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Insurance Claims Specialist

2 months ago

Montpelier, Vermont, United States Vermont Mutual Full time
Job Overview

Vermont Mutual is looking for a dedicated Personal Injury Protection (PIP) Claims Specialist to enhance our team of adjusters. This role focuses on assisting clients involved in automobile incidents, particularly those related to MA PIP coverage, while also addressing limited physical damage claims. The ideal candidate will possess a strong background in MA PIP, coupled with exceptional customer service abilities, effective communication skills, and a keen attention to detail. While an adjuster's license is preferred, we are open to training the right individual.

The primary responsibility includes managing a caseload primarily composed of high-volume, lower financial risk, and lower complexity claims. The focus is on delivering prompt, courteous, and precise claims adjustments for our policyholders and claimants. Claims should be resolved efficiently and fairly, adhering to the insurance policy provisions and legal requirements. All handled files must comply with established claim handling guidelines and other job expectations.

Duties & Responsibilities

  • Conduct thorough investigations on all assigned claims.
  • Negotiate settlements within authorized limits.
  • Maintain accountability for all claims until resolution.
  • Recommend further actions for claims exceeding authority limits.
  • Document all significant activities on assigned claims using designated tools.
  • Review new claims and ensure reserve adequacy while keeping management informed of any adverse developments.
  • Monitor loss adjustment expenses and implement measures to control costs while maintaining quality.
  • Identify coverage issues and collaborate with supervisors for guidance and approval.
  • Ensure proper file handling, documentation, reporting, and expense management for all claims.
  • Provide accurate and timely updates to all customers regarding claim status and inquiries.
  • This position manages claims that may vary in size and complexity based on internal and external factors.
  • Perform additional duties or special projects as assigned.

Supervision Received

Moderate supervision is provided by the Claim Supervisor or Team Leader.

Supervision Exercised

This position does not have supervisory responsibilities; however, it may involve limited oversight of independent adjusters, appraisers, or vendors.

Qualifications

  • Associate's or Bachelor's degree in business, insurance, or a related field, or equivalent experience; zero to one or more years of relevant claims processing experience; or a combination of education and experience that provides comparable knowledge and skills.
  • Willingness and ability to obtain the necessary state Adjuster's License(s) as required by law.
  • Familiarity with property and/or casualty claims handling is preferred but not mandatory.
  • Demonstrated commitment to professional growth through ongoing education related to the role, such as AIC, INS, AEI, or CPCU certification coursework.
  • Strong analytical and negotiation skills.
  • Excellent verbal and written communication abilities.
  • Ability to exercise sound judgment in professional situations and handle confidential information.
  • Capability to work effectively with a diverse range of external firms and organizations.
  • Ability to collaborate efficiently with company management, peers, and support staff.
  • Strong customer service orientation.
  • Proficiency in PC applications, including Microsoft Office (Word, Excel & Outlook), imaging, and estimating software is preferred.
  • Ability to perform job duties effectively under pressure.

Physical Demands/Working Conditions

  • Primarily sedentary office position with frequent keyboarding/computer work required.
  • Physical demands are minimal and typical of similar roles in comparable organizations.
  • The work environment is representative and typical of similar positions in comparable organizations.
  • Rare overnight travel may be required.
  • Potential exposure to stressful situations related to claim disputes.