Medical Only Claims Representative

About the Role

This role is remote in Illinois.

Key Responsibilities

• Manages an inventory of claims to evaluate compensability/liability.
• Conducts claim investigations to confirm coverage and to determine liability, compensability, and damages.
• Determines and may negotiate appropriate claim settlements/reserves within prescribed authority.
• May attend arbitrations, mediations, depositions, or trials.
• Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• May authorize payments in accordance with assigned authority limit and ensures payments are made in a timely manner.
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements.
• Performs other duties as assigned.

Requirements & Tech Stack

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field, or equivalent experience.
• Minimum of 6 months of experience in property and casualty claims handling.
• Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).
• Works within specific limits and authority on assignments of moderate technical complexity and coordination.
• Demonstrates functional analytical, negotiation, and problem-solving skills.
• Demonstrates knowledge of insurance policies, coverage, and claims handling procedures.
• Develops and maintains knowledge of industry laws and regulations.
• Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims.
• Strong interpersonal and communication skills with the ability to build relationships and handle negotiations.
• Proven ability to handle confidential information with discretion.