The Claims Specialist reviews, investigates, evaluates, negotiates, and settles assigned claims, following sound claims handling techniques and in accordance with company claims philosophy, statutory requirements, and quality assurance standards.
Duties and Responsibilities/Essential Functions
- Investigate, evaluate, dispute, and adjust claims in accordance with established claim handling standards and laws.
- Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices to determine if reasonable and related to designated claims.
- Negotiate with medical providers and third parties on self-insurance settlements.
- Negotiate any disputed bills or invoices for resolution.
- Coordinates and participates in strategic planning aimed at identifying developing trends with respect to type of loss, severity, and frequency.
- Makes strategic recommendations for reducing the frequency and severity of losses through the use of the company database and/or other claims data reports.
- Handles and processes casualty and property liability claims.
- Communicates and interacts with medical professionals, support agencies and others to monitor and assess the progress of rehabilitation efforts, and to facilitate either return to work or placement into appropriate alternative actions, ensuring compliance with all appropriate regulations and guidelines.
- Assist Director of Corporate Insurance and Risk with the direction and development of an overhaul of the company’s overall insurance claims program.
- Articulate strategies for loss control so that they are understood throughout our organization.
- Assist the Director of Corporate Insurance and Risk with other departmental and administrative duties as assigned.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Skills and Specifications
- Ability to work collaboratively with multiple managers and teams across business and functional units.
- Knowledge of property and liability claims legislation, regulations, policies, processes, and procedures.
- Knowledge and understanding of insurance policies, including interpretation of policies
- Ability to use independent judgment and to manage and impart confidential information.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Ability to use independent judgement and make appropriate insurance claims adjustment decisions and determinations.
- Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
- Excellent verbal, written and interpersonal communication skills.
- Financial acumen including budgeting and resource allocation.
- Conflict resolution and/or mediation skills.
- Superb attention to detail and ability to produce both standard and ad hoc reports.
- Able to maintain confidentiality in matters involving personnel issues.
- Diligent leadership skills and a passion for tackling complex challenges.
This job operates in a professional office environment and field environments. This role routinely uses standard office equipment such as laptop computers, smart phones, tablets, photocopiers, filing cabinets and other presentation materials. There is an expectation of clear communication in English both written and orally.
While performing the duties of this job, the employee is regularly required to talk or hear. Ability to use fingers is required for computer input.
Position Type/Expected Hours of Work
This is a full-time remote position within the US. Typical hours are 8am – 5pm daily, 40+ hours per week. The ability to work flexible hours including nights and weekends as needed is required.
Available for travel as required.
Required Education and Experience
- High school diploma (or GED equivalent) is required
- Bachelor’s degree in business administration, risk management, or a related field is preferred
- 8+ years of experience managing corporate insurance claims programs, including workers compensation, through an independent insurance agency.
- Property/Casualty and Health/Life Licensure is desired
- Must be authorized to work in the U.S.
- Must pass a drug test, motor vehicle record check, and a background check after accepting a conditional offer of employment.
- Must be able to travel within the Continental United States (CONUS)
Deployed Resources, LLC is an Equal Opportunity and Affirmative Action Employer and prohibits discrimination and harassment of any type on the basis of actual or perceived race, color, national origin, ancestry, sex (including pregnancy, childbirth, breastfeeding and medical conditions related to pregnancy, childbirth or breastfeeding), gender, gender identity, and gender expression, religious creed, disability (mental and physical) including HIV and AIDS, medical condition (cancer and genetic characteristics ), genetic information, age, marital status, civil union status, sexual orientation, military and veteran status, denial of family and medical care leave, arrest record and/or any other characteristic(s) protected by federal, state or local law.
This policy applies to all terms of employment including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, training, compensation, benefits, employee activities, and general treatment during employment.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.