Claim Examiner/Adjuster

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Job description

Duration: 06 months (Possible extension)

Job

Description:

Must Have Active New York Adjusters License

Responsibilities:

Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

Resolve complex, severe exposure claims, using high service-oriented file handling.

Pay and process claims within designated authority level.

Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

Confer with legal counsel on claims requiring litigation.

Contact or interview claimants, doctors, medical specialists, or employers to get additional information.

Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

Experience:

NA

Skills:

Licensing requirements vary by state: Active New York state adjuster's license required; multiple state licenses encouraged.

Proficiency in analytical, document management, and database query software.

Proficiency in Microsoft Office applications.

Two to four years of work-related experience.

Exceptional attention to detail.

Excellent customer service and communication skills.

General knowledge of state and national laws and regulations.

General understanding of medical and legal terms.

Experience in a claims production environment with set goals and quality scores that must be obtained.

Education:

High school diploma or bachelor's degree

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