Claims Specialist

Summary:
Responsible for adjudicating PL, CL, Shipping and CarePlan claims as assigned.  The claims specialist also assists with administrative duties for the department, helping the team effectively negotiate and resolve claims in a timely manner and in accordance with established good faith handling procedures.    

Why Jewelers Mutual:

Since 1913 we’ve been committed to supporting the Jewelry industry and putting customers at the center of everything we do. With over a century of trusted expertise, we’re financially strong, forward-thinking, and driven by curiosity. Guided by our core values of Agility, Accountability, and Relevancy, we lead through innovation.

As a technology focused organization, we embrace cutting-edge tools and data-driven insights to continuously improve our products, services, and customer experience. Our mission is to be the industry’s most trusted advisor by investing in our people, adopting new technologies, and striving for excellence.

Here, you’ll:

• Move fast and embrace change


• Always look for better ways


• Grow, thrive, and help shape what’s next

Join us and be part of a culture where you can make an impact while building your future.

What You’ll Do:

• Investigates, evaluates, and resolves multi-line claims in accordance with established procedures, good faith practices, and in accordance with the policy.


• Examines claim adjustors’ reports or similar claims/precedents to determine extent of coverage and liability.


• Pays claimant/insured amount due according to our contractual obligation and in alignment with our company procedures.


• Identifies and refers questionable claims to the special investigation unit in accordance with established fraud reporting procedures. 


• Maintains excellent written and verbal correspondence with all parties involved on the claim.


• Evaluates and obtains damage documentation to accurately set reserves and effectively resolve claims.


• Maintains current status on claims and reviews claims on diary system.


• In rare circumstances, may be required to provide testimony under oath on claims in litigation.


• Provides quality customer service along with accurate and timely claim investigations and payments.


• Handles monthly bulk payments and applies recoveries as needed.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

What You’ll Bring:

Minimum Qualifications

• High School Diploma or GED


• Proficiency in Microsoft suite applications including Word, Excel, Outlook, and PowerPoint.


• Ability to obtain/maintain an adjuster’s license (product specific)

Preferred Qualifications

• Property/casualty insurance adjusting experience


• Jewelry expertise, including experience working in the jewelry trade


• Proficiency in Guidewire software

Physical Requirements

• Prolonged periods sitting at a desk and working on a computer.


• Occasionally required to stand; walk; use hands to finger, handle, or touch objects or controls; and talk or hear.