Complex Claims Analyst

📋 Description

• • Analyze mid- and higher-level general auto claims to determine scope of damages and ensure adjudication aligns with company standards and industry best practices.
• • Manage commercial and personal lines auto claims by gathering information to assess exposure, assign reserve values, process payments, and settle claims within designated authority limits.
• • Assess liability and resolve claims through thorough evaluation and documentation.
• • Approve and process assigned claims, determine benefits due, and execute action plans in accordance with claim or client contract terms.
• • Manage subrogation processes and negotiate settlements on behalf of the company to recover costs.
• • Communicate claim decisions and actions clearly to claimants and clients to maintain transparency and trust.
• • Ensure all claim files are accurately documented with correct coding and compliance with internal protocols.
• • Maintain professional relationships with clients to support long-term service standards and satisfaction.
• • Perform other duties as assigned, including travel when required.
• • Apply expertise in insurance principles, laws, recoveries, offsets, deductions, claim duration, and cost containment specific to the auto claims line of business.
• • Demonstrate strong analytical and interpretive skills to evaluate complex claim scenarios and make sound decisions.
• • Prepare comprehensive, accurate, and constructive written reports on claim findings and actions.
• • Utilize excellent oral and written communication skills, including presentation abilities, to convey claim outcomes and recommendations.
• • Exhibit strong organizational and interpersonal skills to manage multiple priorities and collaborate effectively within teams.
• • Possess excellent negotiating skills to achieve favorable settlement outcomes in subrogation and claim resolution.
• • Meet or exceed established Performance Competencies for claims handling and customer service.
• • Maintain proficiency in Microsoft Office products and other PC-based systems used for claims documentation and reporting.
• • Secure and maintain state adjusting licenses as required for the position.
• • Demonstrate clear conceptual thinking, sound judgment, problem-solving ability, and discretion under work-related stress.
• • Handle multiple concurrent priorities while consistently meeting deadlines in a fast-paced environment.
• • Perform computer keyboarding tasks and travel as necessary to fulfill job responsibilities.