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Claims Examiner - Perm job in Sanford at The Judge Group

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Claims Examiner - Perm at The Judge Group

Claims Examiner - Perm

The Judge Group Sanford, FL Full Time
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Location: Sanford, FL
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.

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

Required Skills: 

  • ORGANIZATIONAL SKILLS
  • MEDICARE
  • CLAIMS
  • SETTLEMENTS
  • CLAIMS RESOLUTION

Contact: [ Link removed ] - Click here to apply to Claims Examiner - Perm
This job and many more are available through The Judge Group. Find us on the web at [ Link removed ] - Click here to apply to Claims Examiner - Perm
 

Recommended Skills

Subrogation
Claims
Medicare
Adjudication Process
Social Security
Lawsuits

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