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BMI Company, Inc. · 14 hours ago

Complex Claims Specialist

Billings, MO

Full-time

Onsite

Senior Level

5+ years exp

SurSafe Mutual Insurance Company is seeking a qualified applicant for the position of Complex Claims Specialist. The role involves investigating, evaluating, and settling complex claims while ensuring compliance with regulations and providing customer support throughout the claims process.

FinanceInsuranceService Industry

Responsibilities

Investigate high-level auto insurance claims by conducting detailed investigations, including recorded statements, scene analysis, and coordination with experts such as engineers, appraisers, attorneys and medical professionals

Maintain an average active pending caseload between 30 to 60 claims, aligned with claim complexity and company workload standards

Review policy terms to determine coverage and limitations

Evaluate and negotiate settlements within designated authority levels

Coordinate with legal counsel or external investigators

Prepare detailed claim reports and recommendations for payment or denial

Ensure compliance with federal, state, and company-specific regulations

Provide customer support throughout the claim resolution process

Serve as a technical resource for adjusters handling moderately complex claims

Identify trends, improvement opportunities, and best practices to support continuous learning and process improvement

Participate in cross-functional projects and initiatives as assigned

Qualification

Insurance policies knowledgeClaims management softwareDamage evaluationMicrosoft Office SuiteEmpathyCommunication skillsAttention to detailTime managementInterpersonal skills

Required

In depth knowledge of insurance policies, coverage rules and claim processes

Ability to evaluate damage estimates and repair costs

Strong written documentation and reporting skills to maintain regulatory compliance and accurate recordkeeping

Strong attention to detail is crucial for accuracy in data entry, document review, and ensuring policy correctness

Strong interpersonal, written, and verbal communication skills are essential for building rapport and conveying complex information clearly. Must be able to show empathy and professionalism when working with all individuals

Proficiency in Microsoft Office Suite (especially Excel and Word) and the ability to learn and utilize various computer software programs, familiarity with claims management software. (e.g. CCC)

The ability to work independently and prioritize time effectively is critical

Good time management and ability to handle multiple claims at once

Knowledge of Rules of the Road and traffic laws

Active adjusters license(s) as required by state regulations, or the ability to obtain Texas license within a specified timeframe

A minimum of a high school diploma or GED is required

A minimum of 5 years' previous experience in auto claims adjusting is required