Remote Cigna Claims Representative Jobs in Ohio (NOW HIRING)

This is a remote/field position in the West side of Cleveland, Ohio area (Parma, Elyria, Avon, Strongsville, Westlake, Berea).
A Claim Specialist works under minimal supervision, completes investigations, evaluations, and disposition of claims including, but not limited to, moderate to complex cases of property claims, including on occasion litigated files. Estimates losses directly or working with consultants, independent adjusters and other experts to assess building, personal property, business income, heavy equipment, and other damages that can include losses which may range from moderate to large loss levels.
Salary Grade (13)  77,432 - 98,727 - 120,022

Essential Duties and Responsibilities

The following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Investigates claims to determine cause, determines scope and amount of loss, verifies coverage and recommends ultimate resolution on assigned cases.  Scope of investigation should be proportionate to complexity of claim.
• Ability to accurately and independently interpret policies on all lines of business (Personal, Commercial & Farm).
• Promptly and accurately document all developments in claim file.
• Prepares accurate, clear, thorough, and concise notes or correspondence on conclusions and recommendations.  
• Resolves claims within authority or subsequent Home Office approval.
• Identifies potential suspicious claims or possible third-party subrogation.
• Accountable for security of financial processing of claims, as well as security information contained in claims files.
• Ensures accurate reserves and adjusts as warranted. Recommends reserve increases on cases in excess of authority.
• May be necessary to prepare for and may attend trials, settlement conferences, and policyholder meetings. Present company position on coverage and disposition issues.
• Confers directly with policyholders on coverage and resolution issues pursuant to Home Office instructions.
• Analyzes assigned claims and plans for their investigation, may participate in training programs, conferences and departmental and intra-departmental meetings.
• May communicate with excess carriers and reinsures on case status and development.
• Perform onsite and virtual inspection of damages to resolve coverage and damage issues to include preparing complete estimates of repair for the covered damages. May work with contractors, building consultants or independent adjusters in the estimation process, as directed by Home Office.
• Proficient in writing estimates for building repairs.
• Manages claims for business interruption and proactively manages the period of restoration.
• Mentor Claim Representatives and Senior Claim Representatives upon request.
• Maintain continuing education.
• Other critical skills include but are not limited to: Assisting Management with designing and implementing strategic organizational goals. Communicates effectively with all levels of customers, vendors and external stakeholders, in addition to peers and various levels of management. Applies critical thinking skills and sound judgment to various claim and business priorities, as assigned.
• Ensures regular and timely follow-up and brings claims to prompt and appropriate conclusion while keeping the customer informed throughout the life cycle of the claim process

• Effectively manage fluctuating workload while maintaining focus on claims quality and customer experience
• Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner.

• Capable of drafting letters and other correspondence with no grammatical, spelling, or coverage errors 
• May be required to be on-call, on a limited basis, for afterhours emergencies 
• Any other duties deemed necessary by supervisor or management.

SUPERVISORY RESPONSIBILITIES 

None

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• College Degree or Equivalent Experience
• At Least 3 years of moderate to complex Property loss adjusting experience
• Excellent Written and Verbal Communication Skills
• Excellent Interpersonal Skills
• Superior Organizational Skills
• Efficient Time Management skills
• Ability to Demonstrate effective negotiation skills
• Demonstrated abilities using estimating software such as Xactimate
• Experience on a Property team handing field claims
• Previous experience in construction, restoration, or claims

LANGUAGE SKILLS

Excellent verbal and written communication skills.  The individual must be able to effectively and clearly communicate with agents, insureds, departmental and company personnel via telephone, fax, e-mail, one-on-one dialogue and small group presentations in a professional manner.

REASONING ABILITY

The position requires the individual to apply common sense, understanding, reasoning and sound educated judgement coupled with sound Claims training and experience to properly evaluate and analyze claims for recommended action within assigned authority levels.

CERTIFICATES, LICENSES, REGISTRATIONS  

IIA, AIC, or CPCU are highly preferred

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Employees are required to sit at a workstation to perform various PC functions.  Additionally, the employee is required to devote substantial time to telephone communication.

While performing the duties of this job, the employee is regularly required to sit and talk or hear.  The employee frequently is required to use hands to finger, handle, or feel.  The employee is occasionally required to stand, walk, and reach with hands and arms. 

May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.  Requires the ability to access roofs/heights and perform inspections of compromised scenes, where common sense and caution should prevail.

May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.

Employees will be required to travel.  This may require extended periods of time sitting in a vehicle.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Claim Specialist is responsible for the proper handling of claims.  Each Claim Specialist must be able to provide workspace at home that is safe, suitable for work, and provide a distraction free environment from background noises that may distract a member or internal WRG customer.

The environment is reasonably quiet with needed interaction between other team members, Manager, and other company staff.  Moderate noise level from telephone calls is expected. Travel throughout Western Reserve’s footprint will be required to assist in claims resolution or CAT duty.