Claims Examiner

Temporary Experienced Examiner Position

Location: Tampa, FL

Duration: 3 Months

KEY OBJECTIVE:

Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES:

Duties may include but are not limited to:

• Receive new assignments.

• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.

• Contacts, interviews and obtains statements (recorded or in person) from insured’s, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.

• Arrange for surveys and experts where appropriate.

• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.

• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.

• Sets reserves within authority limits and recommends reserve changes to Team Leader.

• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.

• Timely and appropriate management of litigation files.

• Assists Team Leader in developing methods and improvements for handling claims.

• Settles claims promptly and equitably.

• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses.

• Informs claimants, insured’s/customers/ agents or attorney of denial of claim when applicable.

• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.

• Refers claims to subrogation as appropriate.

• May participate in claim file reviews and audits with customer/insured and broker.

• Administers benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks

• Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts

Depending on line of business, other duties may include:

• Maintaining system logs

• Investigating compensability and benefit entitlement

• Reviewing and approving medical bill payments or forwarding for outside review as necessary.

• Managing vocational rehabilitation

SCOPE INFORMATION: The position reports directly to a Claims Team Leader or other member of claims management.

DESIRED QUALIFICATIONS:

• 3-5 years experience handling higher level Workers’ Compensation claims.

• Basic knowledge of claims handling and familiarity with claims terminologies.

• Effective negotiation skills.

Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses.

• Ability to self motivate and work independently.

• Knowledge of Client products, services, coverages and policy limits, along with awareness of claims best practices

• Knowledge of applicable state and local laws

• State adjusters licensing a plus or will require future licensing.

• Familiar in computer systems

• 40 words per minute typing skills