Claims Examiner

Established as one of the premier insurance agencies in the USA, Marsh & McLennan Agency (MMA) is meeting the needs of mid-sized businesses across the country. MMA's services are targeted to customers who seek professional advice and have complex needs, limited resources and desire to work with professionals that have experience, resources and expertise relevant to their industry.

MMA provides global risk management, risk consulting, insurance brokerage, alternative risk financing, and program management services for businesses, public entities, associations, professional services organizations, and private clients (high net worth). We offer specialized solutions and services covering a wide spectrum of business needs and exposures. Our goal is to help our clients achieve their business objectives.

The Claims Examiner is responsible for the investigation, management, reserving and resolution of general and professional liability claims. He or she provides exceptional client service by providing strategic claim guidance and communication with our clients aligned with claims handling best practices and client special handling. This role creates value by minimizing the liability risks for our clients.

CLAIMS

• Investigates and processes claims
• Identifies PCEs (Potentially Compensable Events)
• Communicates with clients, claimants, counsel, vendors and other relevant parties related to claim management
• Evaluates and verify coverage on call claims
• Assesses liability and damages
• Assigns and manages vendors to include, defense counsel, experts, and other vendors as necessary based on the dynamics of the claim
• Sets claim reserves and ongoing evaluation of reserves
• Monitors and communicates policy aggregates
• Negotiates resolution of claims
• Attends claim reviews and trials and mediations, as warranted by claim
• Attends and presents at client board meetings
• Vets panel counsel, approving expert assignment as warranted
• Manages release execution on claim resolution
• Ensures Medicare interested have been addressed
• Adheres to client special handling
• Understands and follows TPA Services procedures

EXECUTION OF CLIENT SERVICE

• Works with both internal staff and external vendors to execute exceptional claims management services for each client, designed to achieve best possible outcomes on each claim
• Provides guidance to clients on claim evaluations and makes recommendations for claim strategies based on those discussions
• Builds personalized client relationships through demonstrated effective claims management and multiple channels of communication such as phone, e-mail and in-person meetings
• Leverages insurance knowledge and communication skills to explain coverage terms, program options and other items to clients as needed
• Manages time effectively to prioritize workload, client service requests and service parameters on business processes
  

DATA AND PROCESS INTEGRITY

• Consistently follows Assurance Best Practices and Client Special Handling in the execution of claim management
• Ensures data integrity within the RMIS System
• Accurately maintains complete client files including clear documentation of claim account detail in RMIS system including basis for file reserves, coverage analysis, file strategy, Medicare compliance and communication
• Achieves desired levels of data completeness and process integrity by consistently meeting diary dates, quality metrics and goals
  

PEER RELATIONSHIPS

• Participates in ongoing scheduled meetings with service team to discuss accounts, renewals, service needs, service platform, etc.
• Develops successful and effective working relationships with agency and claims service team members, managers, carriers and members of other departments
  

REQUIRED:

• Adjuster licensing as required by states (to obtain after employment)
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PREFERRED:

• BS/BA Degree
• JD
• AIC or SCLA Designation
• Proficient in Microsoft Office Suite
• 5+ years of claims handling experience at an agency or insurance carrier
  

We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. Marsh & McLennan Agency offers competitive salaries and comprehensive benefits and programs including: health and welfare, tuition assistance, 401K, employee assistance program, domestic partnership benefits, career mobility, volunteer opportunities, and other programs. For more information about our company, please visit us at:

Marsh & McLennan Companies and its Affiliates are EOE Minority/Female/Disability/Vet/Sexual Orientation/Gender Identity employers.