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Direct Claims Jobs in Nebraska (NOW HIRING)

Omaha National

Claims Adjuster 1

Omaha, NE

Direct vendors such as field nurses, investigators, defense attorneys to positively impact claims outcomes REQUIREMENTS: * Ability to comprehend and learn new workers' compensation regulations while ...

Great American Insurance Group

Does your claims management job feel stale? A process driven organization can lose sight of the ... We need someone who has the ability to help and direct when needed, a group of strong, carefully ...

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Direct Claims information

What are direct claims?

Direct claims refer to insurance claims that are filed directly by the policyholder with their own insurance company, rather than going through a third party or the at-fault party's insurer. This process is common in situations like auto accidents, where the policyholder seeks compensation for damages or losses under their own policy. Direct claims help streamline the process, reduce delays, and ensure the policyholder receives prompt assistance and settlements. They are often associated with 'first-party' insurance coverage, such as collision, comprehensive, or health insurance claims.

What are some common challenges faced by professionals in Direct Claims roles, and how can they effectively manage these challenges?

Professionals in Direct Claims often face the challenge of balancing a high volume of claims with the need for thorough investigation and timely resolution. Managing customer expectations and handling sensitive situations, such as denied claims or complex cases, can also be demanding. Effective communication, strong organizational skills, and staying updated on policy guidelines are crucial for success. Building collaborative relationships with adjusters, underwriters, and other departments helps ensure accurate and efficient claims processing.

What are the key skills and qualifications needed to thrive as a Direct Claims Specialist, and why are they important?

To thrive as a Direct Claims Specialist, you need a solid understanding of insurance policies, claims processes, and relevant legal regulations, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, customer relationship management (CRM) systems, and sometimes industry certifications like AIC or CPCU is typical. Exceptional attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These skills and qualifications ensure claims are processed accurately and efficiently, leading to customer satisfaction and minimized risk for the insurer.

What is the difference between Direct Claims vs Claims Adjuster?

AspectDirect ClaimsClaims Adjuster
CredentialsInsurance license, knowledge of policiesInsurance license, sometimes certifications like AIC or CPCU
Work EnvironmentCustomer service, office or remoteFieldwork, office, or remote
Employer & IndustryInsurance companies, agenciesInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding direct claims handlingEvaluating claims adjustment roles

Direct Claims professionals primarily handle claims directly from policyholders, focusing on processing and resolving claims within the insurance company. Claims Adjusters evaluate, investigate, and settle claims, often working in the field or remotely. Both roles require insurance licensing, but Claims Adjusters may have additional certifications. While their work overlaps in claims processing, Direct Claims roles are more customer-facing, whereas Claims Adjusters focus on assessment and negotiation.

What are popular job titles related to Direct Claims jobs in Nebraska? For Direct Claims jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Direct Claims jobs in Nebraska look for? The top searched job categories for Direct Claims jobs in Nebraska are:
What cities in Nebraska are hiring for Direct Claims jobs? Cities in Nebraska with the most Direct Claims job openings:
Direct Claims jobs near you

Senior Claims Examiner, Medical & Healthcare Claims

Markel International

Omaha, NE • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Job description

What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it.

The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs. Join us and play your part in something special! This position will be responsible for the resolution of moderate to high complexity and moderate to high exposure Medical and Healthcare claims which can be subject to disputes that must be resolved in mediation or litigation. The primary purpose of this job is to handle claims from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. The position will have increased responsibility for decision making within their authority and work with minimal oversight and will provide training and be a technical referral point for other team members.

Responsibilities

  • Handles healthcare malpractice/negligence claims including the following:
  • Analyzes coverage and communicates coverage positions
  • Conducts, coordinates, and directs investigation into loss facts and extent of damages
  • Confirms coverage of claims by reviewing policies and documents submitted in support of claims
  • Drafts coverage position letters
  • Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
  • Handles claims in all jurisdictions
  • Handles litigated and non-litigated bodily injury claims with values up to $450,000 in all jurisdictions, managing the process from inception of the claim until conclusion, including settlement, trial, or appeal, when litigated.
  • Monitors excess and reinsurance claim files with varying levels of attachment point;
  • Identify losses which should be reported to SIU.
  • Participates in special projects or assists other team members as requested
  • Provides excellent and professional customer service to insureds while maintaining a high level of production.
  • Represents Markel in mediations, as required
  • Monitors trial, as required
  • Sets reserves within authority or makes recommendations concerning reserve changes to manager

Education

  • Bachelor's degree or equivalent work experience
  • JD , advanced degree, or focused technical degree a plus

Certification

  • Must have or be eligible to receive claims adjuster license.
  • Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) or
  • Participation in industry training opportunities (CLM Claim College, Munich Re Training, FDCC, etc.)

Work Experience

  • Minimum of 7-15 years of claims handling experience or equivalent combination of education and experience in insurance
  • Successful completion of 5 years as a Claims Examiner

Skill Sets

  • Excellent written and oral communication skills
  • Strong analytical and problem solving skills
  • Strong organization and time management skills
  • Experience in negotiation, mediations, arbitrations and monitoring trials on higher value complex claims
  • Ability to influence claims stakeholders and to effectively direct claims strategy
  • Strong vendor management skills are required including the ability to provide direction and guidance to defense attorneys, independent adjusters, building consultants, forensic accountants and other experts while controlling expenses.
  • Ability to assist with technical training to team claim handlers as required
  • Well developed and advanced expertise and knowledge in most technically complex claims topics
  • Policy language skills enabling accurate and consistent policy wording interpretation
  • Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement.
  • Ability to deliver outstanding customer service
  • Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
  • Ability to work in a team environment
  • Strong desire for continuous improvement

US Work Authorization

US Work Authorization required. Markel does not provide visa sponsorship for this position, now or in the future.

Pay information:

The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure,demonstratedcompetencies, geographic location, and other factors.The salary for the position is $73,600 - $107,250 with a 15% bonus potential.

Who we are:

Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.

We're all about people | We win together | We strive for better

We enjoy the everyday | We think further

What's in it for you:

In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.

  • We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.

  • All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.

  • We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.

Are you ready to play your part?

Choose 'Apply Now' to fill out our short application, so that we can find out more about you.

Caution: Employment scams

Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:

  • All legitimate job postings with Markel will be posted on Markel Careers. No other URL should be trusted for job postings.

  • All legitimate communications with Markel recruiters will come from Markel.com email addresses.

We would also ask that you please report any job employment scams related to Markel to rarecruiting@markel.com.

Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.

Should you require any accommodation through the application process, please send an e-mail to therarecruiting@markel.com.

No agencies please.

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