Claims Service Associate

🔥 3 hours ago

☕ Washington – Remote

☕ Washington – Remote

💵 $70.8k - $105.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Physicians Insurance A Mutual Company

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1982

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Insurance • Finance

Physicians Insurance A Mutual Company is a dedicated provider of medical professional liability insurance, with over 40 years of expertise in protecting healthcare professionals including physicians, clinics, and hospitals. They offer comprehensive malpractice coverage, management liability, and risk mitigation services, along with a strong commitment to member support and guidance throughout the claims process. The company aims to empower healthcare providers by ensuring they can deliver care confidently, backed by excellent financial stability and a focus on responsive service.

📋 Description

• Responsible for the timely and accurate intake, triage, and system setup of reported incidents, claims, and lawsuits. • Serve as the first point of contact for insured members, brokers, and internal departments. • Provide professional, responsive customer experience while gathering, validating, and documenting critical claim information. • Perform limited claim handling within established authority and supports efficient claims assignment and workflow coordination across the Claims Department. • Gather, review, and document comprehensive First Notice of Loss (FNOL) information and supporting documentation to ensure absolute data accuracy and completeness prior to assignment. • Analyze incoming reports for severity, urgency, and coverage considerations; exercise independent judgment to escalate high-priority, complex matters to Claims Management while handling first-tier issues autonomously. • Complete accurate claim setup by verifying applicable coverages, tail endorsements, and policy limitations within the system, and generate formal acknowledgment correspondence. • Maintain precise system data, track intake metrics, and process regulatory reporting or referrals (such as Litigation and Peer Support Programs) in collaboration with Legal and Compliance teams. • Utilize departmental systems, tracking software (including Breezy ATS workflows where applicable), and applications to support daily intake activities, minimize processing lag, and drive process improvements.

🎯 Requirements

• High school diploma or equivalent required; additional education, insurance coursework, or industry training preferred. • Three to five years of experience in administrative, customer service, claims, operations, or related analytical role. • Insurance experience preferred, especially in medical malpractice, professional liability, or related coverage areas. • Strong attention to detail with the ability to enter, review, and maintain accurate claim information and documentation. • Ability to review information, assess urgency or complexity, manage shifting priorities, and escalate issues appropriately. • Excellent organizational, time management, and coordination skills, with the ability to manage competing priorities in a fast-paced environment. • Strong written and verbal communication skills, with a customer-focused approach and the ability to work effectively with internal teams and external stakeholders. • Knowledge of basic coverage principles, claim processes, and medical terminology preferred. • Experience using workflow, claims, or case management systems preferred; ability to learn and adapt to new tools, software, and processes required. • Proficiency with Microsoft Word and Outlook required; strong typing skills preferred. • Ability to work independently and collaboratively while demonstrating professionalism, sound judgment, and integrity.

🏖️ Benefits

• Comprehensive benefits program • Generous retirement program • Paid Time Off • Annual company bonus at an incentive target level of 5%