CLAIMS ASSISTANT JOB DESCRIPTION

A Claims Assistant keeps P&C insurance claims moving from first notice through final resolution. Every incoming loss touches this role: coverage is verified, files are opened in the claims management system, and adjusters receive the documentation they need to make accurate liability and payment decisions. Without timely FNOL intake and accurate reserve entries, adjuster caseloads stall and state-mandated acknowledgment windows are missed. This role sits within the claims operations unit and reports up through claims leadership, providing the administrative backbone that keeps the department audit-ready and service levels intact.

As the Claims Assistant, you keep P&C claim files complete, compliant, and current from the moment a loss is reported through final settlement, enabling adjusters to focus on coverage analysis and negotiation. You work within a structured claims operations team, supporting licensed adjusters across multiple lines of business while managing intake queues, correspondence timelines, and payment processing under the Unfair Claims Settlement Practices Act.

Career Impact: Supporting P&C claims operations builds working knowledge of coverage interpretation, liability law, and state adjuster licensing that forms the foundation for advancement into an adjuster or examiner role.

Business Impact: Accurate FNOL intake and reserve entry directly determine how quickly policyholders receive payments and how cleanly the department clears state compliance audits.

Growth Opportunity: Exposure to Environmental, Commercial Auto, and bodily injury lines broadens your technical depth and positions you to pursue a state adjuster license with employer-sponsored support.

• Receive and process First Notice of Loss reports via phone, mail, and electronic channels, entering complete policyholder and loss data into the claims management system.
• Establish and maintain claim files, including scanning correspondence, updating coverage and reserve information, and closing files upon final resolution.
• Coordinate timely dispatch of new claims to the appropriate adjuster or unit on a rotational basis within established service-level windows.
• Review and process incoming invoices and payment vouchers, issuing approved claim payments in compliance with state rules and company guidelines.
• Prepare and distribute written correspondence to insureds, brokers, attorneys, and vendors, including acknowledgment letters, coverage determination letters, and status updates.
• Generate daily, weekly, and monthly management reports by pulling data from claims and reporting systems, flagging trends or anomalies for supervisor review.
• Support adjusters by ordering medical, legal, and subrogation records and coordinating certified mail, overnight packages, and document retrieval.
• Monitor work queues and assigned diaries, escalating compliance or deadline risks to the Claims Operations Manager before service-level targets are breached.

• High school diploma or equivalent work experience.
• 2 or more years of claims administrative or insurance operations experience, with demonstrated accuracy in high-volume data entry environments.
• Working knowledge of P&C insurance principles, including policy coverage basics, FNOL procedures, and reserve concepts.
• Strong written and verbal communication skills, with ability to correspond professionally with insureds, brokers, attorneys, and internal staff.
• Proficiency in Microsoft Office applications, particularly Excel and Word, with comfort navigating multiple software systems simultaneously.
• Solid organizational skills with proven ability to manage competing priorities, meet strict deadlines, and maintain attention to detail under time pressure.
• Ability to handle sensitive claimant information with confidentiality and in compliance with applicable privacy and regulatory requirements.

• Active state property and casualty adjuster license, or eligibility and willingness to obtain one within 90 days of hire.
• Experience processing claims across multiple lines of business, such as Commercial Auto, Environmental, or Workers' Compensation.
• Familiarity with claims management platforms and reporting tools, including experience running ad hoc data queries or loss run reports.
• Prior exposure to FEMA flood claim procedures, EDI reporting requirements, or subrogation tracking processes.

• FNOL intake accuracy rate, measuring error-free claim setups as a percentage of total losses registered per week.
• Acknowledgment letter turnaround time in days, tracking compliance with state-mandated response windows by line of business.
• Payment processing cycle time in days from adjuster approval to check issuance, reflecting invoice handling efficiency.
• Diary and queue clearance rate as a percentage of assigned open activities completed within the scheduled window.
• Reserve entry error rate per audit cycle, indicating data integrity across the adjuster-supported caseload.
• Typical tools: Claims management systems (commonly Origami, Guidewire); reporting and office tools (commonly PowerBI, Microsoft Excel).

• Base Salary Range: $38,000 to $52,000 annually, depending on experience and location
• Bonus: Discretionary performance bonus, typically 3% to 5% of base salary
• Equity: Not standard at this level in insurance operations roles
• Health Benefits: Medical, dental, and vision coverage; short- and long-term disability; life insurance
• PTO: 10 to 15 days annually, plus standard company holidays
• Common Perks: Adjuster license sponsorship, tuition reimbursement, 401(k) with employer match, wellness programs

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

Employment is contingent on successful completion of a background check, which may include verification of prior insurance industry credentials and driving history where applicable. All qualified applicants will be considered for employment without regard to race, color, religion, sex, national origin, disability, age, or any other characteristic protected under federal, state, or local law. Reasonable accommodations are available to applicants with disabilities throughout the hiring process upon request. Candidates must be authorized to work in the United States.

The Claims Assistant owns end-to-end claims processing operations for a hospital-affiliated team, overseeing adjudication accuracy, KPI achievement, and resource allocation to ensure payments are delivered in alignment with policy guidelines. Working closely with an outsourcing team and reporting through claims leadership, the Claims Assistant builds and trains a customer service-focused unit whose performance directly determines the accuracy and timeliness of claims outcomes.

Key Responsibilities

• Oversee claims processing operations of the hospital and supporting team.
• Devise, implement, and monitor claims procedures to ensure risks are properly assessed and transactions are efficiently administered.
• Develop and monitor plans to increase operational efficiency and ensure service, quality standards, and targeted KPIs are achieved consistently.
• Develop and train employees to achieve personal and company goals.
• Deliver effective, efficient, and accurate claims payments in alignment with policy settings and company guidelines.
• Ensure claims adjudication is completed within agreed service standards and resource allocation.
• Enhance systems and workflows to meet customer needs and service standards.
• Allocate resources to cope with incoming work volume and follow up on all inquiries to minimize risk through effective approval procedures.
• Work closely with the outsourcing team for the achievement of overall claims KPIs.
• Build and lead a customer service-focused team to deliver quality service and value.
• Build training and development plans for staff and ensure accuracy of regular daily, weekly, and monthly reports.

Required Qualifications

• Bachelor's degree preferred.
• Minimum 6 to 8 years of experience in medical claims, with at least 2 years in managerial positions.
• Familiarity with medical practices and insurance policy wording.
• Fluency in written and spoken English and Cantonese is required.
• Demonstrated ability to deal with customers with high levels of integrity, trust, and independence.

Embedded within the Operations and Member Services teams, the Claims Assistant delivers vehicle damage expertise by analyzing damage photos, member feedback, and estimates to reduce risk profiles and claims activity across locations. Working closely with the data team and claims administrator, the Claims Assistant shapes member outcomes by guiding claimants through the damage process and proposing solutions that reduce member contact and improve satisfaction.

Core Functions

• Serve as the vehicle damage subject matter expert by analyzing damage photos, member feedback, and damage estimates.
• Work with the data team to analyze trends and provide actionable feedback to reduce risk profiles and claims activity.
• Recommend improvements to policies and procedures to optimize workflow and train internal and external teams on tools and procedures.
• Monitor member behavior to identify bad actors or needed education and propose solutions.
• Guide members involved in accidents through the damage claim process and explain expected next steps.
• Identify proactive measures to reduce member contact and improve member satisfaction.
• Respond to member inquiries and escalated operational failures in a timely fashion.
• Collaborate with Operations and Member Services teams to communicate with members and identify solutions that reduce member impact.
• Assist the claims team with special projects such as invoice audits, data collection, and financial reviews.
• Analyze the facts of a damage report or accident and determine the viability of accounts.
• Provide notice of urgent incidents to the claims administrator as needed.

Qualifications & Experience

• Bachelor's degree preferred, or 2 years of relevant experience in insurance, transportation, or logistics.
• Ability to communicate effectively at all levels and articulate ideas, results, and recommendations.
• Ability to prioritize work independently, ensuring accuracy while meeting deadlines.
• Proficiency in Microsoft Office.
• Can work across multiple proprietary software systems.
• Strong interpersonal, influencing, and process skills with the ability to work in a fast-paced environment.

Reporting to the Team Leader of Claims, the Claims Assistant administers the full scope of departmental support functions, including claims intake, file setup, correspondence management, and liaison with Underwriting, to ensure accurate and timely service to policyholders and brokers. Partnering with underwriters and claims specialists, the Claims Assistant enables smooth claims processing by maintaining organized records and completing all administrative duties that keep the department running accurately.

Primary Duties

• Act as administrative support for the claims department, including claims intake and setup, scanning, mail delivery, incoming cheques, telephone inquiries, payments, filing, and closed file management.
• Ensure all new claims are set up correctly in various systems, including policy information, coverage, insurer, and loss details.
• Ensure all correspondence, including follow-up emails and responses, is completed on time with insureds and brokers.
• Administer claim records and files, both paper and electronic.
• Liaise with Underwriting as required and complete all other administrative duties as assigned by the Team Leader.

Education & Experience

• Bachelor's degree, college diploma, or equivalent training.
• 1 or more years of related industry or claims experience is an asset.
• Proficiency in Word, Excel, and various computer systems.
• Good organizational skills and excellent attention to detail.
• Strong interpersonal, presentation, and communication skills, both oral and written.
• Strong prioritization and decision-making skills.

A key member of the claims department, the Claims Assistant produces and maintains claim files, correspondence, and management reports by performing data entry, telephone handling, and administrative support that increase departmental productivity. Collaborating across all levels of the organization and with people from diverse backgrounds, the Claims Assistant ensures that daily operations, status tracking, and reporting functions are completed accurately and on schedule.

Duties

• Provide exceptional administrative support for special projects involving gathering, analyzing, and compiling information to increase department productivity.
• Create all claim files by entering them into the automation system.
• Type memos, labels, letters, reports, and other correspondence for the department.
• Perform follow-up on all suspense according to policy and procedure.
• File, fax, and copy correspondence and other documents as needed.
• Answer telephone, give information to callers, transfer calls, complete messages, and follow up as necessary.
• Sort and distribute incoming mail and prepare outgoing mail, including scanning new mail.
• Perform claim status requests and updates and prepare daily, weekly, and monthly reports for management.
• Maintain office supplies and equipment for the department.

Skills & Qualifications

• High school diploma or equivalent work experience.
• Working knowledge of Microsoft Office software.
• Ability to operate standard office equipment.
• Strong verbal and written communication skills.
• Good organizational and time management skills with the ability to work under time constraints and meet deadlines.
• Ability to interact effectively with employees at all levels and with people from diverse backgrounds.

Accurate claims outcomes for a domestic property portfolio depend on the Claims Assistant, who manages the full scope of claim file administration, from coverage examination and reserve-setting through settlement, to ensure policyholders receive well-supported and timely resolutions. Based within a claims operations team and updating the Claims Management System as directed by adjusters, the Claims Assistant advances the organization's service standards by investigating physical damage details, interviewing claimants, and preparing the reports that inform final liability determinations.

Functions

• Enter client reports, correspondence, and documents efficiently and accurately.
• Update the Claims Management System as required by adjusters.
• Take ownership of complex issues from initial query through to resolution while managing customer expectations.
• Communicate with and assist stakeholders across the business.
• Answer incoming calls promptly and respond to client and insured queries via telephone and email.
• Manage a portfolio of domestic property claims and provide support and advice to policyholders during the claims process.
• Examine claim forms, policies, endorsements, and client instructions to determine coverage.
• Investigate claims by analyzing physical damage details, interviewing claimants, and comparing claim information with evidence.
• Set loss reserves and update them when circumstances change.
• Prepare reports by collecting and summarizing required information and settle claims after determining the insurance carrier's liability.

Requirements

• General insurance-related qualifications are preferred but not essential.
• Previous experience in commercial or domestic claims is preferred but not essential.
• Computer literate and proficient in Microsoft Outlook, Word, and Excel.
• Good attention to detail and basic accounting knowledge.
• Strong organizational, interpersonal, report writing, and communication skills.
• Ability to work independently and as part of a team.

As the Claims Assistant, this role receives and dispatches new claim notifications, processes incoming and outgoing documentation, and inputs policyholder loss data to complete First Notice of Loss Reports accurately and on time. The Claims Team relies on this work to maintain rotational claim assignments, organized records, and responsive service across mail, phone, and web channels.

Accountabilities

• Greet all inbound calls warmly and in a professional manner.
• Input all necessary policyholder and loss information into the system to complete a First Notice of Loss Report or process a customer service-related call.
• Dispatch new claims to the appropriate unit on a rotational basis on time.
• Process incoming and outgoing claims documentation and correspondence, including mail, faxes, and emails.
• Assist in filing, data entry, paying invoices, and archiving documents for the Claims Team.
• Assist with mailroom and post office duties as needed and complete additional duties as assigned by management.

Experience & Qualifications

• High school diploma.
• 1 to 2 years of experience in a customer service role.
• P&C industry experience is a plus, and an adjuster's or customer service license is a plus.
• Strong written and oral communication skills.
• Bilingual in English and Spanish is preferred.
• Proven ability to multitask and stay organized in a high-volume environment.
• Willingness to work additional hours as part of catastrophe response is required.
• Valid driver's license and vehicle insurance required.

Claims Assistant builds accurate, complete claim files for a global commercial insurance operation by examining documents, processing payments, and coordinating with external vendors and internal teams across multiple business lines. Success in the position means staying current on industry and procedural changes, ensuring data completeness, and delivering the responsive client service that supports multinational policyholders in managing their risk exposure.

Activities

• Examine claims documents received and establish claims files in the internal system.
• Examine documents to determine any required adjustments.
• Review client inquiries regarding open billing invoices and statements.
• Ensure timely and accurate processing of claim documents, including claim payments and claims setup.
• Stay current on company and industry changes as well as internal process and procedure updates.
• Provide operational support to various business lines by contacting external vendors and obtaining required information.
• Work with internal teams to ensure data completeness.

Technical Qualifications

• Good knowledge of MS Office is essential.
• Strong analytical, organizational, and time management skills.
• Excellent customer focus and interpersonal skills with strong communication ability across all levels.
• English is essential, and proficiency in German, Italian, or other languages is an advantage.
• Strong team player with eagerness to learn, adapt to change, and explore new ideas.

The Claims Assistant produces accurate claim files and damage investigation records for property damage and cable knockdown cases, interacting daily with customers, contractors, insurance companies, and government agencies to locate responsible parties and support the collections process. Reporting through the claims unit and collaborating with team members, the Claims Assistant advances resolution of open claims by applying knowledge of state and local laws governing property damage and excavation activities.

Key Deliverables

• Assist in all aspects of the collection process.
• Perform damage investigations at work sites.
• Develop knowledge of state and local laws governing property damage and excavation activities.
• Interact daily with customers, contractors, insurance companies, and government agencies.
• Maintain current and accurate information in relevant files.
• Work proactively to locate responsible parties for knockdown and cut cable damages.
• Collaborate with team members to accomplish goals and solve problems.

Knowledge, Skills & Abilities

• 3 to 5 years of experience in claims work, collections, or the insurance field preferred.
• Basic knowledge of accounting, logistics, documentation, and receivables and payables.
• Working knowledge of Microsoft Excel and JDEdwards or equivalent software preferred.
• Strong interpersonal, verbal, and written communication skills with excellent time management and organizational skills.
• Ability to adapt to changing priorities, evaluate work histories, and conduct difficult conversations with clients regarding collections.

Embedded within a claims processing unit, the Claims Assistant oversees new loss registration, coverage verification, and payment recording to ensure that agents, insureds, and clients receive accurate and timely service. Working closely with claim representatives and the team leader, the Claims Assistant enables clean file updates and loss registration forms that support downstream adjudication and reporting functions.

Scope of Work

• Receive new losses and verify accuracy of information via coverage.
• Register new loss information on the system and perform all file updates as directed by claim representatives or the team leader.
• Register loss payments on the system and prepare all loss registration forms.
• Provide customer service to agents, insureds, clients, and other customers.

Background & Experience

• 1 year of previous claims processing experience.
• Experience in an automated environment.
• Strong customer orientation with experience supporting customer needs.
• Good computer systems skills, keyboarding, and data entry skills.
• Strong analytical and organizational abilities.
• Strong written and oral communication skills to serve internal and external customers effectively.
• Ability to work well in a team environment and commitment to high standards of performance.

Claims Assistant executes financial processing activities, file maintenance, and adjuster support functions, including issuing payments, completing EDI and state forms, and coordinating certified mail, to keep commercial claim files current and compliant. Reporting to claims adjusters and working across medical, legal, and recovery service lines, the Claims Assistant enables accurate loss assignment and timely resolution by maintaining reports, logs, and correspondence generated from system templates.

Operational Focus

• Perform general maintenance and data entry in claim files.
• Assist adjusters in contacting insureds or other involved persons to obtain missing or incomplete information.
• Perform financial activities including issuing payments, requesting stop pays, processing voids, and obtaining check copies.
• Receive and return telephone calls and emails as directed by claims adjusters.
• Generate letters from system templates and complete state forms, jurisdictional requirements, and EDI where applicable.
• Request file copies for medical, legal, recovery, and subpoena response services.
• Coordinate mailing requests including standard, overnight, and certified mail.
• Submit referrals for various services, assign losses, and maintain reports and logs.

Position Requirements

• Thorough knowledge of commercial claim procedures and policies.
• Basic understanding of business technology.
• Professional telephone demeanor and strong oral and written communication skills.
• Strong organizational and detail-oriented skills.
• Ability to take direction, make decisions, and learn new procedures quickly in a changing environment.
• Ability to work well under pressure, multitask, and work effectively in a team environment.

The Claims Assistant refines claims distribution and reporting operations for a long-haul trucking portfolio by maintaining the claims mailbox, issuing CDN and USA payments, and producing ad hoc reports for the leadership team. Reporting with limited supervision and coordinating with internal and external vendors, the Claims Assistant guides the accuracy and balance of claim assignments while meeting privacy and compliance guidelines.

Day-to-Day Responsibilities

• Maintain the Long Haul trucking mailbox to assign new claims.
• Update various systems and maintain a balanced distribution of claims across the team.
• Order reports and records as requested by the team.
• Create and provide ad hoc reports for the leadership team.
• Meet privacy and compliance guidelines.
• Issue CDN and USA payments as requested on claims.
• Identify problems and relevant issues and assess each using standard procedures.
• Prioritize and organize work with limited supervision and communicate with internal and external vendors.

Professional Experience

• At least 2 years of experience in administrative support.
• Proficiency in Microsoft Office suite.
• Ability to learn various platforms and systems.
• Ability to prioritize and organize personal workload.
• Bilingual or the ability to read French is an asset but not required.

Reporting to the manager, the Claims Assistant creates, files, and analyzes claims documentation, including monthly reports and open and pending claim analyses, to support accurate records management and salvage coordination. Partnering directly with the manager on claim data reports and salvage sales, the Claims Assistant contributes to financial accuracy and claims resolution by maintaining thorough documentation and applying strong negotiation and problem-solving skills.

Work Activities

• Record, investigate, and collect claims documentation.
• File and recover assigned claims.
• Balance monthly claims reports and prepare claim data reports as needed by management.
• Coordinate salvage sale of rejected product in coordination with manager.
• Report and analyze open and pending claims with manager.

Minimum Qualifications

• 2 to 5 years of claims management experience preferred.
• Basic understanding of contracts and certificates of insurance.
• Basic knowledge of accounting, logistics, documentation, and receivables and payables.
• Intermediate to advanced knowledge of Microsoft Office, including Word and Excel.
• Self-motivated, organized, and detail-oriented.
• Strong negotiation, communication, multitasking, and problem-solving skills.

A key member of a collaborative claims team, the Claims Assistant executes accounts payable functions, including invoice data entry, payment voucher creation, and account reconciliation, to ensure accurate reimbursement for member, client, and vendor services. Collaborating across departments to resolve claim and benefit-related issues, the Claims Assistant enables the team to meet client report requirements and quality standards while expanding capabilities into research and third-party administration over time.

Job Functions

• Handle all aspects of processing claims, including setting up claim files, data entry, scanning documents, and validating approvals regarding coverage and benefit limits.
• Set up and maintain a diary with follow-up and deadline dates.
• Respond to and contact providers, insureds, and other related parties to obtain and relay basic information for invoice processing.
• Coordinate and correspond with other departments to resolve claim and benefit-related issues.
• Provide ad hoc information as requested to support claim processing and special projects.
• Participate in administrative tasks including data entry, monthly account reconciliation, client report requirements, quality checks, and documentation requirements.
• Research claim issues and respond to claim inquiries from claimants and clients.

Education & Experience

• High school diploma or equivalent, with an associate's degree preferred.
• Minimum of 2 years of relevant administrative or clerical experience.
• Insurance Adjuster's License and experience using PeopleSoft Financials preferred but not required.
• Solid understanding of email programs such as Outlook and basic software applications and web browsers.
• Intermediate proficiency in Microsoft Office including Excel, Access, PowerPoint, and Word.
• Strong written and verbal communication skills.
• An emphasis on confidentiality, tact, and diplomacy.
• Good organizational and analytical skills with the ability to manage multiple high-priority tasks accurately and provide timely updates.

Claims Assistant coordinates queue management, claim payment processing, and mentoring of less experienced staff within a workers' compensation department operating under the rules and statutes of the WCAB, ensuring that open activities are distributed evenly and completed within departmental timelines. The department relies on this work to maintain accurate diaries, responsive customer service, and escalation of queue issues that affect compliance with state-mandated deadlines.

Strategic Responsibilities

• Manage assigned work queues by distributing and assigning open activities evenly among team members.
• Serve as process owner and backup to departmental work queues as assigned.
• Mentor and train less experienced staff as needed.
• Ensure work is completed promptly and within department goals and objectives.
• Provide customer service by answering telephones and redirecting callers as necessary.
• Provide backup coverage during team member absences.
• Assist in claims administration by making follow-up status calls to providers.
• Perform data entry to work diaries, create activity notes, and complete assigned work via diaries and queues promptly.
• Promptly escalate queue management issues affecting department timelines.
• Respond to all requests and inquiries from claims staff, vendors, and others as appropriate.

Required Qualifications

• 4-year degree required or equivalent knowledge of workers' compensation principles and policies preferred.
• 5 or more years of related administrative office work experience.
• Proficiency in MS Office software and PC applications and systems.
• Strong written and verbal communication skills.
• Attention to detail and deadline structures.
• Ability to work in a fast-paced environment both independently and collaboratively with all levels of staff.

The Claims Assistant executes institutional claims processing, adjudication, and EDI audit functions, interpreting Fee for Service and capitated provider contracts and applying knowledge of ICD-10, CPT, and HCPCS coding to ensure accurate payment and compliance with department quality standards. Reporting to claims management and interfacing with multiple departments to resolve billing issues, the Claims Assistant delivers the contract interpretation and coding accuracy that healthcare payers depend on to meet regulatory and reimbursement requirements.

Performance Expectations

• Accurately process institutional claims and edit and adjust claims per the EDI daily audit report.
• Analyze and adjudicate claims to ensure accurate payment.
• Interpret Fee for Service and capitated provider contracts.
• Review claims periodically and meet department quality and accuracy standards.
• Interface with other departments to obtain necessary information for resolution of claims.
• Advise management of any claim issues or inappropriate and incorrect billing.

Qualifications & Experience

• High school diploma or GED.
• 3 or more years of experience in facility claims processing.
• Medical insurance industry processing experience with experience in contract interpretation.
• Working knowledge of medical terminology, ICD-9, ICD-10, CPT, HCFA, and CMS 1500 forms.
• Medicare and HMO experience with revenue and HCPCS coding skills.
• Data entry experience.

Embedded within a claims administration unit, the Claims Assistant executes daily entry into the claims management system, processes Department of Labor forms, pays adjuster-approved invoices, and distributes mail to ensure that all claim files reach final resolution accurately and on time. Working closely with adjusters and management, the Claims Assistant enables clean file closure and compliant recordkeeping by scanning and saving medical reports, legal correspondence, and DOL documents across the department.

Areas of Ownership

• Assist in daily administration of claims, including entry into the claims management system.
• Design reports as requested and enter new vendors and contacts into the system.
• Manage invoice billing issues and questions.
• Process Department of Labor forms and claimant letters.
• Accurately pay all invoices as approved by the adjuster or manager.
• Perform general administrative duties including scanning and saving medical reports, invoices, legal correspondence, and DOL correspondence for all adjusters.
• Distribute all mail to appropriate adjusters on time.
• Close out files in the system when final resolution has been reached.

Skills & Qualifications

• High school diploma required, with some college classes preferred.
• 2 to 4 years of detailed administrative experience required.
• High proficiency in computer skills.
• Ability to communicate professionally with co-workers, management, clients, insureds, contractors, and other parties involved in the insurance claim process.
• Ability to work independently or in a group and take direction.

Reporting to claims leadership, the Claims Assistant creates foundational experience in insurance claim handling by performing data entry, bill payment, and client interactions with attorneys and outside vendors to support short-term claims processing. Partnering with customers, internal teams, and external parties, the Claims Assistant enables timely problem resolution and consistent customer service that meets the expectations of both internal and external stakeholders.

Role Responsibilities

• Perform basic claim handling functions including data entry, bill payment, and ordering reports from outside parties.
• Interact with clients, attorneys, and outside vendors to gather data and schedule appointments.
• Provide updates on irregularities and discrepancies to find appropriate solutions.
• Collaborate with customers to retrieve and relay information relevant to short-term claims.
• Identify and resolve problems and make time-sensitive decisions independently.
• Provide top-notch customer service by meeting the expectations and requirements of internal and external customers.

Education & Experience

• Bachelor's degree required, all majors encouraged to apply.
• Prior customer service experience in retail, restaurant, or other business settings.
• Strong interpersonal skills.
• Ability to collaborate and work effectively with individuals to strengthen relationships.
• Strong attention to detail while managing multiple concurrent project deadlines.

Claims Assistant coordinates FNOL intake, Loss Run retrieval, Subrogation reporting, and Arb invoice tracking across Environmental and Commercial Auto lines, ensuring that claim setup sheets are accurate and that acknowledgement and closing letters are dispatched on time. The work directly supports compliance requirements and risk-management outcomes by routing Arb Forums to TPAs, monitoring Excess files, and processing payments across multiple offices from a centralized claims support function.

Key Responsibilities

• Research policy and client information in claims systems and review new claims for accuracy after setup.
• Receive FNOLs and create Claim Setup sheets.
• Draft and send acknowledgement letters and closing letters.
• Monitor Excess files as assigned and review bills and process payments.
• Run multiple reports with unique timelines, including monthly Auto trackers, quarterly Subrogation reports, and ad hoc reports.
• Handle incoming and outgoing physical mail for multiple teams across multiple offices.
• Pull Loss Runs from TPAs and internal systems.
• Route daily Arb Forums to TPAs and track monthly Arb invoices.

Background & Experience

• Bachelor's degree preferred, with relevant job experience also considered.
• 3 to 5 years of Claims Administrative Support experience preferred.
• Experience in Environmental or Commercial Auto lines preferred.
• Experience with a claims case management system and understanding of the claims process required.
• Demonstrated knowledge of claims processes and compliance requirements.
• Proficiency in MS Word, Excel, PowerPoint, and PowerBI.
• Strong analytical capability.
• Excellent organizational, time management, communication, and interpersonal skills.
• A service and risk-management orientation.

A key member of a benefit claims processing team, the Claims Assistant reviews, investigates, and adjudicates Flexible Spending Account and Healthcare Reimbursement Arrangement claims in accordance with policy provisions, handling approximately 15 inbound calls daily while maintaining production and quality standards. Collaborating across medical and FSA and HRA systems to validate automated payment data and supporting team members with navigation and benefit determination questions, the Claims Assistant enables accurate reimbursement outcomes and responsive member service for a group insurance membership.

Core Responsibilities

• Review, investigate, and analyze Flexible Spending Account and Healthcare Reimbursement Arrangement claim information in accordance with policy provisions.
• Provide prompt and courteous customer service while maintaining claim production and quality standards, handling approximately 15 calls daily.
• Assist team members with processing and system navigation questions while making decisions on benefit determinations and adjudication of more complex claims.
• Answer incoming calls, emails, faxes, and written correspondence and analyze and respond to requests for benefit information and claim reconsideration reviews.
• Make outbound calls to members or service providers to obtain additional information for claim benefit determination or investigation of disputed benefits.
• Prepare written correspondence to respond to member or service provider inquiries.
• Review reports and validate data to facilitate automated payments between medical and FSA and HRA systems.
• Document system defects and enhancement requests, support the prioritization process, and perform business unit testing of system changes.
• Complete annual recurring premium processing and investigate debit card refunds and process refunds and claims accordingly.

Qualifications & Experience

• High school diploma plus 6 to 18 months of business, healthcare, or insurance-related education or equivalent experience.
• Minimum of 1 year of experience in a claim processing environment or at least 2 years in a healthcare or insurance-related field.
• Group insurance experience preferred, with knowledge of FSA and HRA plans helpful.
• Telephone customer service experience required.
• Proficiency in Microsoft Office including Excel, Word, and Outlook and ability to learn other software tools.
• Ability to manage multiple tasks, maintain production and accuracy goals, exercise judgment, define issues, and draw valid conclusions in a fast-paced environment.
• Strong written and verbal communication skills with the ability to de-escalate difficult customer calls.

Claims Assistant guides flood claim assignments, expert coordination, and FEMA reporting functions, including PIVOT data maintenance and Proof of Loss waiver processing, to support timely adjustment and compliance for a specialized flood claims department. The work directly supports adjusting firms, claims examiners, and legal counsel by maintaining claims databases, running Flood system reports, and cross-training across Underwriting, Customer Service, and Licensing to ensure continuity of service during high-volume periods.

What You'll Do

• Take first reports over the phone, by mail, or fax and process new losses as needed.
• Assign flood claims to the appropriate adjusting firm and claims examiner based on established criteria.
• Review electronic files to ensure all required information is available for the claims examiner.
• Manage the assignment and progress of experts including engineers, CPAs, salvors, and third-party mitigation specialists.
• Manage expert invoices following FEMA bill submission procedures and complete letters associated with claim handling for agents and insureds.
• Work closely with the Litigation and Compliance Manager to assist with legal matters and the needs of internal and external legal counsel.
• Assist with special projects, generate and maintain claims databases, spreadsheets, reports, and logs for the claim unit.
• Run and analyze reports from the Flood system and maintain FEMA reporting responsibilities including daily, weekly, and monthly polling reports and PIVOT data.
• Work closely with FEMA and assist claim examiners with approval requests such as Proof of Loss waivers, property address waivers, and waivers for limitation of coverage.
• Cross-train in other areas of the Flood Department including Underwriting, Customer Service, and Licensing to process endorsements and complete special projects as needed.
• Answer, assist, and direct internal and external callers for both claims and the Flood Customer Service department, managing inquiries received by email, fax, and mail.

Knowledge Skills & Abilities

• High school diploma or equivalent preferred.
• 1 year of claims experience and 1 year of data entry experience preferred.
• Prior insurance claims experience required.
• Strong analytical abilities.
• Experience in data and report analytics preferred.
• Strong knowledge of Microsoft Office, including Excel, Word, PowerPoint, and Outlook.
• Working knowledge of Microsoft Access preferred.

The Claims Assistant executes first- and third-party bodily injury auto claim investigations, liability determinations, and settlement negotiations in compliance with the Unfair Claims Settlement Practices Act and state insurance laws across all assigned states. Success in the position means adjudicating claims with minimal supervision, maintaining accurate reserves, and building professional relationships with insureds, claimants, agents, attorneys, and internal committees while completing continuing education to hold an active adjuster license.

Delivery Expectations

• Determine liability based upon investigation and applicable liability law, including forwarding required forms, obtaining appropriate releases, and negotiating settlements with clients or legal representatives.
• Conduct detailed phone investigations to determine liability and damages, obtain recorded statements, review police reports, and assess the appropriate method of inspection for first and third-party damages.
• Review loss notices and complex policy forms to determine proper coverage, investigate the facts surrounding the loss, and comply with the Unfair Claims Settlement Practices Act and insurance laws in all states assigned.
• Negotiate loss settlements based upon review of facts and establish and maintain proper reserves.
• Determine the suitable method of inspection and assign estimates and vendors.
• Draft professional written correspondence regarding various aspects of the claim.
• Communicate and promote professional relationships with insureds, claimants, agents, attorneys, and internal clients regarding the ongoing status of claim files.
• Review and recognize complex issues that require presentation to management, in-house counsel, defense counsel, and internal committee.
• Conclude claims in compliance with all state rules and regulations and adjudicate all aspects of the claims handling process under minimal supervision.
• Assist in mentoring other claims representatives and complete ongoing continuing education to maintain active adjuster licenses.

Experience & Qualifications

• High school diploma or equivalent required, with a four-year degree in Criminal Justice, Insurance and Risk Management, Business, or Communications preferred.
• Currently hold an appropriate state adjuster license or obtain one following the date of hire.
• 4 or more years of auto claims handling experience, including bodily injury.
• Understanding of statutes, case law, and policy contracts required.
• Working knowledge of CCC or equivalent estimating program preferred.
• Proficiency in Microsoft Office and internal systems.
• Ability to navigate multiple computer programs simultaneously.
• Excellent written and verbal communication skills.
• Strong negotiation, decision-making, time management, and prioritization skills.