Claims Processing Director plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director requires a bachelor's degree. Typically reports to top management. The Claims Processing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Claims Adjuster I – JOB AD
Job Type: Full-time, In-Office
Pay: $60,000 - $70,000
Who Are We?
Capital Claims Management ("CCM") is a boutique insurance claims adjusting firm providing claims handling, defense, and program management services to insurance carriers.
At CCM, we promote work-life balance and provide an enjoyable, low-stress work environment. A welcoming environment committed to developing and accentuating each person’s specific talents. We are different from large carriers who are very metric-driven, with vastly high demands and management that is far removed from direct claims handling. We provide extensive support to our staff’s ongoing success, requiring nearly half the intake and claim volume larger carriers put on their employees. Plus, we offer competitive pay scales. If you are at the end of your rope with your current employer, you may find much more job satisfaction at CCM.
What Is The Opportunity?
In this role, you will primarily handle third-party claims involving Professional Liability (E&O) and Commercial General Liability insurance. Your claim load will consist of non-litigated PL and CGL claims.
As a Claims Adjuster I, you will handle a reasonable load of claims. You will investigate and determine coverage and liability. You will engage with all relevant parties; and accurately, efficiently work to resolve claims. A management team, claims assistants team, and peers will be available for support, to offer guidance, or approval for a higher level of authority.
What Will You Do?
1. Interview and correspond with insureds, claimants, and other parties to complete coverage & liability investigations and resolve claims.
2. Make determinations on coverage and liability based on submitted evidence, discussions, contractual agreement provisions, and applicable local statutes.
3. Write position letters consisting of: Declinations of Coverage, Reservations of Rights, Denials of Liability, and Offers.
4. Approve payment of claims within a specific monetary limit.
5. Guide negotiations, attempting settlement prior to legal actions for claimed losses.
6. Comply to standards set by carrier’s Best Practices and CCM procedures.
What Does Our Ideal Candidate Look Like?
1. 3 years claims adjusting experience. Ideally in property, professional liability, or commercial liability. Workers’ compensation experience will be considered, but is not preferred.
2. Experience working in insurance.
3. Litigation experience either via prior experience claims handling, or at a law firm.
4. Excellent customer service and conflict resolution skills.
5. Excellent written and verbal communication skills.
6. Prior experience authoring formal coverage and liability determination letters.
7. Deadline and detail-oriented with time management skills and executive functioning skills. Professionalism is closely observed.
8. Investigation skills, initiative, self-driven.
9. Acquired a Bachelor's degree.
10. Experience with claims-made policies preferred.
11. General knowledge of residential construction or home inspections is a huge plus.
We offer Medical, PTO, 401(k) matching, Life Insurance, Vision, Dental, and a variety of other generous benefits.
CCM is an Equal Opportunity Employer
Job Type: Full-time
Pay: $60,000.00 - $70,000.00 per year
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Work Location: In person
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