Claims Examiner

Claims Examiner I

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

Key Responsibilities

• 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

Pay Transparency

The pay range for this position is $46,600-$69,800 which includes geographic adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting. The hired applicant will be offered pay within the entire range based on the candidate's geographic location, qualifications, work experience, education, and/or skill level. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws.

As an insurance company, we comply with certain federal, state and local laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC 1033(e)), which restricts our ability to employ individuals with certain types of criminal convictions. Where not restricted by law and for criminal history not covered by this law, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law.

Equal Opportunity Employer

TMHCC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national origin, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable local laws, regulations and ordinances.