Claims Representative II, Professional Liability

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

Benefits offered by this job

Remote and hybrid flexibility

Generous PTO and holidays

Medical, dental, vision plans

Job summary

California Dental Association is seeking a Claims Representative II, Professional Liability for a remote-first role with occasional travel. The position focuses on evaluating coverage, investigating liability, and managing litigation workflow with TDIC and outside partners.

A minimum of three years in liability claims is required, with preferred experience in professional liability. The role supports a national footprint with travel as needed and offers a comprehensive benefits package.

Qualifications

• High school diploma or GED.
• Three years insurance experience in a liability claims role; or equivalent.
• Experience in professional liability and/or general liability.
• Knowledge of state laws, insurance codes and Civil/Health & Safety Codes.
• Excellent interpersonal, verbal and written communication skills.
• Ability to organize and prioritize case load.
• Extensive communication with involved parties via phone.
• Capable of working under supervision.
• Excellent written/verbal communication with policyholders, claimants, attorneys.
• Maintain confidentiality and demonstrate diplomacy.

Responsibilities

• Identify, evaluate and determine issues related to coverage with supervisor.
• Investigate and determine cause/origin of loss and liability; manage outside adjusters and vendors.
• Assist in developing defense strategies and budgets for litigation; may attend meetings, trials and settlements.
• Maintain assigned caseloads; document files and correspond with insureds and claimants.
• Review new claims with supervisor to determine course of action.
• Request authority for significant cases from supervisor/Board.
• Attend mandatory meetings and pursue educational opportunities with supervisor approval.

Skills

Collaboration

Service

Respect

Problem Solving

Courage

Decision Making

Communication skills

Education

High school diploma or GED

Associate’s or Bachelor's degree

Tools

AS400

MS Windows Office

Job description

Location: United States

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:

• 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:

• 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 .

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