Senior Liability Claims Adjuster - Remote

S enior Claims Representative Analyst

Full-time

40 hours/week with Flexible Scheduling Opportunities

Home Office, Telecommuting, and Remote Opportunities in: CO, GA, IL, IN, IA, MN, TN, TX, & WI

Protecting our policyholders’ dreams, passions, and livelihoods has a direct impact on the communities we serve. Society Insurance is seeking an experienced Senior Claims Representative Analyst to join our team. This position will Independently resolve large and significantly complex claims by investigating losses and negotiating settlements. This role also works closely with Claims Manager, Senior Claims Quality Specialist, Compliance Manager, Claims Vendor Manager, and Claims Director to analyze jurisdictional changes and impacts on departmental and company guidelines and standards.

Determines insurance coverage by examining claim forms, policies, and other records; Handles and settles large and significantly complex claims by determining insurance carrier’s liability; reaching agreement with claimants/injured workers according to policy provisions and authority level; Provides departmental support by mentoring and training new and current claims representatives, shared claims staff, and interns.
May support after-hours claims emergencies by being on call 24 hours per day, seven days per week.
Resolves questionable claims by investigating and comparing claims information with evidence.
Manages litigated files and recommends litigation by analyzing negotiated settlement options and evaluating evidence.
Manages file load composed of higher exposure and highly complex claims.
Ensures proper file documentation of assigned files by complying with claims handling guidelines and state requirements.
Prepares reports by collecting, analyzing, and summarizing claim information.
building relationships with agents; Maintains professional, technical knowledge and expertise in a specified line(s) of business through training courses and participating in continuing education coursework/classes.
Resolves litigated claims by referring cases to attorneys as needed, analyzing state statutes, evaluating evidence, and working with the attorneys in developing strategy for resolution of the case.
Stays current on evolving state needs for the company, staff, and individual personal development. This may require travel to attend seminars, training opportunities, monitoring trade publications, and developing key relationships with local contacts who are experts in the region and subject matter.
Attending APCIA, state legislative, workers’ compensation bureau/board updates/webinars; Communicates to the state Claims Manager(s), Senior Quality Specialist and Director any new/updated changes and impacts to handling claims.
In collaboration with Claims leadership (Director, Claims Managers, Senior Quality Specialist), analyzes current business processes and workflows, and prepares recommendations for compliance. Collaborates with Claims leadership (Director, Claims Managers, Senior Quality Specialist) on training. Works with Claims Vendor Manager and Claims Managers on troubleshooting WC vendor issues that impact adjusters’ ability to handle claims.
At the direction of Claims Director, Claims Managers and/or Compliance Manager, assists with state interest credit, state penalties, Physician Panels, annual state reporting needs (e.g., Colorado surveys, change of physician, Longshore reporting) which are not already overseen by another department such as Insurance Product Management.
Works with state Claims Managers and Quality Claims Specialist to update any state materials on the Claims Insider/Sharepoint site and ensure updates are communicated to the floor.

Bachelor’s degree in business or related field and 7+ years of handling complex claims as determined by Society Insurance – OR – 10+ years of claims handling experience involving the exercise of discretionary decision-making and increasing levels of claims complexity, including specialized coverages and loss adjustments as determined by Society Insurance.
Valid driver’s license and a satisfactory driving record as determined by Society Insurance.
Willingness to travel in person to mediations, agency visits, key discovery depositions, and field investigations, when necessary, throughout our service area.
Technical proficiency in commercial property and/or casualty claims demonstrated through knowledge and experience in insurance policies and coverage, claim payment procedures, insurance regulations, and legal terminology.
Familiarity with PC applications including word processing, Internet, spreadsheets, and e-mail software.
Holds and maintains a valid state adjuster license where required preferred.
Knowledge of medical terminology preferred.
Advanced knowledge of litigation processes, procedures, terminology, and the ability to perform legal research preferred.

Salary with bonus plan; health, dental, life, and vision insurance
Company-paid holidays; flexible scheduling; telecommuting options
student loan and tuition reimbursement
Employee Assistance Program; Society Insurance prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Society Insurance also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans With Disabilities Act and applicable state and local laws. Society Insurance is a drug-free workplace.