This is an advanced professional position responsible from inception to conclusion for unique, complex, or high monetary claims or evaluation of potential loss exposures and underwriting of claims. Employees independently develop effective strategies to satisfactorily resolve claims. When accepting a claim, employees at this level have the autonomy to evaluate the economic value and complete necessary documentation to award benefits up to a predetermined payment authority limit. Employees also complete administrative orders setting forth the claim decision based on the most appropriate laws, policy, and procedures. A position at this level may represent an area of knowledge (e.g. loss control) and provide functional expertise; provide advice on the most appropriate course of action; or provide testimony or other support to the legal process.
In addition to those identified in the previous levels: Knowledge of state laws, rules, and policies related to insurance and adjudication of claims. Ability to think critically and solve issues. Ability to interpret and apply policies and procedures, and develop solutions for unique situations.
Bachelor’s degree and 2-4 years of experience. (Substitutions may be allowed.)