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Claims Resolution Jobs in Georgia (NOW HIRING)

The position is responsible for coordinating all aspects of the claim resolution process in ... Manages highly complex investigations of claims, including coverage issues, liability ...

Claims Manager

Atlanta, GA ยท On-site

$110 - $150/hr

Who we are The $250B insurance claims industry runs on fax machines, phone tag, and adjusters ... to the resolution outcome of a claim. * Ensure the highest level of customer experience and ...

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Claims Resolution information

What is claims resolution?

Claims resolution is the process of reviewing, investigating, and settling insurance claims filed by policyholders or third parties. Professionals in claims resolution evaluate the details of each claim, determine coverage eligibility, negotiate settlements, and ensure that all parties receive a fair outcome according to the policy terms. The goal is to resolve claims efficiently, accurately, and in compliance with legal and regulatory standards, while minimizing disputes and maintaining customer satisfaction.

What are the key skills and qualifications needed to thrive as a claims resolution specialist?

To thrive as a Claims Resolution Specialist, you need strong analytical abilities, attention to detail, and a background in insurance or finance, often supported by a relevant degree or equivalent experience. Familiarity with claims management systems, customer relationship management (CRM) software, and sometimes industry certifications like AIC (Associate in Claims) is advantageous. Excellent communication, negotiation, and problem-solving skills help you resolve disputes efficiently and maintain positive client relationships. These skills are crucial for ensuring accurate claims processing, minimizing errors, and delivering high-quality customer service.

How does a claims resolution specialist typically collaborate with other departments to resolve complex claims?

Claims Resolution Specialists regularly work with teams such as customer service, underwriting, and legal to gather necessary information and ensure claims are processed accurately. Collaboration often involves reviewing documentation, clarifying policy details, and communicating updates to all stakeholders. This multidisciplinary approach helps resolve issues efficiently and ensures compliance with company standards and regulations. Effective communication and teamwork are key to successfully managing and closing complex claims.

What is the difference between Claims Resolution vs Claims Adjuster?

AspectClaims ResolutionClaims Adjuster
Required CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; licensing or certification often required
Work EnvironmentOffice settings, customer service interactionsField work and office settings, inspecting damages
Industry UsageInsurance companies, claims processingInsurance companies, claims assessment
Job FocusResolving claims, customer communicationEvaluating damages, determining claim validity

Claims Resolution professionals primarily focus on processing and resolving insurance claims through customer communication, often working in office settings. Claims Adjusters evaluate damages and determine claim validity, frequently conducting field inspections. While both roles are integral to insurance claims, Claims Resolution emphasizes customer interaction and claim processing, whereas Claims Adjusters focus on damage assessment and validation.

WC Claims Resolution Specialist - Special Risk Policyholders

Lawrenceville, GA โ€ข Hybrid

Amerisure Mutual Insurance Company
Insurance Servicesย โ€ขย 501 - 1,000 employees

$21.25 - $29.25/hr

Full-time

Medical, Retirement, PTO

Posted 8 days ago


Job description

Amerisure creates exceptional value for its partners, policyholders, and employees. As a property and casualty insurance company, Amerisure's promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. With an A.M. Best "A" (Excellent) rating, Amerisure serves mid-sized commercial enterprises focused in construction, manufacturing and healthcare. Ranked as one of the top 100 Property & Casualty companies in the United States, we proudly manage nearly $1 Billion of Direct Written Premium and maintain $1.21 billion in surplus.

Amerisure is currently recruiting for a WC Claims Resolution Specialist - Special Risk Policyholders. This role will be hybrid in an office 2 days a week (Tuesday & Wednesday). This role requires Texas expertise, and ideally Arizona, Arkansas and Oklahoma. The ideal candidate will possess the following skill set.

Summary Statement

Manage workers' compensation claims for insureds with loss-sensitive insurance programs, such as large deductibles and retrospectively rated policies. Conducts thorough investigations, evaluates claims, and ensures effective resolution while delivering exceptional customer service to insureds with loss sensitive insurance policies. Builds robust relationships by demonstrating strong analytical, negotiation, and communication skills, with a focus on delivering quality claim outcomes and excellent service.

Essential Tasks/Major Duties

  • Investigate losses, determine coverage, assess compensability, and review and analyze documents and legal pleadings.

  • Collaborate with legal counsel to manage litigated claims, leveraging experience to analyze documents and legal proceedings effectively.

  • Develop and execute proactive claim resolution strategies, including timely damage evaluations, negotiations, and settlements in accordance with guidelines.

  • Establish and maintain accurate claim reserves to reflect financial exposure, ensuring clear and proactive communication with the insured regarding rationale and potential impact.

  • Identify and engage external resources as needed to facilitate proper claim resolutions while monitoring and controlling costs.

  • Partner with insureds, medical providers, and injured workers to facilitate a safe and timely return to work when appropriate.

  • Collaborate proactively with agents, policyholders, and internal stakeholders to analyze claims trends, implement risk mitigation strategies, and provide claims education.

  • Prepare and deliver detailed claim summaries, reserve updates, and other analyses for agents and insureds.

  • Understand and assess loss-sensitive insurance programs, such as large deductible or retrospectively rated policies, keeping insureds informed of financial implications.

  • Mentor and train other claims handlers.

Knowledge, Skills & Abilities

  • Bachelor's degree or equivalent combination of education and experience.

  • 5 years of experience handling workers' compensation claims of medium to high level of severity/complexity.

  • Ability to obtain appropriate state licensing as required.

  • Proficient computer skills required including Microsoft Office Suite.

  • Demonstrated ability to build positive relationships and partnerships within department, across the organization and with external customers.

  • Strong analytical skills and attention to detail.

  • Excellent verbal and written communication skills with the ability to interact with internal and external customers.

  • Ability to travel overnight up to 15%.

#LI-BR1

Just as we are committed to creating exceptional value for our Partners For Success agencies and policyholders, Amerisure also remains committed to being an employer of choice. We reinforce this commitment by adhering to an Employee Value Proposition that, in part, is provided through a competitive total rewards package. This package includes competitive base pay, performance-based incentive pay, comprehensive health and welfare benefits, a 401(k) savings plan with profit sharing, and generous paid time off programs. We also offer flexible work arrangements to promote work-life balance. Recognized as one of the Best and Brightest Companies to Work For in the Nation and one of Business Insurance magazine's Best Places to Work in Insurance, we provide a workplace that fosters excellence and professional growth. If you are looking for a collaborative and rewarding career, Amerisure is looking for you.

Amerisure Mutual Insurance Company is an Equal Employment Opportunity employer. Amerisure provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (to include sexual orientation and gender identity), national origin, age, disability, genetic information, veteran status, or any other protected characteristic under applicable federal, state, or local laws. Amerisure complies with all applicable laws governing nondiscrimination in employment in all locations where the company operates. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Amerisure prohibits harassment or discrimination of any kind and is committed to maintaining a workplace free from unlawful harassment or discrimination. Amerisure prohibits retaliation against anyone who reports discrimination, participates in an investigation, or opposes unlawful practices. Any improper interference with an employee's ability to perform their job duties may result in disciplinary action, up to and including termination.