Claims Adjuster

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and process claims efficiently.

• Interact with insured individuals and third parties to gather necessary information for processing.

• Acquire medical reviews and translations when necessary.

• Prepare files for Tiered Authorization when claims exceed the adjuster's authority.

• Organize files for Carrier Review as required.

• Detect suspicious activities in claim files and adhere to investigation protocols.

• Recognize third-party liability and follow the appropriate subrogation procedures.

• Review assigned escalations promptly and effectively.

• Uphold established quality and production standards.

• Maintain accurate file notations that reflect review outcomes.

• Process claims in accordance with insurance policy terms and conditions.

• Authorize payments and denials as deemed appropriate.

⛳️ Requirements

• A Bachelor’s Degree is preferred.

• At least 2 years of experience in claims processing is preferred.

• A Property & Casualty adjuster license is required, or the ability to obtain one within 90 days of hire.

• Proficiency in MS Office and other relevant software is essential.

• Capability to process claims according to insurance policy terms and conditions.

• Ability to comply with carrier authority guidelines.

• Skill in authorizing payments and denials as appropriate.

• Competence in identifying suspicious claim activities and following investigation procedures.

• Ability to pinpoint third-party liability and execute the subrogation process.

• Proficiency in maintaining quality and production standards.

• Ability to keep accurate claim file notations.

🏝️ Benefits

• Competitive health plans.

• HSA contributions.

• Employer-paid Life & AD&D insurance.

• Short- and Long-Term Disability coverage.

• Competitive employer retirement matching program.

• Paid parental leave for birthing parents, partners, adoptive, and foster parents.

• Flexible paid time off.

• Hybrid and remote work opportunities.

• Flexible scheduling around core hours.

• Internal mobility opportunities.

• Leadership development programs.

• Ongoing coaching and support.

• Exclusive discounts on travel, entertainment, wellness, and more.

• Comprehensive training and mentoring.