Claims Specialist

• Conduct field based investigations by visiting policyholders’ homes
• Use claims handling software, a company car and laptop
• Represents the Company and must conduct oneself as a member of Management
• Use strong customer service skills to negotiate with policyholders

Field Property Claims Adjuster

• Processes and review subrogation claims across all lines of business and all jurisdictions with a mid-level caseload and complexity.
• Processes payment checks received in accordance with company check processing guidelines.
• Processes regular recovery files.
• Coordinates with collection agencies and adheres to company standards and industry best practices within the Claims Recovery Team.
• Responsible for assigned inventory of mid-level subrogation files with recovery.
• Maintains a diary, on cadence, aligned to department service expectations and schedules follow up to ensure timely payment.
• Processes recoveries into various claims systems to ensure the recovery dollars are applied to appropriate claims file.
• Analyzes and processes invoices for various internal/external vendors involved in recoveries including attorneys, collections, and independent investigators.
• Works with collections agencies when appropriate to collect from at-fault parties and records details in claims file.
• Notifies appropriate parties of subrogation lien.
• Uses technology and resources as needed to complete investigation.
• Responds to clients' questions timely and professionally.
• Prepares various type status reports for clients.

Recovery Claims Representative, License Required

• To analyze complex or technically difficult workers compensation claims to determine benefits due;
• to work with high exposure claims involving litigation and rehabilitation;
• and to ensure ongoing adjudication of claims within company standards and industry best practices or client specific requirements.
• Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim;
• manages claims through well-developed action plans to an appropriate and timely resolution.
• Works to move claim towards appropriate claim closure which may include referral for settlement evaluation.
• Monitors reserve adequacy throughout the life of the claim if applicable.
• Monitors and reviews benefits due and payment calculations ensuring accuracy.
• Prepares necessary state filings within statutory limits.
• Follows best practice standards in contested claims including outside legal representation.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
• Ensures claims files are properly documented and claims coding is correct.
• Maintains professional client relationships.
• Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.
• Assesses policy level status of clients; works in coordination with clients' service expectations and assigned service personnel.

Claims Examiner – Workers Comp

• To analyze and process low to mid-level auto and transportation claims.
• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy.
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.
• Maintains professional client relations.
• Performs coverage, liability, and damage analysis on all claims assignments.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Claims Representative, Auto

• Streamlined Processing: Ensure claims accuracy and timely submission, minimizing disruptions for patients and practices.
• Issue Resolution: Address rejected or denied claims promptly, resolving challenges with finesse and professionalism.
• Account Integrity: Conduct thorough audits and manage escalation cases, safeguarding the integrity of every account.
• Financial Recovery: Track and recover missing payments efficiently, optimizing revenue streams for our practices.
• Technological Mastery: Utilize cutting-edge platforms like sFax, Adobe, PureCloud, and JIRA with proficiency, enhancing workflow efficiency and collaboration.
• Professional Growth: Take ownership of your development journey, embracing opportunities for advancement and skill enhancement.
• Cross-Functional Collaboration: Foster strong relationships across OrthoFi departments, understanding their functions and enhancing synergy for maximum impact.

Claims Coordinator

• Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy.
• Updates Explanation of Benefits (EOB), pays and closes claim.
• May order medical records from providers.
• May communicate with clients and providers during treatment.
• Works closely with veterinary hospitals and policyholders to evaluate and review a pet’s medical history to determine a baseline of health.
• Performs other duties and responsibilities as assigned.

Claims Adjuster – Associate

• Investigates, evaluates and adjusts surety bond claims
• Reviews and evaluates coverage and/or liability
• Secures all necessary information and parties’ positions to investigate assigned claims
• Retains and directs approved consultants and outside counsel to assist in the investigation of claims
• Manages litigation process for claims that result in litigation
• Responsible for maintaining cost controls and overseeing the work of outside counsel
• Determines available avenues of recovery and their cost-effectiveness; coordinates approved recovery effort
• Establishes and maintains timely and accurate loss reserves
• Prepares periodic reports and financial evaluations
• Affects settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority
• Ensures that claims payments are issued in a timely and accurate manner
• Ensures compliance with claims handling pursuant to all state, legal, statutory, and regulatory bodies to comply with all company procedures and requirements

Senior Claims Representative, Bond Division

• Handles liability and property claims within designated authority under close supervision.
• Resolves coverage and/or liability issues in accordance with applicable state insurance laws, regulations, and procedures.
• Investigates and adjudicates claims ensuring compliance with appropriate statutory laws.
• Verifies coverage, establishes and maintains reserves, and secures recorded statements.
• Obtains additional information as required to determine liability and documents claim files.

Inside Claims Representative I

• Manages a large inventory of highly complex claims to evaluate compensability/liability
• Strategically orchestrates and leads comprehensive claims investigations to confirm coverage and to determine liability, compensability, and damages
• Analyzes and negotiates appropriate claim settlements/reserves within prescribed authority
• May attend arbitrations, mediations, depositions, or trials
• Conveys highly complex information regarding coverage and settlements to insureds, claimants, and external partners
• Authorizes payments in accordance with assigned authority limit, ensuring timely disbursement
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements
• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports
• Performs other duties as assigned

Senior Workers Comp Claims 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.

Workers Compensation Claims Examiner

Liability Claims Representative – CA, OH, IN, KY Jurisdictional Knowledge – Licensing Required

• Review and monitor open claims files
• Provide assistance with coverage, liability, and damage determinations
• Review closed files and provide feedback to claim handlers
• Review open and closed files to ensure adherence to claim handling guidelines and state’s Fair Claims Practices
• Assist associates in identifying claims with subrogation potential
• Manage the arbitration process for subrogation files
• Assist in developing and presenting educational material to claim associates in classroom and remote settings
• Work effectively with associates and customers at all levels

Claims Examiner – Subrogation Claims

• 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 Workers Comp Claims Representative

Liability Litigation Claims Examiner – Litigation, Premise, Auto, BI & Product Claims Experience

• 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

Liability Claims Examiner, GL, Auto, Bodily Injury, Professional Liability

• To analyze mid- and higher-level workers compensation claims to determine benefits due.
• To ensure ongoing adjudication of claims within company standards and industry best practices.
• To identify subrogation of claims and negotiate settlements.
• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.

Claims Adjuster

• The Quality-Coordinator is responsible performing duties of a commercial claims coordinator to facilitate the resolution of claims for the commercial claims team.
• Perform quality inspection duties as required for product not produced in Tarkett North America plants, including Tarkett Europe, and external supplied products.
• Ensure effective coordination between the Company and its customers with a high level of service and support.
• Maintain positive business relationships both internally and externally to promote company goals.
• Serve as the point of contact for filing manufacturing claims, the analysis of those claims for accuracy, completeness and eligibility along with the resolution of claims to the customers’ satisfaction.
• Responsible for the end-to-end claims processing, working to enter, advance and close claims within the established claims processing guidelines.
• Work closely with the Sales team and with key Distributors to ensure all communications follow the direct sales or distribution channel.
• Summarize information and respond to the customer with claim status after investigation.

Quality Claims Coordinator

• Investigates claims to determine cause, determines scope and amount of loss, verifies coverage and recommends ultimate resolution on assigned cases.
• Ability to accurately and independently interpret policies on all lines of business (Personal, Commercial & Farm).
• Promptly and accurately document all developments in claim file.
• Prepares accurate, clear, thorough, and concise notes or correspondence on conclusions and recommendations.
• Resolves claims within authority or subsequent Home Office approval.
• Identifies potential suspicious claims or possible third-party subrogation.
• Accountable for security of financial processing of claims, as well as security information contained in claims files.
• Ensures accurate reserves and adjusts as warranted.
• Recommends reserve increases on cases in excess of authority.
• May be necessary to prepare for and may attend trials, settlement conferences, and policyholder meetings.
• Present company position on coverage and disposition issues.
• Confers directly with policyholders on coverage and resolution issues pursuant to Home Office instructions.
• Analyzes assigned claims and plans for their investigation, may participate in training programs, conferences and departmental and intra-departmental meetings.
• May communicate with excess carriers and reinsures on case status and development.
• Perform onsite and virtual inspection of damages to resolve coverage and damage issues to including preparing complete estimates of repair for the covered damages.
• May work with contractors, building consultants or independent adjusters in the estimation process, as directed by Home Office.
• Proficient in writing estimates for building repairs.
• Manages claims for business interruption and proactively manages the period of restoration.
• Mentor Claim Representatives and Senior Claim Representatives upon request.
• Maintain continuing education.

Property Claims Specialist – Field

• Manage complex and high-severity insurance claims across assigned lines of business
• Provide advanced technical expertise and ensure compliance with regulatory standards
• Support training and mentoring of junior staff
• Direct the investigation, evaluation, negotiation, and resolution of high complexity claims
• Deliver timely, equitable claim resolutions while maintaining strict adherence to policy provisions, regulatory requirements, and organizational standards
• Cultivate strong relationships through effective communication with policyholders, attorneys, vendors, and cross-functional internal teams
• Mentor and train Claims Representatives and support staff

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Field Property Claims Adjuster

Recovery Claims Representative, License Required

Claims Examiner – Workers Comp

Claims Representative, Auto

Claims Coordinator

Claims Adjuster – Associate

Senior Claims Representative, Bond Division

Inside Claims Representative I

Senior Workers Comp Claims Specialist

Workers Compensation Claims Examiner

Liability Claims Representative – CA, OH, IN, KY Jurisdictional Knowledge – Licensing Required

Claims Examiner – Subrogation Claims

Senior Workers Comp Claims Representative

Liability Litigation Claims Examiner – Litigation, Premise, Auto, BI & Product Claims Experience

Complex Claims Representative

Liability Claims Examiner, GL, Auto, Bodily Injury, Professional Liability

Claims Adjuster

Quality Claims Coordinator

Property Claims Specialist – Field

Claims Adjuster