Senior Claims Adjuster
4 weeks ago
Our client is looking for a strong claims adjuster with a background in either worker's comp or bodily injury claims. This position is entirely remote.
Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefits schedules and requires excellent judgment and accurate computation ability. Work also involves extensive personal contact with others and/or can be of personal or sensitive nature. Work may involve motivating or influencing others. Recognizes the unique needs of elderly claimants and their families and acts to fulfill those needs courteously. Fostering sound, amicable relationships with individuals or entities inside and outside the Company is necessary.
Primary Responsibilities:
- Accurately interprets Long Term Nursing Care policy language and executes accordingly.
- Makes eligibility recommendations for Supervisor consideration.
- Accurately documents for claim direction and updates as needed.
- Assesses various types of new information to support claim direction.
- Recommends Nurse Care Manager Visits, Medical Consultant Reviews, Surveillance, and Independent Medical Evaluations when required.
- Timely handling of mail and correspondence to meet/exceed company standards.
- Communicate with claimants/representatives via phone, e-mail, or fax.
- Handles incoming calls and returns voice mail messages timely.
- Manages daily reports to assure productive claim handling.
- Ability to work in an environment that embraces Best Practices.
Prerequisites for the Job:
- Previous long-term care or disability claims experience or equivalent.
- Proficiency in oral and written English language communication.
- Willingness to work cooperatively with others.
- Detail-oriented.
- Able to manage multiple tasks and projects under time constraints.
- Previous experience using e-mail, Windows and Microsoft Office, and other applicable computer systems.
- Well organized.
Ideally, we'd like to see:
Long-Term Disability Claim Experience
Worker's Compensation Claim Experience
Property and Casualty Claim Experience
Short-Term Disability Claim Experience
Auto Personal Injury Claim Experience
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