Claims Analyst

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NC - CHARLOTTE

2 days ago Requisition

The Claims Analyst will utilize experience within commercial property and casualty claims to manage, monitor and assess complex claims activity of Third-Party Administrators (TPAs); use direct systems to access and monitor claim files, denials, reservations of rights, and settlements conducted by TPAs; ensure that the TPAs are performing within their authority, pursuant to agree upon processes and practices, within the agreed upon territories and market segments;

ensure compliance with internal policies and regulations; consult with the Chief Risk Officer, Legal, Compliance, Finance, Underwriting, and IT departments to identify specific trends or problems within a program; keep records of all monitoring activity and report to the management team, support data-driven decision making with quantitative and qualitative measures and assessments.

• Provides front-line oversight of Third-Party Administrators’ personnel through direct communication and monitoring claims online using the Third-Party Administrators’ claim systems.
• Identifies, analyzes and discusses monthly loss run trends, reportable claims and/or problematic claims.
• Providesexcellentclaimservicetoexternalclients andinternalpartners.
• Participatesinclaimfilereviewswithagents,broker sand
  
  Third-Party Administrators’ claim personnel.
• Interfaces with Clear Blue and external underwriting on claim status, exposures, and other factors impacting their risks.
• Reviewsandapproves Third Party Administrators ’monthlyclaimhandlingfee.
• Prepares and presents internal management reports for large losses and large loss potential; usually over $250,000.
• Conducts remoteandonsiteclaim file audits of Third-Party Administrators.
• Performsotherdutiesasrequiredbymanagementincludingreinsuranceand subrogation.
• Theresponsibilitiesofthispositionrequirecontinuousinteraction internally (executive team, managers, supervisors, and fellow associates) and externally (with TPAs, managing general agents, reinsurers, and brokers/intermediaries).

• Bachelor’s degree in business, Finance, Risk Management, Insurance, or equivalent related experience
• Three (3) to Five (5)+ years of experience in claims analysis or a related role, experience in claim handling, relevant litigation, or TPA management.
• Industry certifications (e.g., AIC) preferred.

• Strong analytical and problem-solving skills with high attention to detail.
• Proficient in claims systems, Excel, and data analysis tools.
• Demonstrated success in evaluating claims, making coverage determinations based onpolicy provisions, and managing litigation.
• Some travelisrequiredandwill varydependingonbusiness needsandcaseload.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and work independently under tight deadlines
• Knowledge of insurance policies claims regulations, and industry best practices.
• Strong interpersonal skills and ability to work cross-functionally.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.