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Spectraforce

Claims Examiner

Career Insights for Claims Examiner (General)

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What they do

A Claims Examiner evaluates insurance claims in accordance with applicable contracts and government regulations within their insurance type. Determines member eligibility and financial responsibility of the insurance company.

$77,316 / year median in Oregon

+1% projected growth

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Job Description

Job Title:
Claims Examiner Location:
Portland, OR 97223
Duration:
3 months Assignment (potential for conversion depends on business needs)
Job Schedule:
Onsite Shift/Hours:
40hours/week, (Start/End): 8 am - 4:30 pm
Key Objective:
Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.
Major Duties & Responsibilities:
Receive new assignments. Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business. Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. Arrange for surveys and experts where appropriate. Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract. Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. Sets reserves within authority limits and recommends reserve changes to Team Leader. Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. Timely and appropriate management of litigation files. Assists Team Leader in developing methods and improvements for handling claims. Settles claims promptly and equitably. Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses. Informs claimants, insured's/customers/ agents or attorney of denial of claim when applicable. May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial. Refers claims to subrogation as appropriate. May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current exposure and future risks Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts
Scope Information:
The position reports directly to a Claims Team Leader or other member of claims management.
Desired Qualifications:
3-5 years' experience handling higher level Workers' Compensation claims. Basic knowledge of claims handling and familiarity with claims terminologies. Effective negotiation skills. Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses. Ability to self-motivate and work independently. Knowledge of Client products, services, coverages and policy limits, along with awareness of claims best practices Knowledge of applicable state and local laws State adjusters licensing a plus or will require future licensing. Familiar in computer systems. 40 words per minute typing skills.

Benefits

  • Dental Insurance