Claims Specialist
- Manages an inventory of claims to evaluate compensability/liability.
- Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.
- Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.
- Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate.
- Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.
- Performs other duties as assigned.
- BS/BA degree or equivalent work experience.
- Minimum of 2 years experience in claims adjustment, general insurance or formal claims training.
- Required to obtain and maintain all applicable licenses.
- Continuing education courses leading to industry certifications preferred (e.g., AEI, IIA, CPCU).
- Knowledge of claims investigation techniques, medical terminology and legal aspects of claims.
- California
- Los Angeles Incorporated
- Los Angeles Unincorporated
- Philadelphia
- San Francisco
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