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Become A Senior Claims Representative

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Working As A Senior Claims Representative

  • Getting Information
  • Resolving Conflicts and Negotiating with Others
  • Interacting With Computers
  • Communicating with Supervisors, Peers, or Subordinates
  • Identifying Objects, Actions, and Events
  • Unpleasant/Angry People

  • Mostly Sitting

  • Repetitive

  • Make Decisions

  • $62,980

    Average Salary

What Does A Senior Claims Representative Do At Unitedhealth Group

* Use pertinent data and facts to identify and solve a range of problems within area of experience Understand and interpret explanations of benefits (EOB) data from variety of carriers in a variety of formats Basic analysis and investigation of trends in the data and competitors product and rates Retrieve and interpret claim reports to assist with efficient and accurate documentation of claims for delivery to internal and external customers Research, identify and obtain data/information needed to help accurately interpret the data as needed Provide feedback to co-workers through peer review process Anticipate customer needs and contribute to proactive identification of solutions Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment.
* You’ll need to be comfortable navigating across various computer systems to locate critical information.
* Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim

What Does A Senior Claims Representative Do At Nationwide

* Investigates, evaluates, and negotiates commercial, personal and professional lines claims to a successful resolution and in compliance with company quality standards.
* Handles files involving litigation.
* These claims may include first and third party claims of a moderate severity and complexity/exposure level.
* Responsible for managing the work and performance of vendors to achieve successful resolution of claims.
* May handle files in litigation.
* Responsible for meeting the expectations and requirements of internal and external customers.
* Responsible for developing and maintaining open and trusting working relationships with insureds in order to gather pertinent information.
* Responsible for timely and appropriate evaluation of claims to identify and manage reserves in compliance with company standards.
* Maintains current knowledge of: all 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 and training sessions.
* Performs other related duties as assigned.
* May be assigned more complex claims including claims with litigation

What Does A Senior Claims Representative Do At Liberty Mutual

* 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.
* Writes simple to moderately complex property damage estimates or review auto damage estimates.
* 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

What Does A Senior Claims Representative Do At Combined Insurance

* Duties include but are not limited to:
* Under close supervision, receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
* Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, healthcare providers, attorneys, police officers, etc. to secure necessary claim information.
* Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
* Sets reserves within authority limits and recommends reserve changes to Team Leader.
* Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
* Settles claims promptly and equitably.
* Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
* Informs claimants, insureds/customers or plaintiff attorney of denial of claim when applicable.
* ESIS ProClaim offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, a retirement savings plan, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress.
* ESIS ProClaim is an equal opportunity employer and our employment decisions are made without regard to race, color, religion, age, gender, national origin, disability, handicap, marital status or any other status or condition protected by Federal and/or State laws, except where bona fide occupational qualifications apply

What Does A Senior Claims Representative Do At DXC Technology

* Actively participates as a key member of the team.
* Adjudicate claims in an automated system using reference manuals, reports, and online capabilities.
* Resolve claims billing errors, process adjustments, facilitate claim adjudication, and other claims resolution functions.
* Project a positive attitude toward co-workers, providers, and all customers.
* Other general clerical tasks and additional duties as assigned by leadership.
* DXC Technology is EEO F/M/Protected Veteran/ Individual with

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How To Become A Senior Claims Representative

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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Senior Claims Representative jobs

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Top Skills for A Senior Claims Representative

BodilyInjurySettlementsAutoAccidentsTotalLossInsuranceClaimsCustomerServicePersonalInjuryClaimsGeneralLiabilityClaimsBodilyInjuryClaimsAutomobileClaimsWorkersCompensationClaimsDefenseCounselPropertyDamageClaimsSpecialInvestigationUnitPersonalLinesCatastropheCoverageIssuesCasualtyClaimsPolicyCoverageComplexClaimsMedicalClaims

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Top Senior Claims Representative Skills

  1. Bodily Injury Settlements
  2. Auto Accidents
  3. Total Loss
You can check out examples of real life uses of top skills on resumes here:
  • Evaluated and negotiated bodily injury settlements with injured parties and attorneys.
  • Investigated auto accidents of Progressive Insurers and claimants with quickness and high efficiency.
  • Served as subject matter expert in auto total loss settlements and negotiations.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Provided customer service to insureds and claimants using knowledge gained through training and experience.

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