Insurance Resolution Specialist at PANTHERx handling patient pharmacy and medical claims. Verifying claims, processing authorizations, and coordinating with insurance providers in a hybrid role.
About the role
- Workers' Compensation Claims Specialist managing multi-party claims of moderate to high complexity. Join Zurich's team in Las Vegas to ensure efficient, customer-focused claims service.
Responsibilities
- Handle multi-party personal or commercial line Workers’ Compensation claims of moderate to high exposure and complexity
- Document claims file by accurately capturing and updating claims data/information in compliance with best practices
- Exercise judgment to determine liability by gathering and analyzing relevant facts
- Exercise judgment to determine policy verification and coverage determination
- Work to have a timely resolution to claims by developing case strategy
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit
- Assess damages by calculating applicable damages or range of damages allowed by law
- Negotiate settlement of claim by establishing appropriate negotiation strategy
- Meet quality standards by following best practices
Requirements
- Bachelor’s Degree and 6 or more years of experience in the Claims and/ or Litigation Management area
- OR Juris Doctor and 2 or more years of experience in the Claims and/ or Litigation Management area
- OR Zurich Certified Insurance Apprentice, including an Associate Degree with 6 or more years of experience in the Claims and/ or Litigation Management area
- OR Completion of Zurich Claims Training Program and 6 or more years of experience in the Claims and/ or Litigation Management area
- OR High School Diploma Equivalent and 8 or more years of experience in the Claims and/ or Litigation Management area
- AND Must obtain and maintain required adjuster license(s) in the state of Nevada
- Microsoft Office experience
- Knowledge of insurance regulations, markets and products
Benefits
- Competitive pay and comprehensive benefits for employees and their families
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