Claim Examiner

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Job description

Claims Examiner

Our award-winning Claims Department has an exciting career opportunity for an individual who enjoys independent problem solving and utilization of their interpersonal and collaboration skills to build relationships with insureds, agents, and internal business partners.

Responsibilities

Duties may include, but are not limited to:

• Accurately evaluate and process claims based on relevant documentation.
• Evaluate claim submissions, determine policy benefits, and request additional information as required to finalize claims.
• Manage inquiries, escalations and pending files on claim decisions.
• Provide exceptional customer service by promptly following up and collaborating with internal and external business partners to address concerns and/or questions.
• Build broad knowledge of the various online systems for claims processing, imaging, and policy administration.
• Maintain appropriate documentation on all claim files and manage caseload in a timely manner while meeting quality standards and SLAs.
• Research, analyze, and interpret policy language and State law as it relates to submitted claims.
• Communicate and collaborate effectively with Adjusters, Supervisors, and Managers to ensure service levels are met daily.
• Recognize, prioritize, and escalate service and claims issues according to escalation guidelines.
• Support an environment of continuous improvement by offering ideas and suggestions to improve workflows and processes.
• Performs other duties as assigned.

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