Claims Specialist Job Description

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Claims Specialist Job Description

Job descriptions
Insurance

Job summary 1

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.

Duties & Responsibilities 1

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Responsible for all assigned claims, operating under moderate direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Determines proper policy coverages and applies where necessary. Applies best claims practices to conclude, investigate, evaluate, and negotiate assigned material/physical damage claims cases per company guidelines.
Opens, closes, and adjusts reserves by company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary, according to Corporate Reserving Guidelines. Adheres to file conferencing notification and authority procedures.
Maintains and develops current knowledge of assigned insurance lines; court decisions that may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training sessions.
Submits severe incident reports, reinsurance reports, and other information to claims management as needed.
- Assists or prepares files for suit, trial, or subrogation.
- Initiates and conducts follow-ups via proficient use of claims systems and related business systems
- Adheres to high standards of professional conduct while providing delivery of superior claims service.

Requirements & Skills 1

Education: Undergraduate studies in business administration or related field preferred and/or relevant experience.
- License/Certification/Designation: State licensing where required. Successful completion of required/applicable claims certification training/classes.
- Experience: One to three years related experience in property claims or equivalent. Prefer exposure to commercial claims.
- Knowledge, Abilities, and Skills: Demonstrated knowledge of best claims practices to resolve claims of low severity and complexity. General knowledge of insurance theory and practices, insurance contracts and their application, and property damage estimating. Ability to operate various claims systems and related software. Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience. Analytical skills are necessary to make decisions and resolve conflicts in such areas as the application of coverages to submitted claims, the application of laws of jurisdiction to investigate facts, and the application of policy exclusions and exceptions. Ability to successfully negotiate commercial claims of low severity and complexity. Command of written and verbal communication skills for contact and/or negotiations. Organizational skills to effectively establish work priorities by best claims practices. Ability to operate a personal computer and related software.

Job summary 2

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.

Duties & Responsibilities 2

Participate in review processes to evaluate liability, case value, and reserving functions and manage total claims cost. Ensures proper file documentation of assigned files by complying with company and state requirements.
Directs defense counsel about settlement values, defense tactics, and strategies per department guidelines. Maintains communication with supervisor, defense counsel, and client. Review and approve reasonable legal expenses and fees associated with the claim file, and negotiate adjustment of charges when appropriate. Participate in the selection of expert witnesses when appropriate.
Represent the Company by attending trials, settlement conferences, mediations, and insured meetings. Recommend settlement strategies when necessary.
- Responsible for preparing reports for management by collecting, analyzing, and summarizing claim information. Keep apprised of changes in the law and court procedures affecting claims in jurisdictions supervised.
- Participate in negotiations when appropriate.
- Perform special projects as directed by management.

Requirements & Skills 2

Job summary 3

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.

Duties & Responsibilities 3

Provide telephone support for numerous programs by answering healthcare provider and claimant inquiries while meeting process and quality standards.
Manage priorities and work distribution
Answer customer inquiries (phone or correspondence) of a moderately complex nature
Perform research to answer coverage inquiries
- Provide support to other members of the business and special projects as required – manager may change assignments/duties to meet business needs
- Provide excellent customer service to providers and claimants
- Be thorough when researching to handle calls and/or mail look-up

Requirements & Skills 3

Professional and courteous telephone skills when talking to customers and internal colleagues
Ability to identify priorities based on business needs
Attention to detail and quality
Anticipate client needs
- Ability to multi-task and handle a high volume of calls efficiently and accurately
- Flexibility
- Bachelor’s degree or equivalent years of industry experience.

Job summary 4

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.

Duties & Responsibilities 4

Requirements & Skills 4

Job summary 5

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.

Duties & Responsibilities 5

Requirements & Skills 5

Job summary 6

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.

Duties & Responsibilities 6

Analyzes coverage and communicates coverage positions, as warranted, under the direction of supervisor and coverage unit.
Conducts, coordinates, and directs investigation into loss facts and extent of third-party damages.
Directs and closely monitors assignments to experts and defense counsel.
Evaluate information on coverage, liability, and damages to determine the extent of exposure to the insured and the company.
- Sets reserves within authority or makes claim recommendations concerning reserve changes to supervisor.
- Reports to reinsurers and facilitates the prompt collection of reinsurance on those matters where they are accountable.
- Travels to conferences, mediations, and trials as necessary.

Requirements & Skills 6

Job summary 7

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.

Duties & Responsibilities 7

Collaborate proactively with agents, policyholders, and internal stakeholders on claims of high complexity/severity and provide strategic input on the book of business.
Investigate losses, identify coverage, evaluate liability and damages, and review and analyze documents and legal pleadings independently.
Collaborate with counsel to manage litigated claims and leverage experience to analyze documents and legal pleadings.
Develop a plan of action to proactively conclude claims, timely evaluate damages, engage other parties in negotiations, and settle claims under guidelines.
Establish and maintain proper reserves for each claim to accurately reflect the financial exposure.
Determine the need for, identify, and engage external resources as needed to execute proper resolutions while monitoring and controlling costs.
- Address contractual indemnifications and/or additional insured coverage issues.
- Review and interpret commercial insurance policies and accordingly communicate coverage issues verbally and in writing.
- Participate on cross-functional teams to identify and resolve issues and design and implement solutions to prevent future occurrences as necessary.

Requirements & Skills 7

Job summary 8

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.

Duties & Responsibilities 8

Deals with all assigned claims, promptly and effectively, with little or no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Initiates and conducts follow-ups and is proficient in the use of claims systems and related business systems.
Verifies proper policy coverages and applies best claims practices to conclude assigned cases per company guidelines.
Opens, closes, and adjusts reserves according to company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. Establishes and authorizes adequate reserves and claims payments within the delegated authority.
- Maintains current knowledge of: multiple insurance lines; court decisions; current guidelines in the claims function; and policy changes and modifications. May be required to maintain knowledge of other functions within the material damage field. This may require attendance at various seminars and/or training sessions.
- Submits administrative reports as the need arises.
- Partners with Special Investigations Unit and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for lawsuits, trials, or subrogation.

Requirements & Skills 8

Undergraduate degree or equivalent experience.
State licensing where required. Successful completion of required/applicable claims certification training/classes. Participation in technical insurance or industry coursework is preferred.
Three to five years of successful experience in customer service and/or claims handling is required. Material/physical damage experience preferred. Related repair industry experience is a plus.

Job summary 9

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.

Duties & Responsibilities 9

Managing assigned professional liability claims across multiple lines of business by setting the case strategy for resolving these claims in partnership with Regional Practice Leaders and claims management to take all available steps to achieve the best outcome.
Partnering with internal and external counsel in setting and pursuing effective and cost-efficient litigation strategies for claims in litigation.
Producing internal reports and ensuring that reserves are set according to best practice guidelines.
- Coordinating and managing communications with internal colleagues and key external stakeholders (e.g., clients, brokers, reinsurers, vendors, etc.) ensuring we are providing the highest level of customer service.
- Preparing coverage letters addressing relevant policy provisions for any given claim.
- Identifying, monitoring, and reporting on emerging liability and coverage trends.

Requirements & Skills 9

Job summary 10

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.

Duties & Responsibilities 10

Requirements & Skills 10

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.

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