Claims Examiner
MaritzCX
Come work at a place where we take pride in creating a workplace environment that values hard work, commitment, and growth.
Job Description:Education:
High School diploma or equivalent requiredAssociate’s degree in Business Administration or relevant field of study preferredInsurance adjuster license requiredWork Experiences:
4+ years’ claims experience working with workers’ compensation, general liability, and property insurance preferably in an insurance related industry.We encourage candidates with prior examiner, adjuster, paralegal and/or other relevant claims handling experience to apply. Multi-jurisdictional knowledge, advanced degrees and/or JD are a plus.Texas non-subscription claims experience preferredActive Texas All Lines Adjuster license or able to obtain the specified license within ninety days of hire dateSkills:
Ability to consistently apply sound judgment, and operate professionally, effectively and ethically as an individual contributor and member of a teamAbility to establish rapport and maintain harmonious working relationshipsSuperior interpersonal, written, and verbal communication skills, with the ability to create thorough documentation and interface effectively with individuals at various levelsExcellent time management skills, ability to support multiple projects, and effectively prioritize and manage a large volume of workAbility to remain organized, pay strict attention to detail, and meet critical deadlines within a high volume, fast-paced environmentAnalytical with strong problem-solving abilities and creative resolution skillsMaintain professional and technical knowledge by attending educational workshops and reviewing technical publicationsProficient use of Microsoft Office programs, including Word and ExcelResponsibilities:
Understands and performs domestic claim programs, policies, and procedures for: reporting, investigation, and analysis; resolution/outcome management; and the delivery of claim information.Manage mostly non-complex claims, but may handle moderately complex claims with limited reserve and/or settlement authority including workers’ compensation, Texas non-subscription claims, general liability and property claimsMaintain claims and insurance filesSecure evidence related to claims (merchandise, statements, photos and video footage)Partner with external TPA and insurance carriers as neededMonitor claim files to ensure that external TPA is managing files appropriately and in accordance with Claims Service Handling Instructions, establishing appropriate reserves, and issuing benefit payments timely. Process service invoices occasionallyCoordinate substance abuse testing for post-accident, reasonable suspicion, and property damage to include communication of results to appropriate business partnersPartner with management on the status of injured team members and estimated return to work dateCoordinate return-to-work effortsFacilitate superior service experience for the injured team members and customersNotify HR and Payroll of team members who have been placed on leave due to a work-related injuryGenerate various loss analysis reports as requiredMaintain current on changes in workers’ compensation laws and other claims-related laws, regulations, and information by attending educational workshops and seminarsDevelop a thorough understanding of Academy policies, procedures, and safety rulesDuties may change; Team Members may be required to perform other duties as assignedProperly maintain applicable state licensePhysical Requirements & Attendance:
Acceptable level of hearing and vision to perform job dutiesAdhere to company work hours, policies, procedures and rules governing professional staff behaviorFull timeEqual Employment OpportunityAcademy is an Equal Opportunity Employer and does not discriminate with regard to employment opportunities or practices on the basis of race, religion, national origin, sex, age, disability, gender identity, sexual orientation, or any other category protected by law.
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