Claims Examiner Liability
Job Location:
Job Location:
Orlando, FL - USA
Monthly Salary:
Not Disclosed
Monthly Salary:
Posted on:
3 days ago
Posted on:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
Job Title: Claims Examiner - Liability
Location (On-site Remote or Hybrid): Orlando FL (Remote)
Contract Duration: Contract until 01/01/2027
Work Hours: 8:00 AM - 5:00 PM EST
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.
Location (On-site Remote or Hybrid): Orlando FL (Remote)
Contract Duration: Contract until 01/01/2027
Work Hours: 8:00 AM - 5:00 PM EST
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 organizations quality program(s).
- Travels as required.
