Senior Medical Only Claims Representative

Essential Job Functions and Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
• This is a Medical Only position.
• This role is remote in Illinois.
• Performs other duties as assigned.

Job Requirements

Education: Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.Experience: Generally, a minimum of 5 years of experience in property and casualty claims handling. Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).
Scope of Job/Qualifications: Works within significant limits and authority on assignments of higher technical complexity and coordination. Demonstrates strong analytical, negotiation, and problem-solving skills. Demonstrates knowledge of insurance policies, coverage, and claims handling procedures. Maintains knowledge of industry laws and regulations. Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims.  Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations. Proven ability to handle confidential information with discretion.

This job is non-exempt in California and Washington

Company:

SCI Summit Consulting, LLC

Salary Range:

$69,600.00 -$92,400.00

Benefits:

We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

 

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

 

*Excludes seasonal employees and interns.