Claims Specialist

• Develop and execute the vision of the General Motors Insurance quality improvement function within the claims department, continuously improving, and enhancing this function in accordance with claims best practices and regulatory requirements
• Create and maintain file audit dashboards to educate Claims leadership on trends, performance, and opportunities for improvement
• Develop and implement automated systematic claims handling quality file review and audit processes
• Collaborate with claims leaders to develop and implement policies, standards, processes, controls, and related documentation of best practices, guidelines, and workflows to ensure a center of excellence within Claim Quality Improvement
• Develop and implement quality and compliance reviews of General Motors Insurance Company claims to ensure quality and appropriate service results, to drive best in class claims handling
• Develop meaningful, updated audit forms calibrated to claims best practices and current regulatory requirements, analyze audit results, reporting on the results, and developing post-audit management action plans to drive continuous improvement
• Monitor, coordinate, track, measure, and report to internal stakeholders trends, issues, opportunities, and analysis on file quality data
• Collaborate with Claims leadership and related internal stakeholders on training initiatives, job aids, guidelines to continuously improve claims handling quality and execution in support of team and individual professional growth and development
• Bring a solid understanding of compliance issues and regulatory environment in all project development and implementation.
• Build and maintain key relationships with internal stakeholders (e.g., Peers, Operations, Learning & Development, various executive management leaders) and external stakeholders (e.g., auditors and vendors)

Claims Quality Improvement Analyst

• Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability.
• Partners with vendors and internal business partners to facilitate complex claims resolution.
• May also involve external regulatory coordination to ensure appropriate documentation and compliance.
• Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources.
• May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.
• Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate.
• Determines coverage through analyzing information involving complex policy terms and contingencies.
• Determines and negotiates complex claims settlement within authority limits.
• Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes.
• Maintains accurate, thorough, and current claim file documentation throughout the claims process.
• Advance knowledge of estimating technology platforms and virtual inspection tools.
• Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims.
• Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
• May be assigned CAT deployment travel with minimal notice during designated CATs.
• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
• Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience.
• Adjusts complex claims with attorney involvement.
• Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.
• May require travel to resolve claims, attend training, and conduct in-person inspections.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Property Claims Adjuster Specialist – Desk

• Adjusts attorney-involved moderately complex bodily injury claims with demonstrable injuries (e.g. torn meniscus, broken bones, disc herniations), as well as all auto physical damage associated with those claims
• Identifies, confirms, and makes coverage decisions on moderately complex bodily injury claims
• Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines
• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions
• Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates
• Collaborates and supports team members to resolve issues and identify appropriate matters for escalation
• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution
• Supports workload surges and/or Catastrophe Operations as needed
• May act as an informal resource for team members with less experience

Senior Injury Claims Adjuster

• 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.

Claims Adjuster – Workers Compensation

• Analyze complex coverage issues, conduct detailed investigations, and evaluate damages and liability to determine the validity of moderate to highly complex commercial property and casualty claims
• Handle high-exposure property losses, including large commercial building, business personal property, business interruption, inland marine, equipment breakdown, crime, and bond claims
• Investigate and evaluate third-party casualty claims, including general liability, premises liability, product liability, contractual liability, and bodily injury/property damage claims
• Formulate and issue formal coverage position letters and liability determinations based on policy language, facts, and applicable legal principles
• Conduct comprehensive investigations, including interviews of insureds, claimants, witnesses, and other involved parties to determine coverage, liability, causation, and damages
• Coordinate and manage field investigations, site inspections, scene examinations, and independent adjuster assignments as necessary
• Identify, retain, and manage experts including engineers, building consultants, forensic accountants, cause-and-origin specialists, medical professionals, accident reconstructionists, and defense counsel to support claim resolution
• Review and analyze repair estimates, contractor bids, engineering reports, medical records, litigation documents, and expert evaluations to determine the extent of damages, liability exposure, and appropriate claim disposition
• Assess comparative negligence, liability defenses, subrogation opportunities, and risk-transfer provisions where applicable
• Establish, monitor, and recommend appropriate reserves based on claim complexity, damages, liability exposure, and settlement potential
• Develop and execute claim resolution strategies for large-loss and high-severity claims, including those with significant litigation potential
• Collaborate with defense counsel and litigation management teams on litigated matters, monitoring case strategy, budgets, exposure assessments, and settlement opportunities
• Prepare detailed large loss and management reports summarizing coverage positions, liability assessments, damage evaluations, reserve adequacy, and settlement recommendations
• Present claim evaluations and settlement recommendations to management for claims exceeding assigned authority limits
• Negotiate fair and timely settlements with insureds, claimants, attorneys, contractors, and other parties within delegated authority
• Communicate effectively with insureds, agents, brokers, claimants, attorneys, and internal business partners to provide superior customer service and ensure transparency throughout the claims process
• Manage a high-volume and complex caseload while maintaining proactive diary management and meeting all regulatory and company service standards
• Maintain complete, accurate, and organized claim files in accordance with company policies, best practices, audit standards, and regulatory requirements
• Identify trends, emerging risks, and exposure concerns and provide recommendations to management regarding claim handling strategies and risk mitigation opportunities

Senior Claims Adjuster, Property and Casualty

• Extensive policy document and legal contract interpretation
• Ability to analyze and identify coverage and related coverage issues
• Leverage a working knowledge of insurance contracts, Unfair Claims Settlement Practices, insurance codes, civil codes, vehicle codes, arbitration rules and regulations, tort law, claims best practices handling and management as part of your ongoing adjudication of claims
• Manage, investigate, and resolve claims within prescribed authority levels
• Recommend ultimate resolution on assigned cases in excess of authority to claims management
• Rely on a deep background of litigation handling experience in both General Liability and Casualty files to resolve claims
• Consistently drive litigation, attend mediations, trials, and other alternative dispute resolution avenues
• Communicate with policyholders, witnesses, and claimants in order to gather information regarding claims, refer tasks to auxiliary resources as necessary, and advise as to the proper course of action
• Preemptively communicate and respond to various written (email, SMS, fax, mail) and telephone inquiries, including status reports
• Present file materials for authority and roundtables
• Work with nurses, doctors, and attorneys on file reviews
• Comply with all statutory and regulatory requirements of all applicable jurisdiction
• Meet detailed quality assurance standards and meet set goals for performance
• Set and revise case reserves in accordance with the reserving policy
• Identify potentially suspicious claims and refer to SIU; identify opportunities for third-party subrogation
• Be accountable for the security of the financial processing of claims, as well as security information contained in claims files
• Work with, and provide claim-specific guidance to, independent field adjusters
• Partner closely with internal teams and advise leadership of key claim activities and exposures

• Provides first notice of loss support and claim creation for Auto Claims
• Investigates to uncover the Auto claim customers' needs and manages the customer experience from Auto claim intake to the assignment of the claim
• Answers incoming calls and emails from customers or other parties involved in claims; provides timely and correct product and service information
• Assists customers by completing the first notice of loss process, directing calls, or initiating tools to assist the progression of the claim
• Ensures accuracy of first notice of loss entry
• Obtains and inputs information relating to accidents for new claim creation
• Assists with starting the claims process by initiating method of vehicle inspection, rental car set up, etc.
• Provides excellent customer service at all times
• Seeks guidance from team members to resolve issues and identify appropriate issues for escalation
• Contributes to business goals, performance metrics, and effectively uses tools & technology
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated catastrophic events

Claims FNOL Representative II

• Investigates, evaluates, and resolves first- and third-party property claims and general liability claims in compliance with Claim Handling Guidelines, Best Practices, and client-specific requirements
• Conducts site inspections, scene investigations, and recorded statements; gathers estimates, contractor bids, and supporting documentation to determine cause, origin, and scope of loss
• Analyzes property policy language, including perils, exclusions, valuation, and coinsurance provisions, and general liability policy language, including exclusions and retentions; prepares coverage position letters and issues reservation of rights correspondence as warranted
• Prepares or reviews property damage estimates using industry-standard estimating tools; evaluates repair and replacement costs and negotiates settlements with insureds, claimants, and contractors
• Establishes and maintains accurate reserves in accordance with applicable guidelines and client requirements
• Manages independent adjusters, appraisers, engineers, defense counsel, and other vendors to achieve timely, cost-effective outcomes on both expense and indemnity
• Coordinates with coverage counsel on complex coverage questions and monitors developments in underlying litigation
• Participates in mediations, settlement conferences, and large-loss roundtables as required
• Maintains timely diary management and thorough documentation of all claim activity, coverage determinations, reserve changes, and strategic decisions
• Prepares claim status reports and large-loss summaries for carriers and clients; participates in client claim reviews as required
• Provides outstanding service to internal and external stakeholders throughout the claims process
• Participates in team training, quality review processes, and departmental initiatives that support the continued growth of the claims operation

Senior Claims Examiner

• 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

• Demonstrate the ability to independently and timely manage all aspects of the most complex, high-value claims while exhibiting a detailed knowledge of the claim, a well-reasoned analytical focus and a clear strategy for resolution
• Provide proactive communications to customers and business partners in the management and resolution of claims
• Respond to inquiries from customers and provide superior customer service
• Review and analyze multiple complex policies and coverage parts (including general liability and umbrella/excess liability)
• Write and articulate clear, concise and accurate coverage positions
• Conduct investigations regarding claims and/or lawsuits
• Effectively manage litigation and counsel, inclusive of litigation planning/budgeting, and proactively position claims for resolution
• Develop and persuasively articulate complex coverage, liability and damage assessments
• Provide detailed impactful recommendations to leadership
• Pursue and finalize coverage and liability risk transfer against other liable parties and insurance carriers
• Conduct complex negotiations and articulate coverage/liability positions
• Attend mediations and trials as necessary
• Proactively manage accurate expense, reserve and financial transactions
• Consistently maintain up-to-date claims metrics

Claims Specialist – Latent Bodily Injury

• Proactively manages assigned claims caseload comprised of complex damages that require commensurate knowledge and understanding of claims coverage including potential legal liability
• Partners with vendors and internal business partners to facilitate complex claims resolution
• May also involve external regulatory coordination to ensure appropriate documentation and compliance
• Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources
• May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics
• Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate
• Determines coverage through analyzing information involving complex policy terms and contingencies
• Determines and negotiates complex claims settlement within authority limits
• Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes
• Maintains accurate, thorough, and current claim file documentation throughout the claims process
• Advance knowledge of estimating technology platforms and virtual inspection tools
• Utilizes platforms and tools to prepare claims estimates to manage complex property insurance claims
• Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours
• May be assigned CAT deployment travel with minimal notice during designated CATs
• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed
• Works independently solving complex problems with minimal guidance; acts as a resource for colleagues with less experience
• Adjusts complex claims with attorney involvement
• Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations
• May require travel to resolve claims, attend training, and conduct in-person inspections
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Property Adjuster Specialist – Field Claims

• Independently and timely manage all aspects of the most complex, high-value claims
• Provide proactive communications to customers and business partners in the management and resolution of claims
• Review and analyze multiple complex policies and coverage parts (including general liability, contractors professional liability and wrap-up policies)
• Write and articulate clear, concise and accurate coverage positions
• Conduct investigations regarding claims and/or lawsuits
• Effectively manage litigation and counsel, inclusive of litigation planning and budgeting
• Develop complex coverage, liability and damage assessments and persuasively articulate them to leadership
• Pursue and finalize coverage and liability risk transfer against other liable parties and insurance carriers
• Attend mediations and trials as necessary
• Proactively manage accurate expense, reserve and financial transactions
• Consistently maintain up to date claims metrics

Construction Defect Claims Specialist

• Manage moderate to complex commercial claims involving bodily injury and property damage
• Independently investigate, evaluate, negotiate, and resolve third-party General Liability claims
• Serve as a technical resource, mentor, and trusted partner within the claims organization
• Support strong file quality, collaboration, and continuous improvement.

Senior Claims Representative – Specialty BI/GL

• We are seeking an experienced and dynamic Catastrophe Claims Adjuster & Field Service Manager to join our team in the Lubbock, TX or Amarillo, TX area.
• This position will handle West Texas, Oklahoma and potentially New Mexico.
• This is a highly field-intensive position where you will represent Ford and its various departments.
• You will manage complex physical damage claims and respond to catastrophic events, requiring extensive travel.
• Manage complex insurance claims in a key-pointed area, work independently, schedule appointments for vehicle inspections, and travel throughout your key-point territory.
• Conduct thorough coverage investigations, including fire, theft, false pretense claims, and coverage decisions for floor-planned units.
• Prepare accurate damage estimates using computerized estimating systems (e.g., Mitchell Connect) to establish the cost of repairs.
• Lead subrogation investigations, salvage disposal, and fraud investigations.
• Perform loss prevention reviews and provide essential dealer training activities.
• Remain on-call for CAT/Storm losses and be prepared for extensive travel away from home for extended periods of time. Interested candidates must be willing to travel overnight as required and the travel can be as much as 50-70% particularly during CAT (storm) season.

Auto Claims Adjuster

• Investigate, evaluate, negotiate, and resolve property insurance claims
• Analyze and manage claims by verifying coverage and gathering pertinent information
• Maintain action plans for timely resolution in accordance with policies
• Recognize coverage issues, potential fraud, and subrogation potential
• Calculate and assign timely reserves to claims; monitor reserve adequacy
• Conduct detailed damage and bill reviews; control claim expenses
• Communicate claims decisions clearly and professionally

Claims Examiner

• Analyze Workers Compensation claims on behalf of our valued clients to determine benefits due.
• Ensure 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.
• 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.

Claims Examiner – Workers Compensation

• 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

• Investigate, evaluate, and adjust auto liability, bodily injury, and property damage claims in accordance with Corporate Claim Standards and client-specific requirements
• Manage claims from assignment through resolution, including represented and non-represented bodily injury claims
• Conduct liability investigations and determine appropriate claim strategies
• Establish and maintain reserves within authority levels
• Evaluate medical records, bills, repair estimates, legal documentation, and other claim-related expenses
• Negotiate settlements with claimants, attorneys, and authorized representatives
• Authorize claim payments within established authority
• Coordinate with defense counsel and vendors when appropriate
• Identify and pursue subrogation opportunities
• Maintain timely and accurate claim documentation and diary management
• Prepare claim reports, reserve analyses, and client communications as needed
• Monitor files in accordance with service commitments and client expectations
• Deliver responsive, high-quality service to clients and other stakeholders

Auto Liability, Bodily Injury Claims Adjuster

• 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

• Design, build, and support the Epic PB Admin and PB Claims applications.
• Analyze business requirements and optimize Professional Billing and claims workflows.
• Troubleshoot production issues and provide ongoing application support.
• Participate in testing, upgrades, implementations, and go-live support.
• Collaborate with operational, IT, and vendor teams to deliver effective solutions.

Claims Specialist jobs in Texas

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