Claims Examiner, Casualty

• Investigate and manage all aspects of a medical only claim, maintaining phone/written contact with all necessary parties
• Verify coverage, investigate, manage, and resolve medical only claims promptly and accurately
• Authority to approve or deny payment of medical invoices, and determine case reserves, with up to $10,000 in reserve approval authority
• Required to handle medical only claims in Maryland, New Jersey, and Pennsylvania with the largest volume of claims being Pennsylvania

Senior Medical Claims Representative – Workers Compensation

• Manages mid to complex Auto and/or General Liability claims, including bodily injury and property damage
• Handles litigated files and works with delegated authority
• Receives claims, confirms policy coverage and acknowledgment of the claim
• Determines validity and compensability of the claim
• Investigates claims and handles Auto and/or General Liability claims
• Establishes reserves and authorizes payments within reserving authority limits
• Communicates claim status with the customer, claimant, and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Collaborates with team members on more complex or problematic claims as necessary
• Additional duties as assigned

Senior Liability Claims Specialist

• Accountable for the full handling and control of all claim matters assigned from inception to resolution including: timely coverage analysis and letter writing; investigation; incident response, evaluation; reserve adequacy and timeliness; diary maintenance; management of defense and coverage counsel; reinsurance reporting; and claim disposition.
• The handling of these claims may require the occasional in-person attendance at mediations, settlement conferences and trials nationwide.
• Consistent prompt evaluation of potential exposure present as to all claims assigned as well as an ability to adapt to changing circumstances as claims develop.
• An ability to segregate potentially significant claims possessing considerable exposure from straightforward claims.
• Ability to consider and formulate a possible resolution strategy at the earliest possible opportunity, including setting appropriate and timely reserves and communicating with defense counsel, insureds, coverage counsel or others to successfully achieve such strategy.
• Claim presentations, both written and oral, will be required on a regular and timely basis to bring management up to speed, obtain authority and/or formulate appropriate action plans on claims that present the risk for considerable exposure.
• Superior customer service to all co-employees, agents, policyholders and others encountered during the claims handling process is expected.
• When needed, the Executive Specialist is expected to market claim services, update underwriting department personnel on claims trends, and coordinate and participate in presentations to industry personnel, including brokers and insureds.

Executive Specialist, Claims

• Develop the investigation and analytical skills necessary to properly evaluate and settle claims through close interaction with experienced staff in providing exceptional customer service and claims handling support.
• Review standard operating procedures and training manuals to determine correct work flow steps and document requirements when handling various claims scenarios.
• Develop proficiency in reviewing medical records and in analyzing various contracts (leases, contractor agreements).
• Participates in special projects and performs additional duties as required.

Liability Claims Examiner, Trainee

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, including CEOs, claimants, providers' offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster – Northeast Jurisdictions

• Investigating, evaluating, negotiating, and settling workers compensation claims on behalf of our clients.
• Communicating with a wide variety of individuals, to include CEO's, claimants, providers offices, and attorneys.
• Handling claims in multiple jurisdictions is vital for success in this role.

Workers Compensation Claims Adjuster, Northeast Jurisdictions

• Handle claims from coverage enquiry through legal liability assessment and quantum analysis
• Ensure timely and accurate resolution of claims and communicate developments to stakeholders
• Confirm coverage of claims by reviewing policies and submitted documents
• Prepare coverage position letters and refer suspicious losses to SIU
• Conduct, coordinate, and direct investigations into loss facts and extent of damages
• Direct and monitor assignments to experts and outside counsel
• Evaluate information on coverage, liability, and damages to determine insured's exposure
• Set reserves within authority and recommend reserve changes to manager
• Negotiate and settle claims typically in litigation within authority
• Present at roundtables to senior claims leaders on cases going to trial
• Participate in special projects and may lead larger projects
• Represent Markel at mediations, trials, and conferences
• Analyze loss information for business stakeholders and present findings during meetings
• Serve as a technical resource to underwriting and assist with drafting policy wording
• Assist in training new hires and providing guidance to others

Senior Claims Examiner, Construction

• Investigate, negotiate and settle complex primary and excess policy claims including legal malpractice
• Investigate and analyze coverage under primary and excess professional liability insurance policies
• Manage litigation filed nationwide against insureds
• Communicate with underwriting as needed to manage claims
• Maintain and adhere to Markel’s guidelines and procedures
• Contribute and assist in the implementation of a wide range of initiatives
• Actively participate in the ongoing training and development of the claims examiners

Executive Claims Examiner

• Serving as a Claims Specialist focused on Employment Practices Liability claims
• Determining the appropriate valuation of complex claims
• Recommending settlement strategies and collaborating with insureds
• Traveling to participate in mediations and trials
• Developing claim and litigation strategies

Claims Specialist – Employment Practices Liability

• Review and approve Major Loss Reports for domestic and international losses
• Review reinsurance treaty contracts
• Identify large losses and high-profile matters
• Create and maintain Excel workbooks for data analysis
• Respond to non-MLR reinsurance verification requests
• Investigate and flag discrepancies and account issues
• Monitor and analyze financial impact of changes in reinsurance coverage
• Collaborate with colleagues on various projects
• Support AIG Next and reinsurance governance initiatives

Reinsurance Claims Analyst

• 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.

Claims Specialist jobs in New Jersey

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