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Claims Examiner - GL PL

eTeam Inc.

Memphis, TN(remote)

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JOB DETAILS
SALARY
$35–$41 Per Hour
SKILLS
Adjudication, Alliance/Partner Management, Analysis Skills, Applications Security, Best Practices, Claims Coding, Claims Management, Claims Processing, Computer Skills, Cost Control, Customer Relations, Customer Support/Service, Data Collection, Develop and Maintain Customers, Insurance Regulations, Licensing, Litigation, Medical Protocols, Medical Treatment, Medicare, Microsoft Office, Microsoft Product Family, Negotiation Skills, Presentation/Verbal Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Team Player, Time Management, Vendor/Supplier Planning, Willing to Travel, Writing Skills
LOCATION
Memphis, TN
POSTED
7 days ago
Title- Claims Examiner - GL PL
Location- Memphis, TN, 38125 (Remote)
Duration- 3 Months

Manager's note:
  • Claims Examiner General Liability Professional Liability
  • Work location: Remote across US.
  • FL (or any other reciprocal state) and/or NY licenses preferred.
  • Active license is mandatory.
  • Product liability is a plus but not a requirement.
  • Years of experience: 3-5 years of relevant experience

PRIMARY PURPOSE:
To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Assesses liability and resolves claims within evaluation.
Negotiates settlement of claims within designated authority.
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Prepares necessary state fillings within statutory limits.
Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

QUALIFICATION
Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations



 

About the Company

e

eTeam Inc.

Looking for a great job? Join eTeam. We’re looking for talented staffing professionals to join our staff. We also provide contract assignments and full-time jobs at Fortune 2000 Companies. We’ve been named one of the best companies to work for by Staffing Industry Analysts and New Jersey Business.
COMPANY SIZE
100 to 499 employees
INDUSTRY
Other/Not Classified
FOUNDED
1998
WEBSITE
www.eteaminc.com

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