Insurance Claims Resolution Specialist

Sentry; El Paso (TX); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Hybrid flexibility

Dining stipend

Tuition reimbursement

Comprehensive benefits

Paid time off

401(k) match program

Community involvement

Job summary

Sentry is seeking an insurance claims professional to investigate and resolve claims with an emphasis on accuracy, efficiency, and fair settlements. You will independently manage caseloads, review policies, negotiate liability, and coordinate with medical providers, repair shops, and other stakeholders.

The role supports a hybrid work model with optional work-from-home days, and includes opportunities for ongoing learning and career growth within a leading mutual insurance company.

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum 1 year of related work experience.
• Prior attorney rep experience highly preferred.
• Ability to review and analyze detailed documents, insurance policies, coverages, medical bills and records.
• Ability to make appropriate claim decisions, prioritize, and manage workload; time limit demands.
• Effective verbal and written communication skills.
• Demonstrated fundamental negotiation skills.

Responsibilities

• Investigate and resolve insurance claims with a focus on accuracy, efficiency, and fair resolution and independently manage caseloads and negotiate settlements.
• Verify coverage by thoroughly reviewing the policies and interpreting policy terms, conditions and language.
• Evaluate liability by taking recorded statements, reviewing police reports, and compiling other pertinent evidence. Negotiate or deny liability based on the investigation outcome.
• Evaluate physical damage and bodily injury claims based on estimates, photos, appraisals, medical reports, medical bills, and other evidence. Working closely with medical providers, repair shops and/or contractors to facilitate necessary and related services.
• Set appropriate claim reserves in a timely manner based on ongoing evaluations of liability. Negotiate bodily injury settlements with policyholders, claimants, attorneys, and other insurance carriers to reach fair resolutions within established guidelines. Ensure claims are paid promptly and within authorized limits.
• Ensure compliance with industry regulations, legal requirements, and internal policies by thoroughly documenting all decisions, communications, and activities throughout the entire claims process.
• Provide empathetic and supportive service to customers as they navigate challenging situations, clearly explaining the claims process, keeping them informed of their claim process, and communicating decisions along with the reasoning behind them.
• Ability to obtain and maintain state licensing requirements

Skills

Negotiation skills

Verbal and written communication

Policy interpretation

Document review

Education

Bachelor's degree or equivalent work experience

Job description

Sentry is seeking an insurance claims professional to investigate and resolve claims with an emphasis on accuracy, efficiency, and fair settlements. You will independently manage caseloads, review policies, negotiate liability, and coordinate with medical providers, repair shops, and other stakeholders.

The role supports a hybrid work model with optional work-from-home days, and includes opportunities for ongoing learning and career growth within a leading mutual insurance company.