Claims Examiner

2 days ago

Garden City, United States Synectics Inc Full time
Job DescriptionJob Description

Responsibilities:

  • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

  • 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, further investigating 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 system, 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 such as records of settled claims and an inventory of claims requiring detailed analysis.

Qualifications

  • Licensing requirements vary by state: Active New York state adjuster's license required; multiple state licenses encouraged.

  • Bachelor's Degree.

  • Computer savvy - working with different applications, work between different applications; comfortable with a busy environment, can hit the ground running.

  • Proficiency in analytical, document management, and database query software.

  • Proficiency in Microsoft Office applications.

  • 2-4 years of work-related experience.

  • Attention to detail.

  • Excellent written and verbal communication skills

  • Excellent customer service 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.

  • Must have claims adjustment experience in a production floor environment where they are held to required KPIs.

Benefits:

Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics. Premiums are subsidized by Synectics.

Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

Vision Insurance: Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins. Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.

Technical Certification Bonus: Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification. In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us. Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus. It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.

Synectics is an equal opportunity employer.

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