Claims Specialist II

The Claims Specialist works within a Claims Team, using the latest technology to manage an assigned caseload of routine to moderately complex claims from the investigation of the claim through resolution. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claim’s management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers.

This is a remote/hybrid position. You will be required to go into the office twice a month if you reside within 50 miles of one of the following offices: Plano, TX; Boston, MA; Las Vegas, NV; Suwanee, GA; Chandler, AZ; Lake Oswego, OR; Indianapolis, IN; Hoffman Estates, IL and Weatogue, CT. Please note this policy is subject to change.

Responsibilities:

• Manages an inventory of claims to evaluate compensability/liability.
• Establishes action 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, within assigned authority limits, to settle claims.
• Performs other duties as assigned.
• Handles commercial claims and as a 3rd party administrator.