What are the responsibilities and job description for the Claims Examiner position at eTeam?
Must have an active adjusters license for multiple states."
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 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.
Salary : $18 - $20
