Professional Liability Claims Examiner III
- medical terminology
- Excel
Not enough detail in this posting to match
POSITION SUMMARY:Under the oversight of the Area Manager, the Claims Examiner III reports to the Claim Supervisor and/or Area Manager and is responsible for managing all aspects of Professional Liability claims from inception through resolution, within established authority and company guidelines. Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.
DUTIES AND RESPONSIBILITIES:
- Review, process and conclude assigned claims including investigation and evaluation of professional liability claims.
- Review and interpret policies, coverage determination.
- Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
- Maintain an ongoing diary.
- Continually assess exposure and evaluate accurate reserves and settlement recommendation.
- Prepare Loss Reports providing thorough analysis of liability and damages.
- Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
- Document all correspondence, reports, discussions and decisions in the claim file record.
- Provide outstanding service to the client.
- Assist Supervisors and Claim Department with requested tasks or special projects.
- Other duties as assigned.
Position is remote/working from home.
EQUIPMENT OPERATED/USED: Computer, and other officeequipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriateoffice attire when on video or attending client meetings.
Qualifications
QUALIFICATIONSREQUIRED:
Education/Experience: Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills, andAbilities:
- Technical knowledge of coverage, statutory regulations, and medicalterminology.
- Analyticalskills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
- Ability to interact with people at all levels in the businessenvironment.
- Ability to independently and effectively manage very complexclaims.
- Proficient in Word and Excel(preferred).
OtherQualifications:
- Active Independent Adjuster New York StateLicense
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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MENTALANDPHYSICALREQUIREMENTS |
- MENTALEFFORT
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- Reasoningdevelopment:
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Followone-ortwo-stepinstructions,routine,repetitivetask.
Carryoutdetailbutuninvolvedwrittenorverbalinstructions,dealwithafewconcrete variables.
Followwritten,verbal,ordiagrammaticinstructions,severalconcretevariables.
X Solvepracticalproblems;varietyofvariableswithlimitedstandardization;interpretinstructions.
Logicalorscientificthinkingtosolveproblems;severalabstractandconcretevariables.
Widerangeofintellectualandpracticalproblems;comprehendmostobscureconcepts. |
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b. Mathematicaldevelopment:
Simpleadditionalandsubtraction;copyingfigures,counting,andrecording.
Add,subtract,multiply,anddividewholenumbers.
X Arithmeticcalculationsinvolvingfractions,decimals,andpercentages.
Arithmetic,algebraic,andgeometriccalculations.
Advancedmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination.
Highlycomplexmathematicalandstatisticaltechniquessuchascalculus,factoranalysis,andprobability determination requires theoretical application. |
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c. Languagedevelopment:
Abilitytounderstandandfollowverbalordemonstratedinstructions;writeidentifyinginformation; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtainbasicinformationsuchasage,occupation,andnumberofchildren;guidepeopleandprovidebasic direction.
Abilitytotranscribedictation;makeappointmentsandprocessmail;writeformlettersorroutinecorrespondence; interpret written work instructions; interview job applicants.
X Abilitytocomposeoriginalcorrespondence,followtechnicalmanuals,andhaveincreasedcontactwith people.
Abilitytoreport,write,oreditarticlesforpublication;preparedeeds,contracts,orleases,prepareand deliver lectures; interview, counsel, or advise people; evaluate technical data. |
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount offorcefrequentlyorconstantlytolift,carry,push,pull,orotherwisemoveobjects.Sedentarywork |
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involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Lightwork:
(Iftheuseofarmand/orlegcontrolsrequiresexertionofforcesgreaterthanthatforSedentaryWork and the worker sits most of the time, the job is rated for Light Work).
Mediumwork:
Heavywork:
Veryheavywork:
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b. Visualrequirementsnecessarytoperformthejob:
Far vision: clarity of vision at 20 feet ormore
X Near vision: clarity of vision at 20 inches orless
X Mid-rangevision:clarityofvisionatdistancesofmorethan20inchesandlessthan20feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Colorvision:abilitytoidentifyanddistinguishcolors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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c. Physicalactivitynecessarytoperformthejobandfrequency(e.g.,continually,frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing |
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Balancing:
X Stooping:
X Kneeling:
X Crouching:
Crawling:
X Reaching:
X Standing:
X Walking:
X Pushing:
X Pulling:
Foot Motion:
X Lifting:
X Fingering:
X Grasping: |
requiredexceedsthatrequiredforordinarylocomotion.
Maintainingbodyequilibriumtopreventfallingwhenwalking,standing,or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
Bending body downward and forward by bending spine at the waist.Thisfactorisimportantifitoccurstoaconsiderabledegreeandrequiresfull use of the lower extremities and back muscles.
Bending legs at knee to come to a rest on knee orknees.
Bendingthebodydownwardandforwardbybendinglegsandspine.Moving about on hands and knees or hands and feet. Extendinghand(s)andarm(s)inanydirection.Particularly for sustained periods of time. Movingaboutonfoottoaccomplishtasks,particularlyforlongdistances.
Usingupperextremitiestoppressagainstsomethingwithsteadyforceinorder to thrust forward, downward, or outward.
Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Using feet to pushpedals.
Raising objects from a lower to a higher position or moving objectshorizontallyfrompositiontoposition.Thisfactorisimportantifitoccursto a considerable degree and requires substantial use of the upper extremities and back muscles.
Picking,pinching,typing,orotherwiseworkingwithfingersratherthanwith the whole hand or arm as in handling.
Applyingpressuretoanobjectwiththefingersandpalm. |
Occasionally |
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Occasionally Occasionally |
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Occasionally Occasionally Occasionally Occasionally |
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Occasionally |
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Frequently |
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Frequently |
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Occasionally |
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2. PHYSICAL EFFORT(cont.) |
FREQUENCY |
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XTalking: Expressing or exchanging ideas by means of the spoken word. Thoseactivitiesinwhichworkersmustconveydetailedorimportantspokeninstructions to other workers accurately, loudly, or quickly.
XHearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to |
Frequently
Frequently |
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makefinediscriminationsinsound,suchaswhenmakingfindadjustments on machined parts.
Feeling: Perceivingattributesofobjects,suchassize,shape,temperature,ortexture by touching with skin, particularly that of fingertips.
XRepetitive Substantialmovements(motions)ofthewrists,hands, Motion: and/or fingers. |
Frequently |
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3. WORKINGCONDITIONS
Disagreeablejobconditionstowhichtheemployeemaybeexposedandthefrequency(e.g.,continually,frequently, or occasionally) of this exposure. |
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WORKINGCONDITION ENVIRONMENTAL FACTOR |
NATURE/REASONOF EXPOSURE |
FREQUENCY |
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Dirt/Dust |
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Noise |
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Temperatureextremes |
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Dampness |
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Vibrations |
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Equipmentmovementhazard |
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Chemicals/solvents |
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Electricalshock |
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Significantworkpace/pressure |
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Odors/Fumes |
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Other(specify): |
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Professional Liability Claims Examiner III · Tristar Insurance