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Claims Examiner
Ref No.: 18-30938
Location: Plano, Texas
Position Type:Direct Placement
Start Date: 05/04/2018
Job Description:
  • Evaluates and analyzes documentation thoroughly to determine claim processing according to policy/certificate provisions and state regulations with limited authority limits
  • Analyzes any additional information/documentation received to determine how to proceed with a review of a claim under supervision and determines methods of obtaining information from alternative sources.
  • Manages the review of a claim and the outside sources used in the review.
  • Thoroughly documents correspondence and conversations.
  • Corresponds verbally and in writing with claimants, medical providers, medical examiners, and law enforcement.
  • Works closely with manager claims examiner, legal counsel, medical director, claims assistants, and other departments.
  • Monitors claims for fraud and proceeds accordingly
  • Infrequently testifies in depositions, hearings and trials; communicates the Company's position regarding the claim
Maintains compliance with regulations and respond to any insurance department complaints
 
Experience Required  
  • Bachelors degree or equivalent work experience required
  • Up to 2 years experience in claims
  • Quickly learn product language and provisions
  • Strong communication skills-verbal and written
  • Proven organizational abilities
  • Ability and initiative to perform with moderate supervision