Claim Examiner- WC
: Job Details :


Claim Examiner- WC

Hornet Staffing

Location: Lake Zurich,IL, USA

Date: 2024-11-13T08:41:29Z

Job Description:
Description:
  • Receives claim assignment, confirms policy coverages and directs acknowledgement of claims.
  • Interprets and makes decisions using independent judgment on moderate difficulty claims and policy coverages and determines if coverages apply to claims submitted.
  • Investigates, evaluates, negotiates and adjudicates first and third party claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required.
  • Analyzes claims activity and prepares reports for clients/carriers and management.
  • Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
  • Make settlement decisions promptly and equitably and issues company drafts in payments for claims within authority limits.
  • Develops subrogation and third party recovery potential and follows reclaim procedures.
  • Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
Skills:
  • Ability to work independently while assimilating various technical subjects.
  • Good verbal or written communication skills.
  • Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
  • Strong ability to identify, analyze and solve problems.
  • Effective interpersonal skills to be capable of dealing with external sources and all levels of employees.
Education:
  • Bachelor's degree or equivalent experience required.
  • Comprehensive claims investigations/settling experience 1-3 years experience in Claims or similar organization
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