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Direct Claims Jobs in Rhode Island (NOW HIRING)

Progressive

Auto Damage Claims Adjuster

Warwick, RI

$73K - $89K/yr

Progress. As an auto damage claims adjuster , you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end ...

Brownhealth

Denials Appeal Representative

Pawtucket, RI

$20.96 - $34.61/hr

... denied claims, and identifies patterns contributing to recurring denials. The Denials Appeal Representative prepares monthly denial reports for the Director of Finance and collaborates with EPIC ...

Bcbsri

Director Payment Integrity

Providence, RI · On-site +1

$116K - $187K/yr

Direct and assist team in the interpretation of health care and claims payment information. Provide subject matter expertise for corporate initiatives as it relates to audit and claims editing ...

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All JobsDirect Claims JobsDirect Claims Jobs in Rhode Island

Direct Claims information

What is a direct claim?

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 the key skills and qualifications needed to thrive as a direct claims specialist?

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 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 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 Rhode Island?

For Direct Claims jobs in Rhode Island, the most frequently searched job titles are:

What job categories do people searching Direct Claims jobs in Rhode Island look for?

The top searched job categories for Direct Claims jobs in Rhode Island are:

What cities in Rhode Island are hiring for Direct Claims jobs?

Cities in Rhode Island with the most Direct Claims job openings:

Direct Claims jobs near you

Claims Complex Property Adjuster

ACSC Management Services Inc

Lincoln, RI • Remote

$38.64 - $51.46/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Job description

Claims Complex Property Adjuster

Job Summary
This position supports the Property Claims operation by handling claims reported on Homeowner policies written by the Interinsurance Exchange in compliance with all regulatory and statutory requirements. The position handles claims of high complexity. The primary functions include interpreting information from First Notice of Loss reports, loss investigation, coverage and damages evaluation, negotiation strategies and claims resolution. Employs discretion and independent judgment to ensure compliance with state and federal laws. Applies technical and customer service best practices in accordance with company guidelines.
Job Duties

  • Identify and obtain statements from insureds, claimants and witnesses. Conduct phone investigations to determine coverage and damages and differentiate between allegations and facts in each loss. Determine policy obligations by assessing the liability and damage components of the loss. Responsible for maintaining proper activities and service levels.
  • Communicate and interact with a variety of individuals, including members, insureds, claimants, and vendors, as well as coordinating with internal and external departments. Explain policy coverages, benefits, and claims process verbally and/or in writing in compliance with regulatory and statutory requirements. Recognize and appropriately address complex coverage and subrogation issues.
  • Evaluate, assess, and negotiate within settlement authority with insureds to resolve first-party claims in multiple markets. Demonstrate proficiency with assessment of personal property, property damage, coverage, loss of use, arbitration responses, damage evaluations, and claims technology and tool usage. Objectively discern and address issues that may be questioned in an audit.
  • Mentor and assist with the training of less experienced personnel within the Claims promotional/development guidelines and provide coaching in files.
  • May attend and participate in legal proceedings. Direct and interact with in-house and outside counsel on litigated files. Provide sworn expert testimony in Courtroom or Deposition settings.
  • Prepare comprehensive formal reporting on high-profile claims to senior management.
  • Respond quickly to customer needs and problems.


Qualifications

  • Bachelors Equivalent combination of education and experience Preferred
  • 7-9 years Prior claims handling experience. Required
  • 7-9 years Property claims administration experience. Preferred
  • Working knowledge of claims administration best practices and procedures.
  • Advanced knowledge of insurance, coverage investigation, scope and damage assessment, negligence and subrogation principles required.
  • Advanced knowledge of Microsoft Office suite, general computer software and claims software.
  • Comprehensive understanding of building and vehicle repair procedures and third-party liability issues.
  • Advanced leadership skills among peers required.
  • Advanced organization and planning recognition skills required
  • Advanced oral and written communication skills required.
  • Advanced interpersonal skills required.
  • Valid Driver's License, acceptable Department of Motor Vehicles record and minimum liability insurance - Issued by State Required
  • Chartered Property Casualty Underwriter - Insurance Institute of America Preferred
  • Associate in Claims - Insurance Institute of America Preferred
  • An insurance/claims adjuster license may be required for claims administration in specific states.


Travel Requirements

  • Occasional travel to off-site business meetings or conferences. (5% proficiency)

The starting pay range for this position is $38.64 - $51.46 per hour.  Additionally, you will be eligible to participate in our incentive program based upon the achievement of organization, team and personal performance.

Remarkable benefits:

•    Health coverage for medical, dental, vision

•    401(K) saving plans with company match AND Pension    

•    Tuition assistance

•    Floating holidays and PTO for community volunteer programs

•    Paid parental leave

•    Wellness programs

•    Employee discounts (membership, insurance,

travel, entertainment, services and more!)

Auto Club Enterprises is the largest club within the national AAA federation. We have nearly 17,000 employees in 24 states helping more than 18 million members. The strength of our organization is our employees. Bringing together and supporting different cultures, backgrounds, personalities, and strengths creates a team capable of delivering legendary, lifetime service to our members. When we embrace our diversity – we win. All of Us! With our national brand recognition, long-standing reputation since 1900, and constantly growing membership, we are seeking career-minded, service-driven professionals to join our team.

"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”

AAA is an Equal Opportunity Employer

Our organization participates in E-Verify

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