Claims Specialist

Must reside in Texas

• It involves managing claims from initiation to resolution, ensuring thorough documentation, and communicating effectively with all parties involved.

• Investigates both member and third-party claims, reviewing coverage, setting reserves, determining liability, assessing damages, and initiating claim processes to ensure proper handling and settlement.

• Maintains accurate records of all claims and related activities, ensuring that the claim management system is regularly updated, and all documentation is complete.

• Reviews documentation on damaged property, bodily injuries, employment and law enforcement matters, liability, immunity, etc. and determines claims-related damages, prepares releases, and processes payments.

• Communicates regularly with internal staff, Members, claimants, witnesses, repair facilities, contractors, vendors, police, fire departments, special investigators, attorneys, and other parties essential to the claims process.

• Reviews reports from independent adjusters, appraisers, and claimants, ensuring all necessary documentation is provided and properly supported.

• Reviews and handles litigation files, reviews settlement proposals, submits authority requests (as applicable), and prepares settlement documents.

• Identifies and report on subrogation, salvage, and potential fraud in claims.

• Attends mediations and trials as needed for litigation matters.

* The above responsibilities are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required by the position. All employees may have other duties assigned at any time.

• This position is not a people manager.

• This position does not have indirect reports.

• Occasional overnight travel (by car or air)

• Be able to withstand typical office work that includes periods of sitting, standing, typing, etc. indoors.

• In addition to typical office work, must be able to exert up to 10 pounds of force occasionally to move objects.

• Requires close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer screen, visual inspection, assembly of parts, or extensive reading.

• Ability to have a flexible work schedule to meet business needs and be at work on-site during specified or core hours.

• Must be able to operate standard computer hardware.

Required

• B.A. or B.S. degree in Business, Insurance, Risk Management, or related field
• Years of
  
  Experience:
  
  1 - 3
• Area of
  
  Experience:
  
  Claims Processing, Insurance, or related areas
• Active Adjuster License – Texas – Property and Casualty

• None

Required

• Experience in the Property and Casualty Insurance Industry
• Valid driver’s license and a good driving record
• Possess knowledge and understanding of relevant laws, rules, and regulations
• Knowledge of insurance principles and the ability to interpret insurance contracts and endorsements to determine coverage eligibility and liability.
• Decision-making, problem-solving, negotiation, and conflict resolutions skills.
• Proficiency in MS Word
• Proficiency in MS Excel
• Proficiency in MS Outlook

• None

** To perform this job successfully, an individual must be able to perform each primary responsibility satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities.