Claims Specialist

SC Works; Gainesville (GA); Hybrid; USD 70,000 - 92,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Tuition reimbursement

Paid Time Off and holidays

401(k) plan with company match

Employee stock purchase plan

Commuter benefits

Job summary

SCI Summit Consulting, LLC seeks an experienced claims professional to manage and investigate workers' compensation claims from our Gainesville, GA area office. The role combines on-site collaboration with remote flexibility, focusing on liability evaluation, coverage verification, and timely settlements.

The ideal candidate has at least five years in property and casualty claims, strong negotiation and analytical skills, and may pursue the AIC designation.

Qualifications

• Minimum 5 years of property and casualty claims handling experience.
• Completion of or progress toward professional designation such as AIC preferred.
• Strong analytical, negotiation, and problem-solving abilities.

Responsibilities

• Manages an inventory of claims to evaluate compensability and liability.
• Plans and conducts claim investigations to confirm coverage and determine liability and damages.
• Determines settlements within authority and may attend arbitrations or trials.
• Communicates coverage and settlements to insureds, claimants, and partners.
• Authorizes payments within authority and ensures timely disbursement.
• Maintains detailed claim files and correspondence.

Skills

Analytical skills

Negotiation

Communication skills

Relationship building

Education

Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or related field

Job description

Summit provides independent insurance agents and their clients with market-leading workers' comp insurance and elite customer service.

We're growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

Our strength comes from a single-minded focus on workers' comp and a commitment to long-term customer relationships.

Summit is who you turn to when you need a specialist who not only knows workers' comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

Essential Job Functions and Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
• Performs other duties as assigned.
• Great American's culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday-Thursday, with the fourth day determined by business needs.
• The person hired for this position will work out of the Gainesville, GA office which offers a hybrid work environment (4 days in office, 1 day remote) or will work remotely in the following states: Georgia, Illinois, Indiana, Kentucky, North Carolina, South Carolina, Tennessee.
• #LI-Remote

Job Requirements

Education: Bachelor's Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.

Experience: Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).

Scope of Job/Qualifications: Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims. Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion.

This job is non-exempt in California and Washington

Company: SCI Summit Consulting, LLC

Salary Range: $69,600.00 -$92,400.00

Benefits: We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

*Excludes seasonal employees and interns.

Occupation Information for Claims Adjusters, Examiners, and Investigators - Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.