Claims Representative – Accident & Health ID-3319

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group’s member companies are subsidiaries of American Financial Group. We combine a “small company” culture where your ideas will be heard with “big company” expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow.

At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best.

POMI, the Accident & Health division of Great American Insurance Group, specializes in providing accident insurance tailored to businesses, organizations, individuals, and non-profits. Dedicated to protecting volunteers, participants, students, and athletes from the financial burdens of unexpected injuries, POMI prides itself on streamlining the insurance process. With a focus on providing peace of mind, POMI aims to deliver quick, reliable insurance solutions and exceptional service.

Position Overview: Accident & Health Claims Representative

We are seeking a driven and customer-focused Accident & Health Claims Representative who is eager to learn and grow in the insurance industry. The ideal candidate will have strong attention to detail, clear communication skills, and experience in claim processing. This role involves investigating, analyzing, and resolving claims while ensuring compliance with all legal requirements and company policies. The candidate will also support activities related to the expansion of the claims department per divisional objectives.

Essential Job Functions and Responsibilities:

• Investigate and Maintain Claims:
  • Reviews and evaluates coverage and liability.
  • Identifies and pursues subrogation opportunities.
  • Secures and analyzes necessary information (e.g. policies, medical bills, explanation of benefits, receipts, releases, reports, etc.) for claim investigations.
  • Inputs and processes claim-related data with precision.
• Claims Resolution:
  • Proactively works toward resolving claim files.
  • May affect settlements/ reserves within prescribed limits and make recommendations for cases exceeding personal authority.
  • Ensures timely and accurate issuance of claims payments.

• Communication and Professionalism:
  • Conveys simple to moderately complex information (coverage, deductibles, decisions, outcomes, claims process, etc.) clearly to all parties, maintaining professionalism.
  • Provides excellent customer service to internal and external stakeholders.
  • Collaborates with third-party administrators, providers, attorneys, insureds, claimants, agents, brokers, etc. for successful claims outcomes.
• Compliance:
  • Ensures claims handling adheres to file quality standards and complies with all statues, regulations, and legal requirements, and follows company procedures and policies.

• Other Duties:
  • Performs other duties or projects as assigned.
  • Successfully completes all required coursework, training/education, and can obtain licensing.

Key Qualifications: 

• Attention to Detail: Ability to meticulously review and evaluate information for accuracy and completeness.
• Clear Communication: Excellent verbal and written communication skills.
• Customer Service: Strong customer service focus, with experience in resolving issues.
• Customer-Facing Claims Processing: Experience with injury claims and associated medical bill processing.
• Critical Thinking: Strong problem-solving skills to navigate moderate situations and make well-informed decisions.

Preferred Experience: 

• Familiarity with Guidewire ClaimCenter claims handling software and systems.

Job Requirements:

• Education: Bachelor’s Degree or equivalent experience
• Field of Study: Liberal Arts, Business, or related discipline
• Experience: Generally, 6 months to 3 years of related experienc

Additional Information:

• This job is non-exempt in California, Colorado, New York, Washington.
• This position may require occasional travel.
• The successful candidate possesses the will and skill to gain industry expertise and product knowledge, reflecting successful progression through various job levels. Candidate will work within specific limits and authority on assignments of simple to moderate technical complexity. Demonstrates functional knowledge and skills of a fully competent examiner. Work is performed under moderate supervision.

Business Unit:

Accident & Health
Salary Range:

$50,000.00 -$58,000.00

Benefits:

Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role’s scope and complexity, along with business needs.

We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.

Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.