Medical Claims Examiner

7 days ago


Phoenix, Arizona, United States USAA Full time
Why USAA?
At USAA, our mission is to provide financial security to millions of U.S. military members and their families.
We're committed to giving back to those who have served.

In this role as a Medical Claims Examiner - Auto Injury Specialist, you'll adjust complex bodily injury claims and UIM claims, confirming coverage, determining liability, investigating, evaluating, negotiating, defending, and settling claims in compliance with state laws and regulations.
This hybrid position requires spending 3 days a week in the office.

Key Responsibilities:
  • Adjusting 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.
  • Identifying, confirming, and making coverage decisions on complex claims.
  • Investigating loss details, determining legal liability, evaluating, negotiating, and arriving at claim settlement within appropriate authority guidelines.
  • Clearly documenting thought process, investigation, evaluation, negotiation, and settlement decisions.
  • Prioritizing and managing assigned claims workload to keep members and other involved parties informed, providing timely claims status updates.
  • Partnering and/or directing vendors and internal business partners to facilitate timely claims resolution.
  • Serving as a resource for less experienced team members on complex claims.

Required Skills and Qualifications:
  • Expert knowledge and understanding of the auto claims contract, as well as application of case law and state laws and regulations.
  • Aquisition 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).

Benefits:
  • Comprehensive medical, dental and vision plans.
  • 401(k) and pension.
  • Life insurance.
  • Parental benefits.
  • Adoption assistance.
  • 16 paid volunteer hours.

Estimated Salary: $65,000 - $85,000 per year.

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