Industry: Private
Employment Type:- Full Time
Work Hours:- 8 Hours
Locations:- USA
Full Job Description:-
Responsibilities:
- Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Resolve complex, severe exposure claims, using high service-oriented file handling.
- Pay and process claims within designated authority level.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Confer with legal counsel on claims requiring litigation.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
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Qualifications/Education:
- Bachelor’s Degree.
- Licensing requirements vary by state: Active New York state adjuster's license required; multiple state licenses encouraged.
- Proficiency in analytical, document management, and database query software.
- Proficiency in Microsoft Office applications.
- Two to four years of work-related experience.
- Exceptional attention to detail.
- Excellent customer service and communication skills.
- General knowledge of state and national laws and regulations.
- General understanding of medical and legal terms.
- Experience in a claims production environment with set goals and quality scores that must be obtained.
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- a Claims Examiner for Travel Insurance Claims: 2 years (Required)
- Claims Examination Production environment: 1 year (Required)
License/Certification:
- Active NYand multiple state adjuster's license required; (Required)
