Claim Examiner

A-G Administrators LLC designs, markets and underwrites specialty sports, accident, and general liability insurance products. We have been in operation since 1983 and are nationally recognized as a leader in the sports insurance industry.

Job Summary

The Claim Examiner is responsible for managing, investigating, and processing Accident & Health insurance claims. The ideal candidate should be highly detail-oriented, precise, and able to follow and interpret guidelines and requirements.

Essential Duties & Functions

Reasonable accommodations may be made to enable individuals to perform the essential functions.

• Demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage and processing of claims
• Timely and appropriately communicate with the claimant and client, as well as internally
• Establish proof of loss by reviewing medical documentation; assembling additional information as required from outside sources; including claimant, client, provider, and other insurance companies
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments
• Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
• Recognize and properly address coverage issues, potential fraud, and subrogation
• Ensure claim files are properly documented through internal notes and correspondence logs, and claim coding is correct
• Refers cases as appropriate to Manager

Job Skills

• Team Player
• Excellent verbal and written communication
• Prioritize tasks appropriately and maintain organization
• Advanced critical thinking and problem-solving skills
• Strong decision-making ability and sound judgement
• Build client relationships
• Self-starter and self-disciplined in accomplishing tasks
• Willingness to obtain Insurance Adjuster License

Job Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required/Preferred Education and Experience

Required Education: Bachelor's Degree or Equivalent Experience

Preferred Experience: 1-3 years insurance experience, medical billing or coding experience

Preferred Licensure: Accident & Health Adjuster License

Position Type and Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. The schedule for this role can be modified upon Supervisor and Human Resources approval. Some evening and weekend work may be required. Trainings and team meetings may require coming into the office on occasion.

Travel

Limited travel would be encouraged for trainings or team meetings. This would be discussed ahead of time and agreed upon between both Supervisor and employee.

EEO Statement

A-G Administrators, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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