Claims Representative

Ultipro; Clive (IA); On-site; USD 65,000 - 90,000; Full time

Job summary

Ultipro is seeking a claims professional to manage professional liability claims for insured health care providers and facilities. The role involves intake, investigation, and resolution of claims to achieve timely, fair, and cost-effective outcomes.

Responsibilities include communicating with policyholders, lawyers, and experts; drafting letters; and handling settlements and related financials. Licensure within 90 days is preferred, with 3–5 years of claims experience in professional liability.

Qualifications

• Education: College degree with insurance certifications such as AIC, SCLA, and CPCU preferred. Valid applicable adjuster licensure or ability to become licensed within 90 days.
• 3-5 years claims-handling experience, with emphasis on professional liability claims preferred.
• Knowledge of medical and legal terminologies and concepts; ability to read and interpret policy language.

Responsibilities

• Answering phone calls in claims queues and documenting all calls in claims notes.
• Handling professional liability and administrative claims, including claim intake, review, and settlement directives.
• Drafting claim letters and reservation of rights letters with policy language citations.
• Completing financial transactions, including settlement payments and defense/expert bill payments.
• Attending court appearances and mediations as required.
• Other duties as assigned.

Skills

Negotiation

Time management

Verbal communication

Written communication

Policy interpretation

Medical terminology

Legal terminology

Attention to detail

Reading comprehension

Education

Bachelor's degree

Insurance certifications (AIC/SCLA/CPCU)

Job description

Position Purpose: Responsible for the investigation, evaluation, negotiation, and resolution of professional liability claims involving insured health care providers and facilities. This role manages claims from initial notice of claim through final disposition, ensuring timely, fair, and cost-effective outcomes while complying with applicable laws, regulations, and company policies.

Essential Functions:

Answering phone calls in the claims phone queues, including risk management questions and claim reporting intake, and documenting all phone calls in detailed claim or policy notes.

Handling professional liability claims and administrative claims such as licensing board proceedings and insurance audits, including claim intake, coverage verification, claim opening, assigning counsel, retaining expert consultants, review of medical records, investigating, evaluating, providing directives and communicating with defense counsel, and negotiating settlements within provided settlement authority.

Drafting claim letters, including detailed reservation of rights letters, coverage denial letters citing specific policy language, basic claim opening and closing letters.

Completing financial transactions, including settlement payments with NPDB reporting, paying defense and expert bills both manually and via Datalytics, completing check voids.

Attending court-ordered appearances and mediations, either virtually or in-person as required.

Other duties as assigned.

Requirements:

Education: College degree with insurance certifications such as AIC, SCLA, and CPCU preferred. Valid applicable adjuster licensure or ability to become licensed within 90 days.

Experience: 3-5 years claims-handling experience, with emphasis on professional liability claims preferred.

Skills: Excellent time management and ability to prioritize pending work based on urgency. Excellent negotiating skills, verbal and written communication skills, listening and reading comprehension, attention to detail. Ability to read and interpret insurance policy language, apply it to various claim scenarios, and effectively communicate coverage decisions. Knowledge of medical and legal terminologies and concepts.

Mental Demands: Ability to focus on tasks for extended periods of time. Flexible and able to work with a variety of tasks and colleagues. Ability to plan, organize, be detail and deadline oriented, and maintain high accuracy. Able to maintain professional communications when discussing sensitive topics, questions, or claims situations. Able to interpret data and problem solve to make effective and efficient decisions independently or collaboratively.

Physical Demands: Continuous sitting, some standing, walking, bending and reaching. Frequent use of fingers and hands to manipulate computer, telephone, and other office equipment. Ability to travel by car or plane if necessary.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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