Remote Claims Processor Jobs Near Me

Key Responsibilities of the Role  

Leadership and Culture

• Supports operational teams and senior management by providing timely, consistent, and defensible coverage guidance aligned with policy intent and claim handling best practices
• Serves as a centralized internal resource for coverage interpretation, promoting consistency across claim teams, jurisdictions, and lines of business
• Communicates clearly and proactively with Claims, Underwriting, Insurance Product, and other stakeholders to enable effective risk decisions and reduce friction created by inconsistent coverage positions
• Promotes sound legal governance, including appropriate management of attorney-client privilege and documentation practices in claims and coverage consultations

Claims Coverage Support

• Provides legal analysis and guidance on personal lines and complex commercial lines claims involving coverage questions, including interpretation of forms, endorsements, exclusions, conditions, tenders, additional insured issues, and priority/other insurance disputes
• Reviews and standardizes key coverage correspondence, including reservations of rights, coverage position letters, denial letters, non-waiver agreements, and tender response communications
• Conducts targeted legal research and prepares written coverage assessments and recommendations for claim professionals and leadership, including identification of escalation triggers and extra-contractual exposure considerations
• Develops and maintains reusable work product (templates, playbooks, issue-spotting tools, and guidance notes) to improve quality and speed of coverage decisioning
• Implements and supports an intake, triage, and prioritization approach for coverage requests; establishes service expectations and feedback loops with claim teams
• Manages the use of outside counsel for novel, high complexity, or high exposure coverage matters; scopes assignments appropriately, enforces budget discipline, and captures lessons learned for internal knowledge sharing
• Delivers training to claim professionals on recurring coverage issues, quality documentation, and best practices for defensible coverage communications

Insurance Product and Underwriting Support

• Provides coverage and form interpretation support to Insurance Product and Underwriting on personal lines and commercial lines to enable consistent underwriting intent and claim outcomes
• Participates in form and endorsement reviews, offering recommendations to improve clarity, reduce ambiguity, and minimize preventable coverage disputes
• Identifies recurring coverage issues and claim dispute drivers and communicates actionable insights to Product and Underwriting, including opportunities for wording clarification or process improvements

Participates in cross-functional working sessions to align coverage interpretation, underwriting strategy, and claims handling practices as the organization grows or expands into new markets

Claims Compliance Support

• Provides targeted guidance to support regulatory compliance, audit readiness, and adherence to claims handling standards, including documentation, timeliness, and required notices
• Supports Medicare-related and other claims compliance obligations as applicable by providing process guidance and training to reduce operational risk
• Assists with development of practical compliance tools and reference materials that improve consistency and reduce avoidable handling defects

Required Qualifications  

• Juris Doctor (J.D.) from an accredited law school
• Active license and good standing to practice law in at least one U.S. jurisdiction
• 8 years of experience in insurance coverage, claims legal support, and/or insurance litigation with substantial commercial lines property and casualty exposure

Preferred Qualifications  

• Prior in-house experience at a property and casualty insurer supporting claims operations and/or insurance product teams
• Experience supporting both personal and commercial lines product development, forms, endorsements, or underwriting coverage consultation
• Familiarity with multi-state claims handling requirements and both personal and commercial lines coverage trends
• Insurance industry designation(s) (e.g., CPCU) or other relevant credentials

 
Knowledge, Skills, and Abilities

• Ability to translate legal and policy language into practical guidance for claim professionals and business partners
• Demonstrated ability to produce clear, well-reasoned written analysis and draft high-quality coverage correspondence
• Deep knowledge of commercial lines coverage analysis, including policy interpretation, exclusions and conditions, additional insured/contractual risk transfer issues, tenders, allocation, and priority of coverage concepts
• Excellent written and verbal communication skills, including the ability to convey complex legal concepts clearly to non-lawyers and influence outcomes across multiple stakeholders
• Strong legal research and analytical skills with sound judgment and discretion in managing sensitive matters and attorney-client privileged communications
• Operational mindset with the ability to standardize and improve workflows, templates, and guidance to increase consistency and efficiency in coverage decisioning
• Strong collaboration skills across Claims, Underwriting, Insurance Product, Compliance, and external partners; ability to manage competing priorities and deliver timely guidance in a fast-paced environment
• Ability to travel occasionally for business needs, training, mediations, or significant claim reviews, including overnight as required
• Ability to understand Central Insurance’s policies and processes