Senior Claims Representative, Analyst

This is a fully remote position, open to applicants in Colorado, +6 more states.

📋 Description

• Resolve large and notably complex claims independently by investigating losses and negotiating settlements.

• Assess insurance coverage by reviewing claim forms, policies, records, and evidence; interviewing claimants, injured workers, insured individuals, and witnesses; analyzing police and hospital records; and consulting with experts.

• Establish carrier liability and settle claims according to policy provisions and authority levels.

• Manage mediations, arbitrations, subrogation, and litigated files.

• Mentor and train claims representatives, shared claims personnel, and interns.

• Provide after-hours claims emergency support when on call.

• Gather, analyze, and summarize claim information, recommending reserve adjustments and future file management strategies.

• Investigate questionable claims and compare claims details with evidence.

• Suggest litigation and assess negotiated settlement options and evidence.

• Oversee higher-exposure and highly complex claim files.

• Supervise independent adjusters and attorneys to ensure adherence to company guidelines and procedures.

• Prepare reports and ensure accurate file documentation in compliance with claims guidelines and state regulations.

• Participate in catastrophe teams, establish department investigation guidelines, provide underwriting feedback, build agent relationships, and assist in vendor selection.

• Maintain professional and technical expertise through ongoing training and education.

• Research state statutes, laws, regulations, case law, technical bulletins, and jurisdictional changes.

• Communicate changes and implications for claims handling to Claims Managers, Senior Quality Specialists, and the Claims Director.

• Analyze business processes and workflows, propose compliance enhancements, and streamline operations.

• Collaborate with Claims leadership on training initiatives and facilitate state meetings.

• Resolve workers' compensation vendor issues in conjunction with Claims Vendor Managers and Claims Managers.

• Assist with state interest credit, penalties, physician panels, annual state reporting, and compliance reviews.

• Update state materials on the Claims Insider/SharePoint site and inform staff of updates.

⛳️ Requirements

• A Bachelor's degree in business or a related field, plus 7+ years of experience managing complex claims, or 10+ years of claims handling experience involving discretionary decision-making and escalating levels of claims complexity.

• A valid driver's license and a satisfactory driving record.

• Willingness to travel for mediations, agency visits, key discovery depositions, and field investigations throughout the service area as necessary.

• Technical expertise in commercial property and/or casualty claims.

• Knowledge and experience with insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.

• Capability to obtain and maintain necessary licensing before handling a state where it is required by the Society.

• Proficiency in PC applications, including word processing, the Internet, spreadsheets, and email software.

• Ability to develop and sustain positive working relationships.

• Professional designations such as AIC, ARM, CIC, CPCU, or equivalent coursework are preferred.

• A valid state adjuster license where required is preferred.

• Familiarity with medical terminology is preferred.

• Advanced knowledge of litigation processes, procedures, terminology, and legal research is preferred.

🏝️ Benefits

• Competitive salary with a bonus plan.

• Comprehensive health, dental, life, and vision insurance.

• Traditional or Roth 401(k) Defined Contribution Plan.

• Profit-Sharing Plan.

• Company-paid holidays.

• Flexible scheduling options.

• Paid Time Off (PTO).

• Telecommuting options available.

• Career coaching services.

• Company-sponsored courses.

• Student loan and tuition reimbursement.

• Charitable matching contributions.

• Paid volunteer time.

• Team sponsorship opportunities.

• Employee Assistance Program.

• Wellness initiatives and rewards.

• Health coaching services.