Insurance Claims Specialist Job Description

Insurance Claims Specialist Job Description

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Insurance claims specialist provides basic information to employers, claimants and the general public regarding other Department services including but not limited to:.

Insurance Claims Specialist Duties & Responsibilities

To write an effective insurance claims specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included insurance claims specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Develop and implement claims management and return to work strategies on theirassigned caseloads where warranted
Assesses researches and analyzes numerous contracts, documents the appropriate next steps while effectively and professionally communicating outcomes to our clients
Resolves minor conflicts and issues and escalates to others as appropriate
Provides appropriate level of process, system and business support to all types of change initiatives driven by or impacting the Claims organization
Assesses, researches and analyzes numerous disability contracts
Take ownership for managing your own portfolio of clients, dealing with any associated claims from initial notification, right through to settlement
Build and maintain strong working relationships with colleagues, clients, insurers and third parties
Use internal systems to record and update information
Undertake research and investigation to resolve issues
Produce and deliver information and documentation in line with requirements

Insurance Claims Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Insurance Claims Specialist

List any licenses or certifications required by the position: HR

Education for Insurance Claims Specialist

Typically a job would require a certain level of education.

Employers hiring for the insurance claims specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Education, Graduate, Graduate Education, High School Education, Associates, Speech, Technical, Business, Military, Writing

Skills for Insurance Claims Specialist

Desired skills for insurance claims specialist include:

Insurance regulations and policies
Base year extensions
Employers and employer organizations and labor unions
Labor market to assist claimants in seeking and obtaining employment
Laws and procedures to assist other staff
Payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately
TRA/NAFTA training programs
To determine suitable work for claimants
Supportive services available within the community
Basic accounting processes and procedures

Desired experience for insurance claims specialist includes:

Solid general office skills mandatory, including typing, data entry, and file organization skills
Previous experience with procedure writing/change management requests preferred
Manage and prioritise your own workload in order to meet deadlines and maintain Service Level Agreements (SLA’s)
Develop an in-depth knowledge and understanding of your specific sector
Employees are required to obtain a property / casualty license in some states
Investigate new claims by reviewing first reports of loss and supporting materials to determine the best initial contact

Insurance Claims Specialist Examples

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Insurance Claims Specialist Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of insurance claims specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance claims specialist
  • Assesses policy coverage for submitted claims and notifies the insured of any issues
  • Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages
  • Determines and documents, during the investigation process, the potential for subrogation, identifying applicable tort feasors and promptly placing them "on notice" of claim
  • May coordinate elements of litigation efforts, or assume direct responsibility for select litigation efforts for development purposes, associated with assigned claims to ensure a timely and cost-effective resolution
  • Establishes and maintains accurate reserves on all assigned files
  • Negotiate settlements all involved parties
  • Manages an inventory of property/casualty and disability claims
  • Produce reports as required related to claims and coverage
  • Assesses policy coverage for submitted workers compensation claims and notifies the insured of any issues
  • Contacting customers and other parties (i.e.employer, claimants, third parties such as medical providers, repair centres)
Qualifications for insurance claims specialist
  • Intermediate proficiency in MSP with the ability to run passport queries
  • Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, ) to gather information regarding injuries or loss
  • Makes effective use of loss management techniques
  • Investigates new claims by reviewing first reports of loss and supporting materials to determine the best initial contact
  • Negotiates settlement within authority limits
  • Demonstrated work history and strong knowledge of the insurance claim process for damaged tangible goods
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Insurance Claims Specialist Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of insurance claims specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for insurance claims specialist
  • May assist in conducting closed file reviews to determine whether claims were processed in an effective and efficient manner
  • Functions as the primary technical resource for the team in determining settlement authority, assessing best course of action for case resolution, handling inquiries
  • Serves as the primary contact with policyholders/customers and establishes working relationship with customers
  • Makes effective use of loss management techniques and other resources
  • Obtain relevant documentation
  • Review claim cause and process code for correctness after assessment
  • Outsource appropriate matters to local office for resolution
  • Investigates claims to determine whether coverage is provided, establish liability and verify damages
  • Monitors trials and reports daily to Branch Office and HO Examining
  • Manages an inventory of workers' compensation claims, evaluates compensability/liability and losses, and negotiates settlements within prescribed limits
Qualifications for insurance claims specialist
  • Knowledge of internal Mortgage and Home Equity systems preferred
  • Manages an inventory of workers' compensation claims
  • Keen interest in the automotive industry
  • Able to dissect insurance claim process (Own Damage or 3rd Party) into simple customer language
  • Able to discern and handle all types of demands from customers
  • Able to explain the financial implications for any accident clearly to customers and stakeholders
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Insurance Claims Specialist Job Description

Job Description Example
Our growing company is looking for an insurance claims specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for insurance claims specialist
  • Develops and maintains effective working relationships within the office
  • Determines eligibility for OED programs and provides value-added referrals to community resources and supportive services agencies for needed services and/or technical assistance
  • Identifies when wage records are incomplete, and initiates the claim wage redetermination process
  • Maintains flexibility in responding to workload situations
  • Maintains regular and consistent attendance
  • Plan and conduct investigation to determine liability and damages
  • Establish and maintain reserves based on the most probable outcome – , the estimate of the ultimate financial cost to resolve a claim whether through settlement or other adjudication
  • Use claims system to properly document files (including initial resolution strategy, evaluation, negotiations, ), manage a diary and issue payments
  • Performs critical review of itemized appraisals indicating estimated costs of parts, materials and labor hours necessary to restore damaged commercial heavy equipment vehicles /specialty equipment to their pre-damage condition, using specialized technical expertise
  • Leverages technical expertise and industry knowledge to conduct negotiations and progress complex settlement conversations toward resolution
Qualifications for insurance claims specialist
  • Prior industrial experience in the automotive industry
  • Certificate in General Insurance (CGI) is a plus
  • Diploma in Mechanical/Electronics/Electrical Engineering or Business Management
  • Singaporean or Permanent Resident
  • Fluent in French both written and verbal, English is a strong advantage
  • Prior experience in insurance and claims is not required but will be considered as an advantage
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Insurance Claims Specialist Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of insurance claims specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance claims specialist
  • Provides consultative support and technical direction to the field on large losses relating to investigative strategy, confirmation of coverage, determination of liability, scope of damages, reserves, pursuit of recovery interests, and litigation management
  • May be required to handle commercial salvage sales through salvage vendors
  • Manages an inventory of claims to evaluate liability
  • Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission
  • Audit denials and payment variances to determine root cause and correction as required
  • Auditing payment variances ensuring appropriate reimbursement
  • Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims
  • Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance
  • Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets
  • Establish and maintain strong relationships with key business units to understand procurement requirements and pipeline of procurement related work
Qualifications for insurance claims specialist
  • Proficient using Microsoft Excel, Word, Outlook, and Access
  • Minimum of 2 years experience in Motor Claims
  • Fluent in German both written and verbal, English is strong advantage
  • Previous customer service experience required (retail, restaurant )
  • Typically has 1-2 years title insurance or related experience
  • Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the State's tort laws as normally acquired through a bachelor's degree (or equivalent training)
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Insurance Claims Specialist Job Description

Job Description Example
Our company is looking for an insurance claims specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance claims specialist
  • Perform complex cost benefit and financial analysis and identifies and supports quality improvement initiatives
  • Responsible for the End to End acquisition of suppliers for Insurance Claims processing and adjudication commodities (accounting services, auto repair, auto rental, claims adjusting, construction consulting, engineering services, key point garages, special investigation services, ) including negotiation and contract documentation
  • Standardize processes, policy & practices consistent with Corporate Sourcing to institutionalize procurement best practice
  • Work with the Legal department and other support groups to ensure completion of acceptable contracts
  • Promote use of preferred vendors to promote greater standardization, improved compliance, risk mitigation and leverage of purchasing power to increase cost savings
  • Perform other ad hoc assignments to enable the Company to more cost-effectively procure Services
  • Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of Helmsman Management Services clients
  • All other duties as assigned.Search Jobs US
  • As the claims owner, determines coverage, investigates the claims, determines liability, sets and adjusts reserves, evaluates the claim, negotiates a settlement, authorizes and pays the claim
  • Review lawsuit documentation and supporting documents, claims file, investigation, Establish actions to be taken to resolve law suit
Qualifications for insurance claims specialist
  • Solid understanding of Complex Unit Auto and General Liability claims handling techniques and a working knowledge of LMG Claims procedures
  • NY State General Adjuster's License
  • Two years of education or experience
  • Degree holder in any discipline, preferably in professional health care
  • Around 4 years of relevant work experience, preferably from life insurance industry or medical field
  • Experience in handling information on imaging system and AS400 system is highly preferred

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