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Medical Claims Examiner
1 month ago
USAA is a mission-driven organization that provides financial security to millions of U.S. military members and their families.
Job DescriptionWe are seeking a dedicated Medical Claims Examiner - Risk Management Specialist to join our team. This hybrid role requires an individual to be in the office 3 days per week, where you will adjust complex bodily injury claims and UIM claims. Your primary responsibility will be to investigate loss details, determine legal liability, evaluate, negotiate, and arrive at claim settlement within appropriate authority guidelines.
Responsibilities:- Adjusts complex bodily injury claims with significant demonstrable injuries (e.g. traumatic brain injury, disfigurement, fatality) and UIM claims, as well as all auto physical damage associated with those claims.
- Identifies, confirms, and makes coverage decisions on complex claims.
- Investigates loss details, determines legal liability, evaluates, negotiates, and arrives at claim settlement within appropriate authority guidelines.
- Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.
- Prioritizes and manages assigned claims workload to keep members and other involved parties informed, provides timely claims status updates.
- Expert knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations.
- Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts.
- Experience handling UM/UIM injury claims.
- College Degree (Bachelor's or higher).
The estimated salary for this position is $65,000 - $85,000 per year, depending on experience and market data. We have an effective process for assessing market data and establishing ranges to ensure we remain competitive.
Benefits:We offer comprehensive benefits to support your physical, financial, and emotional wellness, including medical, dental, and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs.
