Claims Specialist

• Investigate commercial property claims in the field, generally involving moderate to high complexity and $20,000-$250,000 loss exposure
• Inspect loss sites and utilize experts when needed
• Review coverages, determine liability and compensability, and interpret and communicate coverage and denials
• Prepare estimates, diagrams, inspection reports and upload photos using company systems and guidelines
• Set activities and reserves, authorize payments within authority, and ensure issuance of disbursements while managing loss costs and expenses
• Coordinate investigations and evaluate claims and suits through contact with insureds, claimants, business partners, witnesses and experts
• Seek early resolution opportunities and negotiate complex settlement packages
• Partner with attorneys, account representatives, agents, underwriters and insureds to develop strategies for timely and cost-effective resolution
• Identify recovery and fraud potential and coordinate with subrogation, salvage, Recovery and SIU units
• Accurately record claim circumstances and other business-relevant information
• Provide guidance and assistance to other claims staff and functional areas
• Keep current on state/territory regulations, issues, industry activity and trends
• Report to a Manager or Director

Outside Claims Representative

• Serve as a first responder and member of a dedicated catastrophe claims team
• Investigate and settle personal and commercial lines property claims in the field
• Respond to deployment directives and travel to catastrophe areas and areas with claims assistance needs
• Evaluate, negotiate, and settle property claims in various geographic locations
• Investigate and complete physical inspections of property claims
• Evaluate damages and prepare written estimates according to policy provisions
• Initiate first contact with insureds and relevant parties
• Gather basic information and obtain recorded statements
• Explain the overall claims process
• Assist claims office workloads when deployed or assigned to a claims office

Senior Catastrophe Claims Specialist

• Serve as a first responder and member of a dedicated catastrophe claims team
• Investigate and settle personal and commercial lines property claims in the field
• Maintain on-call availability and deploy at any time, potentially for extended periods
• Travel extensively to catastrophe areas and locations where COUNTRY Financial conducts business
• Work 10 consecutive twelve-hour days followed by 4 days off
• Assist claims office workloads when deployed to claims offices throughout the country
• Assist a claims office with workload when not deployed to CAT duty
• Respond to deployment directives
• Evaluate, negotiate, and settle property claims
• Investigate and complete physical inspections of property claims
• Evaluate damages and prepare written estimates according to policy provisions
• Initiate first contact with insureds and relevant parties
• Gather basic information, obtain recorded statements, and explain the claims process
• Work up to 90% in the field and 10% in the office within the Bloomington, Illinois surrounding territory

• Handle an inventory of claim files
• Perform detailed analysis of each claim
• Evaluate coverage and liability and issue written coverage opinions
• Monitor all aspects of claims files toward resolution
• Hire, monitor, and pay defense counsel
• Develop and implement claim litigation and resolution strategies
• Maintain accurate and detailed claim files, including correspondence, reports, and settlement agreements
• Provide information to underwriters and reinsurers on specific claims, insureds, and relevant legal trends and issues
• Secure and analyze reports, policies, appraisals, releases, statements, records, and other documents during claim investigations
• Attend arbitrations or mediations as necessary
• Affect settlements and reserves within prescribed limits and submit recommendations where applicable
• Ensure timely and accurate claims payments
• Ensure claims handling complies with applicable statutes, regulations, legal requirements, company procedures, and policies
• Provide technical advice to other functional areas
• Maintain necessary adjuster licenses
• Perform other duties as assigned

Claims Representative – Executive Liability Division

• Process low level general liability claims by gathering information to determine liability exposure
• Assign reserve values to claims, make claims payments, and settle claims up to designated authority level
• Develop and coordinate claims action plans to resolution and return-to-work efforts
• Approve and process assigned claims, determine benefits due, and administer action plans pursuant to claim or client contract
• Administer subrogation of claims and negotiate settlements
• Communicate claim action with claimants and clients
• Ensure claim files are properly documented and claims coding is correct
• Process low-level lifetime medical and/or defined period medical claims when applicable
• Handle state and physician filings and decisions on appropriate treatments recommended by utilization review
• Maintain professional client relationships
• Support the organization's quality programs
• Perform other duties as assigned
• Travel as required

Claims Associate – Liability

• Investigate the origin and cause of homeowner property claims
• Contact insureds, claimants, agents, attorneys, contractors, experts, special investigation units, other adjusters, public personnel, and other parties
• Identify complex issues and seek assistance as needed
• Handle 1st party and 3rd party claims under multiple policy types and endorsements
• Conduct on-site inspections, evaluate damages, and negotiate claims with insureds, claimants, attorneys, and public adjusters
• Respond to customer inquiries, make appropriate decisions, and close files
• Interpret policies, leases, by-laws, declarations, articles, and contract coverages and apply them to assigned losses
• Provide claim process and status updates, answer questions, or redirect inquiries
• Work primarily in the field, spending approximately 80% of time interacting directly with customers
• Report to the Property Claim Manager
• Complete other assignments, job duties, or projects as required
• Attend occasional office-based team meetings, training, and cultural events

Property Field Claims Adjuster

• Analyze claims to determine whether benefits are due based on established procedures and industry best practices
• Investigate claims by gathering and processing information from policyowners, physicians and third parties
• Review assigned caseloads and determine benefits due pursuant to policy provisions within designated authority levels
• Refer claim activity outside authority level to a Senior Examiner or Supervisor
• Discuss claims decisions regularly with a Senior Examiner or Supervisor
• Make timely claims payments through prompt and continual follow-up of outstanding claim information as approved
• Communicate claim actions professionally and effectively with claimants and other appropriate parties
• Escalate difficult or complex claims or claimant situations as necessary
• Document claim decisions using claim forms, medical records, independent medical exams and investigations
• Process payments accurately through information systems
• Adhere to claim rules, regulations and laws
• Develop and maintain superior customer service through prompt and courteous service communication
• Attend approved meetings and educational seminars or conferences for professional development
• Learn the insurance industry, the Company, its products, services, claims processing and position expectations
• Develop skills to apply discretion and sound judgment to various claims
• Assume additional responsibilities as necessary

Claims Specialist jobs in Illinois

Outside Claims Representative

Senior Catastrophe Claims Specialist

Senior Catastrophe Claims Specialist

Claims Representative – Executive Liability Division

Claims Associate – Liability

Property Field Claims Adjuster

Claims Examiner – Trainee