Insurance Claims Specialist

JOB SUMMARY:

The Insurance Claims Specialist will be responsible for overseeing, investigating, and managing insurance claims for Workers' Compensation, Employment Practices Liability Insurance (EPLI), General Liability (GL), and Professional Liability (PL) for our assisted living organization with communities across New York and New Jersey. The Insurance Claims Specialist will work closely with the VP of Risk Management mitigating risks, promoting a safe environment for both residents and staff, supporting operational risk initiatives, and safeguarding company resources. This role is integral to supporting the financial health of the organization by collaborating closely with the finance team ensuring accurate invoicing, providing actionable data analysis, ensuring compliance and optimizing claims outcomes.

 

DUTIES AND KEY RESPONSIBILITIES:

1. Claims Management and Oversight
   • Manage and oversee workers' compensation, EPLI, GL, and PL claims from initial reporting through resolution.
   • Respond to inquiries and concerns regarding new and existing claims
   • Conduct timely and thorough investigations, coordinating with internal and external stakeholders, requesting/reviewing witness statements, video footage etc. and ensure all claims are accurately documented and supported.
   • Collaborate with claim and broker partners, build and maintain strong relationships to ensure effective claims handling and dispute resolution.
   • Maintain clear, consistent communication with Vice President of Risk Management, various team members, business partners, and other stakeholders regarding claims handling and their resolutions.
2. Compliance and Reporting
   • Ensure all claims processes adhere to state regulations and company policies, maintaining compliance with industry standards.
   • Prepare and maintain regular reports on claims status, costs, and outcomes for internal review and regulatory purposes.
   • Monitor claim trends and identify risk mitigation opportunities.
3. Financial Coordination and Invoicing
   • Coordinate with the finance team to ensure accurate claims invoicing, payment tracking, and budgeting.
   • Support the finance team with forecasting and financial planning related to insurance claims and associated expenses.
   • Work with finance team to place and monitor appropriate reserves and allocate funds.
4. Data Analytics and Reporting
   • Analyze claims data to provide insights into claim trends, financial impact, and risk management strategies.
   • Develop and maintain dashboards and reporting tools to communicate claims data with key stakeholders.
   • Use data insights to recommend and implement improvements to claims processes and cost-saving initiatives.
5. Collaboration and Communication
   • Work closely with VP of Risk Management, finance, HR, and community leadership teams to streamline claims processing and minimize organizational risk.
   • Serve as a primary point of contact for insurance carriers, third-party administrators, and internal teams on claims-related matters.
   • Provide regular updates to management on claims status, strategic initiatives, and risk trends.
   • Educate team members and on-site staff about claim reporting procedures, documentation best practices, and risk mitigation strategies.
   • Assist in training sessions on safety and risk prevention, fostering a culture of proactive incident management.

 

QUALIFICATIONS:

• 3-5 years of experience in insurance claims management, preferably within the healthcare or assisted living industry.
• Associate’s degree required. 
• Excellent customer service skills
• Strong analytical and problem-solving skills to investigate and diagnose claim driven issues
• Aptitude to investigate complaints for facts and recommend resolutions in a timely manner
• Exceptional interpersonal, verbal, and written communication skills
• Proven customer relationship and conflict resolution skills
• Ability to develop and maintain strong working relationships with internal and external parties
• Strong attention to detail and accuracy in data entry and record keeping
• Must be willing to travel to various community locations for meetings, investigations, and internal audits as required.