Claims Service Associate

Claim Services Associate

Physicians Insurance A Mutual Company is dedicated to protecting, defending, and supporting our Members. As a national boutique mutual insurance company, we passionately serve all our Members and partners with our suite of medical professional liability offerings. We help them overcome obstacles with a team providing underwriting, risk-management, claims, and stop-loss expertisebacked by strong financials and all supported by exceptional, personalized service. In every communication, every expert opinion, every risk assessment, and every claim, all our Members experience the positive impact of our mission on their professional lives. And with over 8,500 Members and growing, this experience is in evidence all over the nation.

The Claim Services Associate is responsible for the timely and accurate intake, triage, and system setup of reported incidents, claims, and lawsuits. Serving as the first point of contact for insured members, brokers, and internal departments. This role provides professional, responsive customer experience while gathering, validating, and documenting critical claim information. The position also performs limited claim handling within established authority and supports efficient claims assignment and workflow coordination across the Claims Department.

Key responsibilities include:

• Serve as the primary point of contact for reported incidents, claims, lawsuits, and precautionary events submitted via phone, email, or online channels.
• Gather, review, and document comprehensive First Notice of Loss (FNOL) information and supporting documentation to ensure absolute data accuracy and completeness prior to assignment.
• Analyze incoming reports for severity, urgency, and coverage considerations; exercise independent judgment to escalate high-priority, complex matters to Claims Management while handling first-tier issues autonomously.
• Provide professional, responsive, and empathetic communication to members, brokers, patients, attorneys, and internal partners regarding intake requirements, policy provisions, and next steps.
• Complete accurate claim setup by verifying applicable coverages, tail endorsements, and policy limitations within the system, and generate formal acknowledgment correspondence.
• Perform low-complexity claims handling within established authority, including managing minor medical/dental negotiations, assigning counsel for deposition requests, and coordinating disciplinary board coverage.
• Maintain precise system data, track intake metrics, and process regulatory reporting or referrals (such as Litigation and Peer Support Programs) in collaboration with Legal and Compliance teams.
• Utilize departmental systems, tracking software (including Breezy ATS workflows where applicable), and applications to support daily intake activities, minimize processing lag, and drive process improvements.
• Provide project support, cross-coverage, reserve data updates, and backup assistance for department staff to ensure overall service-level expectations are consistently met.

Requirements / Qualifications:

• High school diploma or equivalent required; additional education, insurance coursework, or industry training preferred.
• Three to five years of experience in administrative, customer service, claims, operations, or related analytical role.
• Insurance experience preferred, especially in medical malpractice, professional liability, or related coverage areas.
• Strong attention to detail with the ability to enter, review, and maintain accurate claim information and documentation.
• Ability to review information, assess urgency or complexity, manage shifting priorities, and escalate issues appropriately.
• Excellent organizational, time management, and coordination skills, with the ability to manage competing priorities in a fast-paced environment.
• Strong written and verbal communication skills, with a customer-focused approach and the ability to work effectively with internal teams and external stakeholders.
• Knowledge of basic coverage principles, claim processes, and medical terminology preferred.
• Experience using workflow, claims, or case management systems preferred; ability to learn and adapt to new tools, software, and processes required.
• Proficiency with Microsoft Word and Outlook required; strong typing skills preferred.
• Ability to work independently and collaboratively while demonstrating professionalism, sound judgment, and integrity.
• This position may be hired as Senior Claims Associate based on qualifications and experience.

The salary range for this position is $70,800 to $105,800. Starting salary is determined by several factors, including job-related skills, experience, and relevant education or training. This position is also eligible for an annual company bonus at an incentive target level of 5%.

We also offer a comprehensive benefits program, including a generous retirement program and Paid Time Off. Please visit Physicians Insurance - A Mutual Company for detailed benefit descriptions.

At Physicians Insurance, you'll find an exceptional hybrid work environment, and the opportunity to work for an industry leader whose programs have a positive impact on insurance and healthcare.

Our Purpose: To protect, defend, and support our Members. Our Values: People-First - we treat everyone with respect and empathy. Expertise - we strive to be the best at what we do. Commitment - as a mutual company, we are accountable and dedicated to our Members and to each other.

Physicians Insurance A Mutual Company