What are the responsibilities and job description for the Sr. Claims Examiner position at RemX?
Job Summary :
The Senior Claims Examiner is responsible for evaluating and processing insurance claims, providing detailed analysis, and determining the extent of the insurance company's liability for various claims. This role requires a deep understanding of insurance policies, procedures, and regulations. Senior Claims Examiners also provide mentorship to junior examiners and ensure that all claims are handled in compliance with industry standards.
Key Responsibilities :
Claims Review and Processing :
Review complex claims files to assess the extent of damage or loss and determine liability.
Analyze coverage under the terms of the policy, ensuring all necessary documentation is provided.
Make decisions on claims settlements, including negotiation of claim amounts with claimants or service providers.
Ensure compliance with insurance regulations and company policies in all claims handling.
Claims Investigation :
Conduct investigations and obtain additional documentation or evidence if needed.
Interview claimants, witnesses, and experts to gather information and clarify details of the claim.
Evaluate the need for any third-party experts (e.g., adjusters, medical professionals, or forensic accountants).
Mentorship and Supervision :
Provide guidance and support to junior claims examiners, reviewing their work and ensuring they follow company protocols.
Assist in training and development programs for new claims examiners.
Reporting :
Prepare detailed reports of claim decisions, including justifications for approvals or denials.
Document all communication and decisions related to claims in the claims management system.
Collaborate with other departments, including underwriting, legal, and compliance, to resolve claims-related issues.
Claims Settlement :
Negotiate and settle claims within authority limits or prepare recommendations for higher-level approval when necessary.
Ensure accurate and timely disbursement of payments to claimants or third-party vendors.
Monitor outstanding claims to ensure timely resolution.
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