Claims Specialist

• Receive claim assignments and verify and determine coverage applicability
• Interpret complex coverage issues
• Write reservation of rights and declination of coverage letters
• Determine the method and extent of investigation for each claim
• Review and manage claim files for adequate and timely investigation, evaluation, and reserves
• Maintain a timely diary for each claim
• Evaluate and adjust claims within authority level
• Report technical matters to supervisors or management
• Evaluate and manage litigated claims
• Determine future handling and disposition of claims
• Consult with managers, directors, or the Coverage unit on claims requiring assistance or exceeding authority
• Assess risk transfer potential and address tender issues
• Assess recovery potential and pursue recovery
• Manage assigned claims through prompt and equitable disposition according to company Best Practices
• Provide superior customer service to agents, insureds, and others

Senior Claims Specialist, Construction Defect

• Analyze Auto Property Damage claims on behalf of the dedicated client to determine benefits due
• Process low-level Auto Property Damage claims
• Ensure ongoing adjudication of claims within company standards, industry best practices, service expectations, and client service requirements
• Investigate claims and gather information to determine claim exposure
• Develop action plans to reach appropriate and timely resolutions
• Negotiate claim settlements within designated authority
• Identify subrogation of claims
• Communicate claim activity and processing with claimants and clients
• Report claims to excess carriers
• Respond professionally and promptly to requests for directions

Liability Claims Representative – Auto Property Damage

• 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
• Analyze and process claims through action plans to timely resolution
• Investigate and gather information to determine claim exposure
• 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
• Work with autonomy in daily work, location, and career path

Claims Examiner – Workers Compensation

• Conduct virtual and on-site investigations at policyholders’ residences
• Assess property damage, determine liability, evaluate loss extent, and negotiate fair settlements
• Use claims handling software, a company car, and laptop to determine damage and write estimates in a paperless environment
• Evaluate and report potential subrogation opportunities
• Report theft, fraud, or arson incidents to appropriate state and industry agencies
• Perform duties independently with work directly impacting management outcomes
• Represent the company professionally in public interactions
• Engage with policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties
• Negotiate with policyholders to settle claims
• Promote safety and comply with company safety and ergonomic standards
• Perform additional duties as assigned
• Travel to and from policyholder homes

Field Property Claims Adjuster

• Provide technical supervision and guidance for BI and PIP claims handled by Third-Party Administrators
• Ensure adherence to program standards and best practices
• Oversee rideshare claims, including coverage analysis and litigation management
• Control indemnity, expense, and litigation costs through timely reserving, trial preparation, and resolution strategies
• Conduct regular audits of TPA-managed claims for accuracy, timeliness, and compliance
• Review claims data, reserve adequacy, and performance metrics to identify trends
• Recommend process improvements
• Stay informed on evolving rideshare regulations, policy changes, and litigation developments
• Perform other related tasks as assigned

Executive Claims Specialist, Bodily Injury

• Provide senior-level technical oversight of PIP/no-fault claims administered by Third-Party Administrators
• Serve as a subject matter resource for PIP, including coverage, medical benefits, treatment disputes, medical necessities, peer reviews, IMEs, denials and regulatory requirements
• Provide technical guidance on complex, disputed, litigated and arbitrated PIP matters
• Evaluate coverage, benefit eligibility, priority of coverage and potential risk-transfer opportunities
• Review claim handling for accuracy, timeliness, documentation and statutory and regulatory compliance
• Partner with TPA claim professionals and leadership to address concerns and improve claim handling
• Conduct targeted claim audits and quality reviews
• Evaluate reserve adequacy and provide technical recommendations on complex exposures
• Identify trends involving providers, litigation, claim handling, leakage, compliance and emerging exposures
• Coordinate with Legal, SIU, medical review vendors, defense counsel and other partners
• Support enhancements to claim guidelines, workflows, reporting, training and quality controls
• Maintain awareness of legislative, regulatory and judicial developments affecting PIP/no-fault claims

Executive Claims Specialist, PIP

• Analyze Lost-Time 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
• Analyze and process claims through action plans toward appropriate and timely resolution
• Investigate and gather information to determine claim exposure
• Negotiate claim settlements within designated authority
• Communicate claim activity and processing with claimants and clients
• Report claims to the excess carrier
• Respond professionally and timely to requests for directions

Claims Specialist jobs in New Jersey