Gallagher Claims Specialist in La Crescenta, California

Pronto Insurance is one of the fastest growing general agencies in South Texas. Our first agency was founded in 1997 and the managing general agency operations commenced in 2005. Pronto has emerged in the insurance market through its captive agencies, independent agents, and franchise locations. Today Pronto has over 160 captive locations in Texas and recent expansion into California and Florida market. Our vision is to become the industry leader by making Pronto Insurance products a reality for all.

Position Summary:

  • Investigates, evaluates personal injury claims in an assigned area to include verification of coverage, understand the extent of injuries, and determine benefits eligibility which may require contact by telephone or correspondence.

Essential Duties and Responsibilities:

  • Handles a high volume of claims in a virtual or centralized call center environment.

  • Ensures that all compliance requirements for claims handling correspondence are met in a timely and professional manner.

  • Resolves a large volume of claim calls and maintain claim handling policies and practices.

  • Issue payments as per discretionary settlement authority limits.

  • Adjust reserves properly and understand their impact on a claim.

  • Accountable to ensure the claim file is maintained in an organized manner and contains all relevant details to appropriately adjust the claim.

  • Establish and identify serious injury claims to Claims Management for further review.

  • Evaluates and monitors course of treatment, submitting files select files to Claims Management for duplicate billing, excessive treatment or fraud potential.

  • May require other duties.

Required:

  • High school diploma and 1 year of related claims experience required.

  • Appropriately licensed and/or certified in all states in which claims are being handled.

  • Knowledge of accepted industry standards and practices.

  • Proficient in basic computer skills.

Preferred:

  • Bachelor's Degree preferred.

  • Bilingual Spanish a plus.

  • Experience with related claims and business software.

Key Characteristics:

  • Excellent judgement and decision making skills to ensure claims are resolved in the best interest of the Company.

  • Ability to combine pieces of information to form conclusions necessary to determine coverage, evaluate liability and evaluate damage exposures to ensure the claims are paid in a fair and equitable manner.

Gallagher offers competitive salaries and benefits, including: medical/dental/vision plans, life and accident insurance, 401(K), employee stock purchase plan, educational expense reimbursement, employee assistance program, flexible work hours (availability varies by office and job function) training programs, matching gift program, and more.

Gallagher believes that all persons are entitled to equal employment opportunity and does not discriminate against nor favor any applicant because of race, color, religion, sex, age, veteran status, disability, national origin, or any other legally protected status. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Job: Claims

Organization: RPS Pronto

Title: Claims Specialist

Location: California-La Crescenta

Requisition ID: 46511