Claims Analyst jobs in Johnstown, PA

THIS POSITION IS ELIGIBLE TO WORK REMOTELY FROM TN, FL,AL, NC, SC, OH, KY, IN, GA, PA, ME, RI, NH, DE MI, NJ, NY, CT , VT, MA

• Promptly investigates and evaluates moderately complex auto and casualty claims

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees

• Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation

• Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system

• Request and analyze investigative and other relevant reports, claim forms and documents when appropriate

• Documents claim activities, reserve analysis, summaries of reports including Medicare (MSP) modules in the claim system

• Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology

• Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence

• Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines

• Handles litigated files of low complexity

• Recommends and obtains authority from appropriate people leader in the assignment of defense counsel

• Assigns and manages vendors for accuracy and appropriateness with supervisory approval as appropriate

• Reviews bills, receipts, legal invoices and litigation related expenses for accuracy and appropriateness

• Notifies the people leader of claims that may need escalation or reassignment.

• Drafts reservation of rights and coverage denial letters with supervisor approval

• Provides prompt, detailed responses to agents, insureds and claimants on the status of claims

• Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner

• Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains appropriate higher authority as required

• Identifies and protects all liens as appropriate

• Investigates Medicare liens and timely resolve in accordance with EMC and Medicare guidelines

• Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims

• Attends and assists with suits, mediations, and arbitrations

• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed

• Issues timely payments

• Reviews and audits estimates written by independent adjusters, body shops, engineers, and other vendors for accuracy and to ensure the most cost-effective repair approach

• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal as appropriate

• Prepares risk reports for Underwriting and Risk Improvement

• Reviews coverage intent and policy activity with Underwriting

• Reviews account inspection information with Risk Improvement

• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage, liability, and damage

• Assists claims team members as appropriate in handling of claims

• Participates in projects as assigned

• Trains, and serves as a technical resource for team members

• Bachelor's degree or equivalent relevant experience

• Three years of casualty claims adjusting experience or related experience

• Relevant insurance designations preferred

• Strong knowledge of the theory and practice of the claim function

• Strong knowledge of insurance contracts, medical terminology and substantive and procedural laws

• Strong knowledge of computers and claims systems

• Ability to obtain all applicable state licenses

• Ability to adhere to high standards of professional conduct and code of ethics

• Good organizational and empathetic interpersonal skills

• Strong written and verbal communication skills

• Strong investigative and problem-solving abilities

• Excellent customer service skills

• Ability to maintain confidentiality

• Occasional travel required; a valid driver's license with an acceptable motor vehicle report per company standards required if traveling