Claims Examiner

Job Description

Job Description

A client of AlphaStaffHCM™ is searching for an Injury Examiner. This insurance client empowers members to achieve financial security through highly competitive products, exceptional service and trusted advice.

Job Description

As a dedicated Injury Examiner, you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.

Key Responsibilities:

• Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims.
• Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.
• Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates.
• Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation.
• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.
• Serves as a resource for team members on complex claims.
• Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication.
• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Must Have Qualifications:

• High School Diploma or General Equivalency Diploma.
• 4 years auto claims and injury adjusting experience.
• Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.
• Advanced negotiation, investigation, communication, and conflict resolution skills.
• Demonstrated strong time-management and decision-making skills.
• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.
• Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims.
• Ability to exercise sound financial judgment and discretion in handling insurance claims.
• Advanced knowledge of coverage evaluation, loss assessment, and loss reserving.
• Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.

Nice to Have Qualifications

• 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage
• College Degree (Bachelor’s or higher)
• Insurance Designation
• US military experience through military service or a military spouse/domestic partner

Compensation and Perks

• Salary range: $83,000 - $100,000
• Hybrid schedule: Mandatory 3 days in office
• Best-in-class benefits to support their physical, financial, and emotional wellness
• Comprehensive medical, dental and vision plans, 401(k), pension, and life insurance
• Parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs
• Career path planning and continuing education to assist employees with their professional goals

A client of AlphaStaffHCM™ is searching for an Injury Examiner. This insurance client empowers members to achieve financial security through highly competitive products, exceptional service and trusted advice.

Job Description

As a dedicated Injury Examiner, you will be responsible to adjust complex auto and homeowner bodily injury claims, UM/UIM, and small business claims to include confirming coverage, determining liability, investigating, evaluating, negotiating, and adjudicating claims in compliance with state laws and regulations. Responsible for delivering a concierge level of best-in-class member service through setting appropriate expectations, proactive communications, advice, and empathy.

Key Responsibilities:

• Adjusts complex auto bodily injury claims with significant injuries (e.g. traumatic brain injury, disfigurement, fatality) and UM/UIM, and small business claims, as well as some auto physical damage associated with those claims. Identifies, confirms, and makes coverage decisions on complex claims.
• Investigates loss details, determines legal liability, evaluates, negotiates, and adjudicates claims appropriately and timely; within appropriate authority guidelines with clear documentation to support accurate outcomes.
• Prioritizes and manages assigned claims workload to keep members and other involved parties informed and provides timely claims status updates.
• Collaborates and supports team members to resolve issues and identifies appropriate matters for escalation.
• Partners and/or directs vendors and internal business partners to facilitate timely claims resolution.
• Serves as a resource for team members on complex claims.
• Delivers a best-in-class member service experience by setting appropriate expectations and providing proactive communication.
• Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
• Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.

Must Have Qualifications:

• High School Diploma or General Equivalency Diploma.
• 4 years auto claims and injury adjusting experience.
• Advanced knowledge and understanding of the auto claims contract, investigation, evaluation, negotiation, and accurate adjudication of claims as well as application of case law and state laws and regulations.
• Advanced negotiation, investigation, communication, and conflict resolution skills.
• Demonstrated strong time-management and decision-making skills.
• Proven investigatory, prioritizing, multi-tasking, and problem-solving skills.
• Advanced knowledge of human anatomy and medical terminology associated with bodily injury claims.
• Ability to exercise sound financial judgment and discretion in handling insurance claims.
• Advanced knowledge of coverage evaluation, loss assessment, and loss reserving.
• Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.

Nice to Have Qualifications

• 2 or more years of high-value catastrophic injury experience (e.g. traumatic brain injury, disfigurement, fatality) to include UM/UIM coverage
• College Degree (Bachelor’s or higher)
• Insurance Designation
• US military experience through military service or a military spouse/domestic partner

Compensation and Perks

• Salary range: $83,000 - $100,000
• Hybrid schedule: Mandatory 3 days in office
• Best-in-class benefits to support their physical, financial, and emotional wellness
• Comprehensive medical, dental and vision plans, 401(k), pension, and life insurance
• Parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs
• Career path planning and continuing education to assist employees with their professional goals

Disclaimers: AlphaStaff, Inc. and the Client are equal employment opportunity employers and do not discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age, past or present military service, disability, genetic information, or any other basis protected by applicable federal, state, or local laws.