Summary: Investigates and handles to conclusion claims involving coverage determination.
Understands concepts of coverage, policy interpretation, exposure recognition to analyze and move claims towards resolution.
Obtains information and investigates the facts of loss.
Handle all customer questions to conclusion.
Use expert systems to evaluate facts of loss.
Documents files to include all key activities, contacts made, statements taken, including a full outline covering all aspects of the claim and requirements for resolution.
Detail-oriented with strong organizational, negotiation, influential, and customer service skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.
Demonstrated ability to work effectively independently and within a collaborative team oriented environment using sound judgment in decision-making.
Demonstrated ability to manage relationships with both internal and external customers.
Excellent communication skills both oral and written.
Strong analytical and problem solving skills.
Demonstrated proficiency with MS Office products (Outlook, Word, Excel).
Experience / Education:
Bachelor’s degree in Business Administration, a related field, and/or equivalent work experience.
Claims Adjuster License
One year of claims adjusters experience.
Bilingual fluency in Spanish is a plus not required
Knowledge of the game of golf and golf playing experience a big plus!