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Complex Claims Specialist Allied Healthcare Providers
3 months ago
Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.Demonstrated investigative experience with an analytical mindset and critical thinking skills.Developing ability to negotiate low to moderately complex settlements.Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.Professional designations are a plus (e.g. CPCU)