TPA Claims Specialist III

Overview

Description and Requirements: Position can be worked remotely as long as the candidate resides within the New England region.

Requirements

Description and Requirements
Position can be worked remotely as long as the candidate resides within the New England region.

General Description: Casualty Claims Adjuster for the state of NY

NYS Department of Finance Services - Casualty General Adjuster License required.

• Casualty Claims Adjuster in a two-person department. Will be working in partnership with Senior level Adjuster.
• (TPA) claims handling unit responsible for processing, paying and resolving Liability claims according to established policies and procedures and applicable legal and regulatory guidelines.
• Auto and General Liability knowledge needed. Municipal General Lines experience in NY is a plus.
• Coordinate with state director in providing direction, setting goals, evaluating results and ensuring that overall goals are attained. Develops, assigns and monitors plans to ensure completion of goals and objectives and meeting deadlines.
• Ensures adherence to policies, procedures, standards and guidelines. Coordinates compliance with overall division guidelines as well as regulatory agencies.
• Support ongoing claims activities, including receiving client claims, research and information gathering, clients and others as needed, payment determination and ongoing claims administration. Reviews claims files to ensure appropriateness of payments to clients, policy compliance and timeliness of work. Determines staff diary dates and reviews notes for active lost time claims. Ensures proper implementation of established policies and procedures.
• Maintain strong business relationships to exchange information and contribute to ongoing renewal of business. Communicates regularly with production and customer service areas to exchange account status.
• Assist staff with complex aspects of work as necessary. Resolves escalated issues and problems by conferring with staff, management, other internal departments, outside contacts and clients as necessary. Performs claims and other activities personally as workload requires.
• Reviews and evaluates activities on a regular basis, ensuring that established policies and procedures are being followed. Provides management with regular updates on performance; takes corrective action as necessary.
• Maintains knowledge of current developments in the TPA claims industry, including regulatory issues and guidelines; alerts staff to developments and develops recommendations for consideration with division management in reviewing policies and procedures. Shares information with staff as appropriate.
• Participates in civic activities to promote growth and development of the community and a positive image for the Company.
• Participates in special projects and performs additional duties as required.
• Contributes to a positive, ethical and respectful working environment and communicates openly with others. Models Company culture both internally and externally.

• 4-year degree or the equivalent combination of education and work experience required.
• 5-8 years of Liability claims experience required. Auto and General Liability.
• Strong knowledge of Liability claims management.
• Municipal General Lines experience in NY is a plus.
• In-depth knowledge of legal and regulatory requirements.
• Ability to evaluate data and formulate claims strategy.
• Negotiation skills to resolve large claims at minimum cost.
• Ability to coordinate diverse individuals to resolve claims.
• Highly organized, with ability to manage work involving large client volume.
• Strong understanding of claims management technology applications.
• Excellent communication skills, both verbal and written.
• Continuing education required to maintain licensing.
• Ability to do sales presentations.
• Superior written and oral communication skills.
• Ability to work well in a team environment.
• Must have strong analytical thinking and problem-solving skills.
• Strong organizational skills required.
• Strong negotiation skills required.
• Minimal travel is possible.

With approximately $3 billion in revenue and over 10,500 associates across approximately 200 offices nationwide, USI is one of the largest insurance brokerage and consulting firms in the world. At USI, we have created one of the most dynamic personal and professional development cultures in the industry. We invest heavily in our associates, and we take pride in celebrating their growth and success through our one-of-a-kind employee reward and recognition programs.

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