Text copied to clipboard!
Title
Text copied to clipboard!Claims Examiner
Description
Text copied to clipboard!
We are looking for a meticulous and detail-oriented Claims Examiner to join our dynamic team. In this role, you will be at the forefront of our efforts to ensure the integrity and accuracy of insurance claims processing. Your primary responsibility will be to review, investigate, and make decisions on insurance claims across various types. This involves verifying insurance coverage, determining liability, and ensuring that claims are resolved in a timely and fair manner. You will work closely with claimants, insurance agents, and adjusters to gather necessary information and documentation. Your analytical skills will be crucial in identifying discrepancies, potential fraudulent activities, and ensuring compliance with policy terms and regulatory requirements. This role demands a high level of professionalism, ethical judgment, and an unwavering commitment to customer service. The ideal candidate will have a strong background in insurance, law, or finance, with a keen eye for detail and a methodical approach to problem-solving. By joining our team, you will play a key role in maintaining the trust and confidence of our clients, while also protecting the financial health of our company.
Responsibilities
Text copied to clipboard!- Review and evaluate insurance claims to determine coverage and liability.
- Investigate claims by contacting claimants, witnesses, and medical professionals.
- Analyze documentation and evidence to support claim decisions.
- Negotiate settlements with claimants and attorneys.
- Coordinate with insurance adjusters and agents to gather additional information.
- Identify and document potential fraudulent activities.
- Ensure compliance with policy terms and regulatory requirements.
- Maintain accurate and up-to-date records of claim decisions and communications.
- Provide exceptional customer service to claimants and policyholders.
- Stay informed about industry trends, regulations, and best practices.
- Collaborate with legal teams on complex claims or disputes.
- Educate policyholders on claim processes and coverage details.
- Participate in training and development opportunities.
- Assist in developing and implementing claims policies and procedures.
- Manage workload to meet or exceed performance targets.
- Use claims software and technology tools efficiently.
- Report on claim trends and issues to management.
- Work closely with underwriting to provide feedback on policy risks.
Requirements
Text copied to clipboard!- Bachelor's degree in insurance, finance, law, or related field.
- Proven experience as a Claims Examiner or similar role in the insurance industry.
- Strong understanding of insurance laws, coverage, and terminology.
- Excellent analytical and decision-making skills.
- High level of attention to detail and accuracy.
- Strong negotiation and conflict resolution skills.
- Effective communication and interpersonal skills.
- Ability to manage multiple tasks and prioritize effectively.
- Proficiency in claims management software and MS Office.
- Commitment to ongoing professional development.
- Certification in Claims Adjusting or similar credentials preferred.
- Knowledge of medical terminology and understanding of medical claims a plus.
- Ability to work independently and as part of a team.
- High ethical standards and professionalism.
- Flexibility to adapt to changing regulations and industry trends.
- Strong customer service orientation.
- Ability to maintain confidentiality of sensitive information.
- Willingness to undergo background checks.
Potential interview questions
Text copied to clipboard!- Can you describe your experience with claims management software?
- How do you stay updated on changes in insurance laws and regulations?
- Describe a complex claim you handled and how you resolved it.
- How do you handle conflicts with claimants or policyholders?
- What strategies do you use to identify fraudulent claims?
- Can you explain a time when you had to negotiate a settlement? What was the outcome?
- How do you prioritize your workload when handling multiple claims?
- What do you find most challenging about the claims examination process, and how do you overcome it?
- How do you ensure compliance with policy terms and regulatory requirements?
- What motivates you to provide exceptional customer service in difficult situations?