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Claim Examiner/Adjuster

US Tech Solutions, Inc.
Atlanta, GA, United States
Full-time

Duration : 06 months (Possible extension)

Description :

Must Have Active New York Adjusters License

Responsibilities :

  • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, severe exposure claims, using high service-oriented file handling.
  • Pay and process claims within designated authority level.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Confer with legal counsel on claims requiring litigation.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

Experience : Skills :

Skills :

  • Licensing requirements vary by state : Active New York state adjuster's license required; multiple state licenses encouraged.
  • Proficiency in analytical, document management, and database query software.
  • Proficiency in Microsoft Office applications.
  • Two to four years of work-related experience.
  • Exceptional attention to detail.
  • Excellent customer service and communication skills.
  • General knowledge of state and national laws and regulations.
  • General understanding of medical and legal terms.
  • Experience in a claims production environment with set goals and quality scores that must be obtained.

Education :

High school diploma or bachelor’s degree

8 days ago
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