Claims Representative – Medical Only

• Manage an inventory of claims to evaluate compensability and liability
• Conduct claim investigations to confirm coverage and determine liability, compensability, and damages
• Determine and potentially negotiate claim settlements and reserves within prescribed authority
• Attend arbitrations, mediations, depositions, or trials as needed
• Communicate routine to moderately complex coverage and settlement information to insureds, claimants, and external partners
• Authorize payments within assigned authority limits and ensure timely payment
• Maintain accurate and detailed claim files, including correspondence, reports, and settlement agreements
• Perform other duties as assigned

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field, or equivalent experience
• Generally, a minimum of 6 months of experience in property and casualty claims handling
• Completion of or continuing progress toward a professional designation such as Associate in Claims (AIC) preferred
• Ability to work within specific limits and authority on assignments of moderate technical complexity and coordination
• Functional analytical, negotiation, and problem-solving skills
• Knowledge of insurance policies, coverage, and claims handling procedures
• Knowledge of industry laws and regulations
• Ability to organize and prioritize caseloads for timely claim resolution
• Strong interpersonal and communication skills to build relationships and handle negotiations
• Ability to handle confidential information with discretion
• Role is non-exempt in California and Washington

Demonstrates expertise in claims management, including evaluating compensability, conducting investigations, and negotiating settlements. Proficient in maintaining detailed claim files and adhering to industry regulations while effectively communicating with stakeholders.

• Claims Management
• Negotiation Skills
• Insurance Policy Knowledge
• Analytical Skills
• Bachelor’s Degree in Business Administration

• Claims Handling
• Compensability Evaluation
• Liability Assessment
• Settlement Negotiation
• Claims Investigation
• Payment Authorization
• File Maintenance
• Regulatory Compliance
• Problem-Solving
• Caseload Organization

• Interpersonal Skills
• Communication Skills
• Discretion
• Relationship Building
• Time Management

• Associate in Claims (AIC)

• Property and Casualty Claims
• Insurance Coverage
• Claims Handling Procedures
• Industry Laws
• Risk Management