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Become A Claim Specialist

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Working As A Claim Specialist

  • Identifying Objects, Actions, and Events
  • Interacting With Computers
  • Getting Information
  • Documenting/Recording Information
  • Processing Information
  • Unpleasant/Angry People

  • Mostly Sitting

  • Make Decisions

  • Stressful

  • $74,350

    Average Salary

What Does A Claim Specialist Do At Nationwide

* 1. Promptly and effectively handles to conclusion assigned claims with little to no direction and oversight which may include complex and catastrophic casualty losses
* Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight.
* Makes decisions within delegated authority, recommends settlement values in the disposition of serious and sometimes complex claims as outlined in company policies and procedures.
* Adheres to high standards of professional conduct consistent with the delivery of superior service
* Utilizes various methods of settlement in those cases where warranted; assigns cases to outside vendors as warranted
* Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy.
* Recommends Special Reserves where necessary.
* In accordance with Corporate Reserving Guidelines.
* Adheres to file conferencing notification and authority procedures
* Maintains current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications.
* This may require attendance at various seminars or training session5.
* Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management
* Partners with SIU and Subrogation to identify fraud and subrogation opportunities.
* Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty)
* Oversees defense counsel in all lawsuit activities from inception throughout the life of the claim
* Delivers a positive On
* Your
* Side customer service experience to all internal, external, current and prospective Nationwide customers
* Other duties as assigned

What Does A Claim Specialist Do At Metlife

* Provide timely and accurate communication, information gathering, and rendering decisions on Long-term Disability (LTD) claims according to provisions of LTD certificates.
* Communicate with a variety of constituents (claimants, doctors, nurses, employers, and attorneys) to gather information relevant to rendering decisions based on the provisions of the policy.
* Claim Specialist Trainees will be routinely evaluated for increases in their authority levels as they become more experienced in their decision making and demonstrate consistency in meeting metrics.
* Learn to use appropriate systems, tools and resources to research and document claims.
* Learn to develop an action plan and identify the Likely Claim Progression including identifying the return to work potential.
* Complete regular updates on financial offsets such as SSDI.
* They will utilize CMG which provides an overview of high level topics, factors to consider in the administration of claims, and examples of claim situations

What Does A Claim Specialist Do At Combined Insurance

* Duties may include, but are not limited to:
* Confirms coverage of claims by reviewing policies and documents submitted in support of first party commercial claims.
* Analyzes coverage and communicates coverage positions under direction of Director/ Coverage unit.
* Conducts, coordinates, and directs investigation and subrogation into loss facts and extent of first party damages.
* Directs and monitors assignments to experts and field adjusters .
* Evaluates information on coverage and damages to determine the extent of exposure.
* Sets reserves within authority or makes claim recommendations concerning reserve changes to Director/Team Leads.
* Reports to business partners, as warranted.
* Travels to conferences, mediations, and trials as necessary

What Does A Claim Specialist Do At Massmutual Financial Group

* Attention to detail is required to capture information, determine benefit amounts, review applications and any policy changes that have occurred during the policy history
* Review claim forms, death certificates and legal documents to determine when claim is eligible for payment
* Adhere to state and company guidelines to ensure our beneficiaries are paid or supplementary contracts are placed in a timely manner
* Utilize resources to approve claim for payment based on in good order requirements
* This is a customer focused role to ensure that claims are completed timely, accurately and empathetically

What Does A Claim Specialist Do At Liberty Mutual

* Investigates claims to determine whether coverage is provided, establish compensability and verify exposure.
* Resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority.
* Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management.
* Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols.
* Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely.
* Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure.
* Establishes and maintains accurate reserves on all assigned files.
* Makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority.
* Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insureds.
* Demonstrates the ability to understand new and unique exposures and coverages.
* Demonstrates the ability to understand key data elements and claims related data analysis.
* Confers directly with policyholders on coverage and resolution strategy issues.
* Coordinates and participates in training sessions for less experienced staff, including both Complex & non
* Complex staff

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How To Become A Claim Specialist

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher level positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

The varying types of work in these occupations can require different backgrounds or different college coursework. For example, a business or an accounting background might be best for someone who wishes to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have the formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Most insurance companies prefer to hire people trained as law enforcement officers, private investigators, claims adjusters, or examiners, because these workers have good interviewing and interrogation skills.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims, under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must both evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

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Claim Specialist jobs

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Real Claim Specialist Salaries

Job Title Company Location Start Date Salary
Homeowner Claims Specialist Liberty Mutual Insurance Company Boston, MA Jun 02, 2015 $137,030 -
$148,300
International Insurance and Reinsurance Claims Specialist Kennedys Latin America LLC Miami, FL Jan 26, 2015 $107,000
Construction Claim Specialist Precision Mechanical, Inc. Cocoa, FL Apr 10, 2009 $60,000
Claims Management Specialist Outokumpu Stainless USA, LLC Calvert, AL Sep 18, 2015 $48,000
Cargo Claims Specialist, Risk Management & Insurance Expeditors International of Washington, Inc. Seattle, WA Sep 01, 2015 $47,000
Claims Management Specialist Outokumpu Stainless USA, LLC Calvert, AL Sep 12, 2014 $45,500 -
$48,500

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Top Skills for A Claim Specialist

CustomerServiceLossInsuranceCompaniesInsuranceClaimsAutoClaimsMedicalProvidersProcessClaimsDataEntryDisabilityClaimsMedicalClaimsBodilyInjuryClaimsMedicalRecordsMedicaidCompensationClaimsGeneralLiabilityClaimsAuditCPTSpecialProjectsPhoneCallsNewClaims

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Top Claim Specialist Skills

  1. Customer Service
  2. Loss
  3. Insurance Companies
You can check out examples of real life uses of top skills on resumes here:
  • Provided customer service, entered data, assisted with computer operations, assisted with the unemployment insurance program and website.
  • Created process that expedited and prioritized information process flow for loss mitigation cases.
  • Disbursed hazard insurance payments to insurance companies from customer escrow accounts.
  • Processed insurance claims and maintained customer account information.
  • Demonstrated high level of professional knowledge of techniques associated with investigation, documentation and evaluation of auto claims.

Top Claim Specialist Employers

Claim Specialist Videos

A Day in the Life of a Claim

Career Advice on becoming a Risk Manager by Martyn R (Full Version)

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