Claim analyst Jobs in Boston, MA

We Enable Possibility

With a company culture rooted in collaboration, expertise and innovation, we aim to promote progress and inspire our clients, employees, investors and communities to achieve their greatest potential.

Position Responsibilities

Ensure compliance with all local, federal and state regulations related to claims while minimizing risk/exposure to the Arch organization.

Provide technical expertise and oversight to TPA adjusters handling workers compensation, auto liability & general Liability claims which also include handling and supervision of outsourced claims.

Work with our TPA's to ensure proper claims handling and service delivery, this includes:

• Performing claims oversight on claims with an expected value of over $50,000 for guaranteed cost policies and at 50% of the retention for deductible and self-insured business
• Attending mediations and trials.
• Granting reserve and settlement authority on cases above the TPA's authority
• Making coverage determinations and writing Reservation of Rights and coverage disclaimer letters
• Completing claims audits at TPA branch claims offices or online
• Handling or facilitating administrative tasks between Arch and the TPA to ensure seamless service delivery to the client.

Act as the Service Manager/Arch claims contact for all accounts written by NAC, which includes:

• Participating in client set-up meetings
• Participating in telephonic as well as in person claims reviews.
• Participating in mid-term meetings
• Helping to resolve any claims or service issues that arise

Work with Underwriting and Risk Control to assist in the risk selection process, which includes:

• Reviewing new/renewal submissions and commenting on any claims, legal or jurisdictional issues
• Addressing potential solutions to current claims or service problems
• Participating in meetings with brokers and/or prospective accounts
• Identifying loss trends on an account or book of business level
• Conducting due diligence reviews on new TPA's or accounts that want to self-administer claims.

Collaborate with other internal business units such as Finance, IT and Legal on any issues or projects that arise.

Address state and federal regulatory issues (Medicare issues, state insurance department audits/complaints, state workers compensation board requirements, etc.)

Candidate Skillset Requirements

Provided below are the guidelines the recruiter will use to source and qualify resume submissions:

• Bachelor's degree preferred.
• Exceptional communication (written and verbal), influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines.
• Strong problem-solving, analytical, organizational, multitasking, and time management skills
• Ability to take part in active strategic discussions.
• Ability to analyze and utilize data to make direct impact on claims outcomes.
• Minimum of ten (12) years' working experience overseeing and managing multi-line claims including auto liability, general liability, workers' compensation, products and professional liability for high deductible and self-insured accounts.
• Experience monitoring committee process.
• Proper Adjuster Licenses in all applicable states
• Ability to handle high severity claims.
• Knowledge & expertise with multiple jurisdictions
• Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word
• Ability to work independently and in a team environment.
• Willing and able to travel 25%.

Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you.