Claims Specialist Job Description
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Do you have a strong desire to resolve complicated insurance claims by providing prompt, courteous, and fair service to customers? Are you a skilled investigator, negotiator, and communicator? If you thrive in an environment where you can problem-solve claims resolution, while following processes that provide fair resolution, customer satisfaction, and cost management, then we want to hear from you! As a Claims Specialist, you will investigate, evaluate, negotiate, and resolve commercial property damage claims of low severity and complexity. We’ll count on you to promote and provide exemplary customer service in person and on the telephone when handling claims. In addition, you will be responsible for the handling of claims by prescribed authorizations.
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The primary responsibility of the Claims Specialist position is to provide direction and guidance throughout the life of the claim. The Claims Specialist directs the management of claims including claims investigation, coverage analysis, monitoring of defense counsel activities, control of legal expenses, preserving, and providing technical expertise throughout the life of the claim file.
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As a Claims Specialist, you will report directly to the Underwriting Manager of Claims working in the challenging and rewarding segment of insurance. The main responsibility is providing telephone support by answering questions raised by healthcare providers and claimants. This position also provides support for the scanning team which includes but is not limited to, opening and looking up mail, prepping documents to be scanned, scanning, and the process known as shipping which is processing the scanned document from one system to another. This position also helps with the monitoring of incoming faxes and emails to a shared mailbox.
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The Claims Specialist is responsible for all aspects of complex claims within the assigned coverage specialty, including automobile liability, premises liability, product liability, and personal injury from the date of notice through resolution ensuring best practices and standards are implemented and followed.
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The Claims Specialist protects the fiduciary interests of the Corporation through prompt investigation and administrative handling of personal injury and property damage claims brought by passengers, employees, and others.
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The Claims Specialist is responsible for investigating and settling high-exposure, high-risk claims. Ensure a high level of customer service and claim file quality.
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We're currently recruiting for a Claims Specialist with experience with handling claims that deal with risk transfer, subcontractors, and general contractors. This role can sit remotely. The ideal candidate will also possess the following skill set. Provides quality investigation and analysis to adjust claims of high complexity/severity, including litigated files, to the proper resolution. Promotes the success of the organization through the development of relationships with agencies, policyholders, and employees. Serves as a relationship contact for an assigned agent(s) related to all claims.
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As a Claims Specialist, you’ll investigate, evaluate and resolve material damage repairable, total loss, or fire and theft claims of a moderate to severe nature. We’ll count on you to promote and provide outstanding customer service. In addition, you’ll be responsible for handling claims according to prescribed authorization and claims best practices.
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As a Claims Specialist claims unit, you will play a critical role by managing and resolving claims under various types of primary and excess professional liability policies, which could include public company directors & officers liability policies; financial institutions, and errors & omissions policies; fiduciary liability policies; and/or employment practices liability policies. You will work closely with your manager to bring claims to resolution. You will interact and collaborate with regional practice leaders, the professional underwriting team, and brokers and clients on assigned accounts, taking ownership of critical issues relating to claims management.
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The Claims Specialist is responsible for the coordination, development, and implementation of programs and strategies to improve service to customers in the area of claims processing.
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Frequently asked questions
What is the role of a claims specialist?
A claims specialist is responsible for processing insurance claims and ensuring that they are handled in an accurate, timely, and efficient manner. The specific duties and responsibilities of a claims specialist can vary depending on the industry they work in but generally include:
Evaluating claims: The claims specialist evaluates insurance claims to determine whether they are covered under the policy and if the amount claimed is reasonable.
Investigating claims: The claims specialist conducts investigations to gather information about the claim, such as interviewing witnesses, reviewing medical records, and inspecting the damaged property.
Communicating with customers: The claims specialist communicates with customers to explain the claims process, answer questions, and provide updates on the status of the claim.
Negotiating settlements: The claims specialist negotiates settlements with customers or third-party claimants, working to reach a fair and equitable resolution.
Documenting claims: The claims specialist documents all aspects of the claim, including gathering and organizing supporting documentation, such as medical bills, police reports, and property damage estimates.
Adhering to legal and regulatory requirements: The claims specialist ensures that all claims are processed in compliance with applicable laws, regulations, and industry standards.
Coordinating with other departments: The claims specialist coordinates with other departments within the organization, such as legal, underwriting, and risk management, to ensure that claims are handled appropriately.
Analyzing claim data: The claims specialist analyzes claim data to identify trends and patterns, and make recommendations to improve claims processing efficiency and customer satisfaction.
Providing customer service: The claims specialist provides excellent customer service, working to resolve customer issues and complaints in a timely and professional manner.
Overall, the role of a claims specialist is to process insurance claims efficiently and effectively, while ensuring that they are handled in compliance with legal and regulatory requirements, and providing excellent customer service to policyholders and claimants.
Who does a claims specialist work with?
A claims specialist works with a variety of stakeholders, both internal and external to the organization. Some of the key individuals and groups that a claims specialist may work with include:
Customers: The claims specialist works directly with customers who have filed insurance claims, providing guidance and support throughout the claims process.
Third-party claimants: The claims specialist may also work with third-party claimants, such as individuals who have been injured or suffered property damage due to the actions of an insured individual or organization.
Insurance adjusters: The claims specialist may work with insurance adjusters to evaluate claims and determine whether they are covered under the policy.
Legal teams: The claims specialist may work with legal teams within the organization, such as attorneys and paralegals, to evaluate claims and negotiate settlements.
Underwriters: The claims specialist may work with underwriters to evaluate policies and ensure that claims are handled in compliance with policy provisions.
Risk management teams: The claims specialist may work with risk management teams to evaluate claims and identify opportunities to reduce risk and improve claims handling processes.
Regulatory bodies: The claims specialist may work with regulatory bodies, such as state insurance departments, to ensure that claims are processed in compliance with applicable laws and regulations.
Other departments: The claims specialist may work with other departments within the organization, such as finance, accounting, and customer service, to coordinate claims processing and ensure that customer needs are met.
Overall, the claims specialist works with a wide range of stakeholders to ensure that claims are processed accurately, efficiently, and in compliance with legal and regulatory requirements, while providing excellent customer service to policyholders and claimants.
