Claims Specialist

• To analyze Lost-Time Workers Compensation 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.
• 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 Adjuster – DE & CT Jurisdiction Knowledge Required – PA NJ MA Preferred

• Make initial contacts with interest parties
• Handle moderate to high exposure construction defect claims involving residential and commercial projects.
• Analyze coverage and draft coverage position letters as needed
• Conduct liability investigations
• Comply with DOI regulations
• Retain and coordinate with defense counsel and experts to develop and execute agreed-upon litigation strategies, while managing plans and budgets to ensure effective case resolution
• Coordinate the retention of experts, subject to an agreed upon budget
• Establish timely indemnity and expense reserves based on an exposure analysis that is documented in the claim file, revisiting reserve adequacy on a continual basis
• Draft well written and comprehensive captioned reports to request reserve and settlement authority on higher exposure cases that outline all critical aspects of the case in preparation for roundtable presentations to the carrier partners
• Travel up to 10% to attend mediations, settlements conferences and trials on appropriate cases
• Keep current on key changes in case law and industry trends
• Assist underwriting and other business partners

Senior Casualty Claims Examiner – Construction

• Manages an active desk of general liability property damage claims under business owner policies
• Analyzes coverage issues under the Business owners coverage form, Excess and Umbrella coverage form, Garagekeepers, Hired/Non-owned Auto, Auto Services and other standard industry forms
• Analyzes, investigates, and evaluates new loss notices and claim tenders
• Handles litigated claims and actively coordinates and strategizes with defense counsel
• Expeditiously analyzes and positions claim under applicable coverage
• Collaborates on setting reserves at appropriate level for claims
• Uses good judgment in managing ALAE in claims investigation
• Appropriately documents claim files in accordance with established guidelines
• Obtains and maintains adjuster licenses, as required

Senior General Liability Claims Representative – Property Damage

• Responsible for communication, coordination, and administration of Paid Family Leave/Disability Claims within New York
• Determination of compensability and the prompt provision of benefits
• Work as a liaison between the employer and employee to provide information about Paid Family Leave/Disability
• Responsible for informing employers on the proper management and impact of Paid Family Leave/Disability claims

Medical Claims Representative – Paid Family Leave, Disability

• Learn to evaluate and determine the compensability of workers’ compensation claims in accordance with applicable laws and company policies
• Support early return-to-work initiatives and ensure timely delivery of benefits
• Communicate with employers, injured workers, and medical providers to facilitate claim resolution
• Authorize and monitor medical treatment and coordinate care with providers
• Maintain accurate documentation of all claim activity

Workers' Compensation Claims Associate

• Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines
• Confirm the presence of necessary documents within submitted claims
• Validate the accuracy of medical codes provided in claim submissions
• Assess the eligibility status of claims based on established criteria
• Review and verify other insurance coverage information in submitted claim
• Evaluate authorizations provided in claim submissions for accuracy
• Analyze account benefit plans to ensure claims align with coverage and policies
• Identify discrepancies, errors, or missing information
• Utilize multiple computer applications simultaneously
• Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision
• Meet or exceed quality and productivity goals
• Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows
• Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors

Claims Representative

• Investigate and resolve commercial auto liability and physical damage claims related to trucking
• Review policy language to determine coverage and consult with coverage counsel as needed
• Manage a caseload of moderate to high complexity claims, including higher exposure files
• Communicate with insureds, claimants, attorneys, repair facilities, and law enforcement to gather information
• Work with defense counsel and vendors on litigated claims and recovery efforts
• Handle claims in accordance with company guidelines and regulatory requirements
• Participate in file reviews, team meetings, and training

Senior Trucking Liability Claims Adjuster, JD Required

• 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

• To analyze mid- and higher-level general auto claims to determine scope of damages.
• To ensure ongoing adjudication of claims within company standards and industry best practices.
• To identify subrogation of claims and negotiate settlements.
• Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure.
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• Maintains professional client relationships.

Auto Claims Adjuster

• Provide direction and guidance throughout the life of the claim
• Direct the management of claims including investigation, coverage analysis, monitoring defense counsel activities, control of legal expenses, reserving, and providing technical expertise
• Participate in review processes to evaluate coverage, liability, causation, damages, case value, reserves, and manage total claims cost
• Collaborate with defense counsel regarding case value, defense tactics, and strategies
• Responsible for preparing reports for management by collecting, analyzing, and summarizing claim information
• Represent the Company through attendance at trials, settlement conferences, mediations, and insured meetings
• Review and approve reasonable legal expenses and fees associated with the claim file and negotiate adjustment of charges when appropriate
• Recommend resolution strategies and participate in settlement negotiations when appropriate

Claims Specialist – Medical Professional Liability

• Manages an inventory of moderate to high complexity and exposure commercial claims
• Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners
• Verifies coverage and establishes timely and adequate reserves
• Conducts focused investigation to determine compensability, liability and covered damages
• Establishes and maintains working relationships with appropriate internal and external work partners
• Authorizes and ensures claim disbursements within authority limit
• Contributes to expense management by timely and accurately resolving claims
• Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences
• Achieves quality standards on every file by following all company guidelines
• Maintains compliance with state/local regulatory requirements

Workers Compensation Claims Specialist

• Receives and processes claims including entering/verifying claims data
• Resolves claim edits and determines benefit eligibility
• Reviews payment levels and elevates issues to supervision as necessary
• Meets production and quality standards, ensuring timely and accurate work
• Maintains accurate records including timekeeping
• Attends all required training classes

Associate Claims Processor

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

• Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
• Researches and analyzes claims issues.
• Learning the activities/tasks associated with his/her role.
• Works under direct supervision.
• Relies on others for instruction, guidance, and direction.

Claims Processor I

• Responsible for the investigation, evaluation and resolution of commercial automobile claims involving property damage
• Arch’s point of contact with customers – directing and making decisions regarding the repair process from beginning to end
• Managing your own inventory while working independently to negotiate repair pricing and assess liability
• Investigate, evaluate, and resolve commercial auto claims nationwide
• Identify and assess coverage issues
• Execute on claims strategies to achieve claims quality, customer service and operational objectives
• Coordinate vehicle inspections, review estimates, manage rental and salvage and set clear expectations
• Document information related to the claims and make decisions consistent with claims standards
• Evaluate and handle claim payments
• Review and determine validity of any supplement requests
• Serve as a mentor to less-experienced claims professionals

Claims Examiner, Commercial Auto

• Establishes immediate contact with Policyholders and claimants.
• Conducts extensive investigations into causes and origins of all major property claims.
• Interviews insureds, claimants and others as required.
• Inspects property damage, reviews information to prepare estimates, evaluates and makes recommendations regarding coverage of claims, determines liability and total value of claims and negotiates settlements.
• Sets and maintains adequate reserves.
• Exercises discretion and independent judgment in evaluating property damage in order to determine the extent of damage.
• Determines liability and total value of claim, develops estimate and obtains an agreed scope of work and cost of repair with contractor and/or Policyholder.
• Determines value as they apply to the coverage.
• Determines steps necessary to initiate investigation of a property loss.
• Uses outside experts and attorneys as required.
• Documents claim files and submits final report to file for closure.
• Assigns and supervises the handling of property losses by independent adjusters when necessary.
• Advises claims adjusters regarding handling of claims.
• Conducts related training of field office claims personnel in the branch and at the Home Office.
• Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department.
• Establishes and maintains relationships with local, state and regional organizations and agencies which are involved in related activities.
• Acts as coordinator of the Catastrophe Team activities at catastrophe site.

Property Claims Specialist

• Evaluate coverage on sophisticated insurance products
• Hire and manage counsel to help evaluate coverage and to defend our insureds.
• Assess damages with support of outside experts
• Evaluate financial impact to AIG and to our insureds
• Formulate and execute strategies for favorable claim resolution; negotiate with insureds and third parties.
• Advise business partners concerning exposures and concerning potential product changes and enhancements.
• Advise claims and business leaders on emerging risks.

Senior Claims Adjuster – Casualty Coverage, Mass Tort

• 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

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

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