The Claims Advisor is responsible for assisting clients with the filing of their claims with insurance carriers and TPA's (third party administrators). The Claims Advisor should be able to provide claims information for various lines of insurance coverage claims (i.e. Workers' Compensation, Auto, Property, General Liability and Equipment Claims/IM) and communicate clear expectations to our clients in regard to the claims process.
The Claims Advisor should follow-up with the claims adjusters assigned by the carriers to check on current status and plan of action on claims. They should provide suggestions to help move the claim toward resolution as needed. They should be able to review a claim and the reserves set on a claim to determine if the reserves are justified. If Not, they should be able to request re-evaluation of those reserves and provide reasoning for the adjuster to do so. The Claims Advisor should be able to provide analysis of claims trends and provide e-mod analysis and forecasts for clients.
Principal Duties and Responsibilities:
- Report claims (telephonically or electronically) to insurance carriers and TPA’s.
- Follow-up with claim adjusters and clients on updated status and plan of action of claims.
- Have discussions (verbally and via email) with claim adjusters on strategies/recommendations to move claims to resolution.
- Provide information to clients when claims are reported on the anticipated claim process so they know what to expect.
- Help identify occupational clinics and assist clients in setting up protocols and designated clinics.
- Complete e-mod analysis reports and forecasts for clients.
- Schedule, coordinate and facilitate claims reviews in person or telephonically with clients and insurance carriers or TPAs.
- Track, document and share with clients claims financial impact on their claims as a result of proactive claim management. (i.e. Requests for reserve reductions, closures and/or strategic recommendations that helped move claims to resolution.)
- Have ability to participate in prospect meetings and explain claim advisor role and potential financial impact on claims.
- Facilitate “nuisance/claims within retention levels” as needed. This would include communication with the claimants verbally and/or electronically. Follow-up with claimants to provide incident report forms, request estimates and any other documentation they have to support their claim. Providing this documentation to our clients and then determining plan for resolution or reporting of the claim the insurance carrier, if needed.
Knowledge, Skills and Abilities:
- Bachelor’s degree preferred, but not required.
- 1-3 years of prior insurance industry experience, preferably as a claims adjuster.
- Proficient in Microsoft Excel, Word, PowerPoint and Outlook.
- Ability to analyze and creatively solve problems.
- Ability to pay close attention to detail.
- Ability to prioritize tasks, juggle multiple tasks and meet project deadlines.
- Ability to demonstrate at least an intermediate level of technical knowledge in various lines of commercial insurance coverage.
- Effective verbal and written communication skills.
- Ability to work efficiently in a team setting and independently.
- Ability to respond quickly to requests in professional and friendly manner.
- Ability to provide excellent customer service to both internal and external customers.
- Work is performed indoors in a climate controlled environment
- General technology as it relates to office administration
- Regular business hours with additional hours required during certain periods
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Expected Hours of Work/Travel:
This is a full-time position. Days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.
Reseco Group Holdings and all of its divisions, are an equal opportunity employer