What are the responsibilities and job description for the Claims Analyst position at Allied Solutions?
The Claims Analyst position will handle claims of greater complexity and will require a higher level of investigation, negotiation, evaluation, disposition and settlement of complex/specialty claims and large loss exposure. This position may also be responsible for providing support and direction to claims adjusters as well as training, auditing and on-going claim associate development.
Ideal candidates should possess leadership and conflict management skills, along with strong attention to detail and a passion for providing excellent customer service. This position will work independently and require minimal coaching from leaders while managing routine, complex and specialty case load of claims. This position will manage a fairly heavy case load of claims with a specific determined financial limit.
Ideal candidates should possess leadership and conflict management skills, along with strong attention to detail and a passion for providing excellent customer service. This position will work independently and require minimal coaching from leaders while managing routine, complex and specialty case load of claims. This position will manage a fairly heavy case load of claims with a specific determined financial limit.
Job Duties and Responsibilities:
Adjudication of Claims (70%)
- Investigate and determine appropriate application of coverage. Makes recommendations to management for settlement amounts outside of authority limits.
- Accurately evaluate and determine settlement of complex/specialty claims.
- Proficiently understand the use of policy coverage and be able to recognize questionable coverage and situations that will require supervisor involvement
- Review all claim assignments in detail
- Ensure proper diary management on all claims
- Ability to manage the full-life cycle of all assigned claim files.
- Requires a deep technical expertise and ability to utilize multiple systems to handle/process claims
- In depth understanding of overall claim operations and key stakeholders
- Excellent oral, written, interpersonal communication and keyboarding skills along with the capacity to multi-task in a structured work environment
- Follow all regulatory and jurisdictional requirements associated with state regulations and guidelines.
- Serves as a resource for less experienced staff, providing training and support as appropriate.
- Recognizes and solves obstacles that occurs in the claims process without supervisory approval.
- Able to clearly communicate concise action plans, and present plans for moving the claim to conclusion.
- Involve supervisor when handling claims that trigger special service instructions.
- Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim.
- Interacts extensively with various parties involved in the claim process.
- Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
- Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses.
- Uses discretion and independent judgment in claim handling
- May provide training and mentoring to adjusters.
- Makes decisions in an informed, confident and timely manner
- Proven track record of handling specialty or complex claims
Service Delivery to customers (10%)
- Promptly answer inbound calls
- Maintain a record of call regarding claims in appropriate system
- Effectively communicate to clients/borrower
- Promptly and efficiently respond to all email communications (4-8 hrs)
- Follow policy/procedures regarding calls
- Multi-task
Thorough understanding of claims compliance and state mandated regulations (20%)
- Maintains appropriate adjusters license in all states required
- Follow state by state requirement on continuing education
- Follow mandates required by state statues and regulation regarding all claim adjudication
- Complies with timeliness, accuracy and service standards of the company and underwriters.
- Other duties as may be assigned
Qualifications (Education, Experience, Certifications & KSA):
- High School Diploma or GED required
- Must obtain and maintain a residence adjusters license
- 3 – 4 years related experience
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The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with a job.
We offer our employees a robust compensation package! Our comprehensive benefits include: medical, dental and vision insurance coverage; 100% company-paid life and disability coverage, 401k options with company match, three weeks PTO by the end of the first year and much more. Allied proudly promotes from within as part of a strong commitment to providing career growth opportunities for employees of all levels. Our diverse business portfolio allows employees broad career options with the advantage of staying with the same organization.
All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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Salary : $38,000 - $48,100
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