Claims Analyst

Clear Blue Insurance Services Puerto Rico LLC • Charlotte, NC

2d • Hybrid

About The Position

The Claims Analyst will utilize experience within commercial property and casualty claims to monitor and assess claims activity of Third-Party Administrators (TPAs). This role involves using direct systems to access and monitor claim files, denials, reservations of rights, and settlements conducted by TPAs. The analyst will verify that TPAs are performing within their authority, pursuant to agreed-upon processes and practices, and within agreed-upon territories and market segments. The position requires consulting with the Credit Risk, Legal, Compliance, Finance, Underwriting, and IT departments to identify specific trends or problems within a program. The Claims Analyst will maintain records of all monitoring activity and report to the management team, including both quantitative and qualitative measures and assessments. Additionally, the Claims Analyst will develop long-term relationships with TPA staff and the third-party reinsurance panel participating in the risk of the program through the appropriate reinsurance broker. The role involves internally and externally communicating any observations, problems, trends, strengths, and opportunities discovered, with the goal of growing the business and maintaining and improving program results for the benefit of Clear Blue and other stakeholders.

Requirements

• One (1) to Three (3) years of experience in claim handling, quality assurance, relevant litigation, TPA management, or equivalent related experience.
• Demonstrated success in evaluating claims, making coverage determinations based on policy provisions, and managing litigation.
• Strong communication (verbal and written) and interpersonal skills.
• Some travel might be required and will vary depending on business needs and caseload.
• Working knowledge of Microsoft Office.
• Ability to manage time effectively, set priorities and meet deadlines.
• Teamwork and ability to work and interact with departments throughout the organization
• Time management
• Excellent attention to detail
• Ability to safeguard confidential information.

Nice To Haves

• AIC certification preferred, or other relevant course work.

Responsibilities

• Providing front-line oversight of Third-Party Administrators’ personnel through direct communication and monitoring claims online using the Third-Party Administrators’ claim systems.
• Identifying, analyzing, and discussing monthly loss run trends, reportable claims and/or problematic claims.
• Providing excellent claim service to external clients and internal partners.
• Participating in claim file reviews with agents, brokers and Third-Party Administrators’ claim personnel.
• Interfacing with Clear Blue and external underwriting on claim status, exposures, and other factors impacting their risks.
• Preparing and presenting internal management reports for large losses and large loss potential; usually over $250,000.
• Conducting remote and onsite claim file audits of Third-Party Administrators.
• Performing other duties as required by management including reinsurance and subrogation.
• Focus on monthly auditing of Third-Party Administrators

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree