Claims Examiner managing complex general liability claims for a global risk and claims administration partner. Analyzing claims and ensuring timely resolutions within service expectations in a hybrid work setting.
Responsibilities
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.
To identify subrogation of claims and negotiate settlements.
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 claims 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.
Travels as required.
Requirements
5 years of claims management experience or equivalent combination of education and experience required.
High School Diploma or GED required.
Bachelor's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
General Liability and Bodily injury experience preferred.
Licensing: TX/FL preferred.
Jurisdiction Knowledge: 18 states within the eastern and south eastern region.
Benefits
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
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