Claims Resolution Specialist II, No Fault

• Manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates liability, medical necessity, causality and settles claims within prescribed authority. • Communicates with policyholders, agents, witnesses, and claimants in order to gather information regarding claims and refers tasks to auxiliary resources as necessary. Responds to various written and telephone inquiries including status reports. • Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim. • Ensures adequacy of reserves and settlement authority. • Confirms or denies coverage and liability and advises policyholders, agents and claimants as to proper course of action. • Makes effective use of loss management techniques (IMEs, Nurse Review, and Bill Review). Negotiates settlements with attorneys, claimants, and medical providers. Arranges for expert inspections involving third party or potential fraud actions as needed. • Updates files and provides comprehensive reports as required. • Identifies and recommends referral of potentially fraudulent claims to the Special Investigation Unit. • Recognizes continuous improvement opportunities and develops.

• Strong written and oral communications skills required. Good interpersonal, analytical, decision making, and negotiation skills required. • Customer service experience preferred. • Knowledge of legal liability, general insurance policy coverage and the ability to review and understand medical records to determine causality and medical necessity. • The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 6-12 months of directly related experience. • Ability to obtain proper licensing as required.

Description Manages, investigates and resolves medical claims assigned by the Claims Team Manager and assists in providing service to policyholders and agents under general supervision. May perform field investigation on assigned cases and make recommendations on additional work as indicated. Recognizes and solves problems of moderate scope and complexity. Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory NJ No Fault experience is required. Responsibilities: • Manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates liability, medical necessity, causality and settles claims within prescribed authority. • Communicates with policyholders, agents, witnesses, and claimants in order to gather information regarding claims and refers tasks to auxiliary resources as necessary. Responds to various written and telephone inquiries including status reports. • Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim. • Ensures adequacy of reserves and settlement authority. • Confirms or denies coverage and liability and advises policyholders, agents and claimants as to proper course of action. • Makes effective use of loss management techniques (IMEs, Nurse Review, and Bill Review). Negotiates settlements with attorneys, claimants, and medical providers. Arranges for expert inspections involving third party or potential fraud actions as needed. • Updates files and provides comprehensive reports as required. • Identifies and recommends referral of potentially fraudulent claims to the Special Investigation Unit. • Recognizes continuous improvement opportunities and develops. Qualifications • Strong written and oral communications skills required. Good interpersonal, analytical, decision making, and negotiation skills required. • Customer service experience preferred. • Knowledge of legal liability, general insurance policy coverage and the ability to review and understand medical records to determine causality and medical necessity. • The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 6-12 months of directly related experience. • Ability to obtain proper licensing as required. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices • California • Los Angeles Incorporated • Los Angeles Unincorporated • Philadelphia • San Francisco Originally posted on Himalayas Claims-Resolution, Insurance-Claims, No-Fault-Claims, Claims-Investigation, Medical-Claims-Processing, Claims-Resolution-Specialist, Claims-Operations-Specialist, Claims-Generalist-(P&C)