Position Overview
The Claims Specialist is responsible for evaluating, processing, and managing liability, property, auto, general liability, and employment claims in compliance with state regulations. This includes documenting activities, communicating claim status and benefits, and providing testimony in disputes. The role requires discretion, independent judgment, critical thinking, and exceptional customer service skills.
Primary Responsibilities
- Evaluate and manage liability, property, auto, general liability, and employment claims in compliance with applicable regulations.
- Adjudicate auto and general liability claims, including determining validity and reaching closure.
- Analyze liability exposure to ensure appropriate actions are taken.
- Attend legal hearings, settlement conferences, and mediations to provide testimony and monitor proceedings.
- Maintain accurate claims files and records to ensure compliance with policies and legal requirements.
- Oversee third-party claim providers and litigation management for complex cases.
- Prepare reports, summaries, and presentations documenting claim activities.
- Respond to inquiries from claimants, internal stakeholders, and other involved parties to resolve issues and facilitate communication.
- Provide timely, balanced, and accurate claims decisions in accordance with regulations and deadlines.
- Act as a primary point of contact for claimants, demonstrating empathy, active listening, and clear communication throughout the process.
- Document conversations and actions within claim files with professionalism and appropriate detail.
- Collaborate with internal and external professionals, such as physicians, attorneys, and vocational consultants, to gather relevant information.
- Identify and reconcile inconsistencies in claim data, involving fraud prevention resources when necessary.
- Calculate benefits due, including adjustments for offsets and cost-of-living allowances.
- Address and resolve escalated customer complaints promptly.
- Perform other duties as assigned.
Qualifications
- Strong time management skills and ability to meet tight deadlines.
- High attention to detail with excellent organizational skills.
- Proven critical thinking, independent judgment, and decision-making abilities.
- Excellent written and verbal communication skills.
- Strong interpersonal skills with a collaborative and proactive approach.
- Knowledge of relevant regulations and risk management principles.
- Proficiency in Microsoft Outlook, Word, and Excel.
- Ability to manage multiple systems and technology tools simultaneously.
Education & Experience
- Bachelor’s degree or equivalent combination of education and experience.
- 7+ years of experience handling workers’ compensation, liability, property, auto, and general liability claims.
- Experience with damages assessment, investigations, contractual disputes, and litigation support.
- Valid driver’s license with an acceptable driving record.
- Multi-jurisdictional knowledge of legal issues preferred.
Physical Requirements
- Regular use of hands for handling objects, tools, or controls.
- Frequent standing, walking, talking, and hearing; occasional climbing, balancing, stooping, kneeling, or crawling.
- Ability to lift/move up to 10 lbs frequently and up to 25 lbs occasionally.
- Vision requirements include close, distance, color, peripheral vision, depth perception, and focus adjustment.
Equal Employment Opportunity Statement
This employer is an equal opportunity organization and considers applicants without regard to age, race, color, religion, creed, sex, sexual orientation, gender identity or expression, national origin, marital status, disability, veteran status, or any other status protected by law
Job Type: Full-time
Pay: $85,000.00 - $100,000.00 per year
Work Location: In person
