Claims Specialist

A significant responsibility associated with this role is to adjudicate PL, CL, and CarePlan claims as assigned.  The claims specialist will review and apply applicable coverage terms and conditions, effectively communicate with insureds, select and direct appropriate vendors, effectively fight fraud, and effectively negotiate and resolve claims in a timely manner and in accordance with established good faith handling procedures.    

A secondary responsibility within this role is to ensure that our Salvage-related documentation, record keeping, and associated controls are accurate, timely, and in compliance with established guidelines.  This will require effective collaboration with the Jewelry Recovery Specialist(s), Finance team members, and salvage vendors. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Investigates, evaluates, and resolves multi-line claims in accordance with established procedures, good faith practices, and in accordance with the policy.
• Examines claim adjustors’ reports or similar claims/precedents to determine extent of coverage and liability.
• Pays claimant/insured amount due according to our contractual obligation and in alignment with our company procedures.
• Identifies and refers questionable claims to the special investigation unit in accordance with established fraud reporting procedures. 
• Maintains excellent written and verbal correspondence with all parties involved on the claim.
• Evaluates and obtains damage documentation to accurately set reserves and effectively resolve claims.
• Identifies subrogation and salvage recovery opportunities and collaborates with Jewelry Recovery Specialist on recovery strategy.
• Maintains current status on claims and reviews claims on diary system. Also monitors and reports of salvage results
• May be required to provide testimony under oath on claims in litigation.
• Provides quality customer service along with accurate and timely claim investigations and payments
• Processes all salvage-related invoices, payments, and recoveries.
• Proofs all incoming salvage product and paperwork for accuracy
• Maintains ongoing relationships with jewelers and jewelry trade association groups, as well as key recovery and claim vendors

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

LEADERSHIP RESPONSIBILITIES

None.

QUALIFICATIONS

• Bachelor’s degree preferred.
  • individuals with an associate degree and 2 years of claims or insurance-related experience will be considered.
• Property/casualty insurance adjusting experience is desired.
• Accounting expertise, specifically the ability to accurately record, process, and balance all applicable salvage recoveries and expenses, is desired.
• Jewelry expertise, including experience working in the jewelry trade, is desired.
• Proficient in Microsoft suite applications including Word, Excel, Outlook, and PowerPoint.
• Proficiency in Guidewire, Premiere Suites, and Diamond Track software desired.

CERTIFICATES, LICENSES, REGISTRATIONS

• None

PHYSICAL REQUIREMENTS

• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear.