Senior Claims Representative - Accident & Health

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.

At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.

POMI, the Accident & Health division of Great American Insurance Group, specializes in providing accident insurance tailored to businesses, organizations, individuals, and non-profits. Dedicated to protecting volunteers, participants, students, and athletes from the financial burdens of unexpected injuries, POMI prides itself on streamlining the insurance process. With a focus on providing peace of mind, POMI aims to deliver quick, reliable insurance solutions and exceptional service.

Position Overview: Accident & Health Claims Representative

We are seeking a meticulous and customer-focused Senior Accident & Health Claims Representative. The ideal candidate will have strong attention to detail, clear communication skills, and experience in injury and medical bill processing. This role involves investigating, analyzing, and resolving claims while ensuring compliance with all legal requirements and company policies. The candidate will also support activities related to the expansion of the claims department per divisional objectives.

Essential Job Functions and Responsibilities:

• Investigate and Maintain Claims:
  • Reviews and evaluates coverage and liability.
  • Identifies and pursues subrogation opportunities.
  • Secures and analyzes necessary information (e.g. policies, medical bills, explanation of benefits, receipts, releases, reports, etc.) for claim investigations.
  • Inputs and processes claim-related data with precision.
• Claims Resolution:
  • Proactively works toward resolving claim files.
  • May affect settlements/ reserves within prescribed limits and make recommendations for cases exceeding personal authority.
  • Ensures timely and accurate issuance of claims payments.

• Communication and Professionalism:
  • Conveys moderately complex information (coverage, deductibles, decisions, outcomes, claims process, etc.) clearly to all parties, maintaining professionalism.
  • Provides excellent customer service to internal and external stakeholders.
  • Collaborates with third-party administrators, providers, attorneys, insureds, claimants, agents, brokers, etc. for successful claims outcomes.
• Compliance:
  • Ensures claims handling adheres to file quality standards and complies with all statues, regulations, and legal requirements, and follows company procedures and policies.

• Support and Guidance:
  • May provide guidance and assistance to junior positions and other functional areas.
• Other Duties:
  • Performs other duties or projects as assigned.
  • Successfully completes all required coursework and training/education.

Key Qualifications:

• Attention to Detail: Ability to meticulously review and evaluate information for accuracy and completeness.
• Clear Communication: Excellent verbal and written communication skills.
• Customer Service: Strong customer service focus, with experience in managing sensitive interactions and resolving issues.
• Injury and Medical Bill Processing: Skilled in handling injury claims and processing associated medical bills.
• Critical Thinking: Strong problem-solving skills to navigate complex situations and make well-informed decisions.

Preferred Experience:

• Familiarity with Guidewire ClaimCenter claims handling software and systems.
• Insurance Designation from The Institutes and/or the American Educational Institute
• Previous experience as a mentor or team lead is preferred.

Job Requirements:

• Education: Bachelor’s Degree or equivalent experience
• Field of Study: Liberal Arts, Business, or related discipline
• Experience: Generally, 3 to 5 years of related experience
• Claims Adjuster State Licensing: TX or FL preferred

Additional Information:

• This job is non-exempt in California.
• This position may require occasional travel.
• The successful candidate will demonstrate professionalism and a commitment to continuous improvement in claims handling practices. They should possess technical knowledge and skills, including product and industry expertise, reflecting successful progression through various job levels. Work is performed under general supervision.

Business Unit:

Salary Range:

Benefits:

Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.

We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.

Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.