SS
Temporary Experienced Examiner Position
Sunrise Systems Inc
🇺🇸 United States
On-site
Mid level
2 days ago
2 days ago
Job ID: 26-04957
Location: Cheektowaga, NY, 14225
Duration: 2Â Months of Contract
Job Description:
KEY 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 rehabilitation
SCOPE INFORMATION:
- The position reports directly to a Claims Team Leader or other member of claims management.
DESIRED QUALIFICATIONS:
- 3-5 years experience handling higher level Workers' Compensation claims.
- Basic knowledge of claims handling and familiarity with claims terminologies.
- Effective negotiation skills.
Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses.
- Ability to self motivate and work independently.
- Knowledge of Chubb products, services, coverages and policy limits, along with awareness of claims best practices
- Knowledge of applicable state and local laws
- State adjusters licensing a plus or will require future licensing.
- Familiar in computer systems
- 40 words per minute typing skills
Ghouse: Ghouse.M@sunrisesys.com | (732) 395-4372 | URL: www.sunrisesys.com
Temporary Experienced Examiner Position · Sunrise Systems Inc