Claims Specialist - Semi-Conductor Construction
About The Position
The Claims Specialist investigates, evaluates, processes, and resolves insurance or risk-related claims while ensuring compliance with company policies, contractual obligations, and regulatory requirements. The role is the primary point of contact for claimants, vendors, insurers, and internal stakeholders, providing timely and accurate claim administration from intake through resolution. The position reviews, investigates, and processes claims according to established guidelines and service-level agreements; gathers and analyzes supporting documentation; and communicates with claimants, insurance carriers, attorneys, adjusters, and internal business partners. It assesses claim validity, coverage, and liability, and makes settlement recommendations. The specialist maintains accurate files in claims management systems, monitors reserves, payments, and case progress, ensures regulatory and policy compliance, identifies and escalates potential fraud indicators, provides status updates and analytics, and supports audits, litigation, and dispute resolution as needed.
Requirements
- Bachelor's degree in Business, Finance, Risk Management, Human Resources, or a related field, or equivalent experience.
- 2–5+ years of claims administration, insurance, risk management, workers' compensation, liability, or disability claims experience.
- Knowledge of insurance policies, claims investigation practices, and regulatory requirements.
- Strong analytical, negotiation, and problem-solving skills.
- Experience with claims management software and Microsoft Office applications.
- Excellent written and verbal communication skills.
Responsibilities
- Review, investigate, and process claims in accordance with established guidelines and service-level agreements.
- Gather and analyze supporting documentation, including incident reports, medical records, invoices, contracts, and legal documentation.
- Communicate with claimants, insurance carriers, attorneys, adjusters, and internal business partners.
- Determine claim validity, coverage, and liability, and provide settlement recommendations.
- Maintain accurate claim files and documentation within claims management systems.
- Monitor claim reserves, payment activity, and case progress.
- Ensure compliance with applicable insurance regulations, company policies, and reporting requirements.
- Identify potential fraud indicators and escalate concerns as appropriate.
- Provide status updates and claim analytics to management and stakeholders.
- Support audits, litigation matters, and dispute resolution activities as needed.
Benefits
- Flexible working environment that promotes work-life balance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
