Sr Claim Examiner
Sr Claim Examiner
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Salary Not Disclosed
1 Vacancy
Job Description
Job Description
About Acrisure:
Acrisure is a global Fintech leader that combines the best of humans and high tech to offer multiple financial products and services to millions of businesses and individual clients. We connect clients to solutions that help them protect and grow what matters including Insurance Reinsurance Cyber Services Mortgage Origination and more.
Acrisure employs over 17000 entrepreneurial colleagues in 21 countries and have grown from $38 million to $4.3 billion in revenue in just over ten years. Our culture is defined by our entrepreneurial spirit and all that comes with it: innovation client centricity and an indomitable will to win.
Job Summary:
Sr. Claims Examiner is responsible for managing workers compensation claims as assigned by claims supervisor. Investigates claims. Determines the compensability of the claim and extent of liability. Communicates directly with clients employers injured workers physicians and attorneys to bring claims to a timely conclusion.
Essential Duties and Responsibilities include the following. Other duties may be assigned:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Interviews telephones or corresponds with claimant and witnesses consults police and hospital records.
Contacts physicians to obtain medical diagnoses and projected treatment plans.
Monitors medical progress of claimants and coordinates followup treatments; reports to employers including any restrictions that may be imposed on claimants return to work.
Documents all information from contacts with employers claimants physicians and attorneys into the claims management system and ensures that documentation is current.
Calculates and sets reserves through a reserve worksheet including the nature and scope of claims; adjusts reserves to reflect ultimate known exposures.
Issues medical indemnity legal and expense payments
Prepares reports for excess carriers and requests reimbursement when needed.
Sets reminders to followup on tasks through diaries on the system; reviews and completes diaries daily.
Maintains physical files for claimrelated documents such as medical information legal reports and other correspondence.
Reviews claims submissions for thoroughness and accuracy.
Determines compensability of claims through information gathered and according to workers compensation statutes; makes recommendations as to compensability and coverage of claims.
Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed.
Ensures jurisdictional filings are complete and timely.
Obtains precertification approval for specific treatments as needed.
Reviews bills and medical notes; authorizes and codes bills.
Attends seminars and meetings as needed to stay abreast of current industry knowledge.
May attend mediations hearings trials or other legal proceedings.
Qualifications /Required Education Experience and Skills
High School diploma or equivalent (required)
Minimum of Five 5 years experience handling complex workers compensation lost time claims
Multiline experience (required)
Experienced Workers Comp Claim Adjuster / with active licensing
Bilingual (Spanish) a plus
Strong organizational skills attention to details and the ability to multitask and prioritize works.
Strong verbal presentation and written communication skills
Strong computer skills including proficiency in Microsoft Word Excel and Outlook
Self motivated and customer focused.
Attention to details and accuracy in documentation. Maintain detailed and accurate records of claims.
Ability to establish and maintain good working relationships and rapport with others.
Position Type/Expected Hours of Work
This is a fulltime position. Standard business hours of operations are Monday through Friday 8:30 a.m. to 5 p.m.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers phones photocopiers filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger handle or feel; and reach with hands and arms.
This description is not meant to be allinclusive and may be modified from time to time at the discretion of management.
Pay Details:
: $0 $0Acrisure is committed to employing a diverse workforce. All applicants will be considered foremploymentwithout attention to race color religion age sex sexual orientation gender identity national origin veteran or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure/privacy/caapplicant.
Acrisure is equally committed to supporting social issues. In 2021 the Company cofounded Evolution Advisors a joint venture focused on providing greater access and more effectively distributing insurance products and financial services to minorityowned enterprises. In its home of Grand Rapids Acrisure provided $15 million to create the Acrisure Center for Innovation in Childrens Health at Helen DeVos Childrens Hospital.
To Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisures property and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisures Human Resources Talent Department.
Required Experience:
Senior IC
Employment Type
Full-Time
