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Sr. Claims Specialist

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Robert Half

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Location:
United States , Hinsdale

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Category:
Insurance

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Contract Type:
Contract work

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Salary:

70000.00 - 100000.00 USD / Year
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Job Description:

We are looking for an experienced Sr. Claims Specialist to support insurance follow-up operations in Hinsdale, Illinois. This Long-term Contract position is ideal for someone who is detail oriented and can independently manage complex claim activity, assess supporting evidence, and make sound decisions in fast-paced environments. The role blends traditional claims investigation with the use of AI-enabled tools to strengthen fraud analysis, claim evaluation, and documentation quality.

Job Responsibility:

  • Oversee an active caseload of claims, maintaining consistent review and follow-up to move files efficiently through investigation and resolution.
  • Examine claim records, supporting documents, statements, images, and prior file history to identify key facts, inconsistencies, and potential exposure.
  • Determine appropriate claim outcomes by applying policy guidance and evidence, including approvals, denials, or referral for legal escalation when warranted.
  • Use AI-supported resources such as fraud scoring, severity forecasting, image review, and document extraction tools to inform claim handling decisions.
  • Assess automated insights critically, confirming accuracy and using careful judgment to adjust or override recommendations when necessary.
  • Perform detailed fraud-related analysis on flagged claims to support fair, compliant, and well-documented decision-making.
  • Navigate both established claims applications and newer digital platforms to complete case activity and maintain workflow continuity.
  • Gather evidence manually across multiple systems and data sources when automated information is incomplete or requires verification.

Requirements:

  • Demonstrated experience handling insurance claims, claim investigations, or fraud-related file reviews in a high-volume setting.
  • Strong knowledge of the full claims process, from initial review and evidence analysis through adjudication and escalation.
  • Practical experience working with AI tools used in claims or fraud workflows, including scoring models, predictive analytics, or automated document and image review.
  • Ability to evaluate AI-generated findings, identify limitations, and make justified adjustments based on claim facts and compliance standards.
  • Hands-on familiarity with legacy claims systems as well as modern claims platforms that include embedded or integrated AI capabilities.
  • Solid understanding of documentation practices, including clear recording of claim decisions, supporting rationale, and AI-related overrides.
  • Knowledge of evidence standards for disputed claims, denials, and matters that may require litigation support.
  • Strong analytical ability, attention to detail, and skill in synthesizing information from multiple sources into accurate claim assessments.
What we offer:
  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan

Additional Information:

Job Posted:
May 15, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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