Claims Specialist

• Investigate, evaluate and adjust Arizona workers’ compensation claims
• Establish reserves and provide reserve recommendations within authority levels
• Review, approve or oversee medical, legal, damage estimate and miscellaneous invoices
• Negotiate disputed bills and invoices
• Authorize and make claim payments using a claim payment program
• Negotiate settlements according to corporate standards, client instructions and state laws
• Select, refer and supervise claim files sent to outside vendors
• Assess and monitor subrogation claims
• Review and maintain claim-system diaries
• Prepare reports detailing claim status, payments and reserves
• Compute disability rates in accordance with state laws
• Coordinate communications with clients, claimants and other parties
• Provide notices of qualifying claims to excess/reinsurance carriers
• Handle complex claims with minimal supervision
• Conduct claim reviews and training sessions for designated clients
• Attend hearings, mediations and informal legal conferences
• Comply with corporate claim-handling standards and client instructions
• Support client satisfaction

Workers' Compensation Claims Adjuster

• Analyze reported lower-level general and bodily injury liability claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Analyze and process claims through action plans to timely resolution
• Investigate and gather information to determine claim exposure
• Handle lower-level liability and/or physical damage claims under close supervision
• Support claims representatives, examiners, and leads with larger or more complex claims
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to the excess carrier and respond to requests for directions

Claims Associate – Liability

• Adjudicate assigned claims within given authority
• Provide operational support to the claims team
• Strategize and maximize early settlement opportunities for Construction Defect and 3rd Party Property Damage Claims
• Apply knowledge of coverage triggers and time on risk allocation
• Draft and review coverage analyses
• Manage and partner with local defense counsel while monitoring litigation
• Drive litigation best practices to manage deployment and utilization of defense counsel
• Continually assess exposures and adequacy of claim reserves
• Apply theories of liability and state-specific negligence standards
• Accurately document claim files with relevant correspondence, documentation, and file notes
• Assess ACV vs RCV property damage
• Attend mediations and/or settlement conferences where appropriate
• Identify suspected fraudulent claims and track them with the special investigations unit
• Participate in the Claims/UW/Actuarial feedback loop
• Keep senior claims management informed of key issues
• Liaise daily with insureds and brokers

Complex Claims Specialist – General Liability, Construction Defect

• Assess coverage and review claims for investigations, action plans, evaluation, fraud, and claim resolution
• Gather pertinent information and conduct quality investigations
• Review and evaluate coverage and/or liability
• Secure reports, policies, releases, statements, and other claim-investigation documents
• Analyze liability, assess exposure, and evaluate accurate reserves
• Manage claims from inception through resolution
• Affect settlements and reserves within prescribed limits and submit recommendations on cases exceeding personal authority
• Ensure claims payments are calculated and issued accurately and timely
• Ensure compliance with state, legal, statutory, regulatory, and company requirements
• Maintain a diary to follow claim progress
• Determine liability for permanent disability, mitigate costs, and resolve claims
• Oversee litigation and coordinate claims with the defense team

Senior Workers Compensation Claims Adjuster

• Adjust non-attorney-involved soft tissue bodily injury claims and associated auto physical damage claims
• Confirm coverage and make coverage decisions
• Investigate loss details and determine legal liability
• Evaluate, negotiate, and settle claims within authority guidelines
• Document investigation, evaluation, negotiation, and settlement decisions
• Provide advice and set expectations regarding next steps to members
• Collaborate with team members to resolve issues and identify matters for escalation
• Partner with or direct vendors and internal business partners to facilitate timely claims resolution
• Support workload surges and/or Catastrophe Operations as needed
• Identify, measure, monitor, and control risks associated with business activities
• Follow written risk and compliance policies, standards, and procedures

Injury Claims Adjuster

• Analyze workers compensation claims on behalf of clients to determine benefits due
• Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
• Investigate claims and gather information to determine claim exposure
• Process claims through action plans to timely and appropriate resolution
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to the excess carrier
• Respond to requests for directions professionally and timely

Claims Adjuster – Workers Compensation

• Analyze and process complex or technically difficult California workers' compensation claims
• Investigate claims and gather information to determine claim exposure
• Manage claims through action plans to timely and appropriate resolution
• Negotiate claim settlements within designated authority
• Calculate and assign timely and appropriate reserves
• Manage reserve adequacy throughout the life of claims
• Calculate and pay benefits due
• Approve and make timely claim payments and adjustments
• Settle claims within designated authority level
• Prepare necessary state filings within statutory limits
• Manage litigation processes for timely and cost-effective claims resolution
• Report claims to the excess carrier
• Respond to requests for direction professionally and promptly
• Identify subrogation claims and negotiate settlements

Claims Examiner – Workers Compensation, CA Jurisdiction

• Investigate basic and occasionally moderately complex auto insurance claims
• Handle non-represented claims
• Evaluate coverage, determine liability, and assess damages
• Negotiate and settle claims according to established guidelines and best practices
• Ensure compliance with regulatory requirements and company standards throughout the claim lifecycle
• Investigate minor to moderately complex auto accidents and prepare clear, concise claim summaries
• Conduct recorded statements with claimants, insureds, and witnesses
• Maintain detailed, well-documented claim files, including notes, summaries, and decision rationale
• Collaborate with internal teams to support efficient, customer-centric claim handling
• Resolve claims in a timely, accurate, and customer-focused manner

Auto Claims Adjuster

• Resolve personal lines marine bodily injury claims of all complexities
• Handle claims from coverage inquiry through legal liability assessment, quantum analysis, and timely resolution
• Mitigate indemnity and expense exposure while communicating developments and outcomes to stakeholders
• Identify potential subrogation avenues
• Confirm claim coverage by reviewing policies and supporting documents
• Direct and monitor assignments to experts and outside counsel
• Manage vendors and litigation on moderate- to high-complexity claims
• Analyze coverage and communicate coverage positions; prepare coverage position letters
• Investigate losses and assess damages
• Meet service level agreements and respond to inquiries throughout the claim lifecycle
• Evaluate coverage, liability, damages, and insured exposure
• Set reserves within authority or recommend reserve changes
• Negotiate and settle claims
• Prepare reports by collecting and summarizing information
• Present higher-exposure cases at roundtables to senior claims leaders and underwriters
• Participate in special projects and assist team members
• Deliver technical training and mentor colleagues
• Coordinate loss information and present it to business stakeholders, underwriters, and insureds when applicable
• Travel to mediations, trials, and conferences as required

Claims Specialist jobs in Arizona