Senior Claims Examiner
3 weeks ago
Job Title: Senior Claims Examiner
Job Summary:
We are seeking a highly motivated and detail-oriented Senior Claims Examiner to join our team in a full-time, permanent, Hybrid position with comprehensive benefits. The ideal candidate will possess exceptional claims handling experience and a proven track record of building rapport with clients to facilitate amicable resolutions of liability claims.
Key Responsibilities:
- Claims Analysis: Thoroughly review and analyze claims to ascertain their validity and extent of coverage in accordance with policy provisions.
- Investigation: Conduct comprehensive investigations by gathering pertinent information, including statements from claimants, witnesses, and medical professionals.
- Settlement Negotiations: Engage in negotiations with claimants and other parties involved in the claims process to achieve mutually beneficial settlements.
- Financial Record Keeping: Utilize specialized financial software to meticulously document findings and maintain an accurate record of all claims-related activities.
- Compliance: Adhere to workers' compensation laws and regulations throughout the claims process, ensuring adherence to industry standards.
- Fraud Detection: Implement robust fraud detection measures to identify potentially fraudulent claims and take appropriate actions.
- Customer Service: Provide exceptional customer service by promptly addressing inquiries and concerns from claimants.
- Reporting: Prepare comprehensive reports summarizing findings and recommendations for each claim, ensuring clarity and conciseness.
Preferred Qualifications:
- Proven experience in handling workers' compensation claims.
- Strong organizational abilities to manage multiple claims simultaneously and meet tight deadlines.
- Proficiency in data analysis and decision-making based on analytical insights.
- Excellent negotiation skills to facilitate effective settlements.
- Familiarity with financial software utilized within the insurance industry is advantageous.
- A background in customer service is essential to ensure positive interactions with claimants.
- Knowledge of auto estimating processes is beneficial but not mandatory.
Qualifications:
- Strong negotiation skills to effectively handle settlement discussions
- Proficiency in utilizing financial software for claims processing and analysis
- Experience in auto estimating to accurately assess repair costs
- Knowledge of workers' compensation law to navigate the legal aspects of claims
- Excellent organizational skills to manage multiple claims efficiently
- Ability to provide exceptional customer service throughout the claims process
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