We are currently seeking a Senior Claim Representative to join our OneBeacon Professional Insurance (OBPI) team in Denver , CO . The Senior Health Care Claim Representative investigates, evaluates and attempts to resolve professional and general liability claims that have less complex factual and liability issues and monetary exposure generally less than $100,000; evacuation claims, legal proceeding claims, and Med-Pay claims. In addition, the Healthcare Claims Representative may be responsible for matters in bordereux and performs a number of critical reporting functions detailed below.
1) Makes timely and appropriate contacts, and working with manager completes appropriate level of investigation to determine coverage and identify/resolve all critical factual, legal and damages issues.
2) With direction/assistance from manager, analyzes coverage and prepares coverage position letters on low level exposure claims.
3) Working with manager, establishes adequate loss and expense reserves and makes timely adjustments as required.
4) With direction from the manager, may select, assign and direct activities of counsel/experts as required.
5) Determines settlement value of assigned claims within authority level, negotiates proper settlement of claims within authority and provides recommendations for settlement of claims exceeding authority level.
6) Documents all relevant activity on assigned files and makes recommendations for additional activity as appropriate.
7) Anticipates and meets all customer needs (internal and external).
8) May participate in joint claims/underwriting meetings with selected case presentations.
9) Viewed as a key resource in the department completing various federal state and local reports, credentialing, deductible collection, and other file activities necessary for file closure.
10) Assists examiners and consultants as required in obtaining current loss runs for the establishment and review of bordereaux/various files
Strong analytical skills; must have the ability to interact with both internal and external customers; excellent verbal and written communication skills; demonstrated proficiency with computer software including Windows, Excel, Microsoft Office and Microsoft Outlook. Must maintain attention to detail, and provide follow-through on projects. Requires the ability to maintain confidential information and work as a member of a team.
Education and Experience:
High School diploma with demonstrated insurance or technical experience required. Bachelor’s degree preferred. The ideal candidate will have at least 3-4 years of claims insurance experience.
Great Insurance Jobs - 21 months ago