Claims Service Representative

Gallagher•Irvine, CA

13d

About The Position

At Gallagher, we help clients face risk with confidence because we believe that when businesses are protected, they’re free to grow, lead, and innovate. You’ll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced data and analytics providing a comprehensive overview of the risk landscape is at your fingertips. Here, you’re not just improving clients' risk profiles, you’re building trust. You’ll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebrate new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you’re ready to bring your unique perspective to a place where your work truly matters; think of Gallagher. Overview We are seeking a detail-oriented and analytical Claims Service Representative to manage lower exposure claims in alignment with company policies, procedures, and industry standards. This role involves investigating losses, evaluating claims, and ensuring fair and timely claim disposition while maintaining positive relationships with clients and stakeholders. The ideal candidate will have a background in claims management, preferably in medical malpractice or health benefit claims, and a strong understanding of reinsurance products such as Provider Stop Loss.

Requirements

High school diploma or equivalent.
Minimum of 1 year of related experience in claims management.
Appropriate licensing and/or certification in all states where claims are handled.
Proficiency in MS Office applications and claims-related business software.
Solid analytical skills to make decisions and resolve issues inherent in claims handling.
Strong organizational skills to manage workload and respond to multiple demands.
Excellent verbal and written communication skills.

Nice To Haves

Familiarity with Provider Stop Loss, HMO reinsurance, or managed care reinsurance products designed to cover catastrophic claims.
Experience in medical malpractice claims or health benefit claims, including reviewing, accepting, or denying claims.
Knowledge of medical coding, billing, or working in a health plan or health carrier environment.
Ability to analyze claims data and understand reinsurance layers that protect entities from catastrophic claims.

Responsibilities

Administer exposure claims in accordance with company policies, procedures, and applicable state laws.
Collaborate with clients, claimants, vendors, field personnel, and other internal/external resources to gather necessary information.
Investigate losses to determine cause, scope, extent of damages, liability, and potential subrogation opportunities.
Evaluate claims to set reserves, make appropriate payments, and ensure accurate documentation of all activities.
Review large data files submitted by clients, analyze claims data, and price it against sold policies.
Assist in difficult claims processing and provide support in claims management as needed.
Communicate effectively with claimants, clients, and stakeholders to achieve high levels of satisfaction and maintain positive relationships.
Support producers in reviewing losses from the past year and discussing market trends.
Develop towards managing accounts within the Provider Stop Loss product.
Client-facing work, providing SME knowledge to both internal and external stakeholders.

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program