Claims Examiner, remote position Based out of Garden City, New York. Must Have Active New York Adjusters License. $16-$18 hourly rate.
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.
Skills and Qualifications:
• 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 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.