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

• Investigate, evaluate, and adjust multi‑line liability claims (property damage & bodily injury) in accordance with CCMSI standards and state requirements.
• Manage claims involving commercial vehicles, trucking exposures, and third‑party liability.
• Determine coverage, assess liability, and develop defensible claim strategies.
• Review medical, legal, and vendor invoices for accuracy and reasonableness; negotiate discrepancies as needed.
• Establish, monitor, and adjust reserves in alignment with exposure and authority guidelines.
• Negotiate settlements with claimants, attorneys, and representatives in accordance with client expectations.
• Engage, coordinate, and manage defense counsel or other external vendors when appropriate.
• Identify and pursue subrogation opportunities.
• Maintain detailed and timely claim documentation, diary management, and financial reporting.
• Support excess reporting requirements and client communication needs.
• Deliver consistent, high‑quality service with professionalism and integrity.

Multi-Line Claims Adjuster – Commercial Auto, GL/BI

• 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

• Investigating basic and occasionally moderately complex auto insurance claims.
• Evaluating coverage, determining liability, and negotiating settlements.
• Working directly with claimants, insureds, and other involved parties to ensure timely, accurate, and customer-focused claim resolution.
• Ensuring compliance with all regulatory requirements and company standards throughout the claim lifecycle.
• Conducting recorded statements with claimants, insureds, and witnesses.
• Maintaining detailed and well-documented claim files, including notes, summaries, and decision rationale.
• Collaborating with internal teams to support efficient and customer-centric claim handling.

Inside Auto Claims Adjuster

• 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

• 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

• 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

• Manages mid-level water damage claims by gathering information to determine liability 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.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Claims Examiner - Workers Compensation

• Responsible for working with repair facilities to validate, adjudicate, and approve payment for diagnostics and repair recommendations for pre-sale repairs as well as customer vehicles under warranty.
• Properly adjudicates claims within approval limit and in accordance with department & industry standards.
• Accurately notates all actions taken and interactions with shops and customers within internal systems ensuring proper documentation of interactions.
• Effectively navigates department resources in order ensure adherence to department process flows and policies.
• Manages list of assigned pending claims and provides timely follow up with repair facilities to decision claims.
• Other duties as assigned.

Mechanical Claims Adjuster

• Manage a desk and caseload of workers’ compensation claims in an efficient and professional manner
• Investigate claims thoroughly, including coverage, liability, and exposure analysis
• Evaluate claim exposure and maintain accurate and timely reserves
• Manage litigation activity and coordinate with defense counsel as needed
• Evaluate claims for settlement and negotiate resolutions with claimants and attorneys
• Monitor and manage medical treatment activity and claim progression
• Maintain accurate, timely, and organized claim documentation within the claims system
• Ensure claim payments are processed accurately and timely
• Support timely and compliant claim resolution strategies
• Maintain communication with employers, injured workers, attorneys, medical providers, and clients throughout the claims process
• Participate in required training and maintain knowledge of assigned state workers’ compensation statutes
• Perform additional duties and projects as assigned

Workers Compensation Claims Examiner

• Gain knowledge to verify coverage, compensability, and reasonable payments by thoroughly reviewing the policy, reviewing accident details, and other pertinent information related to the claim.
• Develop investigative claims skills by taking and reviewing recorded statements from involved parties and witnesses, reviewing police reports, and other pertinent evidence.
• Build knowledge to evaluate claims exposure appropriately, establishing timely reserves.
• Comply with industry regulations, legal requirements, and internal company policies through thorough documentation of all decisions, correspondence, and discussions that occur throughout the life cycle of the claim.
• Support customers with empathy and understanding, assisting them through difficult situations and effectively communicating the claims process, ongoing claim status, and decisions, including the reasoning behind them.
• Ability to obtain and maintain state licensing requirements.

Claims Specialist jobs in Tennessee

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Associate Claims Clinical, Care Advocacy

Multi-Line Claims Adjuster – Commercial Auto, GL/BI

Claims Representative, Casualty Large Loss, Auto Injury

Inside Auto Claims Adjuster

Claims Representative Specialist – Litigation

Senior Claims Specialist

Workers Compensation Claims Representative – Multiple Jurisdictions & Licensing Required

Property Claims Examiner II – Wind/Hail

Lost Time Claims Adjuster – Workers' Compensation

Claims Examiner - Workers Compensation

Mechanical Claims Adjuster

Workers Compensation Claims Examiner

Claims Representative, Entry Level – Fast Track

Workers Compensation Claims Examiner