- 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.
- Licensing requirements vary by state.
- Proficiency in analytical, document management, and database query software.
- Proficiency in MS 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.
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Claim Examiner
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Claim Examiner - New York, United States - Collabera
Description
Client:
Management and Consulting company
Title:
Claim Examiner
Location: 100% Remote (Work from home)
Rates:
$18/hr $20/hr
Duration: 6 Months
Note:
Adjuster license in New York State and Washington State is Required
Job Description:
Claims processing experience required
Adjuster license in New York State and Washington State is Required
Responsibilities:
Qualifications/Education:
Desired Qualities:
