Claims Examiner

3 weeks ago


Atlanta, United States US Tech Solutions, Inc. Full time

Job Title: Claims Examiner

Location: Remote

Duration: 06 months contract (C2H)


Job 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.

Experience:

• Candidate must have an adjuster license in New York state.

• 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.

Skills:

• General knowledge of state and national laws and regulations.

• General understanding of medical and legal terms.

Education:

• GED OR High School




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