Claims Specialist

Job Description

REQUIREMENTS

• Strong analysis skills to interpret complex claim information and identify potential issues or fraud indicators.
• Excellent organizational skills to manage multiple claims simultaneously while maintaining accuracy and attention to detail.
• Proficiency in financial software applications used for claim processing and record keeping.
• Knowledge of workers’ compensation law to ensure all claims are handled in accordance with legal standards.
• Skilled in negotiation techniques to settle claims fairly while protecting company interests.
• Customer service orientation with the ability to communicate effectively and empathetically with claimants.
• Experience with auto estimating tools is a plus for evaluating vehicle damage claims related to auto accidents

RESPONSIBILITIES

• Review and assess incoming insurance claims related to workers’ compensation and other policies, ensuring all documentation is complete and accurate.
• Detect potential fraud by analyzing claim patterns, discrepancies, and suspicious activities using specialized fraud prevention tools.
• Utilize auto estimating software to evaluate vehicle damage claims accurately and efficiently.
• Negotiate settlements with claimants, healthcare providers, and other stakeholders to reach fair and timely resolutions.
• Maintain detailed records of claim activities, correspondence, and investigations using financial software systems.
• Collaborate with legal teams to ensure compliance with workers’ compensation law and company policies.
• Provide exceptional customer service by guiding claimants through the process, answering inquiries, and offering clear explanations of coverage decisions.

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