Claims Adjuster I, PD Experience

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

📋 Description

• Evaluate mid- and higher-level general liability claims to establish the benefits owed

• Ensure the continuous adjudication of claims adheres to company standards and industry best practices

• Identify subrogation opportunities and negotiate settlements

• Collect information to assess liability exposure

• Assign reserve values and authorize claims payments when necessary

• Settle claims up to the specified authority level

• Evaluate liability and resolve claims within the assessment

• Approve and process assigned claims while determining benefits owed

• Develop action plans in accordance with the claim or client contract

• Communicate claim actions to claimants and clients

• Ensure claim files are accurately documented and claims coding is correct

• Process complex lifetime medical and/or defined period medical claims when necessary

• Maintain professional relationships with clients

• Support the organization's quality programs

• Perform additional duties as assigned

• Travel as needed

⛳️ Requirements

• Minimum of four (4) years of claims management experience or a comparable combination of education and experience required

• Bachelor's degree from an accredited college or university is preferred

• Expertise in relevant insurance principles and laws applicable to the specific line of business

• Understanding of recoveries, offsets and deductions, claim and disability duration, cost containment principles, medical management practices, and Social Security and Medicare application procedures as applicable

• Exceptional oral and written communication skills, including presentation abilities

• Proficient in PC usage, including Microsoft Office applications

• Strong analytical and interpretative skills

• Excellent organizational abilities

• Good interpersonal skills

• Outstanding negotiation skills

• Capability to work collaboratively in a team setting

• Ability to meet or exceed service expectations

• Proficient in managing multiple priorities simultaneously and meeting deadlines

• Willingness to travel as needed

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) plan with matching

• Paid time off (PTO)

• Disability insurance

• Life insurance

• Employee assistance program

• Flexible spending or health savings account

• Additional voluntary benefits available

• Reasonable accommodations provided as applicable and appropriate