Claims Examiner

The Claims Examiner will be responsible for the investigation, evaluation, establishment of exposure, negotiation, and settlement of claims. Ensures all assigned claims are concluded promptly, equitably, and economically within the provisions of the policy contract and in accordance with the damages presented.

Essential Job Duties

• Receives a controlled number of new losses daily for handling.
• Reviews loss for purposes of coverage verification and potential exposure.
• Recommends and enters potential exposures to management for approval within company guidelines.
• If coverage cannot be verified, refer to management for further instructions and completes coverage investigation as directed.
• Promptly contacts insureds and claimants and conducts an investigation into the facts of the loss as directed and within company guidelines for Best Practices.
• Excellent customer service in all aspects of claims handling.
• With the guidance of management, determines liability using sound judgement and analysis of available facts.
• Answers correspondence received in conjunction with the claim in accordance with state guidelines. Returns telephone calls within 24 hours.
• Handles all claims within the guidelines of the state to which the trainee is assigned and in conjunction with the insurance laws and any other laws applicable to that claim. Adhere to Fair Claim Practices Acts established within a respective state.
• Makes investigative reports promptly to the file with clear and concise file documentation. Makes initial reports to the files as directed by management.
• Communicates effectively both orally and in writing with management and non-management personnel as well as insureds, claimants, agents, attorneys, appraisers, doctors and other insurance carriers and state insurance departments.
• Payments made in accordance with the laws established by the state. All payments are to be made within the guidelines for Best Practices.
• Negotiates settlement of claims with insureds, claimants and attorneys following established, authorized settlement authority under the guidance of management.
• Maintains a working diary as per Company guidelines for each assigned claim file which includes timely, accurate entry of data.
• Ensures that all subrogation is quickly identified and that proper subrogation letters are sent to responsible parties. Ensure that subrogation is entered into the claim system immediately.

Educational and Qualification Requirements

• Bachelor’s degree required; Risk Management degree preferred.
• Strong communication skills.
• Strong customer service skills.
• Participate in courses and other selected self-study courses with an acceptable level of competencies pertaining to the position.
• Must prepare for any state licensing exams to fulfill licensing requirement. Employee must be in compliance with any state licenses.

Utica First offers a competitive salary and benefits package to include:

• Medical (first of following month)
• Dental
• Vision
• Company paid Life and Disability Insurance
• Flexible Spending Accounts
• Health Savings Account (90% of deductible funded by employer)
• Matching 401(k) Plan
• Roth 401 (k) Plan
• Bonus program
• Generous Paid Vacation, Sick and Personal Time
• Generous holidays (to include birthday & floating)
• Business casual environment