Claim Examiner- WC

Brea, CA - USA

Monthly Salary: Not Disclosed

Posted on: 11 hours ago

Vacancies: 1 Vacancy

Job Summary

Job Title: Claim Examiner- WC

Location: Brea CA

Summary of Job:

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.

Must-have/Required 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.

Nice-to-have skills:

Not specified.

Key responsibilities and duties:

Receives claim assignment confirms policy coverages and directs acknowledgment 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.

Education:

Bachelors degree or equivalent experience required.
Comprehensive claims investigations/settling experience 1-3 years experience in Claims or similar organization.

Job Title: Claim Examiner- WC Location: Brea CA Summary of Job: 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...