Claim Examiner- WC
Brea, CA US
Location –Brea, CA
Duration: 06+ month contract with possible extension and conversion
- Receives claim assignment, confirms policy coverages, and directs acknowledgment of claims.
- Interprets and makes decisions using independent judgment on moderate difficulty claims and policy coverages and determines if coverages apply to claims submitted.
- Investigates, evaluates, negotiates and adjudicates first and third-party claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required.
- Analyzes claims activity and prepares reports for clients/carriers and management.
- Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements.
- Make settlement decisions promptly and equitably and issues company drafts in payments for claims within authority limits.
- Develops subrogation and third-party recovery potential and follows reclaim procedures.
- Analyzes claims activities and prepares reports for clients, carriers and/or management.
- Participates in claim reviews.
- CLIENT COMMUNICATION
- Bachelor's degree or equivalent experience required.
- Comprehensive claims investigations/settling experience 1-3 years’experience in Claims or similar organization