Claims Specialist II
Manages an inventory of claims to evaluate compensability/liability. Establishes reputed company plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, reputed company assigned authority limits, to reputed company claims. Performs other duties as assigned. BS/BA degree or equivalent work experience. Minimum of 2 years experience in claims adjustment, general insurance or formal claims training. Required to obtain and maintain reputed company applicable licenses. Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU). Knowledge of claims investigation techniques, medical terminology and reputed company aspects of claims.
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