Job Description

This individual will proactively manage and consult on the overall claims process with specifically identified clients. The assigned clients will be in the Tier 1 Category or other specific clients as decided by management. This individual will serve as the primary claims contact and see claims through to conclusion. This person will advocate for their clients by participating in coverage analysis and disputing denied claims. This individual will meet with clients to review loss runs or visit large losses as needed. This role may also serve as adjuster for our TPA accounts some of which will require Medicare reporting, Worker’s Compensation Consulting, Subrogation or involvement with Captive work as requested and needed.

This role strictly adheres to our Corporate Standards of Excellence and procedural guidelines spelled out in our Professional Procedure Manual.

Essential Job Functions:

1. Function as main point of contact for client.
2. Address general questions, provide guidance on coverage and inform/educate clients on claims process.
3. Take insured’s first notice of loss, submit to appropriate carrier.
4. Manage diary system for follow up on claims.
5. Manage claim life cycle for all assigned claims / accounts.
6. Work with Clients on providing appropriate services based on the Tiered System.
7. Act as Workers Compensation Consultant on a fee basis as requested.
8. Analyze, consult with and review loss runs with clients when requested.
9. Visit large loss sites and client meetings as needed.
10. Serve as off hours Claims contact on a rotating basis.
11. Serve as adjuster on TPA accounts and handle claims accordingly as needed.
12. Maintain ImageRight files and document activity using claims management system.
13. Serve as back up to Claims Manager as needed.
14. Performs other duties as assigned.

Requirements

Skills and Abilities:

1. Fluency in MS Office products.
2. Superior verbal and written communication skills.
3. Strong knowledge of insurance coverage and terminology.
4. Ability to multitask and operate in an ever-changing environment is critical.
5. Ability to work well in a team environment.
6. Ability to communicate clearly, to work well with others, and to manage time effectively.
7. Fluent with Modmaster if consulting on Worker’s Compensation Claims for a fee.

Education and Experience:

1. Bachelor’s degree or equivalent in work experience.
2. AAI, AIC, CPCU, or CIC designations preferred.
3. 5+ years’ Claims adjusting experience.
4. Claims Adjuster license is required.
5. Producer’s license is Preferred.