Claims Examiner

Location: Tampa, FL

Duration: 3 MonthsKEY 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 rehabilitationSCOPE INFORMATION: The position reports directly to a Claims Team Leader or other member of claims management.