CLAIMS ANALYST JOB DESCRIPTION

Without timely reserve adjustments and accurate coverage determinations, insurers absorb losses that erode underwriting margins and expose carriers to regulatory sanctions under multi-state adjuster licensing requirements. The Claims Analyst is the practitioner who closes that gap, owning each file from first notice of loss through resolution across casualty, professional liability, and commercial lines. Few other roles demand equal fluency in tort law principles, policy language interpretation, and settlement negotiation within delegated authority levels. Results here are measured in dollars recovered, litigation budgets controlled, and reserves that hold through audit.

As the Claims Analyst, you investigate, evaluate, and resolve P&C and specialty liability claims from initial intake through settlement, ensuring every file reflects accurate coverage analysis, properly set reserves, and a documented resolution strategy. You operate within a claims unit that reports to a Claims Vice President or Director of Risk Management, managing relationships with outside counsel, third-party administrators, and insureds across multiple lines of business.

Career Impact: Handling litigated casualty and professional liability files at this level builds the multi-jurisdictional coverage expertise and adjuster licensure portfolio that senior claims roles and TPA oversight positions require.

Business Impact: Accurate reserves and disciplined litigation budgets on your assigned book directly reduce indemnity leakage and protect the carrier's combined ratio on casualty and specialty lines.

Growth Opportunity: Demonstrated performance managing complex, multi-party files and outside counsel creates a clear trajectory into Senior Claims Analyst, Principal Claims Analyst, or claims team leadership within the carrier or brokerage market.

• Investigate assigned casualty and professional liability claims from first notice of loss through final resolution, including coverage analysis and liability determination.
• Establish and adjust case reserves within delegated authority levels to reflect current exposure on indemnity and legal expenses.
• Manage outside counsel on litigated files, including review of litigation budgets, discovery strategy, and pre-trial motion preparation.
• Negotiate settlements with claimants, opposing counsel, and co-defendants to achieve timely, cost-effective resolution within approved authority.
• Interpret primary and excess policy language to identify applicable coverage defenses and communicate findings to insureds, brokers, and mediators.
• Coordinate with underwriting and legal departments to flag coverage issues, track regulatory mandates, and maintain multi-state adjuster license compliance.
• Prepare and present large loss reports, claim reviews, and status updates to senior management and insurer partners at scheduled intervals.
• Document all claim activity, evaluation rationale, and resolution strategy in the claims management system to maintain a complete, audit-ready file history.

• Bachelor's degree in business, legal studies, risk management, or equivalent work experience.
• 3 or more years of claims handling experience in casualty, professional liability, or specialty lines, with exposure to litigated files.
• Working knowledge of tort law principles, multi-state insurance regulations, and policy coverage interpretation across primary and excess layers.
• Demonstrated ability to set, justify, and adjust reserves accurately within delegated authority on files of moderate to high complexity.
• Strong negotiation skills applied to settlement discussions involving multiple parties, including claimants, carriers, and outside counsel.
• Proven ability to manage outside counsel relationships, review legal invoices for accuracy, and enforce litigation budget guidelines.
• Clear and precise written and verbal communication skills suitable for correspondence with insureds, mediators, and executive stakeholders.
• Active or in-progress state adjuster license, or eligibility to obtain required licensure across applicable jurisdictions.

• Juris Doctorate or paralegal background providing direct fluency in legal procedure, contract interpretation, and court filing requirements.
• Professional designation such as AIC, CPCU, or SCLA demonstrating formal commitment to insurance technical standards.
• Experience handling medical malpractice, professional liability, or construction defect claims requiring coordination with technical experts and specialist counsel.
• Prior exposure to third-party administrator oversight or insurer reporting at semi-annual claim reviews on large accounts.

• Reserve adequacy ratio, measuring how consistently set reserves hold through file closure without significant development.
• Litigation cost per closed file, tracking outside counsel spend against approved budgets across the assigned caseload.
• Claim cycle time from first notice of resolution loss, reflecting efficiency of investigation and negotiation workflows.
• Large loss report submission rate, measuring timely escalation of high-exposure files to senior management within required deadlines.
• Settlement rate within delegated authority, indicating the proportion of files resolved without requiring supervisor override or additional approval.
• Adjuster license compliance rate across required jurisdictions, reflecting zero lapsed credentials on the assigned territory.
• Typical tools: Claims management systems (commonly Guidewire ClaimCenter or similar); litigation management platforms (commonly LegalFiles or comparable).

• Base Salary Range: $62,000 to $95,000 annually, depending on seniority and lines handled
• Bonus: Performance-based, typically 5 to 12% of base salary tied to claim quality metrics
• Equity: Uncommon at this level; may apply at senior or principal tier
• Health Benefits: Medical, dental, and vision coverage; employer contribution typical
• PTO: 15 to 20 days annually, plus standard US holidays
• Common Perks: Continuing education reimbursement for adjuster licensing and insurance designations; occasional travel for mediations or client meetings

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Candidates will be considered without regard to race, color, religion, national origin, sex, age, disability, veteran status, or any other characteristic protected under applicable federal, state, or local law. Applicants requiring a reasonable accommodation to participate in the hiring process are encouraged to submit a request to the recruiting team. Employment in this role is contingent upon successful completion of a background check, which may include a review of criminal history and, where applicable, credit history relevant to the position. All candidates must be legally authorized to work in the United States.

The Claims Analyst owns end-to-end investigation and resolution of aviation-related claims, including coverage determination, litigation budgeting, and negotiation with counsel, vendors, and insureds to reach equitable settlements. Working across internal and external customer relationships, the analyst delivers accurate coverage analysis and strategic claim management that protects the organization's financial position on aviation-specific exposures.

Key Responsibilities

• Determine the scope and extent of available coverage.
• Re-evaluate coverage as warranted.
• Prepare and execute investigation strategies that identify critical issues affecting liability, causation, and damages and consider opportunities for third-party contribution.
• Independently negotiate claims after obtaining the appropriate authority.
• Document evaluation, thought process, and strategy.
• Utilize ADR as appropriate and necessary.
• Effectively strategize and budget the litigation of each claim through discussions with counsel, vendors, and insureds.
• Establish with defense and coverage counsel clear ground rules in order to maintain financial control of budget and expenses.
• Make regular and appropriate contact with internal and external customers.
• Give guidance to insured and/or broker to manage expectations.

Required Qualifications

• Bachelor's degree or higher from a college or university preferred, with a pilot's license also preferred.
• 2 or more years of insurance claim adjusting experience preferred, with aviation experience strongly preferred.
• Understanding of 1st and 3rd party insurance coverage via experience or college degree preferred.
• Keen understanding of aviation environments including airplanes, airfields, and hangars, typically gained through experience as an Aviation Mechanic or Pilot.
• Computer proficiency in common and specialized claims systems programs and applications.
• Excellent interpersonal and written communication skills.
• Strong decision-making skills and ability to negotiate.
• Aptitude for learning, adapting, explaining technical issues, and problem-solving.
• Ability to manage time, prioritize projects, work with minimal supervision, and support other departments as needed.
• Ability to speak in public forums to current and prospective clients.

Embedded within the claims and underwriting function, the Claims Analyst delivers coverage determinations, reserve-setting, and resolution planning across a book of property, casualty, and specialty files, reporting on large losses at semi-annual insurer meetings. Working closely with lawyers, adjusters, insurers, insureds, and the underwriting department, the analyst enables accurate claim outcomes and strong client relationships across the full file lifecycle.

Core Functions

• Review and assess new claims to determine coverage and take appropriate action.
• Retain and instruct lawyers, adjusters, and experts as required.
• Determine liability and value of claim, set reserves accordingly, and establish resolution plan.
• Coordinate and control progress of files including liaison with lawyers, adjusters, insurers, and insureds.
• Report to insurers on large claims and present files at semi-annual insurer meetings.
• Prepare for and attend settlement conferences and mediations.
• Liaise with the underwriting department with respect to claims.
• Prepare and deliver presentations to insureds, brokers, and internal audiences.
• Participate in risk management seminars and company events.

Qualifications & Experience

• Two to four years of work experience or education in insurance, claims adjusting, finance, legal, project management, engineering, or construction.
• Strong computer skills in MS Office and Outlook.
• Effective problem-solving and strong analytical skills to develop and implement solutions.
• Exceptional customer service skills to build and maintain relationships with internal and external clients.
• Strong decision-making, organizational, and negotiation skills.
• Excellent oral and written communication skills with sound judgment and great attention to detail.
• Demonstrated interpersonal skills and ability to work both independently and as part of a team.
• Fluency in both official languages, written and oral, is mandatory.

Reporting to senior leadership, the Claims Analyst conducts independent CPM schedule delay analysis and evaluates construction claims across civil, MEP, and specialist systems contracts to support negotiations with contractors and other parties. Partnering with directors, managers, specialists, and contractors, the analyst delivers accurate delay and escalation findings that directly inform dispute resolution outcomes on complex, concurrent projects.

Primary Duties

• Perform independent claims review and determinations and conduct detailed CPM schedule delay analysis.
• Analyze baseline schedules against executed schedules to determine claim accuracy and delay impact.
• Analyze all alleged delay impacts to determine whether caused by the contractor or other principal parties.
• Analyze escalation costs caused by labor wage rate increases and material increases.
• Present analysis and advice on schedule delay, productivity, labor, material escalation, design issues, and contract interpretation for use in negotiations.
• Closely liaise with directors, managers, specialists, and contractors to develop claims resolution strategies.
• Provide advice across concurrent projects encompassing civil, MEP, and other specialist systems contracts.
• Prepare reports, graphics, correspondence, and abstracts of contracts.
• Present findings and opinions in an adversarial setting, conduct weekly site visits, and participate in contract close-out.

Education & Experience

• Bachelor's degree in Engineering or Construction Management.
• Minimum 10 years of experience, including at least 5 years in construction claims.
• Knowledge of delay analysis techniques, productivity loss calculations, contract interpretation, and architectural and engineering drawing interpretation.
• Proficiency in Microsoft Office, project management software, and Primavera P6.
• Excellent written and verbal communication skills.
• Ability to maintain a diplomatic demeanor in highly stressful environments with diverse stakeholders.

Sitting at the intersection of legal strategy and insurance operations, the Claims Analyst investigates, evaluates, and resolves high-exposure casualty specialty claims, including construction defect and complex multi-party litigation across all 50 states. Operating across primary and excess policy layers, the analyst delivers timely reserve establishment, equitable settlements, and documented coverage defense communications that protect both insured relationships and company financial exposure.

Duties

• Investigate, evaluate, and resolve new and existing casualty specialty and high-exposure claims, including construction defect and abuse and molestation claims.
• Interpret and apply primary and excess policy provisions according to the laws in all 50 states.
• Communicate all applicable coverage defenses clearly to insureds, mediators, and other parties.
• Manage outside counsel and review case documents.
• Direct defense counsel on complex, multi-party litigation in all 50 states and document efforts and conclusions.
• Work with experts to evaluate large casualty specialty claims, articulate repair alternatives, and document conclusions.
• Establish timely and appropriate reserves for legal and indemnity exposures, including submission of Major Loss Reports where required.
• Negotiate maximum contributions from other parties and carriers to effect timely and equitable settlements.
• Develop close working relationships with dedicated accounts for mutual benefit.

Skills & Qualifications

• Juris Doctorate preferred.
• 3 or more years of experience in Casualty Specialty Claims adjusting or relevant litigation experience.
• Ability to analyze insurance policies, contracts, legal procedures, legislation, and court opinions and apply findings to claim files.
• Strong analytical, organizational, communication, negotiation, and investigation skills.
• Willingness to travel within the US for mediations and trial attendance as required.

A key member of the warranty operations team, the Claims Analyst audits warranty claims for policy compliance, analyzes labor time data, and produces program metrics reporting to support management decisions on claim processing. Collaborating across cross-functional teams and external vendors, the analyst enables accurate warranty outcomes and continuous improvement of warranty policy and procedures.

Functions

• Analyze and audit warranty claims to ensure adherence to warranty policies and procedures.
• Maintain, audit, and communicate program metrics through analytical reporting, including program trends and opportunities.
• Assemble and distribute warranty reports to management related to claim processing.
• Partner with cross-functional teams to provide visibility on warranty trends and assist in corrective actions.
• Verify Labor Time Guide against warranty tables and analyze warranty labor times for review.
• Review and provide feedback to improve warranty policy and procedures.

Experience & Qualifications

• Bachelor's degree in a related discipline or equivalent combination of education and experience.
• 4 or more years of experience in automotive warranty or a related service industry.
• Basic automotive technical knowledge including theory and operation.
• Microsoft Excel proficiency and ability to learn and adapt to new software systems.
• Excellent written and verbal communication skills.
• Strong ability to collaborate with individuals, groups, and vendors with motivation to improve and maintain processes.

Accurate, timely settlement processing and credit control depend on the Claims Analyst, who calculates and processes transactional claims and contracts within personal authority limits inwards while supporting other business units with process and claims queries. Based within a process-driven claims operations team, the analyst ensures financial accuracy on low and medium risk claims and maintains compliance with agreed segmentation rules and annual review standards.

Accountabilities

• Calculate and process inward transactional claims and contracts accurately in accordance with agreed processes.
• Assist with queries from other teams in a timely and professional manner.
• Communicate effectively with internal customers via face-to-face, phone, and email.
• Process requests for letter of credit creation, increases, withdrawals, cancellations, and bonds.
• Provide process and claims support to other business units.
• Process direct claims accurately and efficiently within personal authority limits and claims segmentation rules.
• Complete annual standard review on low and medium risk value claims and contracts.

Requirements

• Working knowledge of different classes of insurance and reinsurance business.
• Good IT skills, particularly Excel.
• Analytical ability with a logical and methodological approach to problem solving.
• Ability to work independently to a personal authority level and effectively within a process-driven team.
• Highly organized with a professional approach, self-motivated, and proactive.
• Good written and verbal English communication skills.
• Proven ability to build strong relationships.

As the Claims Analyst, this role shapes portfolio trend analysis and automated reporting across global claims systems, delivering data reconciliation, quality assurance, and stakeholder commentary to regional and global subject matter experts. The claims analytics function relies on this work to standardize processes, resolve data errors, and provide the evidence base that underpins sound claims decision-making across an international matrix organization.

Activities

• Analyze data and portfolio trends including development over time and outliers.
• Design, develop, automate, and improve reports based on data from claims systems and other sources.
• Manage regular report deliveries to stakeholders including data reconciliation, analysis, presentation, and commentary.
• Perform data plausibility checks and quality assurance and improvement activities.
• Work with regional and global claims subject matter experts to explain movements and resolve errors.
• Gather information and data using verbal and critical thinking skills and make sound decisions based on analysis and judgment.
• Standardize and continuously improve processes, templates, and reports as part of project assistance.
• Write documentation including user manuals and complete other objectives as assigned.

Background & Experience

• Bachelor's degree in Mathematics, Computer Science, Statistics, or a comparable business qualification.
• Experience in analysis, reporting, and the insurance business.
• Advanced Excel skills, including pivot tables and VBA Macro programming, along with MS Office proficiency including Outlook, Word, Access, and PowerPoint.
• Intermediate SQL skills preferred.
• Analytical, numerical, and adaptive problem-solving skills using a logical and methodological approach.
• Good communication and presentation skills with the ability to express ideas clearly in writing and verbally.
• Proactive, self-motivated, eager to learn, and able to work under pressure in an international matrix organization.

Claims Analyst builds accurate claim submission and payment workflows for Electronic Visit Verification home health visits under the 21st Century Cures Act mandate, collaborating with internal teams, clients, and provider networks to troubleshoot Medicaid billing issues and resolve disputes. The work directly supports operational efficiency and payment integrity for states, payers, and agencies relying on cloud-based EVV claim processing software.

What You'll Do

• Collaborate with internal teams to ensure Electronic Visit Verification home health visits and claims are processed correctly.
• Evaluate accuracy and completeness of claim information to ensure correct submission and payment.
• Track service authorizations for appropriate third-party billing.
• Interface with clients via email and phone to meet research and claims submission requirements.
• Monitor claims processing, payments, and processing results.
• Analyze provider issues and collaborate with departments to resolve them and identify opportunities for provider education.
• Review provider disputes or appeals and provide detailed analysis of findings.
• Conduct claim testing and offer expertise on provider billing and payment guidelines consistent with Medicaid claims policies.
• Document all provider contacts and troubleshoot root causes of problems, providing follow-up and intervention on claim inquiries.

Minimum Qualifications

• High School Diploma or GED required.
• Minimum 3 to 5 years of relevant healthcare claims experience.
• Excellent customer service skills and experience.
• Experience in problem-solving, troubleshooting, and analyzing needs with strong attention to detail.
• Strong written and verbal communication skills.

The Claims Analyst produces accurate medical claim repricing aligned to contracted hospital payment schedules and Medicare reimbursement rates, working within a health plan analytics team to monitor electronic claim flows and identify process gaps. Reporting findings to the Claims Team and health plan partners, the analyst enables cost reduction and payment accuracy for health plans and their members.

Role Responsibilities

• Analyze medical claims to ensure proper coding.
• Reprice claims according to contracted hospital payment schedules and Medicare reimbursement, both manually and software-aided.
• Monitor incoming and outgoing electronic claims via internal processing system.
• Provide detailed reporting on claims volume, billed charges, savings, and related metrics.
• Work with hospitals and customers to resolve claim issues.
• Document claims process and issue resolution clearly.
• Work collaboratively with the Claims Team to identify process gaps and improve procedures.
• Maintain up-to-date knowledge of healthcare industry policies and regulations.

Professional Experience

• High School Diploma or equivalent required.
• AHIMA or AAPC certification preferred but not mandatory.
• 2 years of medical billing or coding experience required, with knowledge of Medicare coding and reimbursement regulations preferred.
• 2 years of customer service experience required.
• Ability to interpret patient records and calculations while maintaining strong attention to detail and accuracy.
• Excellent project management, organizational, and prioritization skills with the ability to operate in ambiguous situations.
• Strong internal and external communication skills, both verbal and written, including managing inbound calls with confidence and compassion.

Reporting to senior client engagement leadership, the Claims Analyst refines complex construction delay, disruption, and cost claims by reviewing project documentation, schedules, and contract language across transportation, water treatment, buildings, and power project types. Partnering with clients, opposing parties, and junior staff, the analyst delivers profitable claim resolution and business development outcomes grounded in deep CPM scheduling expertise and Primavera P6 proficiency.

Project Responsibilities

• Analyze or prepare complex construction delay, disruption, acceleration, and cost claims, taking full responsibility for smaller claims and acting as lead on larger ones.
• Prepare reports, present findings to clients, and assist in claim negotiations with opposing parties.
• Perform construction schedule reviews and provide opinions, advice, and reports on project progress and forecasts.
• Read contract language, determine proper interpretation, and apply findings to facts.
• Manage assignments and deliver profitable results within planned budget.
• Support and execute business development strategies to identify and deliver construction claims opportunities.
• Provide mentoring to junior-level staff and establish professional business relations with clients.

Education & Experience

• Bachelor of Science in Construction Management, Civil, Mechanical, or Electrical Engineering, Architecture, or a related field.
• At least one relevant professional license or certification such as PE, CCM, PMP, PSP, or AIA preferred.
• Minimum 5 years of experience in project controls, delay analysis, productivity analysis, and claims resolution, plus at least 6 additional combined years in project management, CPM scheduling, or contract change management.
• Knowledge of construction contracts and contractor means and methods across project types including transportation, water treatment, and power.
• Proficiency with Primavera P6, Excel, Word, and Outlook.
• Exceptional written and verbal communication and organizational skills.
• A self-motivated, achievement-oriented approach.

The Claims Analyst oversees investigation and determination of new, disputed, and interline freight claims, working directly with the Claims Supervisor on high-ratio accounts and applying Microsoft Office tools to automate manual claims processes. The work directly supports accurate liability resolution and continuous process improvement across the freight claims operation.

Day-to-Day Responsibilities

• Investigate and determine new claims.
• Reinvestigate and determine disputed claims.
• Investigate and determine interline claims.
• Continually work with the Claims Supervisor on accounts with a high claim ratio.
• Assist with administrative duties when the supervisor is absent.
• Apply computer software programs to automate manual processes and continually improve processes.

Knowledge, Skills & Abilities

• High School Diploma or equivalent required.
• Experience with or knowledge of OS&D (Over, Short, and Damaged) is a plus.
• Experience in Microsoft Office including Excel, Word, and Teams.
• Strong attention to detail and processes with the ability to work in a fast-paced environment.
• Good written and oral communication skills.

Embedded within a software implementation and client services team, the Claims Analyst develops deep product knowledge to configure benefit adjudication rules, conduct functional and user acceptance testing, and train clients ahead of go-live dates for health claims processing systems. Working closely with clients and internal technical teams, the analyst ensures claims are paid in accordance with contract agreements and benefit structures, directly enabling operational accuracy and client satisfaction.

Technical Responsibilities

• Develop deep knowledge of company claims software products.
• Work collaboratively with clients to define requirements and map business needs to company technologies.
• Configure claims software to meet customer requirements and document technical solutions.
• Conduct functional testing of new releases and facilitate user acceptance testing.
• Ensure claims are paid in accordance with appropriate contract agreements and client benefit structures.
• Communicate project updates and status reports internally and externally.
• Conduct hands-on customer training in preparation for go-live dates.
• Perform expert-level troubleshooting to investigate and resolve customer issues and document system enhancements and standard operating procedures.

Education & Experience

• Bachelor's degree with preferred focus in Information Technology, Business Information Systems, Computer Science, or a related technical field.
• Minimum 3 years of experience in claims processing, computer operations, data analysis, database management, and custom report creation.
• Knowledge of healthcare claims processing covering the complete claim flow from receipt through payment.
• Exposure to HIPAA transactions including 837, 835, CMS-1500, and UB-04.
• Experience with system updating and testing using CPT, HCPCS, ICD-10 coding, fee schedules, and benefits plans preferred.
• Excellent analytical, troubleshooting, written, and verbal communication skills.
• Ability to manage multiple assignments and meet demanding timelines.

Reporting to operations and compliance leadership, the Claims Analyst coordinates investigation and resolution of cargo loss, damage, and delay incidents on behalf of multiple business entities, advising operations management and carriers on liability disposition under Common Law, the Code of Federal Regulations, and the National Motor Freight Classification system. Partnering with legal, insurance companies, and cross-functional teams, the analyst protects company financial performance by documenting risk exposure and leading loss prevention meetings.

Scope of Work

• Investigate and analyze incidents and claims for loss, damage, and delay to determine company liability while protecting company and customer interests.
• Interpret contractual terms and conditions.
• Act as advisor to operations management, carriers, and customers regarding disposition of incidents and claims.
• Compose professional claims correspondence and liaise with legal on legal notices as necessary.
• Manage incident and claims inventory to meet individual, team, and company goals, processing claims according to company policies and procedures.
• Investigate, review, and document significant events and escalate to appropriate leadership, insurance companies, and compliance to identify and document potential financial impact.
• Hold loss prevention meetings to provide operations guidance on future risk avoidance and damage prevention recommendations.

Position Requirements

• Bachelor's degree or equivalent related work or military experience.
• 1 year of experience as a cargo claims examiner, analyst, or in a similar liability and risk capacity.
• Knowledge of Common Law Liability, Code of Federal Regulations, Rules and Tariffs, Transportation Contracts and Agreements, and the National Motor Freight Classification system.
• Knowledge of multimodal transportation modes and risk reduction processes.
• Proficiency in Microsoft Word and Excel.
• Exceptional customer service skills and excellent written, verbal, and telephone communication skills with the ability to communicate findings to executive management.

A key member of the workers' compensation claims team, the Claims Analyst investigates, negotiates, and settles assigned claims in full compliance with state laws and company guidelines, while also mentoring team members and monitoring regulatory changes across multiple jurisdictions. Collaborating with internal staff and external customers, the analyst delivers prompt, efficient claim resolution that maintains positive professional relationships and supports continuous process improvement.

Performance Expectations

• Investigate, evaluate, negotiate, and settle workers' compensation claims in a good faith manner.
• Complete all claims handling steps on assigned claims in adherence to company guidelines, best practices, and applicable laws.
• Analyze, research, and resolve escalated problem claim cases.
• Assist with checks and balances to ensure manual and automated transactions are processed accurately and recommend process improvements.
• Oversee regulatory changes and mandates by states and other directives and stay abreast of changes and trends.
• Provide leadership, guidance, and training to the team and mentor team members in problem-solving and decision-making.

Qualifications & Experience

• High School Diploma or GED required, college degree preferred.
• Minimum 3 years of experience in workers' compensation claims handling.
• Extensive knowledge of workers' compensation laws and regulations.
• Ability to build and maintain professional working relationships with internal and external customers to ensure prompt and efficient service.
• Willingness and ability to travel to customer locations as needed.

As the Claims Analyst, this role executes workers' compensation claim management, OSHA compliance, FMLA coordination, and government inquiry responses for assisted living facilities, reporting to the Director of Risk Management. The risk management function depends on this work to maintain regulatory compliance, reduce organizational liability, and ensure field personnel are trained on workers' compensation initiatives.

Operational Focus

• Manage workers' compensation claims and handle insurance claim reporting, follow-up, and claim management.
• Ensure compliance with OSHA requirements for assisted living facilities.
• Assist employees in initiating FMLA leave for lost-time workers' compensation cases.
• Respond to government inquiries, including DOL surveys, and assist with records requests.
• Train field personnel on workers' compensation initiatives and complete other claims and risk management projects as assigned.

Experience & Qualifications

• Bachelor's degree preferred.
• Minimum 5 years of workers' compensation claims experience, with 1 to 2 years of insurance claims experience.
• Knowledge of the senior living industry helpful but not mandatory.
• Computer proficiency in Microsoft Office including Word, Excel, and Outlook.
• Strong communication, interpersonal, and customer service skills with excellent organizational ability.
• Proven ability to develop strong client relationships, problem-solve, and work independently as well as part of a team.
• Adaptable, self-starter with integrity and compassion.
• Willingness to travel periodically to client sites and conferences.

Claims Analyst manages medical malpractice and professional liability claims from first notice of loss through resolution for physicians, hospitals, medical facilities, and long-term care facilities, operating within delegated authority under the Professional Lines Business Unit. Success in the position means proactive reserve establishment, disciplined litigation management through panel counsel programs, and timely large loss reporting that keeps the organization's professional liability book financially controlled and legally compliant.

Leadership Responsibilities

• Handle and oversee claims for the Professional Lines Business Unit, including Medical Malpractice claims.
• Conduct proactive claims management covering coverage, investigation, liability, damages, evaluation, and resolution.
• Manage litigated claims proactively in accordance with established litigation guidelines and panel counsel programs.
• Establish reserves under established reserving protocols and authority procedures for primary and excess Professional Liability claims.
• Complete Large Loss Reports as required and maintain compliance with state and federal laws applicable to Professional Lines claims.
• Maintain and apply in-depth understanding of Professional Lines policy language and coverage applicable to Medical Malpractice claims.
• Provide support to the Professional Lines Business Unit and participate in marketing efforts.
• Maintain required state adjuster licenses and annual CE credits and monitor market and industry trends.

Education & Experience

• Bachelor's degree from a four-year college or university.
• Juris Doctorate preferred but not essential.
• Minimum 8 to 10 years of experience managing professional liability claims, specifically medical malpractice, hospital liability, and extended care facilities.
• Comprehensive understanding of state and federal laws applicable to Professional Lines claims.
• Proficiency in MS Office including Word, PowerPoint, and Excel.
• Strong verbal, written, and interpersonal communication skills with excellent negotiation skills.
• High ability to manage complex coverage and legal issues.
• Independent, self-starting work ethic with strong moral character and time management ability.
• Willingness to travel as required.

The Claims Analyst coordinates all aspects of freight claim filing, investigation, and carrier negotiation to maximize recovery on quantity shortages, cargo loss, property damage, and missing freight incidents across a retail supply chain. Serving as the cross-functional liaison between carriers, stores, and the home delivery team, the analyst creates reporting on claim status and recovered dollars that directly reduces operational losses and improves carrier contract terms.

Key Deliverables

• Investigate, gather, and analyze documentation from all involved parties to determine if a claim can be successfully submitted.
• Submit claims to carriers and follow up with additional supporting documentation as requested.
• Provide rebuttals to denied freight claims where appropriate.
• Analyze carrier contracts around claims and provide feedback to enhance carrier contract terms for recouping freight claims.
• Negotiate claims with the party at fault and determine final loss of revenue on each claim processed.
• Assist with the ongoing development of the claims process and provide training for store associates as needed.
• Advise carriers and stores on whether product should be donated, destroyed, or returned.
• Create and share reporting on claims status, total dollars recouped, and root causes of recurring issues to support loss reduction.

Background & Experience

• High School Diploma or GED required, Bachelor's Degree preferred.
• 2 or more years of claims experience preferred, with import and export documentation, transportation, or customer service experience also preferred.
• Basic knowledge of accounting, logistics, documentation, credit and collections, and receivables and payables functions.
• Working knowledge of shipping Incoterms.
• Intermediate proficiency in Microsoft Office including Word, Excel, Outlook, and PowerPoint.
• Detail-oriented, self-motivated, and proactive with the ability to handle multiple tasks simultaneously.
• Strong oral and written communication skills in fluent English.

Embedded within bank card operations, the Claims Analyst processes ATM and Visa debit card dispute and fraud claims in compliance with Regulation E, Visa, and PIN Network requirements, while identifying fraud trends and reporting suspicious activity to BSA and AML teams. Working closely with preferred banking offices, legal, and compliance functions, the analyst enables client advocacy and minimal bank loss exposure across day-to-day card operations.

Areas of Ownership

• Process and reconcile customer disputes, post chargebacks for debit card charges, maintain chargeback documentation, and update reports as needed.
• Prepare and process card claims for daily posting.
• Monitor and update claims with merchant responses and identify fraud trends.
• Provide telephone and email support for preferred banking offices.
• Complete research requests, subpoenas for records, and bank by mail processing.
• Submit and follow up on chargebacks on qualifying claims and submit fraud reporting.
• Adhere to applicable federal and state laws and regulations including the Bank Secrecy Act, US Patriot Act, and Regulation E.
• Identify and report suspicious activity to the BSA and AML group.

Technical Qualifications

• Prior ATM or Card Services Operations experience required.
• Knowledge of Visa, Star, and Accel chargeback procedures preferred, along with basic knowledge of the in-clearing process.
• Knowledge of FED procedures, guidelines, and banking and financial services regulatory compliance.
• Working knowledge of Microsoft Word, Excel, and PowerPoint.
• Strong problem-solving, risk management, and attention-to-detail skills.
• Exceptional verbal and written communication skills.
• Ability to work independently, manage multiple tasks concurrently, handle confidential information, and escalate issues appropriately.
• Strong sense of urgency and client service orientation.

The Claims Analyst guides resolution of allocated casualty claims across commercial and personal lines schemes and packages within a designated personal authority level, instructing counsel on litigation strategy and escalating non-standard cases to supervisors to ensure handling standards are met. Based within a structured claims operations team, the analyst delivers consistent customer and intermediary service outcomes while maintaining full compliance with legal, regulatory, and internal policy requirements.

Job Functions

• Investigate, evaluate, and resolve assigned claims, including non-standard cases, within designated personal authority level.
• Conduct proactive settlement through appropriate negotiation, including instructing and collaborating with counsel on litigation strategy and claim resolution.
• Identify and investigate suspicious or fraudulent claims under supervision.
• Manage customer and intermediary interactions in an efficient, courteous, and timely manner.
• Organize and use approved internal and external suppliers to ensure appropriate and timely services are provided.
• Identify non-standard or complex claims and escalate to supervisor for appropriate handling.
• Provide guidance and assistance to claims associates and support more experienced colleagues on non-standard cases.
• Assist in preparation of reports or analysis and ensure compliance with all legal, regulatory, and policy requirements.

Skills & Qualifications

• Minimum 3 to 4 years of solid claims handling experience in the relevant line of business.
• Professional insurance qualification such as ANZIIF, ACII, or Certificate of General Insurance preferred or in progress.
• Skilled in relevant PC applications.
• Strong negotiation skills and sound judgment with high attention to detail.
• Good team player able to work independently and under pressure with a strong interpersonal and customer service-oriented attitude.
• Proficiency in oral and written English communication.
• Strong planning, prioritization, and organizational discipline with the ability to manage workload and maintain focus on priorities.

As the Claims Analyst, this role leads the investigation of complex third-party bodily injury, property damage, and litigated claims within a gaming and hospitality environment, managing reserve adequacy, outside counsel oversight, and settlement negotiations within delegated authority. The claims management function relies on this work to protect organizational financial exposure through risk transfer identification, accurate claim file administration, and strategic participation in round-table reviews with senior management.

What You'll Do

• Lead the investigation of complex third-party claims resulting in bodily injury, property damage, and litigation, including reviewing documentation, conducting witness interviews, and facilitating onsite inspections.
• Provide support for assigned litigated claims, including communication with outside counsel, discovery requests, pre-trial motion preparation, and attendance at arbitrations, mediations, and trials.
• Maintain the financial aspects of each claim including reserve adequacy, accurate claim payments, and review of outside counsel invoices.
• Investigate and present claim evaluations and participate in round-tables and claim reviews with senior management to guide strategy and resolution.
• Negotiate and resolve claims fairly and equitably within designated authority level and in compliance with settlement policies and procedures.
• Review claims to identify risk transfer potential and prepare timely communications to obtain tender acceptance and indemnification.
• Manage administrative functions including organized claim files, current notes, deadlines, and required forms and reports within the claims management system.

Qualifications & Experience

• Bachelor's degree in a related field or equivalent experience.
• 5 years of relevant insurance and claims experience, including 3 or more years of prior relevant claims experience.
• Experience in Gaming and Hospitality claims, preferably in a resort setting.
• Advanced knowledge of property and casualty insurance principles, tort law fundamentals, and medical terminology as used in claims.
• Advanced negotiation, active listening, critical thinking, diplomacy, and problem-solving skills.
• Ability to communicate effectively in English in both written and oral forms.

Claims Analyst advances accurate trade promotion claim resolution by processing escalated and invalid claims, linking invoices and Proof of Performance, and making final validity decisions that decrease defects and drive automation targets across food brokerage and sales administration workflows. Success in the position means proactive client and customer communication, root cause analysis of recurring escalations, and maintained Standard Operating Procedures that enable the claims team to meet client targets consistently.

Work Activities

• Process escalated claims, assess the reason for escalation, and provide resolution in priority order.
• Search for and link invoices, contracts, and Proof of Performance to claims as needed.
• Use systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information.
• Process invalid claims and correct claims passed in error in accordance with set policies and guidelines.
• Research validation issues and recommend appropriate solutions, reviewing the claims dashboard frequently for actionable items.
• Make final decisions on claims validity for escalated claims and send compliant promotion packages for clearing.
• Contact sales teams, clients, customers, and management for information and proactively manage client target dates to ensure timely processing.
• Monitor escalation data to determine root causes, discuss defect issues with relevant stakeholders, and work to decrease defects and achieve automation targets.

Requirements

• 4 years of claims experience preferred, with food brokerage or sales administration experience strongly preferred.
• Relationship management experience preferred.
• Strong analytical and problem-solving skills with a disciplined, evidence-based approach to decision-making.
• Ability to accept accountability, adapt to change, and align actions with organizational goals.
• Effective communication skills with the ability to interact professionally with clients, customers, sales, and management.
• Ability to operate standard office equipment including a calculator, computer, printer, fax machine, and telephone.

Embedded within a secure banking production environment, the Claims Analyst coordinates productivity reporting, EOD vault performance reporting, data retention supervision, and new employee training to ensure management has accurate, timely information on staff and operational performance. Working closely with tellers, operations management, and senior leadership, the analyst enables financial accuracy and regulatory soundness across currency processing and claims adjustment functions.

Core Responsibilities

• Provide productivity reporting for management indicating adherence to quality and performance targets by employee and function.
• Provide research and adjustments support to ensure customer information requests are fulfilled accurately and on time.
• Provide data and materials retention supervision, including oversight of locally retained materials and proper destruction of disposed materials.
• Provide scheduling and staffing support to management including monitoring of staff hours, schedule management, and projected financial impacts.
• Provide administrative support including management of equipment inventory, maintenance activities, and building safety activities.
• Coordinate and ensure timely completion and reporting of EOD and other performance reporting on vault status, including daily balancing, out-of-balance notifications, and transmission failures.
• Provide specific training for new tellers and recently onboarded staff and ensure proper system and building access for new employees.

Minimum Qualifications

• High School Diploma or equivalent required, 4-year BA or BS degree preferred.
• 3 or more years of experience in analytical functions providing resources to senior management to review and manage complex data and financial information.
• Experience working in a fast-paced, repetitive process and secure production environment.
• Physical requirements include the ability to lift and move up to 50 pounds regularly, push and maneuver currency carts up to 150 pounds, and stand for extended periods.
• Ability to use hands and fingers for typing, data entry, and operating money processing machines with normal hearing and specific vision abilities, including close, distance, and peripheral vision.

Reporting to quality and operations leadership, the Claims Analyst creates accurate DOA and warranty claim determinations for North American customers of overseas-manufactured industrial products, coordinating shop and field repairs, teardown inspections, and 8D corrective action plans with manufacturing plants, engineering, and service centers. Partnering with plant Quality Managers and customer sites, the analyst delivers issue resolution and improvement plans that protect customer satisfaction and control warranty costs across the off-highway product line.

Delivery Expectations

• Complete DOA and warranty claims processing, determine reasonableness of reimbursement requests, and adjust claims that include non-DOA parts or excessive repair times.
• Serve as frontline contact for North American customers experiencing incoming quality issues with overseas-manufactured products and support plant Quality Managers as required.
• Order and arrange shipment of materials needed for customers or service centers and coordinate return of defective parts.
• Direct and facilitate customer intervention, coordinate shop and field repairs, and manage service campaigns with customers and service centers.
• Complete teardowns on failed components and document results in inspection reports.
• Manage major issue resolution using 8D discipline and RED X approach covering safety, customer satisfaction, and cost impact.
• Visit customers and service centers for issue investigation and submit written reports of findings and solutions.
• Develop and lead improvement plans in collaboration with manufacturing plants and engineering, and immediately escalate changes in claims trends for corrective action.

Education & Experience

• Bachelor's degree required, with a focus on industrial or technical disciplines preferred.
• 1 to 3 years of experience in warranty and field technical services support, with automotive business experience preferred.
• 3 to 5 years of exposure to industrial manufacturing processes, with automotive business experience preferred.
• Strong technical knowledge and hands-on experience with off-highway products and failure modes analysis, including 8D discipline and RED X methodology.
• Strong computer skills in Microsoft Office and internet applications.
• High verbal and written communication skills across face-to-face, phone, and email settings.
• Strong process and teaming skills with the ability to work toward department goals with minimal supervision.
• English is mandatory, with additional languages preferred.

A key member of the corporate risk and legal function, the Principal Claims Analyst oversees the full multiline insurance claims program, including domestic and international casualty, property, transit, and professional liability lines, directing third-party administrators and coordinating litigation strategy with Legal to achieve cost-effective resolution. Collaborating with brokers, carriers, coverage counsel, and field operations, the analyst drives compliance with defined Best Practices and KPIs that prevent and manage litigation across a complex, multi-jurisdictional claims portfolio.

Strategic Responsibilities

• Oversee all claims activity and drive claims to timely and cost-effective resolution.
• Manage and direct all claims administrators, providing upper-level supervision and direction on individual claims.
• Coordinate with the field, bottlers, and service providers to obtain information and data from current and archived systems.
• Develop and present training on claims procedures and best practices.
• Coordinate litigation activity, identify complex legal issues, and review lawsuits, interrogatories, affidavits, and depositions to approve defense counsel assignments and litigation budgets.
• Research and obtain discovery documents required for litigation from various company systems and locations.
• Attend trials, hearings, and mediations representing the company.
• Demonstrate proficiency in multiline insurance policy coverage interpretation, identify coverage issues, and coordinate resolution with brokers, carriers, and coverage counsel.

Professional Experience

• 10 or more years of increasingly responsible experience in claims management, law, or a related field, with proven claims technical knowledge and a supervisory role at an insurer, TPA, or insurance broker.
• Multi-jurisdictional knowledge with a strong understanding of legislation and legal precedents related to claims handling and settlement.
• Claims system experience and data analytics capability preferred.
• Persuasive strategic and analytical capability.
• Strong investigative and management skills with the ability to make complex, precedent-setting decisions independently.
• Proficiency in Microsoft Office with strong Excel skills.
• Strong written and verbal communication and negotiation skills.

The Claims Analyst crafts expert commercial auto claim advocacy and account management for commercial clients, serving as the primary liaison between clients, carriers, and the brokerage sales and service team to maximize policy coverage and deliver consistent claims service programs. Operating independently with a minimum of 15 years of commercial auto claims experience, the analyst resolves complex and catastrophic auto claims, maintains thorough EPIC claim file documentation, and notifies leadership of reserve changes exceeding $100,000 to protect client outcomes and organizational reputation.

Ownership Areas

• Advocate for commercial clients by providing expert auto claim oversight and interacting with clients, carriers, carrier experts, consultants, producers, and account managers.
• Research coverage issues and collaborate with clients on coverage rebuttals.
• Author white papers and deliver presentations on topics relevant to client claims challenges as needed.
• Attend client meetings including claim reviews, pre-renewals, and renewals.
• Assist the Sales Team in addressing customer claim issues and participate in new and renewal meetings to present the auto claims platform.
• Assist the Auto Claim Team Leader on projects including refinement of best practices and claim service programs.
• Resolve client claim issues promptly and communicate resolutions to appropriate stakeholders, including notifying leaders of large reserve changes in excess of $100,000.
• Maintain thorough and timely documentation of all claim activity and client interactions in the EPIC claim file system.

Required Qualifications

• Bachelor's degree required, with additional insurance certifications a plus.
• Minimum 15 years of experience in the commercial auto claims industry, with experience at Senior Claims Analyst level or higher required.
• Proficiency in auto insurance products, claims handling and management, and processes.
• Knowledge of general liability, management liability, and workers' compensation coverages preferred.
• Proven background managing complex coverage and large or catastrophic auto claims in a client service or claims management capacity.
• Proficiency in broker-based and carrier claims software applications, with knowledge of the EPIC system a plus.
• Proficiency in Microsoft Office Suite including Excel, Outlook, Word, and PowerPoint.
• Demonstrated expertise in written and verbal communications.
• Strong organizational skills, sound judgment, and the ability to manage multiple internal and external clients concurrently.
• Strong client service orientation with the ability to stay composed in difficult and complex claims situations, follow through on commitments, and maintain integrity in all interactions.

Claims Analyst runs health plan timeliness reporting, claim auditing, ODAG reporting, and provider dispute resolution for Commercial and Medicare Advantage lines within a managed care organization, coordinating directly with health plan auditors and claim examiners to maintain compliance with state and federal guidelines. The work directly supports payment accuracy, regulatory compliance, and continuous workflow improvement for the claims team, health plan partners, and the patient populations they serve.

Core Functions

• Deliver upon the service expectations of both patients and fellow staff members by listening to needs, engaging in positive interactions, and following through on promises in a thoughtful, efficient, and timely manner.
• Respect the dignity, confidentiality, and privacy of patients and work in a safe manner, adhering to general safety precautions.
• Coordinate and prepare health plan timeliness reports and complete the Claims Dashboard, ODAG reports, and PDR database reporting for Commercial and Medicare Advantage provider dispute resolution.
• Generate claim auditing reports and liaise with health plans to address timeliness, audit questions, and complex issues.
• Oversee and coordinate the error rebuttal process, including tracking and reporting of errors challenged by Claim Examiners and outcomes of those challenges.
• Prepare and present all health plan audits including audit materials, pre-audits, and corrective action plans developed in collaboration with health plan auditors.
• Generate routine claim reports, track claim adjustments to identify trends, and participate in handling claims from egregious billers.
• Analyze and trend monthly quality and production standards, provide feedback and recommendations to management, and coordinate on-the-job training for new staff.

Education & Experience

• Bachelor's degree or equivalent education and experience.
• 10 or more years of HMO claims processing and auditing experience in a managed care environment, preferably in a PMG or IPA setting within the last 7 years.
• Comprehensive knowledge of claims reimbursement methodologies, data elements, coding, HMO membership, plan benefits, plan designs, and health plan enrollment protocols.
• Extensive knowledge of medical terminology, HMO claims processing guidelines, including EDI claims, and government claim processing regulations.
• Current knowledge of applicable state and federal claim payment, denial, and provider dispute guidelines and regulations.
• Proficiency in Microsoft Word, Excel, Access, Outlook, and PowerPoint.
• Ability to produce reports, perform data analysis, and make mathematical calculations.
• Excellent oral and written communication skills.
• Strong customer service orientation, with high flexibility and attention to detail.