Claims Examiner

3 weeks ago


Garden City, New York, United States Generis Tek Inc Full time
Job Title: Claims Examiner - Insurance Claims Specialist

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.
Requirements:

  • 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.
About Generis Tek Inc:
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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