Claims Specialist

• 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

• 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

• 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

• 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

• Initiating ERA (electronic remittance advice) set up with clearinghouse and/or third-party portals
• Initiating EFT (electronic funds transfer) set up with payers & third-party portals
• Assist in vendor support of daily cash reconciliation duties
• Clear understanding of RCM Payment Posting Processing (ERA/Manual Posting) of Line-Item Payments/Denials
• Clear understanding of reconciling offset/recoupment payer remits
• Call carriers and third parties to resolve unidentified payments/reconcile items
• Responsible for maintaining payer portal admin and employee registration
• Assist the RCM Manager with various projects

Claims Resolution Specialist

• 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
• Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources
• Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate
• Determines and negotiates complex claims settlement within authority limits
• Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits
• Maintains accurate, thorough, and current claim file documentation throughout the claims process
• 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 independently solving complex problems with minimal guidance

Property Adjuster Specialist – Specialty Claims Team

• Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
• Collaborate with field assessors and facility staff via phone to determine if further information is needed on a claimant or member’s health status
• Call claimants, family members or facility staff to update records on their present health status and provide a new plan of care, as well as handle telephonic assessments
• Work with new clients to develop processes that meet their insureds’ needs.

Associate Claims Clinical Specialist

• Handles claims, moderate to severe in scope, relative to homeowner’s property based on Claim Guidelines.
• Perform CAT duty as needed that will require occasionally working weekend hours, overnight hours, holiday hours (Federal and religious), etc.
• Follows standard practices and procedures in analyzing situations or data where answers can be readily obtained.
• Verifies/analyzes applicable coverage for the reported loss.
• Establishes 24-hour contact and maintain appropriate contact with all involved stakeholders throughout the life of the claim file.
• Investigates each claim by gathering information, conducting interviews, taking statements, conducting website research as needed, reviewing and analyzing reports and related bills.
• Identifies and addresses subrogation/contribution/SIU opportunities.
• Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines.
• Evaluates, negotiates, and authorizes settlements with all stakeholders within designated authority.
• Selects, directs and manages Vendors/Counsel including approval of defense budgets.
• Negotiates directly with claimants and claimant attorneys upon receipt of critical information.
• Drafts correspondence, including but not limited to, coverage letters to stakeholders as required.
• Maintains resident/nonresident adjuster licenses as required.
• Works on problems of limited scope.
• Follows standard practices and procedures in analyzing situations or data from which answers can be readily obtained.
• Perform other duties as needed

Homeowners Property Claims Specialist

• 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 I, Workers Compensation, NE Jurisdiction Experience 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

• To analyze and process low to mid-level auto and transportation claims
• Processes auto property damage and lower level injury claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy
• Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution
• Identifies and pursues subrogation opportunities; secures and disposes of salvage
• Communicates claim action/processing with insured, client, and agent or broker when appropriate
• Maintains professional client relations
• Performs coverage, liability, and damage analysis on all claims assignments
• Performs other duties as assigned
• Supports the organization's quality program(s)

Claims Representative – Auto

• Resolves moderate to high complexity claims
• Analyzes coverage and communicates coverage positions
• Conducts investigation into loss facts and extent of damages
• Confirms coverage of claims by reviewing policies
• Contributes to maintenance of claims guidelines and procedures
• Coordinates loss information for business stakeholders
• Delivers technical training to colleagues
• Directs assignments to experts and outside counsel
• Evaluates information on coverage, liability, and damages
• Negotiates and settles claims typically in litigation
• Prepares coverage position letters on matters in litigation
• Provides timely service throughout the life cycle of the claim
• Sets reserves within authority or recommends reserve changes
• Utilizes acceptable investigation claims handling techniques.

Senior Claims Examiner

• Analyzes and processes complex or technically difficult medical malpractice claims
• Manages claims through well-developed action plans to an appropriate and timely resolution
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions
• Negotiates claim settlement up to designated authority level
• Monitors reserve adequacy throughout claim life
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement
• Coordinates legal defense by assigning attorney, coordinating support for investigation, recognizing opportunities to reduce total claim cost
• Communicates claim activity and processing with the client
• Ensures claim files are properly documented and claims coding is correct
• Refers cases as appropriate to supervisor and management
• Delegates work and mentors assigned staff

Senior Claims Specialist – Professional Liability

• Assemble facts, determine coverage, evaluate the amount of loss
• Analyze legal liability, make payments in accordance with coverage, damage and liability determination
• Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage
• Follow claims handling procedures and participate in claim negotiations and settlements
• Deliver a high level of customer service to our agents, insureds, and others
• Devise alternative approaches to provide appropriate service, dependent upon the circumstances
• Meet with people involved with claims, sometimes outside of our office environment
• Handle investigations by telephone, email, mail, and on-site investigations
• Maintain appropriate adjuster’s license(s), if required by statute in the jurisdiction employed
• Handle complex and unusual exposure claims effectively through on-site investigations and through participation in mediations, settlement conferences, and trials
• Handle confidential information according to Company standards and in accordance with any applicable law, regulation, or rule
• Assist in the evaluation and selection of outside counsel
• Maintain punctual attendance according to an assigned work schedule at a Company approved work location.

Bodily Injury Claims Specialist

• Successfully completing the required basic training
• Able to perform basic job functions with help from co-workers, specialists and managers on non-basic issues
• Must pass the appropriate pre-employment test battery
• Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made
• Researches and analyzes claims issues

Claims Representative I

• Responsible for the resolution of moderate complexity and moderate exposure first party property claims in multiple jurisdictions.
• Handles low to moderate low exposure claims.
• Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
• Analyzes coverage and communicates coverage positions.
• Ability to draft coverage position letters independently.
• Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.
• Conducts, coordinates, and directs investigation into loss facts and extent of damages.
• Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure.
• Sets reserves within authority or makes recommendations concerning reserve changes to manager.
• Utilizes diary system to pro-actively resolve outstanding issues and to ensure timely processing and closure of the claim.
• Negotiates and settles claims directly with claimant.
• Prepares reports by collecting and summarizing information.
• Participates in special projects or assists other team members as requested.
• Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.
• Identifies subrogation opportunities and fraud potential and makes appropriate referrals.

Claims Examiner II

• Investigate, evaluate, and help resolve claims
• Responsible for the resolution of claims of low complexity and exposure
• Review claim information to determine coverage and recommend appropriate next steps
• Assist with evaluating potential exposures on claims and alerting Management or internal partners when needed
• Adhere to Fair Claims Practices Regulations and claims handling guidelines
• Prepare and distribute claim reports
• Build strong relationships with internal stakeholders including Underwriting
• Collaborate with departments across Markel including Claims Vendor Management, Finance, Actuarial, Risk Management, and IT
• Mentor with senior examiners and managers to observe negotiation strategies and claim resolution practices
• Travel to other claim offices and conferences as needed

Associate Claims Examiner

• Investigate, negotiate and settle complex primary and excess policy casualty claims including negligence, premise liability, commercial automobile, construction bodily injury, construction defect, product liability, and sexual assault
• Investigate and analyze coverage under primary and excess casualty insurance policies; make coverage determinations; draft routine and complex coverage correspondence; effectively communicate coverage positions to policyholders and other stakeholders; manage claims involving coverage litigation
• Manage litigation filed nationwide against insureds; appoint, direct and manage defense counsel; proactively work toward expeditious and economical resolution of claims; assist internal business partners, including claims vendor management, disbursement and legal collections teams with defense counsel, bill payment and collection issues
• Communicate with underwriting as needed to manage claims and to alert of any significant developments
• Promptly communicate with management on adverse case developments and provide information on pertinent issues affecting professional liability product lines
• Proven ability to work in a collaborative team environment
• Analyze and convey summations of complex issues; recognize alternative approaches and develop action plans, both orally and in written form
• Maintain and adhere to internal guidelines and procedures
• Ensure proper adherence to internal reporting requirements
• Contribute and assist in the implementation of a wide range of initiatives, discussion and action plans brought forth by management
• Participate in agent related functions and meetings as required
• Actively participate in the ongoing training and development of the claims examiners

Claims Specialist jobs in Virginia

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