Claims Management, Claims Examiner

Claims Management, Claims Examiner#26-17017 Memphis, TN Onsite Job Description Manager's note: Must have at least three years' experience (litigation experience preferred) Licensed in FL Full time - 40 hours per week Monday through Friday Work within client's operational hours: 8:00 AM - 5:00 PM EST Position is remote anywhere within the

US. PRIMARY PURPOSE

To analyze complex or technically difficult general liability 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 general liability 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. Assesses liability and resolves claims within evaluation. 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.

ADDITIONAL

FUNCTIONS and

RESPONSIBILITIES

Performs other duties as assigned. Supports the organization's quality program(s). Travels as required.