Job Summary:

• Investigate cases from initial contact to resolution including research, analysis and synthesis of all medical facts
• Prepares concise reports, secures consultant reviews, directs and monitors attorney work product and executes recommendations regarding case resolution.
• Confirms coverage and resolves coverage issues in collaboration with Claims Management.
• Evaluates liability and damage information to establish consistent and appropriate indemnity and ALAE reserves consistent with Department guidelines. 
• Provides required documentation.
• Communicates with reinsurers and other involved parties in monitoring and resolving cases as appropriate.
• Approves bills and controls expense functions.
• Monitors trial activities and negotiates settlements within given authority, including direct negotiation with plaintiffs and plaintiff attorneys.
• Prepares and presents appropriate cases for all internal reviews.
• Attends trial-related activities including, but not limited to, arbitrations, mediations, settlement conferences, pre-trial conferences and trials as appropriate.
• Assists with various Team and Departmental projects

Skills on Resume: 

• Investigative Skills (Hard Skills)
• Report Writing (Hard Skills)
• Legal Coordination (Hard Skills)
• Coverage Confirmation (Hard Skills)
• Liability and Damage Evaluation (Hard Skills)
• Documentation Management (Hard Skills)
• Communication and Negotiation (Soft Skills)
• Trial Support (Soft Skills)

Job Summary:

• Pulls documents to prepare document packages as set forth by investor, insurer guidelines
• Contacts appropriate internal/external contacts if a document is not readily available
• Monitors mortgage insurance (MI) company websites for additional document requests
• Notifies clients of any MI company’s intent to deny a claim due to unobtainable documents
• Handles internal and external document requests via email
• Complies with and have working knowledge of all FHA, VA, PMI, investor, client, and master servicer rules and regulations
• Assists in training new employees
• Answer a high volume of inbound calls from existing and potential customers who have enquiries regarding motor insurance policies
• Consistently provide a superior customer service experience for customers, responding flexibly to evolving needs and managing expectations of the claim process
• Make liability determinations for some claim types
• Contribute to managing claims costs through effective pathing of vehicles for repair, and through excess collection
• Resolve inquiries in a timely manner

Skills on Resume: 

• Document Management (Hard Skills)
• Communication Skills (Soft Skills)
• Monitoring and Proactive Response (Hard Skills)
• Email Management (Hard Skills)
• Regulatory Knowledge (Hard Skills)
• Training and Mentorship (Soft Skills)
• Customer Service Excellence (Soft Skills)
• Claims Management (Hard Skills)

• Reporting to the Vice President, Claims & Legal and working as part of an integrated team, you will / Claims Specialist
• Job Summary:
• Assess relevant policies to determine coverage available.
• Research, gather and analyze documentation, including evidence, expert reports, legal pleadings, building codes, construction products and building systems.
• Evaluate liability and damages Working with internal and external experts
• Assess the potential extent of the policyholders’ liability to quantify damage sought or loss suffered by third party(s).
• Maintain accurate and timely reserves, actively and effectively mitigate and manage costs and expenses.   
• Engage professionals and consultants and assess liability. 
• Direct internal and external counsel and other consultants.
• WWorking with the VP Legal & Claims and both internal and external counsel
• Ensure appropriate litigation strategies are identified. 
• Support the full claims lifecycle including mediations, pre-trial conferences and other procedures, negotiations and settlements.
• Maintain a full and complete chronology of events for each claim.

Skills on Resume: 

• Policy Assessment (Hard Skills)
• Research and Analysis (Hard Skills)
• Liability Evaluation (Hard Skills)
• Reserve Management (Hard Skills)
• Engagement with Professionals (Hard Skills)
• Legal Oversight (Hard Skills)
• Litigation Strategy (Hard Skills)
• Documentation Management (Hard Skills)

Job Summary:

• Adopt a service-orientated approach that is focused on early intervention and the interests of workers and employers
• Assist in encouraging early conversations about lump sum entitlements and earlier evidence gathering to see payments occurring earlier on in the life of a claim
• Provide Whole Person Impairment advice to stakeholders such as workers, employers and providers
• Collaborate with Mobile Claims Specialists, Liability Specialists and other technical and support experts
• Assist and provide guidance to the worker and employer through the Whole Person Impairment process and provide support in the completion of relevant documents to ensure timely WPI determination
• Ensure that active and timely intervention occurs to improve recovery and return to work outcomes
• Receiving, organizing, reviewing, and resolving product complaints related to product safety and quality for Philips products.
• Requesting complaint failure investigations and ensuring returned products are sent to the appropriate facility for investigation.
• Making required contact attempts with the consumer via phone or email in order to gather all necessary information regarding complaint and retrieve the product for investigation.
• Providing consumer resolution for all received complaints.
• Checking requests to settle consumer claims
• Maintaining accurate and up to date records to ensure complete regulatory compliance
• Sharing feedback to the development and manufacturing teams on potential product improvements, product defects and safety evaluations.

Skills on Resume: 

• Claims Management (Hard Skills)
• Whole Person Impairment (WPI) Advice (Hard Skills)
• Process Guidance (Hard Skills)
• Complaint Handling (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Service-Oriented Approach (Soft Skills)
• Collaboration (Soft Skills)
• Intervention and Recovery (Soft Skills)

Job Summary:

• Ensure that customer complaints are dealt with efficiently and with the right level of sensitivity. 
• Monitor, respond to and engage with customers on various channels that may require both sales and service support. 
• Manage will mainly be UK customers (because of that, fluency in this language is essential)
• Investigating and resolving customer complaints through a variety of channels.
• Take ownership, ensuring the customer is kept informed of any developments relating to claim until a full resolution is reached.
• Provide feedback to internal stakeholders about results and potential improvements.
• Navigating the web site and the travel booking systems efficiently and effectively.
• Lead by example representing the values of the business.
• Reasonable accommodations may be made torts b enable individuals with disabilities to perform the essential functions.
• Processing of claims, conveyance, CWCOT, and/or liquidation.
• Work with internal and external business partners in conveyance and asset disposition processes.

Skills on Resume: 

• Customer Complaint Resolution (Hard Skills)
• Multichannel Customer Engagement (Hard Skills)
• Fluency in UK English (Hard Skills)
• Problem-Solving and Investigation (Hard Skills)
• Ownership and Communication (Hard Skills)
• Stakeholder Feedback (Soft Skills)
• Efficient System Navigation (Hard Skills)
• Leadership and Values Representation (Soft Skills)

Job Summary:

• Maintains accurate patient demographics and makes changes and updates as necessary.
• Performs verification of benefits and captures information in patient record.
• Supervises the prior authorization process from start to finish based on payor specific requirements.
• Reviews coding for accuracy and specificity prior to claim submission and works with providers to assure capture of accurate coding.
• Submits primary and secondary claims through clearinghouse and verifies payer acceptance
• Monitors clearinghouse dashboards to assure timely submission of all claims, identify roadblocks, and resolve held, rejected, and/or denied claims.
• Reads and interprets insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and takes appropriate steps to resolve issues.
• Posts payments into the PM system, captures remittance codes, and makes adjustments in accordance with Strata guidelines.
• Collects unpaid balances from patients and payors, monitors A/R Aging, and identifies denial trends.
• Prepares and sends Medical Records and appeals packets to insurance to secure appropriate reimbursement.
• Follows short-paid and non-paid claims from appeal through final claims adjudication.
• Resolves issues related to incorrect billing and resubmits corrected claims per payer guidelines.

Skills on Resume: 

• Attention to Detail (Hard Skills)
• Insurance Verification and Benefit Verification (Hard Skills)
• Prior Authorization Management (Hard Skills)
• Medical Coding Knowledge (Hard Skills)
• Claims Submission and Management (Hard Skills)
• EOB/RA Interpretation (Hard Skills)
• Payment Posting and Adjustment (Hard Skills)
• Accounts Receivable Management (Hard Skills)

Job Summary:

• Maintains patient ledgers, ensuring all receivables are collected promptly and accurately posted to patient accounts.
• Processes patient statements.
• Addresses incoming billing questions and disputes raised by patients with best-in-class service. 
• Reviews status of delinquent accounts and initiates collection activity per policy.
• Manages access to payor portals.
• Works closely with internal and external groups and to assure smooth workflow, thorough communication, and high-level of performance that meets and exceed stakeholder expectations.
• Documents all correspondence with insurance, clients, patients, and/or insurance in the patient records.
• Ensures compliance with all HIPAA/HITECH, applicable federal, state and local laws and regulations, and policies and procedures relating to documentation, coding and billing as legally required.
• Adheres to all relevant Strata policies and procedures.
• Presents professionally and communicates clearly both verbally and in written form.
• Demonstrates ability to solve problems and work as a positive member of a team.

Skills on Resume: 

• Accounts Receivable Management (Hard Skills)
• Billing and Statement Processing (Hard Skills)
• Customer Service Excellence (Soft Skills)
• Collections Management (Hard Skills)
• Payor Portal Management (Hard Skills)
• Workflow Coordination (Soft Skills)
• Documentation and Compliance (Hard Skills)
• Communication Skills (Soft Skills)

Job Summary:

• Use the ANZ Claims Team Operating Model and bespoke Client Engagement plans
• Improve the management of existing external client relationships
• Influence consistent standard methodology claims processes and procedures
• Proactively manage the claim portfolios of L&H clients, subject to treaty terms and conditions
• Use claims insights and services to support new business and product development
• Provide knowledge-sharing opportunities and technical direction to L&H clients.
• Training, audits, complex case consulting, and operational improvement activities.
• Actively assisting in the analysis of relevant insurance data 
• Assist with risk management and identification of future risks and opportunities
• Deploying technical claims management expertise
• Ensure sound decision-making (assessment and adjudication) in line with policy and regulatory frameworks
• Create and deliver client-focused services, in line with the client strategy

Skills on Resume: 

• Expertise in Claims Management (Hard Skills)
• Client Relationship Management (Soft Skills)
• Standard Methodology Development (Hard Skills)
• Business Development Support (Hard Skills)
• Knowledge Sharing and Technical Guidance (Soft Skills)
• Training and Audit Expertise (Hard Skills)
• Data Analysis and Risk Management (Hard Skills)
• Sound Decision-Making (Hard Skills)

Job Summary:

• Provides guidance, direction, and specialized assistance for the resolution of difficult and complex claims issues.
• Works on claims issues of significant risk or impact to the organization requiring advanced knowledge of claims principles.
• Presents claims findings in a formal environment.
• Documents and drafts reports of claims analysis findings.
• Reads and understands complex construction plans and documents.
• Correlates and organizes project documentation data.
• Researches claims data and oversee claims review.
• Reads project diaries and assigns CPM codes to contractors’ activities.
• Assists in training less experienced staff.
• Work with Loss Analysis on reconciliation/recognition process in partnership with vendors and internal customers.
• Adhere to all state, regulatory, federal, and investor requirements.
• Perform invoice review functions
• Review/approval of invoices to third parties including attorneys, field services, utilities, Condo/HOA and other vendors.

Skills on Resume: 

• Advanced Knowledge of Claims Principles (Hard Skills)
• Documentation and Reporting (Hard Skills)
• Analytical Skills (Hard Skills)
• Technical Understanding (Hard Skills)
• Presentation Skills (Hard Skills)
• Claims Resolution (Hard Skills)
• Training and Mentorship (Soft Skills)
• Compliance and Regulatory Knowledge (Hard Skills)

Job Summary:

• Read and interpret insurance documents and reinsurance contracts in order to analyze, resolve and process ceded accident & health reinsurance claims
• Review and understand accident and health claim records including clinical terminology, diagnostic and laboratory data, treatment plans, case management notes, and pharmaceutical dosing and pricing information
• Analyze reported losses via bordereaux or individual notifications to verify that the reinsurance claim was properly coded and promptly pay all accurately calculated valid losses
• Quickly identify large losses and/or developing trends on accounts serviced
• Contribute to client education support and special projects
• Works directly with ceding company and/or broker claims contacts
• Collaborates with internal underwriting, actuarial and technical accounting departments to resolve questions arising from claims and supports the determination of appropriate reserves and identify high-risk diagnoses for further review and pricing consideration
• Manage own portfolio of clients and undertake client visits, claim reviews and cedent audits
• Contribute to special claims analysis projects, RFP’s, presentations, onboarding of new clients, facilitating client education webinars, and perform other additional dutiesd
• Attends and participates in client meetings as appropriate
• Engage with and influence partners across Swiss Re, including relevant teams from L&H Products, Client Markets and L&H Business Management.
• Ensure compliance with claims guidelines and controls, with local and group guidelines

Skills on Resume: 

• Insurance Document Interpretation (Hard Skills)
• Medical Records Review (Hard Skills)
• Claims Analysis (Hard Skills)
• Risk Identification (Hard Skills)
• Client Interaction and Support (Soft Skills)
• Collaboration with Internal Departments (Soft Skills)
• Portfolio Management (Soft Skills)
• Project and Presentation Skills (Soft Skills)

Job Summary:

• Handling Paris Specialty Casualty, PI and Casualty claims through all stages
• Recording claims on relevant systems, coverage analysis, liability and quantum assessment, establishing and supervising appropriate reserves and making claims payments
• Handling of claims emanating from the Paris Third party book (a mix of primary/excess and lead/follow) with efficient service and results (
• Support, training/supervision of more junior members of the Claims team
• Overseeing and controlling relevant service suppliers, including external legal counsel, adjusters and other external representatives
• Providing support to the Paris and London Third Party Underwriting teams, Actuaries and Senior
• Management including advising on claims related information, drafting and/or approving policy wordings and endorsements, updating on legal trends, and more
• Reporting to local and global Senior Management, FP Underwriters, Actuaries and Risk Management as required by Claims Manager
• Ensuring effective, timely and accurate claims transaction processing and identifying and implementing day to day operational procedures to improve the claims handling process and/or control or improve cost efficiency
• Participate in and contribute as a member of the team on cross-functional initiatives and innovations

Skills on Resume: 

• Claims Handling Expertise (Hard Skills)
• System Proficiency (Hard Skills)
• Coverage Analysis (Hard Skills)
• Liability and Quantum Assessment (Hard Skills)
• Reserve Management (Hard Skills)
• Supplier Management (Hard Skills)
• Stakeholder Communication (Soft Skills)
• Operational Efficiency (Hard Skills)