Senior Claims Specialist

1 week ago

Waterloo, United States VGM Group Full time

VGM Insurance Services is headquartered in Waterloo, Iowa, and has provided Protection Beyond Policies for over 30 years. VGM Insurance offers industry-specific insurance products and risk management solutions nationwide for a variety of post-acute healthcare industries, as well as golf and hospitality markets. Learn more at www.vgminsurance.com.

Position Summary

As a Senior Claims Specialist, one will use their organization and investigative skills in a fast-paced environment while protecting VGM Insurance Services insureds. The position of Senior Claims Specialist is responsible for investigating, evaluating, negotiating, and resolving medical malpractice, products liability (DME) and general liability claims on losses of varying value and complexity. Individuals in the role must provide quality claim handling throughout the claim life cycle (customer contacts, coverage, investigation, evaluation, reserving, negotiation, and resolution) while maintaining full compliance with internal and external quality standards and state specific regulations.

Reporting Accountability: Vice President of Claims

Working Location: Waterloo, IA

Work Hours Classification: Full-time, exempt

Responsibilities/Duties of the Job

As a Senior Claims Specialist, one's primary duties are to promptly and effectively handle to conclusion all assigned claims. One is empowered to make decisions within delegated authority as outlined in company policies and procedures. As expected of any VGM employee, the Senior Claims Specialist adheres to exacting standards of professional conduct while delivering superior claims service. Specific duties may include:

  • Investigates each claim to obtain relevant facts necessary to determine coverage, causation/ damages, extent of liability/establishment of negligence, damages, contribution potential and exposure with respect to the various coverages provided through prompt contact with appropriate parties.
  • Initiates and conducts follow-ups via proficient use of claims systems and related business systems.
  • Verifies proper policy coverages and applies best claims practices to conclude assigned cases in accordance with company guidelines.
  • Maintains current knowledge of multiple insurance lines; court decisions; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars and/or training sessions.
  • Determines settlement amounts, negotiating and conveying claim settlements within authority limits to insureds and claimants. As appropriate, writes denial letters.
  • Manage all associated claim expenses including legal fees to maximize efficiency
  • Submits administrative reports as required.
  • Delivers consistent high-quality service throughout the claim life cycle, including but not limited to prompt contact, explaining the process, setting expectations, on-going communication, and follow-through and meeting commitments to achieve optimal outcome on every file.
Position Qualifications

VGM Insurance Services prides itself on customer service and accountability; the Claims Specialist must desire to work in a fast-paced environment and can maintain a high-volume workload managing multiple priorities.
  • 2-year/4-year degree desired
  • Minimum of 5 years of previous experience in general liability, medical professional liability, products liability, and/or bodily injury claims required
  • J.D. would set you apart as an ideal candidate
  • Strong skills in research, coverage evaluations, claim resolution, claims payments and cases
  • Knowledge of insurance coverages, contracts, claims handling guidelines, legal and medical terminology
  • Experience handling claims from receipt to resolution including coverage verification, investigation through resolution
  • Strong verbal and written communication skills, attention to detail ensuring accuracy
  • Demonstrated ownership attitude and customer centric response to all assigned tasks
Physical Requirements
  • Sitting for long amounts of time
  • Using technology efficiently such as computers, phones, misc. office equipment
  • Standing

This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Related additional duties may be assigned to the individual Associate.

VGM Group, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, pregnancy, national origin, disability, genetic information, military or veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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