Claims Specialist

Job not on LinkedIn

🔥 14 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $100k - $130k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Next Insurance

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2016

🛡️ Insurance

💸 Finance

🤝 B2B

Insurance • Finance • B2B

Next Insurance is an innovative insurance provider specializing in offering tailored insurance solutions for small businesses. They leverage technology to simplify the process of getting insured, making it more accessible and efficient for entrepreneurs. Next Insurance aims to provide transparent, affordable, and easy-to-understand insurance policies that meet the unique needs of small business owners.

📋 Description

• Serve as a subject matter expert in the Claims department • Handle high-severity and high-complexity commercial claims • Interpret policy documents and legal contracts • Analyze and identify coverage and related coverage issues • Apply knowledge of insurance contracts, claims practices, insurance codes, civil codes, vehicle codes, arbitration rules, regulations, and tort law • Manage, investigate, and resolve claims within prescribed authority levels • Recommend resolutions for cases exceeding authority to claims management • Handle litigation involving General Liability and Casualty files • Drive litigation and attend mediations, trials, and alternative dispute resolution proceedings • Communicate with policyholders, witnesses, and claimants to gather claim information and advise on appropriate action • Respond to written and telephone inquiries, including status reports • Present file materials for authority reviews and roundtables • Work with nurses, doctors, attorneys, and independent field adjusters on file reviews and claim-specific guidance • Comply with statutory and regulatory requirements • Meet quality assurance standards and performance goals • Set and revise case reserves according to reserving policy • Identify suspicious claims and refer them to SIU • Identify third-party subrogation opportunities • Maintain security of financial claim processing and information in claims files • Partner with internal teams and advise leadership on claim activities and exposures

🎯 Requirements

• BS/BA Degree required • Advanced studies or insurance designation preferred • At least 10+ years of directly related experience with Commercial General Liability and Litigation • Strong written and oral communication skills • Strong interpersonal, analytical, investigative, and negotiation skills • In-depth knowledge of multi-jurisdictional claims handling issues • Willingness to utilize and adapt to evolving technologies within Claims operations • Ability to work independently and be a self-starter • Must have, or be able to promptly obtain, a Texas Independent Adjuster License • Effective communication, presentation, negotiation, and persuasion skills • Ability to collaborate with cross-functional teams • Proven success delivering strong results in a rapidly changing claims environment • Commitment to excellence, company policies, and regulatory compliance • Team orientation and ability to build strong working relationships • Comfort navigating ambiguous environments and assisting coworkers with workloads or organizational projects • Receptivity to feedback, continuous improvement, and learning proprietary and off-the-shelf software systems • Some travel capability, likely up to 10%

🏖️ Benefits

• Annual performance-based incentive program • Partially subsidized medical plan • Fully subsidized vision and dental options • Life insurance • Disability insurance • 401(k) • Flexible paid time off • Parental leave • Equal employment opportunities and diverse, inclusive, and respectful workplace