Medical Claims Processor

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Injury Claims Examiner (Central to West regions), you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM , and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications both over the phone and in writing, advice, and empathy. This role is remote eligible in the continental U.S. with occasional business travel. However, individuals residing within a 60-mile radius of a USAA office will be expected to work on-site three days per week. What you'll do: * Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality), high exposures including umbrella claims and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims. * Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes. * Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates. * Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation. * Partners and/or directs vendors and internal business partners to facilitate timely claims resolution. * Serves as a resource for team members on complex claims. * Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication. * Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed. * Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: * High School Diploma or General Equivalency Diploma. * 4 years auto injury claims adjusting experience. * Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations. * Advanced negotiation, investigation, communication, and conflict resolution skills. * Demonstrated strong time-management and decision-making skills. * Proven investigatory, prioritizing, multi-tasking, and problem-solving skills. * Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims. * Ability to exercise sound financial judgment and discretion in handling insurance claims. * Advanced knowledge of coverage evaluation, loss assessment, and loss reserving. * Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts. * Should be in Central, Mountain or Pacific time zone. What sets you apart: * 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage * College Degree (Bachelor's or higher) * Insurance Designation * US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $85,040 - $162,550 . Licensed positions require a background check, that includes criminal history, education, employment verification, and a credit check consistent with applicable laws. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). USAA will consider qualified applicants with a criminal history pursuant to the San Diego County Fair Chance Ordinance and the California Fair Chance Act. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if USAA is concerned about a conviction(s) that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Find out more about the Fair Chance Ordinance by visiting the San Diego County Office of Labor Standards and Enforcement webpage. USAA will consider qualified applicants with a criminal history pursuant to the L os Angeles County Fair Chance Ordinance and the California Fair Chance Act. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if USAA is concerned about a conviction(s) that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report. Find out more about the Fair Chance Ordinance by visiting the Los Angeles County Office of Labor Standards and Enforcement website. Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.