Claims Specialist

• 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

• Acting as the primary support contact for the application's end‐users
• Identifying issues that arise in their application area as well as issues that impact other application teams, and working to resolve them
• Guiding workflow design, building and testing the system, and analyzing other technical issues associated with Epic software
• Identifying and implementing requested changes to the system
• Serving as a liaison between end users' workflow needs and Epic implementation staff
• Maintaining regular communication with Epic representatives, including participating in weekly project team meetings
• Working with Epic representatives, your organization's business community, and end users to ensure the system meets the organization's business needs in regards to the project deliverables and timeline
• Developing an understanding of operational needs to set the direction for the organization's workflows by attending site visits and other integrated sessions
• Participating in training and working with end users
• Troubleshooting problems and questions
• Reviewing the status of projects and issues on an ongoing basis with leadership

Epic Application Analyst – Resolute Claims I - IV

• 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

• Provide exceptional customer support for incoming and outgoing Provider Claims processing
• Review, research, and process claims
• Refer claims to appropriate department and prepare RTP forms
• Maintain accurate workload tracking and communicate status updates

Claims Resolution Specialist

• Manage Workers' Compensation medical-only claims from initial report through resolution.
• Determine compensability and ensure timely delivery of benefits.
• Coordinate medical treatment and facilitate early return-to-work efforts.
• Review and process medical bills for payment.
• Serve as a liaison between injured workers, employers, and medical providers.
• Provide guidance regarding Workers' Compensation processes and claim management.
• Maintain accurate claim documentation and comply with applicable regulations and company procedures.

Claims Representative – Medical Only

• Investigates, evaluates, negotiates, and resolves assigned claims
• Handles the most complex claims with minimal manager oversight
• Establishes and maintains positive relationships with customers
• Assists in building business relationships with agents, insureds and partners
• Develops and mentors other associates
• Assists leadership in training and resources development
• Maintains proper reserving through proactive investigation
• Assists other departments with investigations as required

Claims Representative, Casualty Large Loss, Auto Injury

• 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

• Manage an inventory of moderate to high complexity and exposure commercial claims
• Provides exceptional customer service by interacting professionally with insureds and claimants
• Verifies coverage and establishes timely reserves by reviewing policy language
• Conducts investigations to determine compensability, liability, and covered damages
• Establishes working relationships with internal and external partners
• Authorizes claim disbursements and negotiates settlements
• Contributes to expense management by timely resolving claims and delivering high quality service
• Identifies and addresses potential fraud occurrences
• Maintains compliance with state/local regulatory requirements

General Liability Claims Specialist

• 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 an inventory of low to moderate complexity and exposure commercial claims.
• Investigates, evaluates, and resolves claims in accordance with company protocols.
• Verifies coverage and establishes timely and adequate reserves.
• Conducts investigations to gather pertinent information.
• Negotiates settlements and escalates to manager as appropriate.
• Maintains compliance with state/local regulatory requirements.

Commercial General Liability 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

• Adjudicate claims from initial intake to final settlement
• Handle claims pursuant to state specific insurance regulations along with K2 Claims’ Best Practices
• Provide excellent customer service to all stakeholders
• Respond to claim calls, emails, and requests from agents
• Work closely with partners to complete coverage evaluations
• Review and negotiate emergency service estimates with vendors
• Evaluate subrogation/salvage opportunities

Senior Property Claims Examiner

• Responsible for the investigation, evaluation and settlement of claims arising from physical damages to vehicles, property of customers (higher and more complex cases) and third parties (medium to high exposure bodily injury claims)
• Direct tasks and activities of independent adjuster and other support services
• Review and negotiate rates for services provided
• Supervise work product of subordinate adjusters on complex claims
• Perform a variety of duties which require in-depth knowledge, specialized training and experience to understand risks under management, products offered and insurance investigation techniques within the claims office
• Maintain integrity of proprietary information

Claims Adjuster II

• Reviews claims and extracts information for processing
• Assists beneficiaries and family members with questions and claim status through an incoming call line
• Collects information and processes death claims
• Verifies, corrects, and completes claims information by telephone, letter, or personal contact
• Conducts investigations and gathers supporting documentation on claims
• Calculates benefits payable
• Approves (to a specified amount) or denies claims in accordance with established procedures

Senior Claims Examiner – Virtual

• Responsible for the prompt review of policy information to determine coverage for loss/damage/injury
• Conduct an efficient claim examination and investigation leading to the final resolution of liability claims
• Frequent contact and interaction with involved parties including claimants and their legal representatives
• Maintain an ongoing diary and prepare Loss Reports providing thorough analysis of coverage, liability, and damages.

Commercial Auto, BI & GL Claims Examiner III

• Responsible for the prompt review of policy information to determine coverage for loss/damage/injury.
• Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation.
• Frequent contact and interaction with involved parties including claimants and their legal representatives.
• Recommendations regarding loss exposure and associated reserve and settlement strategy communicated to the client.
• Review and interpret coverage, process, and conclude assigned Personal Injury Protection (PIP) claims including investigation and evaluation of Auto and/or General Liability Casualty Claims in the jurisdiction of NY and NJ.
• Respond to PIP Arbitration Proceedings.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of coverage, liability, and damages.
• Determine if subrogation and/or risk transfer exists and initiate recovery efforts in the direction of the client.
• Document all correspondence, reports, discussions, and decisions in the claim file record.
• Provide outstanding service to the client.

Commercial Auto No Fault, PIP Claims Examiner III – Temp

• Investigate, evaluate and settle more complex first and third-party commercial insurance property claims.
• Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
• Communicates with all relevant parties and documents communication as well as results of investigation.
• Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
• Travel is required to attend customer service calls, mediations, and other legal proceedings.

Claims Specialist – Professional Liability

• 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.

Claims Specialist jobs in Pennsylvania

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