Claims Examiner 1

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Job Title:

Claims Examiner 1

Job ID #

J0092

Job Family:

Specialist

Reports To Position:

Senior Leadership

FLSA

PRIMARY PURPOSE

Answer calls and work closely with more senior examiners and/or leadership regarding Investigations and evaluations of claims. 

Incumbents have up to $5,000 reserve authority; $2,500 settlement authority and $1,000 payment authority.

ESSENTIAL FUNCTIONS

Investigate claims made as a result of reports filed by insureds and/or third parties.

Initiate and conduct appropriate follow-ups via proficient use of the claims handling diary system and other related systems.

Determine best 3rd party independent adjuster to utilize for each situation.

Correspond with policyholders, claimants, witnesses, attorneys, etc. to gather information to support decisions.

Calculate payments and provides recommendations for settlement of routine claims. As directed, negotiates settlements of claims.

Examine claim forms and other records to determine coverage.

Prepare reports of investigation findings.

Complete training necessary to promptly and effectively handle claims to conclusion.

Proactively work to assist others in achieving the organization's objectives.

WORKERS COMP INJURY

Handle medical only and first aid claims in multiple state jurisdictions.

WORKERS COMP INJURY

Gain knowledge on federal, state and local work injury laws.

Associate's degree or equivalent combination of education and/or experience required.

1+ year's experience in claims entry/handling required.

Must be able to take direction from leadership and be detail-orientated.

Must be very organized and able to multi-task.

Must be able to make timely commitments and follow through on commitments made.

Must be able to learn new processes.

Must be able to work in a fast-paced environment and possess excellent time management skills.

The Company is an equal employment opportunity employer.  The Company’s policy is not to unlawfully discriminate against any applicant or employee on the basis of race, color, sex, sexual orientation, gender identity, religion, national origin, age, military status, disability, genetic information or any other consideration made unlawful by applicable federal, state, or local laws.  The Company also prohibits harassment of applicants and employees based on any of these protected categories.