Senior Claims Representative

Job not on LinkedIn

October 1

🚗 Michigan – Remote

Although this job is listed in Michigan, this company may be open to hiring remote in other states.

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Westfield Health

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Healthcare Insurance • Wellness • B2B

Westfield Health is a provider of health and wellbeing solutions dedicated to improving the quality of life of individuals and the communities they serve. Established in 1919, the company offers a range of services including health cash plans, private health insurance, mental health support, and corporate wellbeing strategies tailored to enhance employee engagement and productivity. Westfield Health aims to empower customers and businesses with effective health management tools and promotes a proactive, preventative approach to wellness.

201 - 500 employees

Founded 1919

⚕️ Healthcare Insurance

🧘 Wellness

🤝 B2B

📋 Description

• Determines whether proper coverage exists for the type of claim assigned. • Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, legal climate, potential exposure, and damages, and makes decisions on claim resolution. • Meets established goals & objectives, arranges for salvage disposition and other recovery proceedings as necessary, participates in claim file reviews and audits with customer and broker. • Provides support in negotiation of settlements with insureds, claimants, vendors, attorneys, and other insurance companies. • Manages approved vendors and counsel utilized as necessary in the claim process, including approval of investigation plans and budgets. Monitors, reviews, and issues payments to vendors and counsel in accordance with guidelines and standards. • Supports to review proper reserves for each claim based upon thorough investigation, evaluation, and experience. • Identifies and refers all claims to management for further handling and assignment instructions. • Refers claims exceeding authority to appropriate manager or complex claims specialist with recommendations. • Formulates sound recommendations for claims file handling, subsequent transactions, and renewal processing. • Requests additional information from an agent, identifies the need for referral to the field based on underwriting guidelines. • Maintains effective and ongoing communication with insureds, claimants, agents, attorneys, other insurance companies, representatives, vendors, and company personnel. • Completes appropriate reports to ensure that the claim status is clearly documented, obtains all necessary documentation to support claim evaluation. • Interprets complex and detailed documents such as contracts, legal documents, insurance regulations and policies as needed. • Maintains knowledge of related coverage, law, and legislative environment and trends, participates in professional industry groups staying abreast of industry changes and advancements and incorporates best practices. • Adjusting first party homeowners and commercial property claims. • Efficient in use of Xactimate to evaluate first party property claims. • For field roles only: Travels as often as needed including regular utilization of assigned fleet vehicle in order to cover assigned territory. This may involve traveling on short notice or other daily driving duties as assigned. May be required to travel for extended periods to fulfill storm duty responsibilities.

🎯 Requirements

• 4+ years of Claims Handling experience. • Bachelor's degree in Business, Communication, or a related field and/or commensurate work experience. • For field roles only: Valid driver’s license and a driving record that conforms to company standards.

🏖️ Benefits

• This role is not eligible for visa sponsorship.