Claims Representative

• Support the Claims Division in achieving and promoting the lowest fair claims settlement
• Perform routine administrative and customer service aspects of the claims handling process according to established Claims Division guidelines
• Train team members on current processes as directed by leadership
• Enter data into claims processing systems while adhering to quality and productivity guidelines
• Input proper coverages and classifications when setting up new claims
• Answer approximately 100 Claims switchboard calls per day, provide basic information, and transfer calls to appropriate adjusters
• Perform filing, mail distribution, check printing, and other clerical tasks supporting the Claims Division
• Provide prompt and professional customer service to agents, policyholders, and internal customers regarding new claim notifications, inquiries, and requests
• Research policies and other systems to resolve claims processing issues
• Communicate with internal and external customers by phone, fax, and email
• Prepare written communications according to department standards
• Identify and utilize appropriate resources to solve customer problems
• Escalate customer risks and accelerate follow-up and action to resolve issues
• Work with supervisors to identify development and shadowing opportunities
• Provide coverage, guidance, or assistance to colleagues when needed
• Maintain direct contact with Claims Service Office Managers, Team Leaders, adjusters, Home Office Claims personnel, and Underwriting personnel

Claims Service Representative

• Support coordination of communication among clients, claim examiners, insurance carriers, and captive managers
• Respond promptly to inquiries from clients and internal teams
• Provide guidance on reporting guidelines and procedures
• Provide overall support to the TPA Services team
• Process and track claims, verify information, report according to client instructions, and maintain data integrity
• Handle escrow funding, Medicare and NPDB reporting, credentialing and loss runs, defense counsel invoice reviews, and internal claims procedure support
• Support Claims Examiners and internal teams by executing client strategies, processing requested changes, and documenting updates accurately
• Build strong client relationships through clear communication, insurance knowledge, cross-functional collaboration, and effective workload management
• Communicate timely, complete information with Claims team members to support effective service execution

Claims Service Representative – TPA

• Sort and index claims-related documents so Claims Adjusters can begin servicing customers
• Process billing invoices
• Complete forms and letters for relevant parties as requested by the Claims Adjuster
• Request and obtain relevant claim documentation and ensure timely follow-up
• Mail and print letters, files, and other claims documents
• Perform work within vendor web portals
• Perform research while working exception reports
• Complete required internal claims reports timely
• Perform financial transaction job tasks
• Handle manual exception checks
• Update vendor files with new vendors or updates to existing vendors
• Perform other duties as assigned
• Conform with corporate policies and procedures

Claims Service Representative, Entry-level

• Sort and index claims-related documents daily so Claims Adjusters can begin servicing customers
• Process billing invoices
• Complete forms and letters for relevant parties as requested by the Claims Adjuster
• Request and obtain relevant claim documentation and ensure timely follow-up
• Mail and print letters, files, and other claims documents
• Perform work within vendor web portals
• Perform research while working exception reports
• Complete required internal claims reports on time
• Perform financial transaction job tasks
• Handle manual exceptions checks
• Update vendor files with new vendors or updates to existing vendors
• Perform other duties as assigned
• Conform with corporate policies and procedures

• Investigate, evaluate, and negotiate settlements of complex PL Casualty Liability Claims
• Investigate, evaluate, and adjust assigned complex liability claims within authority limits
• Summarize cases exceeding authority and submit them to managers or specialists for approval
• Handle complex claims with minimal supervision
• Establish and maintain positive relationships with internal and external customers
• Provide excellent customer service
• Communicate regularly and effectively with agents, including face-to-face visits when required
• Assist other departments with investigations when required
• Handle workload efficiently with limited supervision or direction
• Report large losses and present claims to the CAB Committee
• Ensure appropriate reinsurance reporting on claims

Claims Representative jobs in United States

Claims Service Representative

Claims Service Representative – TPA

Claims Service Representative, Entry-level

Claims Service Representative, Entry-level

Claims PL Casualty Complex Representative