Claims Specialist

• Manage a caseload of General Liability, Construction Defect, and Professional Liability claims from first notice of loss through resolution
• Conduct thorough coverage analysis on all new losses
• Investigate claims by gathering and analyzing relevant documentation
• Assign, direct, and manage outside defense counsel
• Maintain accurate and timely reserves on all files
• Proactively communicate with insureds, brokers, and carriers on claim status
• Identify subrogation, contribution, and recovery opportunities on applicable files

Claims Examiner – General Liability, Professional Lines

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost-effective claims resolution.
• 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.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

Claims Examiner – Workers Compensation, TX preferred

• Investigates, evaluates, and resolves property damage and general liability claims
• Conducts or coordinates field inspections, property assessments, and damage estimates for property claims as required
• Prepares coverage position letters, and issues reservation of rights correspondence as appropriate
• Develops and executes resolution strategies with clear file notes reflecting focus, control, and momentum
• Maintains timely diary management and accurate documentation of all claim activity

Senior Claims Examiner, Property

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

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Claims Specialist II

• Provide concierge-level customer service to one of Group Insurance’s largest clients
• Take a consultative approach in guiding and coaching our client’s employees through the life cycle of a disability claim
• Deliver world-class service that ensures a more effortless experience for the employee
• Engage Expert Resources to further enhance the claim journey, addressing Behavioral Health and Vocational opportunities within their block of claims
• Interact directly with the Leave team at the client during quarterly virtual meetings
• Interface daily with the client’s Benefits Business Partners
• Seek out opportunities to further enhance the claimant experience
• Serve as an ambassador for continuous process improvement within the Concierge Team
• Oversee a block of complex claims, including those with co-morbidities, behavioral health issues, and self-reported symptoms

See all jobs on JobTailor

Claims Examiner – General Liability, Professional Lines

Claims Examiner – Workers Compensation, TX preferred

Senior Claims Examiner, Property

Senior Claims Adjuster, Large Loss

Claims Specialist II

Senior Disability Claims Examiner