Claims Representative II, Professional Liability

California Dental Association; California; Remote; USD 74,000 - 93,000; Full time

Benefits offered by this job

Remote and hybrid flexibility

PTO 22 days + 13 holidays

Medical/dental/vision plans

401(k) with company match

Parental leave

Wellness programs

Professional development opportunities

Job summary

TDIC, the Dentist Insurance Company, is seeking a Claims Representative II, Professional Liability. This remote-first role requires evaluating coverage, coordinating with adjusters and counsel, and negotiating resolutions while traveling as needed.

Ideal candidates have 3+ years in liability claims, strong communication, and the ability to work with supervisors on complex cases. Telework flexibility and California or nearby states are preferred.

Qualifications

• Requires 3+ years of insurance claims experience in liability.
• Experience with professional liability and/or general liability.
• Excellent interpersonal, verbal and written communication skills.
• Willingness to travel for auto/air travel as needed.

Responsibilities

• Identify and evaluate coverage issues with supervisor guidance.
• Investigate claims related to loss and liability; coordinate with adjusters and legal counsel.
• Negotiate claim resolutions under supervisor direction.
• Maintain diary system and document claim files with timely communications.
• Review new claims to determine appropriate actions and approvals.
• Attend meetings, trials, and settlements as required.

Skills

Insurance claims experience

Professional liability

Communication skills

Travel ability

Education

High school diploma or GED

Associate or Bachelor's degree in insurance (preferred)

Tools

AS400

Job description

Job Title: Claims Representative II, Professional Liability

Pay Information: Non Exempt, $74,200 - $92,700 per year

Location: Remote first work environment with occasional travel and in office meetings. Preference for candidates in California, Oregon, Washington, and Nevada.

Who we are: We are The Dentist Insurance Company (TDIC), and we promise to protect only dentists, protect them better than any other insurance company and be there when they need us.

TDIC was founded in 1980 by a small group of California Dental Association members in response to skyrocketing malpractice premiums that impacted dentists’ ability to practice productively and patients’ ability to access care. Since that time, we’ve grown to protect 24,000+ policyholders across 15 states with a comprehensive suite of dentist-centric insurance products and risk management tools. With this singular focus and the unparallelled expertise of people who understand dentistry, we’ve earned the trust of our community.

TDIC has been rated A (Excellent) by AM Best for financial stability for 28 consecutive years, as well as the Best of Insurance award from ClearlyRated for client satisfaction. We’ve also earned endorsements from nine dental associations.

At TDIC, we seek out, welcome and support the best and brightest individuals across unique specialties and prioritize diversity in our hiring practices. We know our employees are an integral part of our success. We value individual talents while encouraging a collaborative, inclusive, respectful and forward-thinking work environment.

As our organization continues to innovate and grow, we invite you to be a part of what’s next.

Company Benefits: At TDIC, we offer a robust benefits package that enhances overall employee well-being and provides options to meet the needs of our diverse workforce. We listen to our employees on matters of wellness and devote time and resources to continuously evaluate our benefits to ensure we can best support their work-life goals.

• Remote and hybrid flexibility and technology to support remote work
• Generous time off program starting at 22 days of PTO and13 paid holidays (includes a floating holiday and winter closure)
• Highly competitive medical, dental and vision plans, including FSA and HSA account options
• 401(k) plans, with a generous match and safe harbor contributions upon eligibility
• Paid parental leave
• Wellness programs, including incentives and an In-Shape Family Fitness discount
• Opportunities for professional development, training and leadership skill-building
• Critical illness, accident, life, pet, short term and long-term disability insurance options
• Employee Assistance Program (EAP) for support navigating day-to-day challenges

Universal Competencies:

• Collaboration: Proactively engages with an iterative mindset to enhance ideas and achieve organizational results; Cultivates relationships, builds partnerships, shares and learns without boundaries.
• Service: Focusing on meeting needs and exceeding expectations for those served inside and outside the organization.
• Respect: Embracing others for their true authentic self; nurture and promote an environment that values diversity of thought, input, experience and expertise.

Role Specific Competencies:

• Problem Solving: Applies analysis, creativity, resilience and logic to reach optimal outcomes; develops and implements solutions.
• Courage: Appropriately engages in hard conversations; asks tough questions without hesitation; provides timely, empathetic and constructive feedback.
• Decision Making: Decides with intention, reflection and reason while maintaining a big-picture mindset; clarifies purpose, evaluates alternatives and analyzes risks

How the position contributes:

• Working with supervisor to identify, evaluate and make determinations on issues related to coverage.
• Working under close supervision to investigate and make determinations related to cause and origin of loss and liability, including retaining and supervising outside adjusters, legal counsel and other vendors, to ensure efficient adjustment of claims. The Claims Representative II will also work with the claims supervisor to continually evaluate and establish appropriate case values and reserves.
• Working with claims supervisor to manage the course of litigation including, the development of defense strategies and budgets in accordance to TDIC Litigation Guidelines. The Claims Representative II may attend meetings with policyholders, defense attorneys, and consultants. He or she may also attend trials, mediations, and settlement conferences with supervisor approval. The claims representative may also negotiate claim resolutions with claimants and/or their legal representatives under the direction of the claims supervisor. The Claims Representative may also negotiate resolutions with policyholders and identify, manage, and resolve all issues related to subrogation of claims with the assistance of the supervisor.
• Maintaining assigned caseloads on a diary system, including, documenting claim files and timely corresponding with insureds, vendors, claimants and/or their legal representatives. The Claims Representative may be responsible for reviewing vendor bills, challenging billed items when appropriate and with supervisor guidance, approving payments.
• Reviewing new claims with the supervisor to determine an appropriate course of action.
• Identifying cases of significance with the assistance of the supervisor, and preparing appropriate requests for authority from supervisor, management, and/or the Board
• Attending mandatory meetings and pursuing educational opportunities, including seminars, insurance courses, workshops, and in-house training, with approval from the claims supervisor.

Minimum Qualifications:

• High school diploma or GED.
• Requires a minimum of three years insurance experience in a liability claims or similar position; or equivalent combination of education and experience.
• Must have experience in professional liability and/or general liability.
• General knowledge of state laws, insurance codes and principles, and the applicable Civil Codes, Health and Safety Codes.
• Requires excellent interpersonal, verbal and written communication skills.
• Requires intensive communication with involved parties via phone.
• Must be able to perform job duties under supervision.
• Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with policyholders, claimants, attorneys, and independent adjusters.
• Must maintain confidentiality. Must demonstrate diplomacy and tact while interacting with all levels within and outside of the organization.
• Ability to organize and prioritize case load.
• Requires computer skills, including the ability to operate MS Windows Office, including experience with
• AS400 or other database management program.
• Regular auto/air travel required.

Preferred Qualifications:

• Associate’s or Bachelors’ degree with courses in insurance preferred.
• Commercial property insurance and in-person negotiation experience preferred.
• Experience with claims management and estimating software programs preferred.

Working Conditions: Occasionally (1-33%) Frequently (34-66%) Constantly (67-100%)

• Constantly reviewing and analyzing data on a computer screen.
• Frequently maintains a stationary position.
• Occasional auto/air travel required.
• Occasional overnight travel as needed.

We Are CDA

Over our 150-year history, the California Dental Association (CDA) has become a leader in oral health throughout California and the country. Today, we continue to support our community of over 27,000 dentists through our family of companies, which include The Dentists Insurance Company (TDIC), TDIC Insurance Solutions, Rotunda Partners and the CDA Foundation. At CDA, we value individual talents, encouraging a diverse, collaborative, and innovative work environment fueled by new ideas. As our organization continues to grow, we invite you to be a part of what’s next.

CDA is an equal opportunity employer and is committed to the principle of equal employment opportunity for all employees and providing a safe work environment. CDA does not tolerate discrimination or harassment and all employment decisions are based on job requirements and individual qualifications, without regard to race, color, religion, national origin, age, gender, gender identity or expression, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran or military status. If you have a disability or special need that requires accommodation, please contact us at [e-mail].

To see our privacy policy, go to www.cda.org/Home/About/Careers-at-CDA/Apply