Senior claims representative job description

This position is responsible for investigating, evaluating and negotiating settlement of assigned property claims with the goal of serving the customer and ensuring quality file handling.
What You'll Be Doing:



Handles moderate to large complexity Personal and Commercial Lines Claims. Ability to handle large losses with oversight as dictated by workloads. An active member of the mid-level large loss team. Perform onsite and virtual inspection of damages to resolve coverage and damage issues to include preparing complete estimates of repair for the covered damages. Pursuant to line of business strategies and good faith claim practices: document all claim activity to support the claim file, including the recognition and documentation of SIU and Subrogation opportunities and refer accordingly. Create a high level of policyholder satisfaction by complying with established service standards. Investigate and evaluate onsite to resolve complex coverage and damage issues to include preparing complete estimates of repair for the covered damages. Explain coverage of loss, assists policyholders with itemization of damages, emergency repairs and additional living arrangements. Works with and may coordinate a number of vendor services such as contractors, emergency repair, cleaning services and experts. Creates alignment regarding policy and procedures across vendors for handling losses. Serves as a technical subject matter expert for the department. Proactively works with leadership to leverage subject matter expertise in a manner to support line of business initiatives. Identify trends and share best practices across group and within line of business. Active member of catastrophe team, which may include overnight travel on short notice for what could be extended periods of time, in order to investigate, negotiate and settle assigned claims. Responds to inquiries from policyholders, agents, internal partners and others. Contribute to a positive work environment by positively influencing others, striving for high performance results with a "can do" attitude. Exhibit accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun. Assist leadership with the technical evaluation during candidate selection processes. Serves as mentor to members of Claims team. Operates and maintains company vehicle.



What You'll Bring To The Company:


High school diploma or equivalent education plus 3-5 years claim experience preferred. Bachelor's degree in related field preferred. Must possess ability to work independently in a remote setting with strong communication, time management and organization skills. Proficient with personal computer and app technology. Demonstrated ability to interact with customers and agents in a professional manner. Valid driver's license and good driving record required. Lifting requirement of 40-50 pounds, ability to climb up on roofs and work in confined spaces. State specific adjusters' license may be required.


About Us:


Grange Insurance Company, with $3 billion in assets and more than $1.3 billion in annual revenue, is an insurance provider founded in 1935 and based in Columbus, Ohio. Through its network of independent agents, Grange offers auto, home, life and business insurance protection. Life insurance offered by Grange Life Insurance and Kansas City Life Insurance. Grange Insurance Company and its affiliates serve policyholders in Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia and Wisconsin.


Who We Are:


We are committed to an inclusive work environment where we welcome and value diversity and inclusion. We hire great talent from a wide variety of backgrounds, and our associates are our biggest strength. The diversity of our associates, their backgrounds, experiences, and individual differences are the foundation for our success. Our inclusive culture empowers all of us to "Be One Team", "Deliver Excellence", "Communicate Openly", "Do the Right Thing", and "Solve Creatively for Tomorrow". We have active Associate Resource Groups and a Diversity and Inclusion Team, that focuses on professional development, networking, business value and community outreach; all which encourage and facilitate an environment that fosters learning, innovation, and growth. Together we use our individual experiences to learn from one another and grow as professionals and as humans.

We welcome the unique contributions that you bring from education, opinions, culture, beliefs, race, color, religion, age, sex, national origin, handicap, disability, sexual orientation, gender stereotyping, gender identity or expression, genetic information, ancestry, pregnancy, veteran status, and citizenship.

Grange Enterprise is proud to be part of the CEO Action for Diversity and Inclusion™, a national initiative of more than 1400 CEOs working for the advancement of diversity and inclusion within the workplace.

Working under the direction of the Manager of Revenue Recovery, this position is responsible for posting revenue with respect to all HP Contractual carves outs for all networks of SJHH. This position will also assist with special claims projects for overpayments. This position will be back up for other department areas as membership increases.
**Required qualifications:**

+ 3 years Experience in medical/institutional claims processing within a medical group/IPA or HMO setting.

+ 1 year Experience with Independent revenue recovery showing outstanding outcomes.

**Preferred qualifications:**

+ Associate's Degree

+ Experience working with health plans on recoveries.

+ IDX experience.

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission of caring for everyone, especially the most vulnerable in our communities.

**About Providence**

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

**About the Team**

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

**Requsition ID:** 106721
**Company:** Providence Jobs
**Job Category:** Claims
**Job Function:** Revenue Cycle
**Job Schedule:** Full time
**Job Shift:** Day
**Career Track:** Admin Support
**Department:** 7520 CLAIMS PROCESSING CA HERITAGE SERVICES
**Address:** CA Anaheim 200 W Center St Promenade

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Based in Woburn, MA, Cabot Risk Strategies is easily accessed off of 93 and 128, and employs 85+ people. Please visit our web site at www.cabotrisk.com.

Purpose and Description

Responsible for handling all phases of assigned complex claims. Involved from initial contact to investigations to forwarding claims payments. Carefully documents all claims information and maintains accurate records complying with established claim procedure requirements.

Essential Job Functions

1. Secures all required claims information from contact and transcribes it for claims file and management review.

1. Follow-up contact by telephone or by letter with claimant on initial reporting of claim. Assures that all information required to take action on claim has been submitted.

1. Attend hearings, mediations, and trials.

1. Obtains information from witnesses, police, or doctors, etc., and secures medical bills or any other proof of loss required to settle claims as quickly and effectively as possible.

1. Determines coverage and requests payment on claims handled under specified authority.

1. Issues claims payments on claims when appropriate. Will provide required documentation to management for tracking all claims.

1. Conducts field investigations required for prompt and equitable settlement of all assigned claims.

1. Responsible for meeting established service standards.

1. Other duties and projects as may be assigned from time to time.

Minimum Requirements

The following are required to enable the employee to perform the essential functions of the job.

1. Skills/knowledge – Excellent communications skills (verbal and written) required, along with the ability to handle in a professional manner claimants who may be upset or impatient. Must be able to maintain credibility with clients and develop a strong, ongoing business relationship with assigned clients. Ability to follow a task through to a timely completion is mandatory. The ability to operate a personal computer, calculator, typewriter, fax, copy machine, shredder, and telephone is essential.

1. Experience/education – Minimum of three years handling professional liability and property and casualty claims required. Must have completed at least one AIC or AEI source or have considerable work experience. College degree required or equivalent work experience considered.