Claims Examiner
Claim Processor Job 16 miles from Medford
Claims Examiner, Andover, Massachusetts
The Andover Companies is seeking a property Claims Examiner to join the Claims team in Andover, Massachusetts.
Key responsibilities include supervision and technical analysis of claims arising out of homeowner, landlord and businessowner insurance policies issued by The Andover Companies. The Examiner will direct all phases of claim file adjustment including coverage determination, damage evaluation, settlement, legal defense and service. The role involves the ability to examine claims to ensure that proper guidelines and processes are consistently followed. Examiners provide claims support and customer service to independent agents and policyholders through effective management of independent adjusters, defense firms and claim experts.
We are looking for a confident, self-starter who is highly motivated, energetic, and knowledgeable. Integrity and natural curiosity are fundamental qualities necessary to this role, our claims process and departmental goals.
Essential Functions
Evaluate and confirm policy coverage.
Assign and direct independent adjusters and experts.
Set and modify coverage reserves and maintains timely diary of case assignments.
Control claim negotiations and provide settlement authority to independent adjusters and legal counsel.
Authorize payment and/or settlement requests.
Verify all required state regulations and administrative code claim handling requirements are observed.
Assign defense counsel, manages litigation and legal costs.
Attend mediations, trials or depositions as required.
Analyze and respond to consumer and insurance department complaints.
Collaborate on special Claims or Company projects.
Assist other Claims Examiners during catastrophes, vacations, leave.
Develop professionally through continuous insurance and claims education.
Competencies
Technical Proficiency resolving property claims.
Ethical Conduct.
Service oriented.
Technical Capacity.
Analytical ability.
Organizational and Time Management.
Strong verbal and written communication skills
Solid interpersonal, analytical and negotiation abilities
Technical knowledge of insurance policy coverages, regulations and legal theories
Excellent organizational and time management skills
The employee is expected to adhere to all company policies
Key Performance Indicators
Resolution of Claims.
Service.
Proficiency in applicable technology.
Required Education and Experience
Bachelor's Degree or five years or more of property claims handling experience or directly related experience.
State specific Adjuster License as required.
Insurance Certification preferred
Property and Casualty claims supervision/management and familiarity of property estimating programs preferred.
This job is located in ANDOVER, MASSACHUSETTS
Quality Claims Specialist / ISO Auditor
Claim Processor Job 10 miles from Medford
This unique position will support both the Customer Quality Management (CQM) Team with warranty claims as well as support the organization with ISO audits and programs.
You will support the CQM team by reviewing and responding to warranty replacement requests and product safety and liability claims through resolution, fielding and discussing technical issues, answering questions from internal and external customers on status of warranty claims. This position will be responsible for approving warranty payments within the limits described in the process. This position will work closely with the Head of Government Affairs and our Product Engineering team with ensuring our newly launched products meet federal, regional and local regulations. This position will also function as lead auditor for our ISO 9001 and ISO 14001 programs at our HQ facility.
Customer Quality Engineering Support
You will provide secondary support to our customer quality engineering team with resolving customer claims through applying resolution within our written warranty terms as quickly and efficiently as possible to meet our customers' needs while remaining fiscally accountable. Claim management includes communicating resolution to customers and sales representatives for those accounts. You will work closely with relevant manufacturing teams to share analysis trends and product feedback to improve future products.
Assignments may include:
Provide first level phone or email technical support to provide updates on the claim status
Respond to customers product safety inquiries and liability claims involving our product via email or phone communications.
Respond to customers and team members questions regarding product quality, certification, expected performance, etc.
Ensure that all claims handled are appropriately reported within Customer Quality Management.
Managing extended warranty submittals and risk tracking
Review stock for obsolete product to insure it is reserved for future warranty claims as well as managing risk reviews through an established process for extended warranty requests.
Regularly administer data review and analysis of customer claim data, return data and reviews
Assess warranty hold quantities before the product is sold, and reserve stock for warranty use.
Regulatory and Auditing
You will work closely with the Head of Government Affairs and our Product Engineering team with ensuring our newly launched products meet federal, regional and local regulations. You will also function as lead auditor for our ISO 9001 and ISO 14001 programs.
Assignments may include:
Maintain product launch certification matrix, used to identify required product certification and compliance regulations
Enter and/or update the Department of Energy and National Resources of Canada (nr CAN) submissions for reporting requirements of regulated products.
Support the Internal ISO 9001/14001 corporate and internal audits, including follow up, with ability to lead future audits.
Manage continuous improvement program as a result of the audit.
Assist in ISO 14001 monthly activities for headquarters
Maintain and manage improvement actions for quality and HQ business processes
In this entry level role you will be exposed to several business functions, teams and levels of our organization which include different business locations. Experience in our quality team will prepare you for many growth opportunities within our organization nationally and globally.
Requirements and Qualifications:
Bachelor's degree in business or engineering or similar fields of study
Preferred candidate will have a minimum of 1 year of experience
Awareness with ISO 9001-2015 and ISO 14001 standards
Demonstrated ability to work within a team structure with cross-functional relationships.
Experience with SAP is a plus and Microsoft Office Suite is required
Must have excellent written and verbal communication. Communications must be in English with concise verbiage that leaves no ambiguity and requires no review / editing prior to submittal directly to customers.
Auditing experience is a plus
Previous lighting experience is a plus
Additional Information:
Relocation and/or work sponsorship are not available with this position.
Position is located in Wilmington, MA and is Monday - Friday, standard business hours
A minimum of 3 days per week in the office is required
Domestic travel is limited to 1-2 business trips per year
Provider Engagement Representative
Claim Processor Job 8 miles from Medford
eternal Health - The Next Generation of Medicare Advantage
Healthcare is confusing, but it doesn't need to be. eternal Health is a consumer-centric, Medicare Advantage Health Plan. We are committed to creating long-lasting partnerships with our members, our providers, and you!
About the role: As a Provider Engagement Representative with eternal Health you will be supporting the end-to-end process of building and maintaining a high-quality provider network. This includes supporting ongoing growth, resolving provider issues as assigned and the day-to-day management of our provider network. A high performing provider network is a critical component of our success, and our relationships with our providers are rooted in trust and
transparency. In this important and valued role, you will gain insight into multiple areas of network management, from recruitment strategy to special projects to collaborating with our providers on performance improvement initiatives. This external facing role will provide the opportunity to fully understand and communicate eternal Health's value proposition to our provider partners. This role will report directly to the VP of Network
We provide a unique opportunity to be a part of a health plan in its beginning stages. By taking advantage of this rare opportunity, you will have insight into the operations and expertise that is required to run a successful and sustainable plan. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.
Responsibilities:
Accountable for the development and enhancement of network relationships through onboarding, business interactions, and outreach.
Resolve network issues in a timely and effective manner.
Collaborate with relevant stakeholders to deliver education, training, and information on eternal Health products and strategy.
Oversight and accountability of all provider data management functionality to include roster management, data validation and management, special projects, and gap/expansion strategy.
Communicate our brand, values, and differentiators effectively and accurately.
Maintain strict privacy and confidentiality in accordance with eternal Health's security standards.
Oversight and monitoring of all communication received through the provider relations email box; responding timely, accurately, and efficiently.
Serve as a communication link between providers and eternal Health as the main point of contact for assigned provider groups.
Respond to and resolve provider issues in an efficient manner.
Conduct regular joint operating committee (JOC) meetings, at minimum quarterly, with strategic provider partners.
All others maintain regular phone and/or video conference check-ins with providers within the assigned territories. Support the sales and marketing teams by assisting in the sourcing and coordination of member support events and distribution of material.
Lead contract negotiations as assigned.
Assist with provider credentialing needs.
Lead special network projects as assigned.
Assist with the onboarding of new employees.
Proactively elicit provider feedback to help enhance their overall Plan experience.
Continuously work to understand the market and provider needs to improve the overall strategic plan.
Additional duties as assigned.
Requirements:
Bachelor's degree in relevant field of study (e.g. Business administration, Data Analytics, Healthcare Operations / Administration) or equivalent work experience.
Minimum 4-5 years of experience in managed healthcare, health plan network contracting, and provider relations experience required.
Strong technical skills, including Microsoft Suite and other collaborative tools.
Effectively communicate needs, process improvements, and wins with your network team and C-Suite officers.
Excellent written, negotiation, and communication skills.
Creative, strategic, and continuously striving for improvement.
Ability to present information to audiences of various skill levels.
Flexible and able to ramp up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
Strong organization skills to sift through large amounts of data to gain insight on members and markets.
Current driver's license and reliable transportation.
Preferred:
Experience in client-facing negotiating roles, and/or in start-ups, tech, healthcare, or insurance is a plus.
Experience with healthcare operations is a plus.
Working with eternal Health: eternal Health is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels, we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternal Health employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternal Health's mission, values, and compliance standards.
Accommodations: Any eternal Health applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process (which may include a job-related assessment) please contact us separately at ********************
Senior Claims Analyst, Management & Professional Liability
Claim Processor Job 43 miles from Medford
Job Title
SeniorClaims Analyst,Management & Professional Liability
Reporting to the Head of Management & Professional Liability, this role is primarily responsible for direct handling a mix of Directors' & Officers (D & O), Errors & Omissions (E & O), Employment Practices Liability Insurance (EPLI), and other Professional Liability claim types. The candidate will manage a portfolio of primary and excess claims that include higher exposure, greater severity and/or complexity. Duties include resolution of coverage and liability issues, claim evaluation, establishment of adequate reserves, litigation management, case resolution and transaction processing, and implementation of strategic initiatives relating to liability work matters, in alignment with the Company's Strategic Vision.
Essential Functions
Directly handles and/or assists in monitoring, reviewing, and coordinating the activities involving management and professional liability insurance claims, including analysis of coverage issues, establishment of adequate reserves, and the resolution and closure of claims.
Reviews loss notices; confirms and interprets policy coverages; establishes adequate reserves; and investigates and handles claims involving management and professional liability primary and excess policies.
Manages litigation with Preferred Counsel under Alternative Fee Arrangements or other defense fee structures.
Pursues and maximizes all risk transfer opportunities by contract or by insurance policy language.
Assigns and manages of work of defense counsel, assignment of expert witnesses and interfacing with peer carriers including design and execution of defense and indemnity contracts, evaluation of liability and damages and participation in settlement negations.
Ensures proper file setup, reserving, general handling and application of company procedure.
Participates in developing claims handling strategy, including defense coordination, litigation strategy and budgets, and expense control.
Records specific claims information and reports as appropriate to a manager relative to pertinent financial and general statistical records.
Maintains diary control, investigates, analyzes, and reports to ensure maintenance of proper reserves to reflect the company's exposure and assists in providing notice to client reinsurers.
Handles diverse and dynamic claims effectively.
Empowered to make decisions within job description and authority. Seeks guidance where appropriate.
Develops creative ideas and solutions to real time business problems and /or business opportunities; takes reasonable, calculated risks even if failure is possible.
Empowers self and teammates to continuously improve Arya/RiverStone's business processes/systems and develops and escalates ideas and solutions.
Seeks continuous development by identifying areas for growth and improvement. Works with continuous improvement team to implement process and technical improvements.
Consistently delivers superior customer service to both internal and external business partners.
Understands Key Performance Indicators and manages towards those priorities.
Performs special projects and assignments related to area of authority as necessary.
Maintains confidentiality.
Establishes and maintains professional relationships.
Assists in Due Diligence inquiries as assigned.
Travels as required.
Obtains and maintains claims adjuster licenses in those states requiring them.
Mastery of the Claims Analyst functions.
Anticipates and identifies risks and opportunities on coverage and liability.
Mentors and guides less experienced claim analysts.
Assists the Liability Claim Manager with departmental problem solving.
Serves on Companywide committees and projects as assigned.
Related Functions
Demonstrates ability and flexibility in a dynamic environment.
Excellent analytical, interpersonal and communications skills, both written and oral.
Customer service oriented with the ability of developing long lasting relationships with internal and external business partners.
Effective organizational skills are required. Must be able to prioritize and handle multiple assignments or projects simultaneously and meet established deadlines.
Critical thinking and problem solving skills.
Business acumen.
Ability to negotiate contracts and implement cost containment strategies.
Must be able to delegate tasks and follow up through delivery.
Excellent interpersonal skills with an ability to interact with people at all levels of the organization.
Strong verbal and written communication skills
Required Skills
Substantial knowledge of issues in D&O and E&O liability claims.
Excellent negotiation and communication skills. Some technical writing experience. Proficient with Microsoft Office products, internet research and typing.
Excellent interpersonal and organization skills.
Ability to accurately and timely analyze coverage and instruct and collaborate with counsel regarding litigation strategy and claim resolution, and resolve claims and otherwise act within the scope of delegated authority.
Organizational
Demonstrates alignment with Arya/RiverStone's Commitments.
Prioritizes and organizes work in self-directed manner.
Attains and maintains knowledge of assigned department.
Performs other duties as required, including supporting and coordinating with other department colleagues.
Other
We empower people to make decisions, in a supportive environment, with accountability for the outcomes.
Experience
5-10 years' experience in Management/Professional Liability claims or related civil litigation role.
Required Education
Four-year college degree is required
Preferred Education or Certification
JD, CPCU, RPLU, SCLA, CCLA
Travel
Some traveled required - up to 10-15% of the time.
Privacy Notice for California Residents
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Work Environment / Physical Demands
This position operates in a professional, collaborative environment and must have the ability to timely produce thorough, accurate work with many competing demands, deadlines, and distractions. The position uses standard equipment such as phones, computers, copiers/printers and filing cabinets. Noise level is moderate. Other Duties (Disclaimer Statement) RiverStone retains the right to change or assign other duties to this position as needed.
Core Competencies
Learning on the Fly: Learns quickly when facing new problems; a relentless and versatile learner; open to change; analyzes both successes and failures for clues to improvement; experiments and will try anything to find solutions; enjoys the challenge of unfamiliar tasks; quickly grasps the essence and the underlying structure of anything.
Problem Solving: Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.
Process Management: Good at figuring out the processes necessary to get things done; knows how to organize people and activities; understands how to separate and combine tasks into efficient flow; knows what to measure and how to measure it; can see opportunities for synergy and integration where others can't; can simplify complex processes; gets more out of fewer resources.
Sizing Up People: Is a good judge of talent; after reasonable exposure, can articulate the strengths and limitations of people inside or outside the organization; can accurately project what people are likely to do across a variety of situations.
Ethics and Values: Adheres to an appropriate (for the setting) and effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he/she preaches.
Diversity, Equity, Inclusion & Belonging
RiverStone Resources, LLC is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, LGBTQ+, national origin, gender identity, disability, protected veteran status, or any other characteristic protected by law.
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Casualty Claims Specialist
Claim Processor Job 8 miles from Medford
Everest is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in the Europe, Bermuda, Canada, Singapore, US, and other territories. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. But the most critical asset in this organization is our people.
Everest is a growth company offering Property, Casualty, and specialty products among others, through its various operating subsidiaries located in key markets around the world. Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.
Everest has an opportunity for an experienced claims professional or attorney to join our Casualty Claims team. This individual will handle mainstream and moderately complex auto, general liability and excess liability and umbrella claims of all varieties.
Responsibilities include but not limited to:
* Reviewing and analyzing complex coverage issues and preparation of coverage position letters.
* Investigating, analyzing and evaluating liability and damages.
* Managing and directing outside counsel.
* Preparing case summary reports related to matters of significant reserve and trial activity.
* Setting timely and appropriate case reserves.
* Developing and executing claim strategies as well as resolution strategies.
* Negotiating and resolving cases.
* Attending trials, mediations and settlement conferences.
* Working with underwriters to support policy construction and drafting, reporting claim trends, data analysis, and risk assessments.
* Extensive communication with insureds, brokers, reinsurers, actuaries, and underwriters.
* Attending client meetings and industry functions to support retention and development of client relationships and business.
* Performing similar work-related duties as assigned.
Qualifications, Education & Experience:
* Strong analytical and organizational skills.
* Excellent verbal and written communication skills.
* Strong negotiation and investigation skills.
* Ability to think strategically.
* Ability to influence others and resolve complex, disputed claims.
* In-depth knowledge of the litigation, arbitration, and trial process.
* Currently holds or readily can obtain all required adjuster licenses.
* Ability to identify and use relevant data and metrics to best manage claims.
* Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency.
* Ability and willingness to present to senior management and to others in other group settings.
* Knowledge of the insurance industry, claims process and legal and regulatory environment.
* 3-5 years of claims handling experience or legal experience.
* B.A. or B.S. required; JD helpful but not required.
Our Culture
At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture.
* Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion.
* Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.
All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.
For NY & CA only: The base salary range for this position is $90,000-$130,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location.
#LI-Hybrid
#LI-VP1
Type:
Regular
Time Type:
Full time
Primary Location:
Warren, NJ
Additional Locations:
Boston, MA, Chicago, IL - South Riverside, Hartford, CT, Houston, TX, Los Angeles, CA, New York, NY, San Francisco, CA
Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************.
Everest U.S. Privacy Notice | Everest (everestglobal.com)
Lead Claims Examiner (DFML)
Claim Processor Job 8 miles from Medford
First consideration will be given to those applicants that apply within the first 14 days. Minimum Entrance Requirements: Applicants must have (A) at least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or (B) any equivalent combination of the required experience and the substitutions below. Substitution: I. An Associate's degree may be substituted for one (1) year of the required experience. II. A Bachelor's degree or higher may be substituted two (2) years of the required experience. III. A Master's or higher degree may be substituted for the required experience.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave
The Program Integrity Claims Examiner/Job Service Representative II is responsible for supporting processes within the Department of Family Medical Leave (DFML). The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed claims to ensure uniformity with PFML statute and regulations by analyzing fact-finding, data and information, ensure that the required information has been obtained accurately and completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process to ensure that appropriate internal procedures were followed. Provide technical assistance and guidance to Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures. Make determinations on eligibility for benefits escalated to DFML operations in accordance with PFML Statute and Regulations
Who we are:
DFML's mission is to implement and run the Commonwealth's Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity.
What you'd do:
Lead Claims Examiner/Job Service Representative II, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA, and is responsible for the following:
Provides technical assistance, guidance and counsel to agency staff, managers, and others on fact-finding, the resolution of PFML case issues and procedural questions concerning eligibility for PFML benefits in order to insure consistent Interpretation of the law.
Reviews escalated PFML applications Involving employer conflicts on claims and analyzes all fact-finding, data and Information to ensure that the required Information has been obtained accurately and completely and properly adjudicates the application based on department operational procedures, statutory and regulatory requirements.
Conducts regular case reviews and discussions with Job Service Representative I's to develop and enhance their capacity and ability to conduct complete and accurate fact finding and make appropriate determinations.
Conducts both Informal and formal quality reviews of the work of Job Service Representative I's) to evaluate quality and identify improvement opportunities.
Provides training to Job Service Representative I's to enhance their knowledge of the Paid Family and Medical Leave, Regulations, Policies, and Procedures and their ability to apply this knowledge effectively to application determinations.
Participates in work groups to develop and enhance procedures for implementing new laws and regulations.
Interprets and explains relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures
Gather data & write reports on performance quality & corrective action recommendations.
Helps to update standard operating procedures in coordination with current Operational protocols when system enhancements or new regulations are added.
Provides information on Department of Paid Family and Medical Leave to employers, claimants and the general public through webinars, stakeholder meetings, correspondence and by the telephone.
Performs related duties such as preparing written reports, maintaining records and data interpretation.
Performs related miscellaneous duties as required and assigned.
Why should you join DFML?
The idea of working for a “government startup” excites you.
You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life.
You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives, and will value you as both a coworker and as a person.
Who you are
We're seeking candidates who have:
Ability to relate in a positive manner with claimants, employers, agency staff members and others in eliciting ail necessary information to issue claim determinations.
Ability to exercise strong technical knowledge of agency, federal and state laws, rules, regulations, codes, policies and procedures governing DFML in order to examine and resolve most complex DFML applications.
Experience in adjudicating claims.
Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence.
Ability to understand, explain and apply the laws, rules and regulations, policies and procedures governing agency activities.
Ability to exercise discretion in handling confidential information.
Ability to work under narrow time constraints.
Ability to negotiate solutions to complex problems.
Ability to interpret variety of instructions in written, oral, picture or schedule form.
Ability to define problems, collect data, establish facts and draw valid conclusions.
Knowledge of work simplification methods.
Ability to supervise, including planning and assigning work according to the nature of the job to be accomplished, the capabilities of subordinates' and available resources; controlling work through periodic reviews and/or evaluations; determining subordinates training needs and providing or arranging for such training; motivating subordinates to work effectively; determining the need for disciplinary action and either recommending or initiating disciplinary action.
Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
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Casualty Claim Examiner
Claim Processor Job 8 miles from Medford
Job Details Experienced Safety Insurance Main Office - Boston, MA Full Time None InsuranceBenefits of Working for Safety
Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs.
Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district.
Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!
Job Summary
We are located in Boston, but you can work from your home in this telecommuting position.
You will be responsible for the fair and accurate disposition of the Company's most complex casualty claims through investigation, evaluation, and settlement or recommendation within the authority level granted by the Territorial Claim Manager.
Duties
Interprets and determines policy coverages under the personal lines and commercial lines classifications
Investigates, analyzes, and evaluates liability and damages
Develops and maintains case files that document all actions
Establishes adequate and timely reserves in accordance with company guidelines
Provides equitable evaluations and settlements through negotiations
Directs and monitors defense counsel in the handling of cases in litigation, through conclusion by trial or settlement
Identifies, investigates, and refers potential fraudulent claims to SIU
Answers questions and resolves problems within established levels of authority
Provides excellent customer service
Assists in training and provides a resource to adjusters
Performs other activities as required
Qualifications
College degree or commensurate casualty claims experience required
5+ years of experience handling MA auto bodily injury claims required
Significant mediation and litigation experience required
Lead Claims Examiner (DFML)
Claim Processor Job 8 miles from Medford
*Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave* The Program Integrity Claims Examiner/Job Service Representative II is responsible for supporting processes within the Department of Family Medical Leave (DFML).
The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed claims to ensure uniformity with PFML statute and regulations by analyzing fact-finding, data and information, ensure that the required information has been obtained accurately and completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process to ensure that appropriate internal procedures were followed.
Provide technical assistance and guidance to Job Service-Representative I's on fact-finding and the resolution of case issues.
Interpret and explain relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures.
Make determinations on eligibility for benefits escalated to DFML operations in accordance with PFML Statute and Regulations *Who we are:* DFML's mission is to implement and run the Commonwealth's Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity.
*What you'd do:* Lead Claims Examiner/Job Service Representative II, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA, and is responsible for the following:** * Provides technical assistance, guidance and counsel to agency staff, managers, and others on fact-finding, the resolution of PFML case issues and procedural questions concerning eligibility for PFML benefits in order to insure consistent Interpretation of the law.
* Reviews escalated PFML applications Involving employer conflicts on claims and analyzes all fact-finding, data and Information to ensure that the required Information has been obtained accurately and completely and properly adjudicates the application based on department operational procedures, statutory and regulatory requirements.
* Conducts regular case reviews and discussions with Job Service Representative I's to develop and enhance their capacity and ability to conduct complete and accurate fact finding and make appropriate determinations.
* Conducts both Informal and formal quality reviews of the work of Job Service Representative I's) to evaluate quality and identify improvement opportunities.
* Provides training to Job Service Representative I's to enhance their knowledge of the Paid Family and Medical Leave, Regulations, Policies, and Procedures and their ability to apply this knowledge effectively to application determinations.
* Participates in work groups to develop and enhance procedures for implementing new laws and regulations.
* Interprets and explains relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures * Gather data & write reports on performance quality & corrective action recommendations.
* Helps to update standard operating procedures in coordination with current Operational protocols when system enhancements or new regulations are added.
* Provides information on Department of Paid Family and Medical Leave to employers, claimants and the general public through webinars, stakeholder meetings, correspondence and by the telephone.
* Performs related duties such as preparing written reports, maintaining records and data interpretation.
* Performs related miscellaneous duties as required and assigned.
***Why should you join DFML? * * The idea of working for a "government startup" excites you.
* You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life.
* You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives, and will value you as both a coworker and as a person.
*Who you are* We're seeking candidates who have: * Ability to relate in a positive manner with claimants, employers, agency staff members and others in eliciting ail necessary information to issue claim determinations.
* Ability to exercise strong technical knowledge of agency, federal and state laws, rules, regulations, codes, policies and procedures governing DFML in order to examine and resolve most complex DFML applications.
* Experience in adjudicating claims.
* Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence.
* Ability to understand, explain and apply the laws, rules and regulations, policies and procedures governing agency activities.
* Ability to exercise discretion in handling confidential information.
* Ability to work under narrow time constraints.
* Ability to negotiate solutions to complex problems.
* Ability to interpret variety of instructions in written, oral, picture or schedule form.
* Ability to define problems, collect data, establish facts and draw valid conclusions.
* Knowledge of work simplification methods.
* Ability to supervise, including planning and assigning work according to the nature of the job to be accomplished, the capabilities of subordinates' and available resources; controlling work through periodic reviews and/or evaluations; determining subordinates training needs and providing or arranging for such training; motivating subordinates to work effectively; determining the need for disciplinary action and either recommending or initiating disciplinary action.
* Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
First consideration will be given to those applicants that apply within the first 14 days.
Minimum Entrance Requirements: Applicants must have (A) at least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or (B) any equivalent combination of the required experience and the substitutions below.
Substitution: I.
An Associate's degree may be substituted for one (1) year of the required experience.
II.
A Bachelor's degree or higher may be substituted two (2) years of the required experience.
III.
A Master's or higher degree may be substituted for the required experience.
_*Comprehensive Benefits*_ When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package.
We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards! *An Equal Opportunity / Affirmative Action Employer.
Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
* The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.
Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements.
We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
**Job:** **Community and Social Services* **Organization:** **Department of Workforce Development* **Title:** *Lead Claims Examiner (DFML)* **Location:** *Massachusetts-Boston-100 Cambridge Street* **Requisition ID:** *24000AIW*
Content Claims Specialist - Field - Level I
Claim Processor Job 8 miles from Medford
The role of Content Claims Specialists is a multi-faceted role, which focuses primarily in the following four key areas of edjuster's content claims handling operations:
Acting/operating as a third party, intermediary between the Insurance Company's property adjusters, and their policyholders with respect to conducting valuations of policyholder's/claimant's total loss contents, which are most commonly caused by theft, water, fire and other perils.
Focusing on the accurate and timely processing of content claims, via the use of edjuster's claims handling professional-service methodology and its Web-based content claims processing and pricing platform/system - exclaim.
Operating from their appropriately set up and equipped home-based offices, edjuster's Content Claims Specialists are consistently (daily/weekly basis) assigned new claim files.
Operating from their home-based offices, edjuster's Content Claims Specialists are responsible for recording all daily claims handling activity, with respect to hours worked/time spent per task as well as fulfilling all of their required administrative job duties.
Responsibilities
As part of this role, responsibilities included, but are not limited to the following:
Conduct site visit to meet the adjusters/policyholders and industry vendors, where they are to explain their roles as Content Claims Specialists, and their respective roles/contributions in the claims handling process.
Visit sites to conduct inventory of the contents lost. Identify claim type and apply appropriate methodology based on the circumstances of the contents loss. May be exposed to diverse conditions (cold, heat, rain, debris, etc.).
Ensure consistent and quality/turnaround of all claims in accordance with the Company's productivity and performance standards.
Work with Central Claims Processing to organize/direct the resources (claims assistants, pricing representatives) required for completing the inventory and LKQ assessment of all damaged/destroyed total loss contents in an efficient and effective manner, and as per productivity standards.
Work with Central Claims Processing to organize/direct the resources (claims assistants, pricing representatives) required to promote/achieve the timely turnaround/closures of all claims.
Adhere to edjuster Inc.'s commitment to timely and informative updates on the content claims process to adjusters/policyholders.
Complete/submit detailed work/time logs on a daily basis, for all claims processed.
Maintain claim related notes in the Company's Claims System/Web-application, exclaim, relating to incurred hours over productivity standards, as well as related to specific issues and other pertinent notes.
Ensure timely and accurate completion/pricing of all outstanding items, which have not been priced via other channels, and following pricing Like, Kind and Quality (LKQ) standards.
Consistently promote edjuster's brand, image and reputation in a professional and positive manner.
Qualifications
A Secondary School diploma.
Some prior background/experience in the Property claims industry would be considered an asset.
Be able to provide an adequate workspace, free of noise.
Employee must provide their own high speed internet service (a portion will be reimbursed).
Company equipment including laptop will be provided. It is the employee's responsibility to care and maintain the equipment, as per policy.
Own vehicle and valid driver's license
Overnight travel required - Currently, overnight travel (out of region) is a regular occurrence. All extended travel costs (flights, rental cars, hotels) will be handled by edjuster in advance. Meal costs will be covered by the employee and expensed after the fact.
Strong computer skills (MS Office/Outlook, etc.).
Strong communication skills.
Demonstrated ability to adapt to change and new technology.
Willingness to learn and continuously improve.
Associate Claims Specialist, Rideshare - Auto Property Damage
Claim Processor Job 8 miles from Medford
Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
Description
Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As an Associate Claims Specialist, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual.
You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Plano, TX; Suwanee, GA; or Westborough, MA. Please note this policy is subject to change.
This position may be filled as a Senior Claims Representative or Associate Claims Specialist. We are open to fill this position depending on related professional skills and experience. The salary listed includes all US regions and may vary based on candidate location.
Responsibilities:
* Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
* Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
* Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
* Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
* Determines and negotiates settlement amount for damages claimed within assigned authority limits.
* Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
* Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
* Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed.
Qualifications
* Effective interpersonal, analytical and negotiation abilities required
* Ability to provide information in a clear, concise manner with an appropriate level of detail
* Demonstrated ability to build and maintain effective relationships
* Demonstrated success in a professional environment; success in a customer service/retail environment preferred
* Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
* Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
* Licensing may be required in some states
About Us
As a purpose-driven organization, Liberty Mutual is committed to fostering an environment where employees from all backgrounds can build long and meaningful careers. Through strong relationships, comprehensive benefits and continuous learning opportunities, we seek to create an environment where employees can succeed, both professionally and personally.
At Liberty Mutual, we believe progress happens when people feel secure. By providing protection for the unexpected and delivering it with care, we help people embrace today and confidently pursue tomorrow.
We are proud to support a diverse, equitable and inclusive workplace, where all employees feel a sense of community, belonging and can do their best work. Our seven Employee Resource Groups (ERGs) offer a centralized, open space to bring employees and allies together to connect, learn and engage.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco
Claims Examiner
Claim Processor Job 46 miles from Medford
Claims Examiner
Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.
Responsibilities:
Provides voice to voice contact within 24 hours of first report.
Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings.
Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals.
Utilizes evaluation documentation tools in accordance with department guidelines.
Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
Maintains and document claim file activities in accordance with established procedures.
Attends depositions and mediations and all other legal proceedings, as needed.
Protects organization's value by keeping information confidential.
Maintains compliance with Claim Department's Best Practices.
Provides quality customer service and ensures file quality
Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
Participates in special projects as assigned.
Some overnight travel maybe required.
Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.
Qualifications:
Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
Adjuster Licensure required.
One to three years of experience processing claims; property and casualty segment preferred.
Experience with Xactware products preferred.
Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
Proficiency with Microsoft Office products required; internet research tools preferred.
Demonstrated customer service focus / superior customer service skills.
Excellent communication skills and ability to interact on a professional level with internal and external personnel
Results driven with strong problem solving and analytical skills.
Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
Detail-oriented and exceptionally organized
Collaborative partner; ability to contribute to a positive work environment.
General Information:
All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.
The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.
Liability Claims Specialist - NERO
Claim Processor Job 7 miles from Medford
We are a team of employees who are passionate to deliver best in-class customer service and innovation in the industry. It's because we put Integrity, Relationships and Excellence in all aspects of our work.
Our employees have the opportunity to fully utilize their talents and bring their best self. We believe that who you are is just as important as what you do!
By joining our growing Claims team as a Liability Claims Specialist, you will ensure high quality claim handling while making coverage determinations, investigating losses, conducting independent assessment as to the company exposure and moving cases towards timely resolution. You will be an effective source for help and support because of your deep knowledge and liability claim expertise.
How You'll Make an Impact
Manages assigned volume of casualty claims within Personal and Commercial underwriting verticals
Investigates, evaluates, negotiates and settles assigned claims within authority limits
Develops and follows strategic action plans throughout the life of the file
Provides proactive hospitality by appropriately setting expectations, building rapport, and responding to requests timely
Builds relationships and appropriately communicates with agency partners, internal and external stakeholders
Conducts thorough and proactive liability claim investigations including utilization of ISO
Implements proper recognition, investigation, referral and communication regarding subrogation
Sets accurate initial reserve in a timely manner and continually reviews accuracy in the context of ultimate probable exposure
Manages liability files through swift resolution of exposures that warrant settlement
Detects and mitigates fraud when investigating claims
Maintains appropriate consideration of file expenses and utilizes approved suppliers
Manages paid losses appropriately; pays what is fair and owed, settles claims at the optimal time in the life of the file
Monitors and collaborates with defense counsel on litigation strategy and development through the litigation process
Assists team development with subject matter expertise learning, and onboarding assistance
Completes training as assigned
Handles special projects as assigned
What You'll Bring
Ability to obtain and maintain all required state department of insurance adjusting licenses and CE's within 90 days of employment
Bachelor's degree and 2 years of related experience
Or Associates degree and 3 years of related experience
Or 4 years of related experience
Travel as needed
Ability to investigate and evaluate liability claims in accordance with our Best Practices
Ability to analyze available information and make effective decisions
Ability to evaluate damages and negotiate fair settlements
Ability to work independently and in a team environment
Positively contributes to Team NPS results
Ability to reach key performance metrics
Properly utilizes diary & mail system to manage timeliness of needed activity
Complies with state regulatory/statutory requirements, corporate privacy and other claim policy requirements
Strong understanding of industry verticals such as transportation, construction, manufacturing, real estate, and small business
Understands and utilizes various resources including technology and tools
Ability to understand Central Insurance's policies and processes
Preferred Qualifications
CPCU, SCLA or AIC designations
Claims experience in both Personal Lines and Commercial Lines
Litigation management experience
Experience drafting coverage letters
Working knowledge of contracts and risk transfer concepts
Work Authorization
Central will only employ those who are legally authorized to work in the United States. This is not a position for which sponsorship will be provided. Individuals with temporary visas such as E, F-1(including those with OPT or CPT) , H-1, H-2, L-1, B, J or TN, or who need sponsorship for work authorization now or in the future, are not eligible for hire.
Equal Opportunity Employer
It is the policy of Central that all recruiting, hiring, training, compensation, overtime, job classification and assignment, facilities, promotions, transfers, employee treatment and all other terms and conditions of employment shall be maintained in a manner which will not discriminate against any person because of race, color, age, sex, national origin, ancestry, religion, marital status, military status, or disability. The applicant should respond to questions on this application in a way that will not divulge such information. #LI-Hybrid #LI-CM1
Other details
Job Family Insurance Claims- Core
Claim Specialist, Casualty (Hybrid)
Claim Processor Job 46 miles from Medford
Company: MAPFRE Bring your passion and enthusiasm for Claims to our TEAM! At MAPFRE we believe we are only as strong as our people. We strive to create an inclusive and welcoming culture, valuing your hard work, integrity and commitment.
Come learn and grow with MAPFRE while offering top notch service to our insureds! Participate in your own Individual Development Plan (IDP) which serves as your blueprint for outlining your aspirations, goals and activities.
We offer a supporting team environment. Our Casualty professionals use their specialized expertise to handle even the most complex matters seamlessly. Be part of this collaborative group of innovative claim handlers.
Understandably, comprehensive benefits are important and we offer a generous package that includes: Tuition Reimbursement, Medical, Dental, Vision, Referral Bonuses and 401K match. Social Responsibility is important to MAPFRE and we offer a Volunteer program where employees are provided PTO for giving their time to a charity of their choice.
Job Summary
**Position can be Hybrid (2 days in Office/3 days Remote) in our Webster or Boston, MA Office or Remote**
In this position, individuals will be handling a pending of Automobile Casualty losses to primarily include moderate and high severity Bodily Injury and Un/Under Insured Motorist claims. This position requires proficiency in interpreting Personal and Commercial Auto policies and may require multi-jurisdictional claims handling. Refers to and interprets policies and practices for guidance and accurate application. The individual will be responsible for all components of the adjustment process to include screening new losses to determine coverage exposures, thoroughly investigating liability, evaluate claim values, negotiate final disposition of claims with appropriate parties, and issue timely and accurate payments if appropriate. The individual will also be exposed to and responsible for litigation and/or arbitration management of claims. Frequent oral and written communication with medical providers, customers and attorneys are required and these contacts must be timely and professional. Strong telephone customer service skills and the ability to empathize with claimants and customers are needed. Individuals should possess a high level of initiative and demonstrate the ability to work both independently and in a team environment with high daily workloads in a fast paced environment. Strong business and decision making skills as well as the ability to maintain a high degree of confidentiality are required. May represent organization on specific projects. Communication involves creating and delivering varied types of messages and information and may involve persuasion and negotiation. A moderate to high degree of independence is expected. May participate in the training of other claims personnel.
Knowledge, Skills and Abilities
**Education:** Bachelor's Degree or professional level of knowledge in a specialized field, or equivalent, related experience.
**Experience:** 2 - 4 years - or Associates Degree equivalent plus 4 - 6 years.
**Knowledge:** Complete understanding and knowledge of industry practices, standards, and concepts within field of work. Applies them to perform or lead work requiring extensive analytical business skills.
**Decision Making:** Makes decisions related to a wide variety of situations within management limits. Interprets guidelines and procedures, applying judgment and discretion. Decisions influence portions of a project, client relationships and/or expenditures.
**Supervision Received:** Works independently under general supervision. Work is reviewed for overall adequacy in meeting objectives.
**Leadership:** May provide training and guidance to less experienced staff.
**Problem Solving /Operations/Direct Work Involvement:** Develops solutions to a variety of problems, typically of moderate scope and complexity. Refers to and interprets policies and practices for guidance.
**Client Contacts:** Contacts other departments and or external organizations or parties frequently. Contacts are primarily at or below upper management levels. Represents organization on specific projects. Communication may involve persuasion, and negotiation.
Additional Knowledge, Skills and Abilities
- Three (3) years of claim adjusting experience is required.
- Ability to assimilate job responsibilities quickly and professionally.
- Insurance Industry Education strongly preferred.
- This position requires excellent written and oral communication skills and the demonstrated ability to organize and prioritize work to assure productivity goals of managing a pending are met.
- Strong telephone customer service skills and the ability to empathize is needed.
- Must possess basic CRT / PC skills with accurate keyboarding abilities.
- Must possess good math skills and be able to work in a fast paced environment.
- Completion of the Casualty Claims training program is required.
If you require an accommodation for a disability so that you may participate in the selection process, you are encouraged to contact the MAPFRE Insurance Talent Acquisition team at ******************************* .
_We are proud to be an equal opportunity employer._
**Nearest Major Market:** Worcester
**Job Segment:** Law, Liability, Claims, Recruiting, Call Center, Legal, Insurance, Human Resources, Customer Service
Apply now »
Claims Specialist
Claim Processor Job 8 miles from Medford
Pay Philosophy
The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
Description
The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim's management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.
This is a hybrid position, however, those within 50 miles of our offices in Boston, MA, Bala Cynwyd, PA, Plano, TX, Suwanee, GA, Indianapolis, IN, Tampa, FL and Hoffman Estates, IL; must report to the office twice a month. Please note that this policy is subject to change.
Responsibilities:
Manages an inventory of claims to evaluate compensability/liability.
Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
Independently investigates, evaluates and negotiates 3
rd
party liability settlements with Attorney involvement
Performs other duties as assigned.
Qualifications
BS/BA degree or equivalent work experience.
Minimum of 2 years experience in claims adjustment, general insurance or formal claims training.
Required to obtain and maintain all applicable licenses.
Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.
About Us
As a purpose-driven organization, Liberty Mutual is committed to fostering an environment where employees from all backgrounds can build long and meaningful careers. Through strong relationships, comprehensive benefits and continuous learning opportunities, we seek to create an environment where employees can succeed, both professionally and personally.
At Liberty Mutual, we believe progress happens when people feel secure. By providing protection for the unexpected and delivering it with care, we help people embrace today and confidently pursue tomorrow.
We are proud to support a diverse, equitable and inclusive workplace, where all employees feel a sense of community, belonging and can do their best work. Our seven Employee Resource Groups (ERGs) offer a centralized, open space to bring employees and allies together to connect, learn and engage.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
California
Los Angeles Incorporated
Los Angeles Unincorporated
Philadelphia
San Francisco
Claims Analyst, APO (Asbestos, Pollution & Other Health Hazards)
Claim Processor Job 43 miles from Medford
MAKE YOUR MARK IN THE COSTLIEST MASS TORTS IN US HISTORY
Claims Analyst, APO
Full-time Remote and Hybrid (Manchester, NH) Opportunities Available
RiverStone is seeking individuals to join a growing and dynamic team tasked with changing the future of the national mass tort and pollution litigation through thoughtful, creative claim handling, litigation strategies, and system-wide initiatives.
Why RiverStone?
RiverStone comprises insurance, reinsurance, and service companies specializing in the management of legacy and run-off insurance businesses and portfolios. With a highly skilled and diverse team of professionals from various disciplines, RiverStone has amassed unrivaled insurance industry and regulatory experience, and is a recognized market leader in the resolution of complex insurance claims arising from multiple lines of business, including asbestos, pollution, molestation, and other health hazards, construction defect, and major bodily injury liabilities.
At RiverStone, we are hard-working but believe in having fun - at work! RiverStone is a Great Place to Work and provides an exciting and fun work environment with regular opportunities to engage with your team for enrichment and team building events. We are also committed to fostering an environment in which diversity of every type can flourish and every associate is positioned to thrive. We welcome and celebrate diverse and talented individuals who bring unique perspectives, expertise and experience to collaborate with our team to craft unique strategies and drive exceptional results. RiverStone is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, LGBTQ+, national origin, gender identity, disability, protected veteran status, and any other characteristic protected by law. We value diversity, equity, inclusion, and want all employees to feel like they belong at RiverStone.
You deserve more than just a paycheck. RiverStone has competitive compensation and benefits packages, including an exceptional health benefits program, potential for an annual financial reward based on both individual and company performance, company-matched 401k plan, flexible work arrangements, paid parental leave, adoption assistance/reimbursement, pre-tax flexible spending accounts for healthcare and dependent care, and a generous employee stock purchase plan through RiverStone's parent, Fairfax Financial. We also pay attention to your individual needs and offer tuition reimbursement, health and wellness programs, time off for charitable endeavors and a generous charitable giving company match, a sabbatical program after 10+ years of employment, and site-specific perks available including an on-site gym, casual dress code, free lunch Fridays, and more!
The Opportunity
Reporting to the Unit Manager, the Claims Analyst will directly handle claims, including asbestos, pollution, molestation and other health hazards (APO). Day to day activities will include: coverage analyses, liability and damage investigations, comprehensive evaluations, litigation management, negotiation, mediation participation and trial attendance as cases require. Potential responsibilities may include special projects and participation in due diligence efforts to evaluate potential new business acquisitions.
Duties/Responsibilities:
Review loss notices; confirm and interpret policy coverages; establish adequate reserves; and investigate and handle claims involving primary and excess coverages
Responsible for assignment to and control of work of defense counsel, assignment of expert witnesses, and interfacing with peer carriers, including design and execution of defense and indemnity contracts, evaluation of liability and damages, and participation in settlement conferences
Ensure proper file setup, reserving, general handling and application of company procedure and coverage interpretation philosophy
Participate in developing claims handling techniques, including defense coordination, expense control, and strategy
Provide specific claims information to senior management relative to all new notices of loss and maintain specific financial and general statistical records which are used for reporting to management
Maintain diary control of reported cases to ensure maintenance of proper resources to reflect the company's exposure and adequate notice to reinsurers, and recovering of specific amounts when payment exceeds the company's retention
Perform special projects and assignments related to area of authority
Qualifications/Experience:
Minimum of 5 years of experience handling commercial line and/or multi-line claims or comparable experience
College Degree (4-year) required
Excellent analytical, interpersonal, and communication skills, both written and oral required
Proven track record of working independently and meeting assigned deadlines
5-10 years handling complex claims and coverage issues preferred
JD, DPCU, SCLA, CCLA desired
Privacy Notice for California Residents:*******************************************************
RequiredPreferredJob Industries
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Casualty Claim Examiner
Claim Processor Job 8 miles from Medford
Job Details Level: Experienced Position Type: Full Time Salary Range: Undisclosed Travel Percentage: None Job Category: Insurance Benefits of Working for Safety Safety Insurance has become one of the leading property and casualty insurance providers in Massachusetts mainly because of our unwavering commitment to independent agents and their customers. Our success is built on a philosophy of offering the highest quality insurance products at competitive rates and providing the best service at all costs.
Through our supportive career, educational and family policies, we enable our employees to be their best. We respect the balance of work and leisure by offering flexible schedules and a 37.5 hour workweek. Safety employees enjoy a positive environment in our convenient downtown office located in the heart of Boston's financial district.
Along with our competitive salaries, we offer a comprehensive benefits package including medical and dental insurance, 100% matching 401k retirement plan, 100% tuition reimbursement and much, much more!
Job Summary
We are located in Boston, but you can work from your home in this telecommuting position.
You will be responsible for the fair and accurate disposition of the Company's most complex casualty claims through investigation, evaluation, and settlement or recommendation within the authority level granted by the Territorial Claim Manager.
Duties
* Interprets and determines policy coverages under the personal lines and commercial lines classifications
* Investigates, analyzes, and evaluates liability and damages
* Develops and maintains case files that document all actions
* Establishes adequate and timely reserves in accordance with company guidelines
* Provides equitable evaluations and settlements through negotiations
* Directs and monitors defense counsel in the handling of cases in litigation, through conclusion by trial or settlement
* Identifies, investigates, and refers potential fraudulent claims to SIU
* Answers questions and resolves problems within established levels of authority
* Provides excellent customer service
* Assists in training and provides a resource to adjusters
* Performs other activities as required
Qualifications
* College degree or commensurate casualty claims experience required
* 5+ years of experience handling MA auto bodily injury claims required
* Significant mediation and litigation experience required
Claims Specialist
Claim Processor Job 8 miles from Medford
About Everest Everest Group, Ltd. (Everest), is a leading global reinsurance and insurance provider, operating for nearly 50 years through subsidiaries in North America, Latin America, the UK & Ireland, Continental Europe and Asia Pacific regions. Throughout our history, Everest has maintained its discipline and focuses on creating long-term value through underwriting excellence and strong risk and capital management. Our strengths include extensive product and distribution capabilities, a strong balance sheet, and an innovative culture. Our most critical asset is our people. We offer dynamic training & professional development to our employees. We also offer generous tuition/continuing education reimbursement programs, mentoring opportunities, flexible work arrangements, and Colleague Resource Groups.
Everest is a growth company offering Property, Casualty, and specialty products among others, through its various operating subsidiaries located in key markets around the world. Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service, and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.
Everest has an opportunity for an entry level Claims professional to join our Casualty Claims team in one of our Everest offices. This individual should possess the ability to evaluate Casualty claims and litigation for potential escalation to our Fast Track, Mainstream or Complex claim teams.
Duties and responsibilities include, but are not limited to:
* Serve as point of contact for policy holders and brokers on recently reported claims.
* Review documentation submitted when the claim was reported.
* Summarize the facts that support what happened and the extent of the injuries alleged. Follow up with involved parties for additional clarification as needed.
* Review relevant policies to confirm coverage details and limits.
* Enter loss details into the claim system and send template correspondence as needed.
* Use the facts collected to assess the potential severity of alleged injuries.
* Flag issues and escalate urgent matters to management.
* Monitor incoming correspondence for material updates to reassess potential severity.
* Respond to inquiries on assigned claims and accounts in a timely and professional manner.
* Investigation, analysis and evaluation of assigned claim.
* Comply with all relevant state and federal regulations, as well as company policies and procedures.
Work Experience & Qualifications:
* A minimum of 2 years of claims/legal experience and working knowledge of the civil litigation legal process.
* Strong oral and written communication skills.
* Strong analytical, organizational and investigation skills.
* Currently holds or readily can obtain all required Adjuster Licenses.
* Knowledge of the insurance industry, claims and the legal and regulatory environment.
* Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency.
Education:
* Bachelor's degree or equivalent work experience required.
* Insurance industry designation(s)/certification(s) preferred.
For NY & CA only: The base salary range for this position is $65,000-$100,000 annually. The offered rate of compensation will be based on individual education, experience, qualifications and work location.
Our Culture
At Everest, our purpose is to provide the world with protection. We help clients and businesses thrive, fuel global economies, and create sustainable value for our colleagues, shareholders and the communities that we serve. We also pride ourselves on having a unique and inclusive culture which is driven by a unified set of values and behaviors. Click here to learn more about our culture.
* Our Values are the guiding principles that inform our decisions, actions and behaviors. They are an expression of our culture and an integral part of how we work: Talent. Thoughtful assumption of risk. Execution. Efficiency. Humility. Leadership. Collaboration. Diversity, Equity and Inclusion.
* Our Colleague Behaviors define how we operate and interact with each other no matter our location, level or function: Respect everyone. Pursue better. Lead by example. Own our outcomes. Win together.
All colleagues are held accountable to upholding and supporting our values and behaviors across the company. This includes day to day interactions with fellow colleagues, and the global communities we serve.
#LI-Hybrid
#LI-VP1
Type:
Regular
Time Type:
Full time
Primary Location:
Warren, NJ
Additional Locations:
Atlanta, GA, Boston, MA, Chicago, IL - South Riverside, Hartford, CT, Houston, TX, Los Angeles, CA, New York, NY, San Francisco, CA
Everest is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy), sexual orientation, gender identity or expression, national origin or ancestry, citizenship, genetics, physical or mental disability, age, marital status, civil union status, family or parental status, veteran status, or any other characteristic protected by law. As part of this commitment, Everest will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Everest Benefits at *********************************.
Everest U.S. Privacy Notice | Everest (everestglobal.com)
Lead Claims Examiner (DFML)
Claim Processor Job 8 miles from Medford
Lead Claims Examiner/Job Service Representative II| Department of Family & Medical Leave The Program Integrity Claims Examiner/Job Service Representative II is responsible for supporting processes within the Department of Family Medical Leave (DFML). The Lead Claims Examiner/Job Service Representative II will review, analyze and evaluate disputed claims to ensure uniformity with PFML statute and regulations by analyzing fact-finding, data and information, ensure that the required information has been obtained accurately and completely and that the determination (s) confirm that proper adjudication procedures have been followed throughout the determination process to ensure that appropriate internal procedures were followed. Provide technical assistance and guidance to Job Service-Representative I's on fact-finding and the resolution of case issues. Interpret and explain relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures. Make determinations on eligibility for benefits escalated to DFML operations in accordance with PFML Statute and Regulations
Who we are:
DFML's mission is to implement and run the Commonwealth's Paid Family & Medical Leave program that provides income support to Massachusetts workers and their families during significant life events while serving as a partner to employers to deliver program integrity.
What you'd do:
Lead Claims Examiner/Job Service Representative II, who reports to the Senior Manager of Benefit Operations & Program Integrity is based in Boston, MA, and is responsible for the following:
* Provides technical assistance, guidance and counsel to agency staff, managers, and others on fact-finding, the resolution of PFML case issues and procedural questions concerning eligibility for PFML benefits in order to insure consistent Interpretation of the law.
* Reviews escalated PFML applications Involving employer conflicts on claims and analyzes all fact-finding, data and Information to ensure that the required Information has been obtained accurately and completely and properly adjudicates the application based on department operational procedures, statutory and regulatory requirements.
* Conducts regular case reviews and discussions with Job Service Representative I's to develop and enhance their capacity and ability to conduct complete and accurate fact finding and make appropriate determinations.
* Conducts both Informal and formal quality reviews of the work of Job Service Representative I's) to evaluate quality and identify improvement opportunities.
* Provides training to Job Service Representative I's to enhance their knowledge of the Paid Family and Medical Leave, Regulations, Policies, and Procedures and their ability to apply this knowledge effectively to application determinations.
* Participates in work groups to develop and enhance procedures for implementing new laws and regulations.
* Interprets and explains relevant laws, regulations, policies and procedures as required to ensure effective operations and compliance with existing established procedures
* Gather data & write reports on performance quality & corrective action recommendations.
* Helps to update standard operating procedures in coordination with current Operational protocols when system enhancements or new regulations are added.
* Provides information on Department of Paid Family and Medical Leave to employers, claimants and the general public through webinars, stakeholder meetings, correspondence and by the telephone.
* Performs related duties such as preparing written reports, maintaining records and data interpretation.
* Performs related miscellaneous duties as required and assigned.
Why should you join DFML?
* The idea of working for a "government startup" excites you.
* You want to work for a place that values your contributions and ideas, moves quickly in implementing solutions, and at the same time, allows you the flexibility to have a good balance between your personal and professional life.
* You will work with a dedicated team who are fueled by our mission of helping the people of the Commonwealth smoothly navigate our program during the big moments in their lives, and will value you as both a coworker and as a person.
Who you are
We're seeking candidates who have:
* Ability to relate in a positive manner with claimants, employers, agency staff members and others in eliciting ail necessary information to issue claim determinations.
* Ability to exercise strong technical knowledge of agency, federal and state laws, rules, regulations, codes, policies and procedures governing DFML in order to examine and resolve most complex DFML applications.
* Experience in adjudicating claims.
* Ability to write concisely to express thoughts clearly and develop ideas in a logical sequence.
* Ability to understand, explain and apply the laws, rules and regulations, policies and procedures governing agency activities.
* Ability to exercise discretion in handling confidential information.
* Ability to work under narrow time constraints.
* Ability to negotiate solutions to complex problems.
* Ability to interpret variety of instructions in written, oral, picture or schedule form.
* Ability to define problems, collect data, establish facts and draw valid conclusions.
* Knowledge of work simplification methods.
* Ability to supervise, including planning and assigning work according to the nature of the job to be accomplished, the capabilities of subordinates' and available resources; controlling work through periodic reviews and/or evaluations; determining subordinates training needs and providing or arranging for such training; motivating subordinates to work effectively; determining the need for disciplinary action and either recommending or initiating disciplinary action.
* Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
First consideration will be given to those applicants that apply within the first 14 days.
Minimum Entrance Requirements:
Applicants must have (A) at least three (3) years of full time, or equivalent part-time professional or paraprofessional experience in personnel interviewing, vocational counseling, employment counseling, rehabilitation counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication, claims settlement, claims examining, claims, investigation, claims interviewing, social work or social casework, or (B) any equivalent combination of the required experience and the substitutions below.
Substitution:
I. An Associate's degree may be substituted for one (1) year of the required experience.
II. A Bachelor's degree or higher may be substituted two (2) years of the required experience.
III. A Master's or higher degree may be substituted for the required experience.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
Claims Examiner
Claim Processor Job 46 miles from Medford
Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.
Responsibilities:
Provides voice to voice contact within 24 hours of first report.
Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings.
Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals.
Utilizes evaluation documentation tools in accordance with department guidelines.
Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
Negotiate disposition of claims with insured's and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
Maintains and document claim file activities in accordance with established procedures.
Attends depositions and mediations and all other legal proceedings, as needed.
Protects organization's value by keeping information confidential.
Maintains compliance with Claim Department's Best Practices.
Provides quality customer service and ensures file quality
Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
Participates in special projects as assigned.
Some overnight travel maybe required.
Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.
Qualifications:
Associate's Degree required; Bachelor's Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
Adjuster Licensure required.
One to three years of experience processing claims; property and casualty segment preferred.
Experience with Xactware products preferred.
Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
Proficiency with Microsoft Office products required; internet research tools preferred.
Demonstrated customer service focus / superior customer service skills.
Excellent communication skills and ability to interact on a professional level with internal and external personnel
Results driven with strong problem solving and analytical skills.
Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
Detail-oriented and exceptionally organized
Collaborative partner; ability to contribute to a positive work environment.
General Information:
All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.
The preceding has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
Heritage Insurance Holdings, Inc. is an Equal Opportunity Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.
Associate Claims Specialist, Rideshare - Auto Property Damage
Claim Processor Job 28 miles from Medford
Pay Philosophy The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
Description
Are you looking for an opportunity to join a claims team with a fast-growing company that has consistently outpaced the industry in year over year growth? Liberty Mutual has an excellent claims opportunity available. As an Associate Claims Specialist, you will review and process simple and straightforward Commercial claims within assigned authority limits consistent with policy and legal requirements. In addition to a wide range of benefits, as a direct employee, your insurance education and training are paid by Liberty Mutual.
You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Plano, TX; Suwanee, GA; or Westborough, MA. Please note this policy is subject to change.
This position may be filled as a Senior Claims Representative or Associate Claims Specialist. We are open to fill this position depending on related professional skills and experience. The salary listed includes all US regions and may vary based on candidate location.
Responsibilities:
* Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
* Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
* Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
* Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
* Determines and negotiates settlement amount for damages claimed within assigned authority limits.
* Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
* Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
* Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed.
Qualifications
* Effective interpersonal, analytical and negotiation abilities required
* Ability to provide information in a clear, concise manner with an appropriate level of detail
* Demonstrated ability to build and maintain effective relationships
* Demonstrated success in a professional environment; success in a customer service/retail environment preferred
* Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent
* Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory
* Licensing may be required in some states
About Us
As a purpose-driven organization, Liberty Mutual is committed to fostering an environment where employees from all backgrounds can build long and meaningful careers. Through strong relationships, comprehensive benefits and continuous learning opportunities, we seek to create an environment where employees can succeed, both professionally and personally.
At Liberty Mutual, we believe progress happens when people feel secure. By providing protection for the unexpected and delivering it with care, we help people embrace today and confidently pursue tomorrow.
We are proud to support a diverse, equitable and inclusive workplace, where all employees feel a sense of community, belonging and can do their best work. Our seven Employee Resource Groups (ERGs) offer a centralized, open space to bring employees and allies together to connect, learn and engage.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: ***********************
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
* California
* Los Angeles Incorporated
* Los Angeles Unincorporated
* Philadelphia
* San Francisco