Sr. Claim Representative - NSA
Sentry Insurance - Scottsdale, AZ

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What You'll Do
  • Provide all aspects of customer service by assisting customers through difficult situations. Support customers with empathy and understanding.
  • Evaluate claims and charges submitted by insureds and medical providers to determine eligibility for benefits, checking for misrepresentation, preexisting conditions and mandated state benefits if applicable
  • Report and communicate claims to senior management. Refer the payment or denial of claims that exceed assigned authorization limits to Senior Claims Representative or Claims Manager with settlement recommendation.
  • Verify coverages and investigate losses by gathering pertinent information. Deny coverage where coverage does not exist.
  • Take recorded statements, obtains pertinent information i.e., police and medical reports, appraisals, estimates, photographs, degree of disability, rehabilitation potential, etc., and evaluates damages/eligibility for benefits, determines liability and sets reserves.

Document all decisions, correspondence, reports and discussions that occur during an investigation.

Settle and pay claims within assigned authority limits. Complete claim by evaluating the loss and settling the claim.

Detect potential problems or trends that require additional review, investigation or research and refers to Specialist or Claims Manager for resolution. Advises the Claims Department of any special problems i.e., questionable repair shops.

Obtain and maintains state adjuster licenses as required.

Receive claim assignments from established workflow and systems.

Adhere to state specific compliance issues for assigned jurisdictions including completion and submission of required forms.

Confer with higher level technical claims personnel for guidance and direction to ensure the file is handled properly.

Determine if subrogation exists and takes steps necessary for recovery.

Coordinate payment of benefits with other insurance carriers if applicable.

Monitor claim files during initial and residual periods to ensure file is accurate and current.

Work closely with health facility, repair facility and/or contractors to facilitate necessary services or repair work.

Notify Underwriting of any adverse findings on a particular risk.

Accurately code data submitted to outside agencies or other Sentry functions.

Provide pertinent background information to legal counsel and assist as possible in reaching an in-court or out-of-court settlement in litigation situations.

Participate in administering fraud control procedures, evaluating and preparing reports, and drafting responses to formal complaints.

May assist in responding to complaints from customers, insurance departments or attorneys i.e., researches complaints, compiles and evaluates information, determines appropriate response, and takes remedial action if appropriate.

May perform quality audits of closed claim files to determine whether claims are being processed properly.

Determine if benefits were applied correctly, if all policy provisions were met, if preexisting conditions and the possibility of fraud were checked, and if all processing procedures were followed in an efficient, timely manner.

Create reports and recommendations are made to address the results of the audit.

May provide work direction and guidance to claims representatives, serve as a technical resource within assigned unit, assist in training unit personnel, and provide backup in Manager’s absence.

May perform after-hours duty responsibilities.

Performs other job-related duties requiring the same general knowledge, skills and degree of responsibility commensurate with assigned level.

Performs other job-related duties requiring the same general knowledge, skills and degree of responsibility commensurate with assigned level.

What it Takes
Bachelors Degree or equivalent work experience.

5-8 years of related work experience.

4-6 years of related work experience.

Thorough knowledge of insurance policies and coverages, claim payment procedures, insurance regulations, and familiarity with medical and legal terminology.

Previous insurance experience and/or coursework.

Possess strong analytical abilities to review, exercise judgment, and evaluate claims to make sound decisions.

Able to review and interpret complex and detailed documents such as contracts, medical reports and insurance regulations.

Experience working with automated claim-paying system(s) preferred.

Effective oral and written communication skills and human relations skills.

Ability to maintain confidentiality.

Personal computer and math skills beneficial.

Ability to pass required coursework applicable to job duties.

Ability to meet the travel requirements of the job to include business related assignments, with limited notice. This may include being away for multiple weeks, as business needs arise, such as after a catastrophic storm event. Travel may include driving, flying or any other necessary form of transportation.

What You'll Receive
Sentry's excellent benefits package is designed to meet today's most important needs. Benefits for full-time Sentry Insurance employees include:
  • Competitive Compensation
  • Group Medical, Dental, Vision and Life
  • 401 (K) plan with a dollar-for-dollar match on your first six percent
  • Comprehensive paid training
  • Generous Paid-Time Off Plan
  • Pretax Dependant Care and Health Expense Reimbursement Accounts

How You’ll Apply
Sentry Insurance has an online employment application. In order to complete it, you need to apply for a specific position. We ask that you apply for one position at a time with us; so if you are interested in several positions, please determine the position in which you are most interested and apply for that position first. If you are not selected for your first choice, we invite you to apply for the next job in which you are interested.

If this is the first time you have applied for a position at Sentry, you will be asked to register. Returning applicants will only need to provide their email address and password.

Who You’ll Want to Contact
Abigail Nordin at 480/860-7522

About Sentry
Sentry employees have been helping individuals and businesses build and protect their futures since 1904. Because of the trust placed in us, Sentry is one of the largest and strongest mutual insurance companies in the United States, and is rated A+ by A.M. Best, the industry's leading rating authority.

Equal Employment Opportunity
It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

About this company
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Founded in 1904, Sentry Insurance is one of the largest and strongest mutual insurance companies in America. Sentry is one of the...