Claims Specialist

GENERAL PURPOSE:

The Claims Specialist is responsible for providing prompt, effective assistance to clients and third parties reporting and settling claims with our agency. They also act as a liaison between the agency and carriers and assist others in the agency with service regarding claims activity.

ESSENTIAL JOB RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty adequately. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Reports loss/claim information to the appropriate carrier the same day it is received.
• Gives prompt and courteous service on a same-day basis to all clients.
• Takes first reports of claims. Organizes claim information on forms and submits claim to appropriate carrier. Sets expectations of the claim process including time frames, deductibles, restoration companies and adjustors.
• Follows up with insurance companies for the timely and accurate settlement of losses.
• Responds to customers’ inquiries and questions regarding the status of loss within 24 hours of inquiry.
• Follows all systems, procedures, and insurance company regulations.
• Authorizes claim payments within agency authority.
• Coordinates, as necessary, any activities between clients and claim adjusters.
• Complete weekly and monthly reports of claims notifications and updates.
• Notifies risk advisor and/or management of severe losses over $100,000. Provides updates to management and or appropriate risk advisor/customer service for clients with severe or frequent losses.
• Deals promptly and with full integrity with all carrier claims personnel, responding within 24 hours to any request for action or information.

REQUIREMENTS:

Knowledge, Skills, and Ability

• Extensive knowledge of claims procedures and insurance coverage
• Ability to satisfy the needs of the customer, both internal and external, needs little assistance from others in this endeavor
• Strong negotiating, decision-making, and relationship building skills
• Excellent customer service and teamwork skills
• Ability to interact with employees, customers and vendor companies
• Working knowledge of computer software packages including Microsoft Word, Excel and Outlook programs
• Ability to use general office equipment, including a computer, calculator, typewriter, fax machine, copier and telephone
• Ability to learn and perform new duties and responsibilities

Education or Experience 

• High school diploma required.
• Bachelor’s degree preferred.
• Must be willing to work toward industry designations
• Requires current driver’s license

Working Environment/ Physical Activities

• General office work environment.
• Requires regular use of arms, hands, and fingers.
• Frequently required to sit for extended periods of time, reach with arm and hands, stand, walk, stoop, talk and hear.
• Required to lift and/or move up to 10 pounds.
• Ability to work during regular business hours (8:00am-5:00pm).
• Travel as needed.

HIPAA Compliance

This position may have access to Protected Health Information (PHI) and Electronic Protected Health Information (ePHI). An employee will be responsible for following the guidelines of the HIPAA Confidentiality Agreement.

Note:   This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with this job. The employee is expected to perform those duties listed as well as other related duties directed by management.