Claims Examiner I

Claims Examiner I

Location: Encino, CA

Reports to: Claims Manager

Employment Type: Full time

Job Summary

Resolves claims by investigating losses through the collecting and analyzing of data according to policy application and client/underwriter guidelines.

Key Responsibilities

Relying on limited experience and knowledge, this role is responsible for accomplishing the following assignments. These assignments are varied in nature and frequently non-routine.

• Determine insurance coverage by examining claim information, policies, and other records and interview claimants and other providers.
• Maintain accurate system by collecting, analyzing, and summarizing information.
• Resolve questionable claims by investigation: comparing claims information with evidence.
• Settle claims by determining insurance carrier's liability, reaching agreement with claimant according to policy provisions.
• Coordinate benefits with other insurance carriers when possible to minimize loss ratios for the client and the company.
• Contribute to phone support by prompt and accurate answering.
• Record/update claims volume and activity in a bordereau for reporting as required by the client, director, or Accounting department.
• Maintain insurance product and the Company reputation by complying with claims guidelines and unfair claims settlement limitations.
• Maintain professional and technical knowledge by attending educational workshops and establishing professional networks.
• Perform special projects as required.
• Contribute to the team effort by accomplishing related tasks as needed.

Competencies

Planning

• Follow work plans, established timelines, and pre-defined goals for assigned work.

• Meet commitments on deadlines.

Communication

• Develop strong customer focus and high service level relationship with clients.

Cost Management

• Perform work thoroughly in a cost-efficient manner and at a high productivity level.

• Utilize company resources effectively.

Business Controls and Policies

• Comply with all corporate policies and procedures.

• Take all reasonable steps to safeguard company assets against waste, loss, unauthorized use and misappropriation.

• Report any breakdown in controls to a supervisor or manager.

People Management

• No people management responsibility

• May assist in orienting and training less experienced employees.

Position Knowledge, Skills, and Requirements

Education

Min/Preferred

Minimum High School or GED

Experience

Years of Experience

2 Years Relevant and progressive claims or insurance experience in area of specialization

Other

• Possess and have ability to apply basic knowledge of principles, practices, and procedures
• Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
• Good organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
• Superlative customer service skills Basic calculator knowledge