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Claims Examiner

Location : Central Islip, NY
Job Type : Direct
Hours : Full Time
Travel : No
Relocation : No

Job Description :

Manage within company best practices lower-level non-complex and non-problematic workers' compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional.



ESSENTIAL JOB DUTIES:



  • Receives claim, confirms policy coverage and acknowledgment of the claim

  • Determine validity and compensability of the claim

  • Establish reserves and authorize payments within reserving authority limits

  • Manage non-complex and non-problematic medical-only claims and minor lost-time workers' compensation claims under close supervision

  • Communicate claim status with the customer and claimant and client

  • Adhere to client and carrier guidelines and participate in claims review as needed

  • Assists other claims professionals with more complex or problematic claims as necessary


 


Required Qualifications :

KNOWLEDGE & SKILLS:



  • Excellent written and verbal communication skills

  • PC literate, including Microsoft Office (Word, Excel)

  • Ability to learn rapidly to develop knowledge and understanding of claims practice

  • Ability to identify, analyze and solve problems

  • Strong organizational skills

  • Good interpersonal skills

  • Ability to work independently

  • Ability to work in a team environment



  • Ability to meet or exceed performance competencies


EDUCATION: College degree preferred, work experience can substitute for educational requirement




LICENSES: As required




EXPERIENCE: Minimum One (1) year of industry experience and claims management preferred


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