AddressClient: 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:
* 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.
Qualifications/Education:
* 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. Desired Qualities:
* General knowledge of state and national laws and regulations.
* General understanding of medical and legal terms.
