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Claims Examiner

Rose International Lake Mary Full-Time
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Client Position Title: Claims Examiner

Position Number: 321787

Location: Lake Mary, FL

Desired Skill Set:

Negotiation, Microsoft Office, Claims

Position Description:

**C2C is not available**
**Only U.S. Citizens and those authorized to work in the U.S. can be considered as W2 candidates.**
Job Title: Claims Examiner
Location: Lake Mary, FL
Duration: Direct Hire

Description:

PRIMARY PURPOSE:
• To analyze complex or technically difficult 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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
• Analyzes and manages complex or technically difficult 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 filings 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 be 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.

SKILLS & KNOWLEDGE:
• In-depth knowledge of appropriate insurance principles and laws for line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

EXPERIENCE:
• Four (4) years of claims management experience or equivalent combination of education and experience required.

Keywords:

Education:
• Bachelor''s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.


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Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.)


Education: 
• Bachelor''s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.



Recommended skills

Subrogation
Claims
Medicare
Social Security
Insurance
Adjudication Process
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Founded in 1993, Rose International is one of the nation's leading minority and woman-owned providers of Workforce and Technology Solutions. We serve companies in all 50 states and employ over 6,000 people across the country. Our customers would testify to the fact that Rose has their interests paramount. We are extremely competent, entrepreneurial and transparent in our approach and responses.

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