Claims Examiner I

Responsibilities Resolve claims by investigating losses through collecting and analyzing data according to policy application and client/underwriter guidelines. 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. Requirements Minimum High School or GED 2 Years Relevant and progressive claims or insurance experience 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) Hard Skills claims investigation data analysis insurance coverage determination claims resolution liability assessment benefits coordination claims reporting unfair claims settlement compliance insurance principles analytical skills Soft Skills communication skills confidentiality tact diplomacy organizational skills multitasking team collaboration professional networking problem-solving attention to detail Certifications & Qualifications High School Diploma GED #J-18808-Ljbffr