Claims Service Associate

Position Summary 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 a 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 Functions 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 elevate 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 elevate 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. Compensation & Benefits Salary range: $70,800 to $105,800. Eligible for an annual company bonus at an incentive target level of 5%. Comprehensive benefits program includes a generous retirement program and Paid Time Off. The role is offered in a hybrid work environment. #J-18808-Ljbffr Physicians Insurance A Mutual Company