Claims Adjuster, Liability

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

📋 Description

• Evaluate mid- and higher-level general liability claims to ascertain entitled benefits

• Ensure ongoing claims adjudication aligns with company standards and industry best practices

• Identify subrogation possibilities and negotiate settlements

• Collect information to assess liability exposure

• Assign reserve amounts and process claims payments as necessary

• Resolve claims up to the designated authority level

• Evaluate liability and conclude claims within assessment

• Approve and handle assigned claims while determining entitled benefits

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

• Communicate claim actions with claimants and clients

• Ensure proper documentation of claim files and accurate claims coding

• Process complex lifetime medical and/or defined-period medical claims as applicable

• Maintain professional relationships with clients

• Support the organization’s quality initiatives

• Perform additional duties as assigned

⛳️ Requirements

• Bachelor’s degree from an accredited institution preferred

• Four (4) years of claims management experience or a relevant combination of education and experience required

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

• Understanding of recoveries, offsets and deductions, claim and disability duration, and cost containment principles

• Familiarity with medical management practices and Social Security and Medicare application procedures as applicable

• Exceptional oral and written communication abilities, including presentation skills

• Proficient in PC usage, including Microsoft Office suite

• Strong analytical and interpretive skills

• Excellent organizational skills

• Strong interpersonal capabilities

• Outstanding negotiation skills

• Capacity to work collaboratively in a team setting

• Ability to meet or exceed service expectations

• Capability to manage work-related stress and multiple priorities simultaneously

• Commitment to meeting deadlines

• Willingness to travel as necessary

🏝️ Benefits

• Work-life balance

• Equal Opportunity Employer

• Drug-Free Workplace

• Reasonable accommodations when applicable and appropriate

• Consideration for other roles if experience does not align perfectly