Senior Medical Claims Representative

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

📋 Description

• Oversee a portfolio of claims to assess compensability and liability

• Organize and perform investigations on claims to verify coverage and establish liability, compensability, and damages

• Identify and negotiate suitable claim settlements and reserves within the defined authority

• Participate in arbitrations, mediations, depositions, or trials as required

• Communicate moderately complex coverage and settlement details to insured individuals, claimants, and external stakeholders

• Approve payments within the designated authority limits and ensure prompt disbursement

• Keep precise and comprehensive claim files, which include correspondence, reports, and settlement agreements

• Manage Medical Only claims

• Execute additional tasks as assigned

⛳️ Requirements

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related discipline or equivalent experience

• Typically, at least 5 years of experience in handling property and casualty claims

• Completion of or ongoing progress toward a professional designation is preferred, such as Associate in Claims (AIC)

• Strong analytical, negotiation, and problem-solving abilities

• Familiarity with insurance policies, coverage, and claims handling processes

• Understanding of industry laws and regulations

• Capability to organize and prioritize caseloads, ensuring timely claim resolutions

• Exceptional interpersonal and communication skills

• Ability to cultivate relationships and facilitate negotiations

• Proven track record of managing confidential information with care

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Wellness plans

• Parental leave

• Adoption assistance

• Tuition reimbursement

• Paid Time Off

• Paid holidays

• 401(k) plan with company match

• Employee stock purchase plan

• Commuter benefits