Summary: Investigates, evaluates, negotiates, and settles covered claims within assigned authority. This position plays a key role in delivering prompt, professional claims service while maintaining strong relationships with policyholders, agents, attorneys, and others involved in the claims process. This position will work remotely in northeast North Dakota, preferably in the Devils Lake area.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Conducts thorough and timely investigations by gathering and evaluating relevant information, including statements, reports, records, photographs, estimates, invoices, and expert opinions as needed.
• Analyzes coverage, liability, damages, and claim-related issues by interpreting policy language, applicable laws, regulations, and company guidelines to determine appropriate claim resolution.
• Maintains accurate, organized, and well-documented claim files, including notes, forms, worksheets, reports, and supporting documentation to ensure proper claim handling and file management.
• Reviews bills, estimates, appraisals, medical documentation, repair documentation, and other claim-related materials for accuracy, reasonableness, and compliance with policy provisions and company standards.
• Evaluates claims and negotiates fair, timely, and cost-effective settlements within established authority limits; prepares recommendations for additional authority when necessary.
• Communicates claim decisions, coverage determinations, settlement explanations, and claim status updates clearly and professionally with customers, claimants, attorneys, vendors, repair facilities, medical providers, and other involved parties.
• Coordinates with internal departments, external vendors, independent adjusters, appraisers, attorneys, medical professionals, engineers, or other specialists as needed to support effective and efficient claim resolution.
• Ensures compliance with company policies, regulatory requirements, service standards, and applicable state laws throughout the claim handling process.
• Manages assigned claim inventory effectively by prioritizing workload, maintaining diary follow-up, meeting established deadlines, and achieving quality and productivity expectations.
• Identifies subrogation potential early in the claim process and takes the necessary actions to preserve evidence and protect the company’s subrogation rights.