Allstate Hiring for Sr. Claim Service Adjuster (A3) (Home-bases Remote) Job at Remote Full Time

The world isn’t standing still, and neither is Allstate. We’re moving quickly, looking across our businesses and brands and taking bold steps to better serve customers’ evolving needs. That’s why now is an exciting time to join our team. You’ll have opportunities to take risks, challenge the status quo and shape the future for the greater good.

You’ll do all this in an environment of excellence and the highest ethical standards – a place where values such as integrity, inclusive diversity and accountability are paramount. We empower every employee to lead, drive change and give back where they work and live. Our people are our greatest strength, and we work as one team in service of our customers and communities.

Everything we do at Allstate is driven by a shared purpose: to protect people from life’s uncertainties so they can realize their hopes and dreams. For more than 89 years we’ve thrived by staying a step ahead of whatever’s coming next – to give customers peace of mind no matter what changes they face. We acted with conviction to advocate for seat belts, air bags and graduated driving laws. We help give survivors of domestic violence a voice through financial empowerment. We’ve been an industry leader in pricing sophistication, telematics, digital photo claims and, more recently, device and identity protection. We are the Good Hands. We don’t follow the trends. We set them. Job Summary:

The Adjusting Function is responsible for verifying policy coverage and limits. The Adjusting function investigates and evaluates damage and/or liability; estimates damages, losses, or total indemnity; sets and maintains reserves; and/or negotiates and settles claims. First party claims involve coverage determination, investigation, negotiation, and resolution of eligible injured parties’ claims.

Under general supervision, this job is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under a personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is limited and occasionally when the policy limits or exposure to the company is moderate. This individual determines coverage and assesses medical claims, evaluates medical bills, and initiates or reviews potential fraud investigations as warranted. The individual explains coverage, negotiates and settles claims, and follows up with the customer on continuing treatments while delivering compassionate service that is fast, fair, and easy, to ensure customer retention. At this level, the individual typically negotiates and settles moderately complex claims, such as claims in less regulated and occasionally moderately regulated states (or in some situations more complex claims with guidance as needed). The individual is capable of working independently, prioritizing the individual’s own responsibilities, and managing the individual’s own workload. The individual also consistently meets band level behaviors, production, quality, and/or customer service goals.

Key Responsibilities:
Customer Service

Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met

Researches and responds to moderately complex customer communications, concerns, conflicts or issues

File Documentation and Reporting

Summarizes documents and enters into claim system notes

Documents a claim file with notes, evaluations and decision making process

Processes medical bills and recognizes medical management opportunities

Medical Management (1st Party)

Assesses medical/physical condition and prior injuries of claimant, and obtains and analyzes medical bills, wage loss reviews, home service or attendant care, mileage payments, and other related claims to determine reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing

Conducts first party file processing/fact gathering, including interviewing claimant, witnesses, medical providers, etc.

Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable

Sets up IME and reviews results

Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage; and investigates coverage denial questions

Determines appropriate benefit and negotiates and settles moderately complex claims, including resolution of moderately complex usual and customary billings

Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims

Handles specialized claims

Other Projects and Responsibilities

May participate in one or more moderately complex special assignments

May serve as a committee team lead for smaller projects or as a committee team member on medium projects

Reviews subpoenas and non-complex demands (e.g., Florida demands)

May serve as an agent advocate

May prepare and negotiate moderately complex subrogation issues or arbitrations

Knowledge/Skills/Abilities/Experience:
Bachelors degree in related field preferred or equivalent experience

Ability to interact effectively with internal or external customers and act with empathy

Applies general knowledge of insurance policy, coverage, and regulation

Applies general knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards

Applies general industry knowledge to discipline practices, including best practices, to support the business unit

Applies general knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data

Applies general knowledge of standardized problem solving and preparation of basic reports for analysis

Applies general ability to leverage learned technical skills in support of team objectives

Applies general negotiation and/or arbitration skills

Applies general conflict management and problem resolution skills in managing internal and external customer relationships

Ability to investigate, evaluate negotiate and settle moderately complex claims

Provides individual decision making within authority limits

Has and maintains all appropriate licenses and registrations for the role per state requirements

Notes: The preceding description is not designed to be a complete list of all duties and responsibilities. May be required to perform other related duties as assigned. Regular, predictable attendance is an essential function of this job.

Compensation offered for this role is $47,200.00-$71,725.00 per year and is based on experience and qualifications.

The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.

Good Work. Good Life. Good Hands®.

As a Fortune 100 company and industry leader, we provide a competitive salary – but that’s just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you’ll have access to a wide variety of programs to help you balance your work and personal life — including a generous paid time off policy. For a full description of Allstate’s benefits, visit allstate.jobs/benefits/

Learn more about life at Allstate. Connect with us on Twitter , Facebook , Instagram and LinkedIn or watch a video .

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

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