Claims Examiner

Job title: Claims Examiner

Location: Alpharetta, GA (40 hours in the office)

Duration: 3+ months (Potential for extension/ Convert to Hire)

Interview process: In-person

Job Hours: 8:00 am-5:00 pm Mon to Fri

Typical Day in the Role

Answering the phone, starting benefits, paying Indemnity payments, coordinating medical, responding to litigation, etc.

Would be good to have someone who is familiar with the Florida litigation process and can manage litigated files

The biggest challenge is the volume/incoming.

• A face-to-face interview is required.
• Candidates should be comfortable providing superior customer service.
• Work environment is collaborative, so a team player attitude is important.
• Professional behavior is always expected.
• Candidates should be highly motivated and willing to put in extra effort to achieve goals.
• Tasks must be completed in a timely manner.
• Paying benefits on time and accurately is extremely important.
• Candidates do not have to be senior, but should understand case management.
• They should know how to handle documents and execute strategies.
• Ability to recognize coverage issues and identify potential fraud is required.
• All files must be maintained in the task management system (training will be provided).
• Candidates should provide timely guidance and work well with the team.
• Being organized is extremely important.
• Ability to multitask is required.
• Experience working with AI is preferred.
• Strong verbal and written communication skills are required.
• A college degree is not mandatory, but is a plus.
• Licenses from FL, SC, or NC are a plus.
• Workers’ compensation experience is preferred.
• Candidates with existing licenses are preferred.

Job descriptions:

MAJOR DUTIES & RESPONSIBILITIES:

• Deliver superior customer service and satisfaction through effective interactions with insureds, claimants, agents, underwriters, and others.

• Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, behavior, and effort to achieve goals and objectives.

• Provide accurate and timely expense and loss assessments on Lost Time claims.

• Timely and appropriately communicate with internal and external customers relative to account trends, issues, and claim activity.

• Consistently demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage, loss assessment, and case management.

• Ensure the establishment, documentation, and execution of appropriate strategies to bring early resolutions to assigned claims.

• Recognize and properly address coverage issues, potential fraud, and subrogation; follow guidelines and completion of reporting forms.

• Keep all files on a current diary system in order to monitor new developments, follow up on requests, update management, and respond to all other diary activities in a timely manner.

• Provide guidance and direction to team members with the ultimate goal of managing and resolving a claim.

MINIMUM REQUIREMENTS:

• A personal commitment to superior performance that adds value to our company.

• An ability to work effectively with a wide variety of people.

• An aptitude for evaluating, analyzing and interpreting information.

• Excellent organizational skills are a must.

• The ability to multi-task along with proven time management and organizational skills.

• An ability to work well in teams.

• Demonstrated critical thinking and decision-making ability.

• Excellent verbal and written communication skills.

EDUCATION/EXPERIENCE

o Bachelor's Degree or equivalent experience preferred.

o Minimum of 3 years of claims handling required.