Adjudications Officer

About the Company

State Farm is a leading insurance and financial services company dedicated to helping people manage the risks of everyday life, recover from the unexpected, and realize their dreams. We protect what matters most and are committed to serving our customers and communities. With a strong presence across the United States, State Farm continually strives to be the first and best choice for our customers’ insurance and financial services needs.

Job Description

We are seeking a diligent and detail-oriented Adjudications Officer to join our team in Kansas City, MO. In this critical role, you will be responsible for reviewing, analyzing, and making informed decisions on complex claims and appeals, ensuring fairness, compliance, and adherence to company policies and regulatory requirements. The ideal candidate will possess strong analytical skills, exceptional judgment, and a commitment to upholding the highest standards of integrity. You will play a vital role in our claims process, directly impacting customer satisfaction and maintaining State Farm’s reputation for reliable service.

Key Responsibilities

• Conduct thorough reviews and investigations of submitted claims, appeals, and grievances.
• Analyze complex documentation, policy terms, medical records, and legal precedents to determine eligibility and appropriate resolutions.
• Interview relevant parties, gather additional information, and consult with subject matter experts as needed.
• Formulate clear, concise, and well-reasoned written decisions based on findings, policy, and regulations.
• Communicate decisions effectively to policyholders, legal representatives, and internal stakeholders, ensuring transparency and understanding.
• Maintain accurate and comprehensive case files, documenting all actions, communications, and decisions.
• Stay current with relevant laws, regulations, and industry best practices affecting claims adjudication.
• Identify and escalate potential fraudulent activities or policy violations.
• Collaborate with legal, compliance, and other departments to ensure consistent application of policies and procedures.

Required Skills

• Minimum of 3 years of experience in claims adjudication, legal support, or a similar analytical role.
• Strong analytical and critical thinking skills with the ability to interpret complex information.
• Excellent written and verbal communication skills for clear articulation of decisions and reasoning.
• Proven ability to exercise sound judgment and make independent decisions.
• High level of integrity and ethical conduct.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Bachelor's degree in Business, Legal Studies, Finance, or a related field.

Preferred Qualifications

• Experience in the insurance industry, particularly with property and casualty or life/health claims.
• Knowledge of relevant state and federal insurance regulations.
• Certifications in claims adjusting or legal studies.
• Master's degree or Juris Doctor (JD).

Perks & Benefits

• Comprehensive health, dental, and vision insurance plans.
• Paid time off and company-paid holidays.
• 401(k) retirement plan with company match.
• Tuition reimbursement program for continued education.
• Employee assistance program.
• Professional development and career growth opportunities.
• Wellness programs and resources.

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