Job Description
Job Title: Claim Examiner
Job ID: 26-04957
Location: Cheektowaga, NY, 14225
Duration: 2 Months of Contract
Job Description:
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:
Duties may include but are not limited to:
Job ID: 26-04957
Location: Cheektowaga, NY, 14225
Duration: 2 Months of Contract
Job Description:
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:
Duties may include but are not limited to:
- 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
Depending on line of business, other duties may include:
- Maintaining system logs
- Investigating compensability and benefit entitlement
- Reviewing and approving medical bill payments or forwarding for outside review as necessary.
- Managing vocational rehabilitation
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 Chubb 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
Contact:
Ghouse: Ghouse.M@sunrisesys.com | (732) 395-4372 | URL: www.sunrisesys.com
Ghouse: Ghouse.M@sunrisesys.com | (732) 395-4372 | URL: www.sunrisesys.com
Numbers & Facts
| Location | Cheektowaga, NY |
| Industry | Staffing/Employment Agencies |
| Company Size | 100 to 499 employees |
| Year Founded | 1990 |
| Website | http://www.sunrisesys.com/ |
About Company
Sunrise Systems was founded in 1990 with a clear vision to deliver world-class staffing service solutions in all labor categories, including IT consulting and solutions; all with the commitment to provide service that exceeds expectations and become the most trusted name in the industry. More than two and a half decades later, we pride ourselves on being at the forefront of the staffing industry. Combining our deep industry expertise, insights, and global resources, we have partnered with our clients to connect them with top professionals across several different industries.
We provide cost-effective Managed Staffing Solutions, Information Technology and Information Technology Consulting Services to several Fortune 500 companies and U.S. Government agencies. We provide our clients with flexible engagement models and customized products that are budget and time specific. Understanding the challenges that every business faces, we offer our services either on-site at the clients' site or from one of our globally distributed technology centers. Our onshore and offshore development capabilities ensure that we excel at meeting customer requirements every single time.
Our collective business experience spans over two and a half decades and ranges from:
- Business, management, and technical fields
- Information technology consulting and software solutions.
- Providing strategic support for the development and long-term growth of new business ventures across several industries including but not limited to; accounting, banking, finance, and recruitment.
- Motivating technology staff and establishing partnerships with Fortune 500 companies
Sunrise Systems has a vast range of competence in:
- Design, development, and support of cloud-based solutions from simple to highly complexed
- Database administration of multi-platform applications, complex databases, and web-based environments that include all aspects of installation, planning, maintenance, and monitoring.
- Data processing and data migration
- Application re-engineering and platform migration
- Working with the Information Systems and end-user communities at all levels to resolve issues and establish consensus.
Skills
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