Claims Examiner

Job Title: Claims Examiner 
Location: Cheektowaga NY 14225
Duration: 3 months Assignment (potential for conversion depends on business needs)
Job Schedule:  Onsite
Shift/Hours: 40hours/week, (Start/End): 8 am – 4:30 pm
 
Key Objective:

• Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.

Major Duties & Responsibilities:

• Receive new assignments. 
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
• Contacts, interviews and obtains statements (recorded or in person) from insured’s, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Arrange for surveys and experts where appropriate.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. 
• Timely and appropriate management of litigation files.
• Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably. 
• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses.
• Informs claimants, insured’s/customers/ agents or attorney of denial of claim when applicable.
• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.  Continues efforts to settle claims before trial.
• Refers claims to subrogation as appropriate. 
• May participate in claim file reviews and audits with customer/insured and broker.
• Administers benefits timely and appropriately.  Maintains control of claim’s resolution process to minimize current exposure and future risks
• Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts

Scope Information:  

• The position reports directly to a Claims Team Leader or other member of claims management.

Desired Qualifications:

• 3-5 years’ experience handling higher level Workers’ Compensation claims.  
• Basic knowledge of claims handling and familiarity with claims terminologies.
• Effective negotiation skills.
• Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive   manner concerning losses.
• Ability to self-motivate and work independently.
• Knowledge of Client products, services, coverages and policy limits, along with awareness of claims best practices
• Knowledge of applicable state and local laws
• State adjusters licensing a plus or will require future licensing.
• Familiar in computer systems.
• 40 words per minute typing skills.

 

At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's pay range is $24.00/hr – $24.59/hr.