About This Role
The Claims Examiner investigates and settles claims promptly and equitably, adhering to established best practices. This role involves reviewing policy information, contacting various parties to gather information, and evaluating facts to determine liability and company obligations. The position reports directly to a Claims Team Leader or other member of claims management.
Responsibilities
- Receive new assignments
- Review claim and policy information to provide background for investigation and determine the extent of the policy's obligation to the insured depending on the line of business
- Contact, interview and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information
- Arrange for surveys and experts where appropriate
- Evaluate facts supplied by investigation to determine extent of liability of the insured, if any, and extent of the company's obligation to the insured under the policy contract
- Prepare reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
- Set reserves within authority limits and recommend reserve changes to Team Leader
- Review progress and status of claims with Team Leader and discuss problems and suggested remedial actions
- Timely and appropriate management of litigation files
- Assist Team Leader in developing methods and improvements for handling claims
- Settle claims promptly and equitably
- Obtain releases, proofs of loss or compensation agreements and issue company drafts in payments for claims and expenses
- Inform claimants, insureds/customers/agents or attorney of denial of claim when applicable
- Assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements
- Continue efforts to settle claims before trial
- Refer claims to subrogation as appropriate
- Participate in claim file reviews and audits with customer/insured and broker
- Administer benefits timely and appropriately
- Maintain control of claim's resolution process to minimize current exposure and future risks
- Establish and maintain strong customer relations i.e. agents, underwriters, insureds, experts
- Maintain system logs (depending on line of business)
- Investigate compensability and benefit entitlement (depending on line of business)
- Review and approve medical bill payments or forward for outside review as necessary (depending on line of business)
- Manage vocational rehabilitation (depending on line of business)
Requirements
