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