Adjudication, Alliance/Partner Management, Analysis Skills, Best Practices, Business Solutions, Claims Coding, Claims Management, Claims Processing, Cost Control, Customer Relations, Customer Support/Service, Data Collection, Develop and Maintain Customers, Health Plan, Litigation, Medicare, Negotiation Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Time Management, Vendor/Supplier Planning
Our Client, a Business Solutions company, is looking for a Claims Examiner - Liability for their Remote location.
Responsibilities:
- To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
- Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
Requirements:
- Must have at least three years' experience (litigation experience preferred).
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities