Claims Specialist

• Investigate and handle automobile claims from initial report through resolution.
• Evaluate coverage, determine liability, and assess damages.
• Negotiate claims and guide customers through the claims process.
• Identify potential subrogation or fraud and partner with internal teams.

Auto Telephone Claims Adjuster

• Investigate and confirm the facts of loss for automobile accidents.
• Determine coverage, liability, damages and adjust and negotiate claims within limit of authority.
• Handle investigation regarding auto claims (coverage, liability and damages).
• Review, evaluate, and negotiate basic injury claims if handled.
• Recognize and identify body parts of a vehicle and understand other potential property damage.
• Identify customer needs and work to meet those needs using appropriate customer service skills.
• Determine subrogation or fraud potential and how to handle.

MD Claims Adjuster

• 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

• Load, review and adjudicate complex claims submitted by providers and members electronically and by paper
• Manage and perform adjustments, reconsiderations and other advanced claim processes
• Consistently exceed processing accuracy and volume standards where appropriate
• Research and resolve complicated claims, quality concerns, and other member or provider issues
• Participation with external parties regarding Subrogation, Other Payer Liability, High Dollar Claims, Stop Loss and the like
• Serve as the point of contact for Claim Processors and Personal Health Assistants claim questions and issues
• Identify and explore trends, patterns and issues that require tool or process changes
• Maintain compliance, privacy and confidentiality in all documentation, communications and correspondence
• Contribute to team wide goals to improve claims processes and integrate additional functions into our operations

• Investigating and confirming facts of loss for automobile accidents
• Determining coverage, liability, damages, and adjusting claims
• Working Monday through Friday, 8 am to 5 pm Pacific Time

Claims Adjuster, Trainee

• 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

• Handle investigation regarding all aspects of auto claims
• Apply understanding of insurance policies
• Identify customer needs using appropriate service skills

Telephone Claims Adjuster

• 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.

Claims Specialist – Large Loss

• 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.

Claims Examiner – Workers Compensation, AZ, CO, UT Jurisdictions

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