Claims Analyst
Clear Blue Insurance Services Puerto Rico LLC • Charlotte, NC7d
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Claims Analyst
Clear Blue Insurance Services Puerto Rico LLC•Charlotte, NC
About The Position
The Claims Analyst provides front-line oversight of Third-Party Administrators (TPAs) handling commercial property and casualty claims. The role monitors claim activity through TPA claim systems, reviews claim files, denials, reservations of rights, and settlements, and verifies that TPAs operate within their authority, agreed processes and practices, territories, and market segments. The analyst identifies trends and issues in coordination with internal departments including Credit Risk, Legal, Compliance, Finance, Underwriting, and IT, and maintains records of monitoring activity and reports quantitative and qualitative findings to management. The position develops long-term relationships with TPA staff and the third-party reinsurance panel through the appropriate reinsurance broker. It communicates observations, problems, trends, strengths, and opportunities to internal and external stakeholders, with the goal of growing the business and maintaining and improving program results for Clear Blue and other stakeholders, including agencies and participating reinsurance companies. The role requires regular interaction with internal associates and external TPAs, managing general agents, reinsurers, and brokers or intermediaries. Some travel may be required, and occasional evening or weekend work may occur.
Requirements
- One to three years of experience in claim handling, quality assurance, relevant litigation, TPA management, or equivalent related experience.
- Demonstrated success evaluating claims, making coverage determinations based on policy provisions, and managing litigation.
- Strong verbal and written communication and interpersonal skills.
- Working knowledge of Microsoft Office.
- Ability to manage time effectively, set priorities, and meet deadlines.
- Ability to work as part of a team and interact with departments throughout the organization.
- Excellent attention to detail.
- Ability to safeguard confidential information.
- Some travel may be required depending on business needs and caseload.
Nice To Haves
- Associate’s or Bachelor’s degree in insurance, finance, or risk management, or equivalent related experience.
- AIC certification or other relevant coursework.
Responsibilities
- Provide front-line oversight of Third-Party Administrators’ personnel through direct communication and online monitoring of claims in TPA claim systems.
- Identify, analyze, and discuss monthly loss-run trends, reportable claims, and problematic claims.
- Provide excellent claim service to external clients and internal partners.
- Participate in claim file reviews with agents, brokers, and TPA claim personnel.
- Interface with Clear Blue and external underwriting on claim status, exposures, and other factors affecting risks.
- Prepare and present internal management reports on large losses and large-loss potential, usually over $250,000.
- Conduct remote and onsite claim file audits of TPAs, with a focus on monthly auditing.
- Monitor claim files, denials, reservations of rights, and settlements, and verify that TPAs act within their authority and agreed processes, territories, and market segments.
- Consult with internal departments to identify trends or problems within a program.
- Maintain records of monitoring activity and report quantitative and qualitative assessments to management.
- Develop long-term relationships with TPA staff and the third-party reinsurance panel through the appropriate reinsurance broker.
- Communicate observations, problems, trends, strengths, and opportunities internally and externally.
- Perform other duties as required by management, including reinsurance and subrogation.
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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
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