Client: Insurance Industry

Title: Claim Examiner

Location: 100% Remote

Duration: 7 months

Job Description:

This is a Claims Examiner for Travel Insurance Claims

Must Have Active New York state adjuster's license required; multiple state licenses encouraged.

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:

• 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 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.
• Experience in a claims production environment with set goals and quality scores that must be obtained.