• Review and process insurance claims accurately using internal guidelines and benefit plans • Research and navigate multiple systems and documents to validate claim details • Confirm required documentation is included and identify missing information • Verify accuracy of medical coding (CPT/ICD-10 preferred) • Evaluate eligibility, coverage, authorizations, and coordination of benefits • Identify discrepancies and resolve errors using established procedures • Maintain productivity and quality standards in a fast-paced environment • Work independently while collaborating with supervisors, coaches, and trainers • Use multiple computer applications and virtual tools such as Outlook, Webex, and internal systems • Continuously improve efficiency through feedback and training support

• Review claim assignments to determine policy coverage and compensability • Make contact with insureds and their employees to research facts through interviews and document analysis • Establish rapport and an outcome-focused relationship with stakeholders throughout the claim process • Analyze medical records to determine compensability according to evidence-based causation • Propose and facilitate vocational support when appropriate • Identify subrogation potential and document evidence • Assess and re-assess claim file reserves with accuracy • Execute all technical claim handling functions

• Investigating, evaluating, and settling property claims within an assigned territory. • Conducting timely and thorough investigations. • Verifying applicable coverages and analyzing applicable coinsurance and deductible. • Estimating damages and evaluating for reserve and settlement. • Communicating resolution of claims through effectively negotiating, settling and/or denial. • Mentoring other Claims Specialists to further their development and skills.

Type forms and reports using Microsoft Word, operate standard office equipment, answer telephone calls, and assist with various departmental duties as needed to support efficient operations and communication.