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Claims Examiner
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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.
$77,901 / year median in the U.S.
+7% projected growth
Job Description
Claims Examiner Eteam Infoservices Private Limited
•4.5 Austin, TX Job Details Contract $45
•$50 an hour 2 hours ago Qualifications Customer relationship building Insurance claims settlement negotiation Insurance dispute resolution Claims negotiation Workers' compensation insurance knowledge Claims documentation management
Full Job Description Title:
Claims Examiner
•
Workers Compensation Location:
Orange, CA REMOTE Duration:
2-3 months
Description:
Manager's note: Work location: Remote or onsite within California Any specific skill/ certification/ license: CA adjuster certification Years of experience: 3+ years of relevant experience.
PRIMARY PURPOSE
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL
FUNCTIONS and
RESPONSIBILITIES
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. ET_VK01
Job Type:
Contract Pay:
$45.00
•$50.00 per hour
Experience:
workers' compensation: 3 years (Required)
License/Certification:
CA adjuster certification (Required)
Work Location:
In person