The specialist supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements, focusing on timely review and accurate case resolution. Key duties include performing data entry, preparing correspondence, investigating requests, conducting research, and preparing case files for review.

The adjuster will review and process Personal Injury Protection (PIP) claims, ensuring compliance with company policies and state regulations by assessing validity, determining coverage limits, and facilitating settlements. Duties include analyzing documentation, communicating with involved parties, conducting interviews, and maintaining organized claim files.

Material Damage Claims Adjuster handling auto claims

The manager makes timely, accurate, and customer-focused Long-Term Disability claim decisions on moderately complex to highly complex claims using advanced independent discretion guided by company procedures and regulatory standards. They document claims accurately, prepare claim management plans, maintain empathetic customer service, and work collaboratively with internal partners.