Claims Representative – Medical Only

Jobtailor; Baton Rouge (LA); On-site; USD 42,000 - 65,000; Full time

Job summary

Jobtailor in Baton Rouge, LA, is seeking a Claims Specialist to manage an inventory of claims, evaluate compensability and liability, and conduct investigations to confirm coverage and damages. You will work to determine and negotiate settlements within your authority and participate in arbitrations or mediations as needed.

You will communicate complex coverage information to insureds and external partners, authorize timely payments, and maintain detailed claim files.

Qualifications

• Bachelor’s degree or equivalent experience.
• 6 months of property and casualty claims handling experience preferred.
• Knowledge of insurance policies, coverage, and claims handling procedures.
• Regulatory knowledge and ability to work within assigned authority.

Responsibilities

• Manage an inventory of claims to evaluate compensability and liability.
• Conduct claim investigations to confirm coverage and determine liability, compensability, and damages.
• Determine and potentially negotiate claim settlements and reserves within prescribed authority.
• Attend arbitrations, mediations, depositions, or trials as needed.
• Communicate routine to moderately complex coverage and settlement information to insureds, claimants, and external partners.
• Authorize payments within assigned authority limits and ensure timely payment.
• Maintain accurate and detailed claim files, including correspondence, reports, and settlement agreements.
• Perform other duties as assigned.

Skills

Claims Handling

Negotiation Skills

Analytical Skills

Interpersonal Skills

Time Management

Education

Bachelor’s Degree in Business Administration / Risk Management and Insurance / Finance

Job description

• Manage an inventory of claims to evaluate compensability and liability


• Conduct claim investigations to confirm coverage and determine liability, compensability, and damages


• Determine and potentially negotiate claim settlements and reserves within prescribed authority


• Attend arbitrations, mediations, depositions, or trials as needed


• Communicate routine to moderately complex coverage and settlement information to insureds, claimants, and external partners


• Authorize payments within assigned authority limits and ensure timely payment


• Maintain accurate and detailed claim files, including correspondence, reports, and settlement agreements


• Perform other duties as assigned

Requirements

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field, or equivalent experience


• Generally, a minimum of 6 months of experience in property and casualty claims handling


• Completion of or continuing progress toward a professional designation such as Associate in Claims (AIC) preferred


• Ability to work within specific limits and authority on assignments of moderate technical complexity and coordination


• Functional analytical, negotiation, and problem-solving skills


• Knowledge of insurance policies, coverage, and claims handling procedures


• Knowledge of industry laws and regulations


• Ability to organize and prioritize caseloads for timely claim resolution


• Strong interpersonal and communication skills to build relationships and handle negotiations


• Ability to handle confidential information with discretion


• Role is non-exempt in California and Washington

Core Competencies

Demonstrates expertise in claims management, including evaluating compensability, conducting investigations, and negotiating settlements. Proficient in maintaining detailed claim files and adhering to industry regulations while effectively communicating with stakeholders.

Highest-signal resume keywords

• Claims Management


• Negotiation Skills


• Insurance Policy Knowledge


• Analytical Skills


• Bachelor’s Degree in Business Administration

ATS Optimization Keywords

Hard Skills

• Claims Handling


• Compensability Evaluation


• Liability Assessment


• Settlement Negotiation


• Claims Investigation


• Payment Authorization


• File Maintenance


• Regulatory Compliance


• Problem-Solving


• Caseload Organization

Soft Skills

• Interpersonal Skills


• Communication Skills


• Discretion


• Relationship Building


• Time Management

Certifications & Qualifications

• Associate in Claims (AIC)

Industry Keywords

• Property and Casualty Claims


• Insurance Coverage


• Claims Handling Procedures


• Industry Laws


• Risk Management