[Hiring] Senior Medical Only Claims Representative @Summit Insurance Group, Inc.

Role Description

Essential Job Functions and Responsibilities:

• Manages an inventory of claims to evaluate compensability/liability.
• Plans and conducts claim investigations to confirm coverage and to determine liability, compensability, and damages.
• Determines and negotiates appropriate claim settlements/reserves within prescribed authority. May attend arbitrations, mediations, depositions, or trials.
• Conveys moderately complex information regarding coverage and settlements to insureds, claimants, and external partners.
• Authorizes 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.
• This is a Medical Only position.
• This role is remote in Illinois.
• Performs other duties as assigned.

Qualifications

• Bachelor’s Degree in Business Administration, Risk Management and Insurance, Finance, or a related field or equivalent experience.
• Generally, a minimum of 5 years of experience in property and casualty claims handling.
• Completion of or continuing progress toward a professional designation preferred, such as Associate in Claims (AIC).

Requirements

• Works within significant limits and authority on assignments of higher technical complexity and coordination.
• Demonstrates strong analytical, negotiation, and problem-solving skills.
• Demonstrates knowledge of insurance policies, coverage, and claims handling procedures.
• Maintains knowledge of industry laws and regulations.
• Demonstrates ability to organize and prioritize caseloads, ensuring timely resolution of claims.
• Excellent interpersonal and communication skills with the ability to build relationships and lead negotiations.
• Proven ability to handle confidential information with discretion.
• This job is non-exempt in California and Washington.

Benefits

• Competitive benefits packages for full-time and part-time employees.
• Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees enjoy Paid Time Off and paid holidays.
• 401(k) plan with company match.
• Employee stock purchase plan and commuter benefits.