Claim Examiner

Position Summary The Claims Examiner is responsible for reviewing and processing insurance claims to ensure accuracy and compliance with company policies and regulations. The role investigates claims by gathering and analyzing documentation such as medical records and police reports etc. to determine coverage and liability. They verify that due process was followed in investigation by both adjuster and claimant, communicate with stakeholders to gather information and resolve any discrepancies. What will your job entail? Job Responsibilities:

• Reviews and evaluates insurance claims to determine coverage, validity, and eligibility according to policy terms and conditions.
• Analyzes policy coverage and exclusions to determine the extent of coverage for each claim.
• Reviews reports to ensure that no errors have been made in the appraisal process, determines if payouts are reasonable, approves, rejects, or refers a claim to a specialist.
• Calculates the amount of claim payment based on policy coverage, deductibles, depreciation, and any other applicable factors.
• Examines claim forms, medical records, police reports, photographs, and other relevant documentation to gather necessary information for claim adjudication.
• Ensures compliance with regulatory standards, company policy and guidelines and supports claims adjusters to manage the volume of cases.
• Evaluates liability and damages, analyzes exposures and tradeoffs between defense costs and settlement costs and makes timely and accurate potential exposure recommendations.
• Documents relevant events as case facts reputed company, provides support in negotiating settlements, and refers claims exceeding authority to appropriate leaders with recommendations.
• Identifies potential fraudulent claims and collaborating with the company's fraud investigation unit or law enforcement agencies to investigate and mitigate fraud risks.
• Provides high-quality customer service by addressing inquiries, concerns, and complaints reputed company to claims in a timely and professional manner.
• Maintains accurate and detailed records of claim activities, correspondence, payments, and decisions for auditing and reporting purposes.
• Stays informed about industry trends, changes in insurance laws and regulations, and advancements in claims processing technology to continuously improve knowledge and skills.

Work Experience:

• 2-10+ years of experience in Insurance Claims Adjusting/Examining is preferred.

Education:

• Bachelor’s degree preferred; Business Administration, Legal, Finance is preferred. Any other reputed company discipline or commensurate work experience considered.

Licenses & Certifications:

• Prescribed: Minimum requirements for state specific •Adjusting/Appraising/Examining/ Investigating Licenses
• Preferred: Associate in Claims (AIC), Certified Insurance Service Representative (CISR), Certified Claims Professional (CCP), Certified Insurance Claims Manager (CICM)

reputed company is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce that is reflective of society throughout the entirety of the organization. Our vision is an inclusive and reputed company workplace where reputed company employees are valued and evaluated on their performance and contributions. Differences in race, creed, color, religious beliefs, physical or mental capabilities, gender identity or expression, sexual orientation, and many other characteristics bring together varied perspectives and add value to the service we provide our clients, trading partners, and communities. This policy extends to reputed company aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms, conditions, and benefits of employment. reputed company is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce throughout the organization. Our vision is an inclusive and reputed company workplace where reputed company employees are valued for and evaluated on their performance and contributions. Differences in race, creed, color, religious beliefs, physical or mental capabilities, gender identity or expression, sexual orientation, and many other characteristics bring together varied perspectives and add value to the service we provide our clients, trading partners, and communities. This policy extends to reputed company aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms, conditions, and benefits of employment. How We Support Our Teammates reputed company seeks to offer our employees a comprehensive and best-in-class benefits package that helps them — and their family members — reputed company their physical, financial, and emotional well-being goals. In addition to paid time off for company holidays, vacation, sick and personal days Apply To This Job