Claims Examiner

Overview

The Claims Examiner is responsible for the investigation, management, reserving and resolution of general and professional liability claims.  He or she provides exceptional client service by providing strategic claim guidance and communication with our clients aligned with claims handling best practices and client special handling. This role creates value by minimizing the liability risks for our clients.

Responsibilities

CLAIMS

• Investigates and processes claims
• Identifies PCEs (Potentially Compensable Events)
• Communicates with clients, claimants, counsel, vendors and other relevant parties related to claim management
• Evaluates and verify coverage on call claims
• Assesses liability and damages
• Assigns and manages vendors to include, defense counsel, experts, and other vendors as necessary based on the dynamics of the claim
• Sets claim reserves and ongoing evaluation of reserves
• Monitors and communicates policy aggregates
• Negotiates resolution of claims
• Attends claim reviews and trials and mediations, as warranted by claim
• Attends and presents at client board meetings
• Vets panel counsel, approving expert assignment as warranted
• Manages release execution on claim resolution
• Ensures Medicare interested have been addressed
• Adheres to client special handling
• Understands and follows TPA Services procedures

 

EXECUTION OF CLIENT SERVICE

• Works with both internal staff and external vendors to execute exceptional claims management services for each client, designed to achieve best possible outcomes on each claim
• Provides guidance to clients on claim evaluations and makes recommendations for claim strategies based on those discussions
• Builds personalized client relationships through demonstrated effective claims management and multiple channels of communication such as phone, e-mail and in-person meetings
• Leverages insurance knowledge and communication skills to explain coverage terms, program options and other items to clients as needed
• Manages time effectively to prioritize workload, client service requests and service parameters on business processes

 

DATA AND PROCESS INTEGRITY

• Consistently follows Assurance Best Practices and Client Special Handling in the execution of claim management
• Ensures data integrity within the RMIS System
• Accurately maintains complete client files including clear documentation of claim account detail in RMIS system   including basis for file reserves, coverage analysis, file strategy, Medicare compliance and communication
• Achieves desired levels of data completeness and process integrity by consistently meeting diary dates, quality metrics and goals

 

PEER RELATIONSHIPS

• Participates in ongoing scheduled meetings with service team to discuss accounts, renewals, service needs, service platform, etc.
• Develops successful and effective working relationships with agency and claims service team members, managers, carriers and members of other departments

Qualifications

REQUIRED:

• Adjuster licensing as required by states (to obtain after employment)

PREFERRED:

• BS/BA Degree
• JD
• AIC or SCLA Designation
• Proficient in Microsoft Office Suite
• 5+ years of claims handling experience at an agency or insurance carrier

About AssuranceAssurance, a Marsh & McLennan Agency LLC, company, is a full-service brokerage providing business insurance, employee benefits, private client insurance, and retirement services to businesses and individuals across the country. Assurance operates as Marsh & McLennan Agency's Midwest regional headquarters. Consistently recognized as a top workplace, Assurance attracts and retains its insurance talent by rewarding expertise and investing in career development. Assurance employees enjoy an award-winning culture that fosters a highly productive and results-driven working environment.

 

Services: Business Insurance, Employee Benefits, Financial Services, Private Insurance, SuretyAwards: Assurance is continually named a "Best Place to Work" by leading publications and organizations such as Fortune magazine, the National Association for Business Resources, The Chicago Tribune, Crain's Chicago Business and Business Insurance magazine (check out all of our accolades).Culture: Our employees enjoy an environment that fosters success and creativity and provides countless opportunities for growth. We make sure our employees are happy and motivated by offering enviable benefits, rewards programs, celebrations, perks and a few surprises around every corner. Together, it all adds up to a company that develops and retains passionate individuals who deliver superior performance and measurable results to our clients.

 

Fun Fact: 31% of Assurance experts agree the best Saturday Night Live skit of all time is "More Cowbell".

 

Assurance has won over a hundred workplace awards largely due to our intentional and caring approach that begins with meeting our people where they are, celebrating their differences and creating an inclusive environment.

 

Assurance is a proud equal opportunity employer. We celebrate diversity and we are committed to equal employment opportunities regardless of age, race, ethnicity, color, religion, creed, sex, sexual orientation, gender identity, gender expression, national origin, marital status or civil partnership/union status, veteran status, citizenship, pregnancy, genetic information, physical or mental disability, or any other status or characteristic protected by federal, state or local law.

 

Harassment or discrimination based upon any of the above is inconsistent with our values and will not be tolerated; this includes harassment or discrimination for being associated with or knowing someone that identifies with any of the above.

 

Marsh & McLennan Agency (MMA) provides colleagues the freedom to make a career and difference. We encourage you to explore your curiosity and creativity. We gain new insight from diverse thinking, and take risks on new ideas. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. We are always seeking those with ethics, talent, and ambition who are interested in joining our client-focused teams. More than just insurance brokers, we believe that a business culture that supports a healthy, safe work environment does so by offering the right benefits, programs, policies and opportunities to keep employees engaged and productive including: health and welfare, tuition assistance, 401K, employee assistance program, volunteer opportunities, and other programs.

Employment Type: FULL_TIME