Claims Analyst

The Claims Analyst will: utilize experience within commercial property and casualty claims to monitor and assess claims activity of Third-Party Administrators (TPAs); use direct systems to access and monitor claim files, denials, reservations of rights, and settlements conducted by TPAs; verify that the TPAs are performing within their authority, pursuant to agree upon processes and practices, within the agreed upon territories and market segments; consult with the Credit Risk, Legal, Compliance, Finance, Underwriting, and IT departments to identify specific trends or problems within a program; keep records of all monitoring activity and report to the management team, including both quantitative and qualitative measures and assessments. The Claims Analyst will also develop a long-term relationship with the TPA staff and the third-party reinsurance panel participating in the risk of the program through the appropriate reinsurance broker, and will internally and externally communicate any observations, problems, trends, strengths, and opportunities discovered. The goal of the position is growing the business and maintaining and improve the program results for the benefit of Clear Blue and the other stakeholders, including the agencies and participating reinsurance companies. MAIN DUTIES AND RESPONSIBILITIESProviding front-line oversight of Third-Party Administrators’ personnel through direct communication and monitoring claims online using the Third-Party Administrators’ claim systems. Identifying, analyzing, and discussing monthly loss run trends, reportable claims and/or problematic claims. Providing excellent claim service to external clients and internal partners. Participating in claim file reviews with agents, brokers and Third-Party Administrators’ claim personnel. Interfacing with Clear Blue and external underwriting on claim status, exposures, and other factors impacting their risks. Preparing and presenting internal management reports for large losses and large loss potential; usually over $250,000. Conducting remote and onsite claim file audits of Third-Party Administrators. Performing other duties as required by management including reinsurance and subrogation. Focus on monthly auditing of Third-Party Administrators EDUCATION AND QUALIFICATIONS• Associate’s or Bachelor’s degree in insurance, finance, or risk management; or equivalent related experience. • AIC certification preferred, or other relevant course work. REQUIREMENTSOne (1) to Three (3) years of experience in claim handling, quality assurance, relevant litigation, TPA management, or equivalent related experience. Demonstrated success in evaluating claims, making coverage determinations based on policy provisions, and managing litigation. Strong communication (verbal and written) and interpersonal skills. Some travel might be required and will vary depending on business needs and caseload. Working knowledge of Microsoft Office. Ability to manage time effectively, set priorities and meet deadlines. The responsibilities of this position require continuous interaction internally (executive team, managers, supervisors, and fellow associates) and externally (with TPAs, managing general agents, reinsurers, and brokers/intermediaries). GENERAL SKILLSTeamwork and ability to work and interact with departments throughout the organization Time management Excellent attention to detail Ability to safeguard confidential information. PHYSICAL AND MENTAL DEMANDSThe position requires sitting, standing, and walking associated with a normal office environment, talking and hearing. This position requires minimal weightlifting or force exertion. ENVIRONMENTAL AND WORKING CONDITIONSThe Claims Analyst is exposed to a general normal office environment and some travel. The Claims Analyst may work occasionally in the evenings or weekends. The noise in the work environment is moderate. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.