Claims Representative

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

📋 Description

• Conduct investigations and evaluations of low-complexity third-party auto, casualty, and premises liability claims, which includes performing coverage analysis and assessing liability.

• Make prompt contact with insured individuals, claimants, witnesses, clients, and other parties involved, generally within 24 hours of receiving the claim assignment.

• Collect statements, assemble documentation, review police and fire reports, and identify potential subrogation or recovery opportunities.

• Set and maintain appropriate claim reserves based on risk exposure and claim developments.

• Acquire and review medical records, bills, invoices, receipts, and other relevant documentation for claim assessment purposes.

• Prepare notifications for excess carriers and escalate complex claims to management when further expertise is necessary.

• Address inquiries related to claim status, coverage details, liability, and damages.

• Draft reservation of rights letters and denial notices with the required management approval.

• Negotiate and resolve claims within the assigned authority, suggest settlements that exceed authority limits, and process payments as appropriate.

• Create evaluations for bodily injury and property damage as well as settlement documentation.

• Ensure the proper execution of releases and agreements.

• Maintain active claim diaries, adhere to client-specific handling instructions, prepare claim summaries and reports, engage in file reviews, and keep updated through continuous training.

⛳️ Requirements

• Associate degree or equivalent relevant experience is required.

• At least one year of experience in claims handling, insurance, or a related field is necessary.

• Experience in handling low-complexity third-party auto, casualty, and premises liability claims is strongly preferred.

• A Bachelor’s degree may be accepted in place of the claims handling or insurance experience requirement.

• AIC, INS, or other insurance-related certifications are preferred.

• Fundamental understanding of the claims adjusting process is essential.

• Basic knowledge of insurance contracts, medical terminology, and legal aspects of court procedures related to legal liability is required.

• Proficient computer skills, including familiarity with claims systems, are needed.

• Excellent organizational, written, and verbal communication skills, including documentation capabilities, are necessary.

• Strong investigative and problem-solving skills are essential.

🏝️ Benefits

• Comprehensive benefits package including life, medical, dental, vision, and prescription drug coverage.

• Competitive paid time off plan.

• An entire day of volunteer time off each year.

• 401(k) plan with matching contributions.

• Pension plan.

• OneEMC bonus program.

• Recognition and awards for anniversaries.

• Opportunities for professional development and growth.

• Tuition reimbursement available.

• Wellness initiatives aimed at improving team member well-being and lowering health insurance costs.

• Flexibility in dress code to suit your day.

• Options for alternative work arrangements.