What are the responsibilities and job description for the Claims Examiner position at Success Spark Solutions?
Top Reasons to Work with our client
- Great work-life balance!
- Market leader in commercial insurance and risk management!
- Offer a wide range of career paths and opportunities for growth!
- Competitive Compensation and Benefits: health insurance, retirement plans, and other benefits!
- Investigate and manage workers' compensation claims in multiple jurisdictions.
- Handle medical and litigation management to drive claims to closure.
- Coordinate with nurse case managers, counsel, external vendors, and insureds for efficient claims handling.
- Complete and document initial loss investigations to determine compensability.
- Establish initial and subsequent reserves to ensure adequacy for anticipated exposure.
- Review medical bills for causal relationship to reported claims.
- Liaise with insureds, nurse case managers, and counsel to manage claims and facilitate returns to work.
- Develop and maintain action plans to ensure reserve adequacy and timely resolution of claims.
- Negotiate settlement of claims within designated authority.
- Prepare and present claim review summaries for insureds, brokers, and internal contacts as requested.
- Participate in roundtable discussions with insureds and counsel on strategies for successful claim closure/resolutions.
- Provide guidance and assistance to insureds and brokers on timely reporting of claims.
- Manage insured onboarding, including training on claims reporting and the use of the insured portal.
- Bachelor’s degree preferred.
- Professional designation such as CPCU, ARM, CRM, or similar preferred.
- Proficient in Microsoft Office with an aptitude to learn other software applications.
- Excellent oral and written communication skills.
- Detail-oriented with a high accuracy rate.
- Strong critical thinking and organizational skills.
- Ability to problem solve and use good judgment.
- Self-motivated with excellent time management skills.
- 5 years adjusting workers' compensation claims in multiple jurisdictions.
- Experience in NY, NJ, and PA preferred; NY experience required.
- Experience in the healthcare industry preferred.
- Experience in the construction industry preferred.
- 5-7 years experience as a Workers' Compensation loss time claim adjuster.
Salary : $80,000 - $115,000
