Senior Medical Only Claims Representative
About The Position
Summit provides workers’ compensation insurance and customer service to independent insurance agents and their clients. This remote Illinois role manages medical-only claims, evaluating compensability and liability, investigating coverage and damages, and determining and negotiating settlements and reserves within assigned authority. The representative communicates coverage and settlement information to insureds, claimants, and external partners; authorizes timely payments; and maintains accurate, detailed claim files. The role may include attending arbitrations, mediations, depositions, or trials, and performing other duties as assigned. The position handles assignments of higher technical complexity and coordination within significant limits and authority.
Requirements
- Bachelor’s degree in Business Administration, Risk Management and Insurance, Finance, or a related field, or equivalent experience.
- Generally, at least 5 years of experience in property and casualty claims handling.
- Strong analytical, negotiation, and problem-solving skills.
- Knowledge of insurance policies, coverage, claims handling procedures, industry laws, and regulations.
- Ability to organize and prioritize caseloads to ensure timely claim resolution.
- Excellent interpersonal and communication skills, including the ability to build relationships and lead negotiations.
- Ability to handle confidential information with discretion.
Nice To Haves
- Completion of or continuing progress toward a professional designation, such as Associate in Claims (AIC).
Responsibilities
- Manage an inventory of claims to evaluate compensability and liability.
- Plan and conduct claim investigations to confirm coverage and determine liability, compensability, and damages.
- Determine and negotiate appropriate claim settlements and reserves within prescribed authority.
- Attend arbitrations, mediations, depositions, or trials as needed.
- Communicate moderately complex coverage and settlement information to insureds, claimants, and external partners.
- Authorize payments within assigned authority and ensure payments are made in a timely manner.
- Maintain accurate and detailed claim files, including correspondence, reports, and settlement agreements.
- Perform other duties as assigned.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Wellness plans
- Parental leave
- Adoption assistance
- Tuition reimbursement
- Paid time off
- Paid holidays
- 401(k) plan with company match
- Employee stock purchase plan
- Commuter benefits
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What This Job Offers
Job Type
Full-time
Career Level
Senior
