Claims Adjuster - Liability

Claims Analyst

PRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

REQUIREMENTS:

100 % REMOTE, please omit anyone in CA and NY. Preferred to work CST standard work hours. Resource will be dedicated to 1 account, they will need 2-4 years Claims Handling, touching base with attorneys, following up on claims and update on bodily injury claims - Communication and Injury Claims are critical coupled with Customer Service. Negotiate exp is a plus.

QUALIFICATION:

Education & Licensing: Bachelor's degree from an accredited college or university preferred.

Experience: Four (4) years of claims handling experience or equivalent combination of education and experience required.

Skills & Knowledge: Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations.

WORK ENVIRONMENT:

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking.

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."