Claims Specialist

• Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding Voluntary Claims.
• Leveraging knowledge of coverage, contract provisions, eligibility & benefits as well as other appropriate resources to review submitted claim information for payment.
• Applying core knowledge of voluntary insurance products and claims processes to review questions/concerns and provide specific information to internal/external stakeholders.
• Making routine & non-routine decisions under close supervision, applying limited discretion within role.

Voluntary Claims Specialist

• Handle entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution
• Provide service to agents, insureds, and others to ensure claims resolve accurately and timely
• Participate in training and development completion of the Company’s claims training program for the assigned line of insurance
• Investigate, evaluate, and settle entry-level insurance claims
• Study insurance policies, endorsements, and forms to develop foundational knowledge on Company insurance products
• Learn and comply with Company claim handling procedures
• Develop entry-level claim negotiation and settlement skills
• Build skills to effectively serve the needs of agents, insureds, and others
• Meet and communicate with claimants, legal counsel, and third-parties
• Develop specialized skills including but not limited to, estimating and use of designated computer-based programs for loss adjustment
• Study, obtain, and maintain an adjuster’s license(s), if required by statute within the timeline established by the Company or legal requirements.

Auto Claims Representative

• 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

• 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

• Handles insurance claims in the field under general supervision
• Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
• Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
• Become familiar with insurance coverage by studying insurance policies, endorsements and forms
• Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
• Ensure that claims payments are issued in a timely and accurate manner
• Handle investigations by phone, mail and on-site investigations

Field Claims Representative

• 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

• Handle insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution
• Provide service to agents, insureds, and others to ensure claims resolve accurately and timely
• Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
• Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
• Become familiar with insurance coverage by studying insurance policies, endorsements and forms
• Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
• Ensure that claims payments are issued in a timely and accurate manner
• Handle investigations by phone, mail and on-site investigations

• Handles claims, moderate to severe in scope, relative to homeowner’s property based on Claim Guidelines.
• Perform CAT duty as needed that will require occasionally working weekend hours, overnight hours, holiday hours (Federal and religious), etc.
• Follows standard practices and procedures in analyzing situations or data where answers can be readily obtained.
• Verifies/analyzes applicable coverage for the reported loss.
• Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file.
• Investigates each claim by gathering information, conducting interviews, taking statements, conducting website research as needed, reviewing and analyzing reports and related bills.
• Identifies and addresses subrogation/contribution/SIU opportunities.
• Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines.
• Evaluates, negotiates, and authorizes settlements with all stakeholders within designated authority.
• Selects, directs and manages Vendors/Counsel including approval of defense budgets.
• Negotiates directly with claimants and claimant attorneys upon receipt of critical information.
• Drafts correspondence, including but not limited to, coverage letters to stakeholders as required.
• Maintains resident/nonresident adjuster licenses as required.
• Works on problems of limited scope.
• Follows standard practices and procedures in analyzing situations or data from which answers can be readily obtained.
• Perform other duties as needed

Homeowners Property Claims Specialist

• Responsible for active case management of Life claims
• Ensures claims are processed accurately within regulatory and company guidelines
• Deliver an exceptional customer experience and ensure customer commitments and deliverables are achieved
• Review and interpret medical records, utilizing resources as appropriate
• Complete financial calculations specific to claims when applicable
• Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
• Apply contract/policy provisions to ensure accurate eligibility and liability decisions
• Foster strong relationships with customers to understand their needs and ensure high levels of satisfaction

Life Claims Examiner

• Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding Long Term Disability Claims and state and federal benefits when applicable.
• Collaborating with fellow case managers, nurse case managers, vocational case managers, and consulting physicians to make appropriate, ethical, and timely claim determinations.
• Reviewing complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning throughout the life of the claim.
• Providing exceptional customer service and proactively recognizing customer needs and areas of opportunity.

Recertification Claims Specialist

• 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

• Investigate and resolve litigated claims in an efficient and accurate manner.
• Negotiate settlements and communicate effectively with policyholders, vendors, and other stakeholders.
• Verify coverages through investigation and reviewing policy terms, conditions, and language.
• Evaluate liability by taking recorded statements from involved parties and witnesses and reviewing police reports, accident scene photos, and other pertinent evidence.
• Negotiate claims settlements with claimants and their legal representation within assigned authority limits.
• Comply with industry regulations, legal requirements, and internal policies through thorough documentation of all decisions, correspondence, and discussions that occur throughout the life cycle of the claim.
• Work with and mentor other associates.

Claims Representative Specialist – Litigation

• 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

• Manages an inventory of claims to evaluate compensability/liability
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority
• May attend arbitrations, mediations, depositions, or trials
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners
• Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements
• Performs other duties as assigned.

Senior Claims Specialist

• 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

• 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

• Provide quality investigation and analysis to adjust claims of low complexity/severity
• Collaborate and communicate with agents, policyholders and internal stakeholders on claims 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
• Collaborate with manager and counsel to manage litigated claims
• Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing

Workers' Compensation Claims Adjuster

• 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

• Investigate and handle personal and commercial auto bodily injury claims of a complex and serious nature.
• Perform special claims investigations and handle matters requiring broad technical claims knowledge.
• Operate on an independent basis with little supervision.
• Settle claims within assigned authority.
• Maintain contact with attorneys concerning serious claim matters.
• Review court decisions, law and coverage interpretations.
• Broad knowledge and understanding of the law and claim practices.
• May assume duties of the Claims Supervisor in the Supervisor's absence.

Claims Specialist jobs in North Carolina

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Voluntary Claims Specialist

Auto Claims Representative

Associate Claims Clinical, Care Advocacy

Senior Technical Specialist – General Liability Claims

Field Claims Representative

Senior Liability Claims Specialist

Field Claims Representative

Homeowners Property Claims Specialist

Life Claims Examiner

Recertification Claims Specialist

Claims Processor – Part-Time

Claims Representative Specialist – Litigation

Senior Workers' Compensation Claims Adjuster

Senior Claims Specialist

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing Required

Property Claims Examiner II – Wind/Hail

Senior Commercial Claims Specialist, GL & Auto

Workers' Compensation Claims Adjuster

Lost Time Claims Adjuster – Workers' Compensation

Senior Claims Specialist – Auto Bodily Injury