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Role Description

This role involves analyzing mid- and higher-level general liability claims to determine benefits due and ensure ongoing adjudication of claims within company standards and industry best practices.

• Manages mid-level general liability claims by gathering information to determine liability exposure
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
• Assesses liability and resolves claims within evaluation
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
• Manages subrogation of claims and negotiates settlements
• Communicates claim action with claimant and client
• Ensures claim files are properly documented and claims coding is correct
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
• Maintains professional client relationships

Qualifications

• Bachelor's degree from an accredited college or university preferred
• Four (4) years of claims management experience or equivalent combination of education and experience required
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

Requirements

• Clear and conceptual thinking ability
• Excellent judgment, troubleshooting, problem solving, analysis, and discretion
• Ability to handle work-related stress
• Ability to handle multiple priorities simultaneously
• Ability to meet deadlines
• Computer keyboarding, travel as required
• Hearing, vision and talking

Benefits

• Comprehensive benefits package including medical, dental, vision
• 401k and matching
• PTO
• Disability and life insurance
• Employee assistance
• Flexible spending or health savings account
• Other additional voluntary benefits