Casualty Claims Senior Representative

MedStar Health; Westfield Center (OH); Remote; USD 60,000 - 80,000; Full time

Job summary

MedStar Health is seeking a Claims Senior Representative who will serve as a technical expert on claims adjusting. This role involves overseeing the claims process, from investigation to resolution, while delivering exemplary customer service. Ideal candidates should have a degree in a relevant field and substantial claims handling experience. This position is fully remote, offering flexibility in a dynamic work environment.

Qualifications

• 4+ years of Claims Handling experience required.
• Bachelor's degree or equivalent work experience preferred.
• Valid driver's license for field roles.

Responsibilities

• Determines coverage, investigates claims, and negotiates settlements.
• Monitors payments and manages vendors in claims process.
• Maintains communication with all parties involved in claims.

Skills

Claims Investigations

Claims Adjustment

Customer Relationship Management

Data Analysis and Reporting

Project Management

Education

Bachelor's degree in Business, Communication, or related field

Job description

Job Summary

The Claims Senior Representative serves as a technical expert on claims adjusting and handles injury, material damage, negligence, compensability, damage, and coverage issues. The role determines coverage and investigates, analyzes, negotiates, and settles claims not requiring outside investigation. The role delivers quality customer service in a high volume, moderate complexity work environment and mentors less experienced Adjusters on the team. Westfield Casualty Claims resolves third party liability claims involving injury, property damage, construction defect, personal & advertising injury, and environmental cleanup - both pre-suit and in litigation.

Job Responsibilities

• Determines whether proper coverage exists for the type of claim assigned.
• Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions on claim resolution.
• Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker.
• Determines the value of the physical damage of property, automobiles, or injuries through appropriate tools, recognizes claim file exposures and escalates appropriately.
• Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies.
• Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets.
• Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards.
• Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience.
• Identifies and refers all claims to management for further handling and assignment instructions.
• Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations.
• Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing.
• Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines.
• Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel.
• Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation.
• Interprets complex and detailed documents such as contracts, legal documents, medical reports, insurance regulations and policies as needed.
• Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices.

Job Qualifications

• 4+ years of Claims Handling experience.
• Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience.
• For field roles only: Valid driver's license and a driving record that conforms to company standards.

Location

Remote

Licenses and Certifications

• Certified Professional Claims Management (CPCM) (preferred)

Behavioral Competencies

• Collaborates
• Communicates Effectively
• Customer Focus
• Decision Quality
• Nimble Learning

Technical Skills

• Account Management
• Claims Investigations
• Claims Adjustment
• Financial controls
• Case Management
• Customer Relationship Management
• Project Management
• Business Process Improvement
• Auditing
• Data Analysis and Reporting

This job description describes the general nature and level of work performed in this role. It is not intended to be an exhaustive list of all duties, skills, responsibilities, knowledge, etc. These may be subject to change and additional functions may be assigned as needed by management.

Founded in 1848, Westfield is a global leader in property and casualty insurance, delivering superior risk insights and innovative solutions to customers through a diverse portfolio of insurance products. Westfield underwrites commercial, personal, surety, and specialty lines of coverage through a network of leading independent agents and brokers in the United States and specialty products through Lloyd's of London Syndicate 1200. As a mutual insurance company with more than 3,000 employees, Westfield has revenues in excess of $4 billion and more than $10 billion in assets.