Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Review and analyze claim submissions to determine coverage and applicable policy provisions.

• Conduct investigations, gather supporting documentation, and verify details related to claims.

• Communicate effectively with policyholders, brokers, and other stakeholders to provide status updates.

• Document claim files accurately and maintain compliance with regulatory and company guidelines.

• Coordinate with internal teams and external vendors to facilitate efficient claim resolution.

• Recognize and escalate complex or suspicious claims to appropriate senior resources or management.

• Ensure high standards of customer service and timely handling of claims within defined service levels.

• Resolve damages

• Maintain a working diary

• Review, analyze and negotiate medical bills

• Negotiate claim totals with attorneys

EDUCATION AND EXPERIENCE

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Bachelors degree

• 5-7 years of experience in claims handling, insurance operations, and commercial insurance.

• Knowledge of commercial insurance principles, practices, and terminology is desirable.

• Experience working in a service-oriented environment with client interaction is advantageous.

CERTIFICATIONS / LICENSES / REGISTRATIONS

• Must possess a current adjusters license in the states business is conducted in and the ability to obtain licenses in 90 days

FUNCTIONAL SKILLS 

​​• Claims investigation and evaluation skills. 
• Knowledge of insurance policy interpretation and coverage analysis. 
• Negotiation and settlement proficiency. 
• Ability to manage multiple claims and meet deadlines. 
• Strong verbal and written communication skills. 
• Analytical and problem-solving capabilities. 
• Proficient in claims systems and Microsoft Office Suite. 
• Customer service orientation with attention to detail.​