Claims Examiner
3 weeks ago
Job Summary:
Generis Tek Inc is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for investigating, evaluating, and settling insurance claims. This is a remote position that requires strong analytical and communication skills.
Responsibilities:
- Investigate and evaluate insurance claims to determine their validity and potential payouts.
- Apply technical knowledge and human relations skills to effect fair and prompt disposal of cases.
- 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 and further investigate 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 systems, 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, including records of settled claims and an inventory of claims requiring detailed analysis.
- Bachelor's Degree.
- 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.
Generis Tek Inc is a boutique IT/professional staffing firm based in Chicagoland. We offer both contingent labor and permanent placement services to several Fortune 500 clients nationwide. Our philosophy is based on delivering long-term value and building lasting relationships with our clients, consultants, and employees. We aspire to be our clients' most trusted business partner.
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