Medical Claims Examiner
2 weeks ago
Quality Carriers, Inc. is a leading tank trucking company, transporting a wide range of chemical products and providing value-added services to our customers. We are a core carrier for many Fortune 500 companies and provide services to top chemical producers worldwide.
Key Responsibilities:- Respond to claims within 3 hours of the initial report.
- Conduct timely coverage analysis and communicate with insured parties based on policy information and case facts.
- Exercise judgment and decision-making skills to analyze claims exposure, determine the proper course of action, and settle claims effectively.
- Interact with various parties involved in the claim process.
- Investigate claims through prompt contact with policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers, and technical experts to determine liability, damages, and contribution potential.
- Identify resources for specific activities required to properly investigate claims, such as Subrogation, Fire, IA, or Fraud investigators, and other experts.
- Maintain an effective diary management system to ensure timely handling of claims.
- Negotiate claim dispositions with insureds and claimants or their legal representatives.
- Manage litigated claims if assigned, developing litigation plans with management or defense counsel, tracking and controlling legal expenses.
- Participate in EUOs, mediations, arbitrations, pre-trials, trials, and other legal proceedings as needed.
- Update parties as needed, providing new facts and their impact on liability analysis and settlement options.
- Protect the organization's value by keeping information confidential.
- Maintain compliance with Claim Department's Best Practices.
- Represent the company as a technical resource, attend legal proceedings as needed, and act within established professional guidelines and applicable state laws.
- Provide quality customer service and ensure file quality.
- Support workload surges and/or Catastrophe operations as needed, including working significant overtime during designated CATs.
- Communicate with co-workers, management, clients, vendors, and others in a courteous and professional manner.
- Participate in special projects as assigned.
- Work as the on-call Claims Examiner on a previously scheduled swing basis.
- Some overnight travel may be required.
- Maintain the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.
- Bachelor's Degree preferred.
- Ten years of experience processing claims, preferably in commercial trucking auto and casualty segments and general liability.
- Experience with Origami and Microsoft products preferred.
Quality Carriers is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.
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