automobile insurance claim examiner

ECP, Inc.

Automotive Claims Specialist (Appraisal &amp; Appearance Protection)Job Description: ECP Incorporated is currently seeking a detail-oriented Automotive Claims Specialist, preferably with technical appraisal experience. We are searching for a representative capable of defining problems and collecting data, specifically regarding appearance protection claims (Paint, Windshield, and Interior).The ideal candidate has a background in automotive damage estimation and a strong understanding of repair software and consumer correspondence. This is a professional office-based role focused on technical adjudication rather than retail service writing.Summary: Responsible for adjudicating appearance protection warranty claims by corresponding with customers, body shops, and glass/upholstery technicians.Essential Duties and Responsibilities:<ul><li>Receives and processes appearance claims (Paint, Fabric/Leather, and Windshield) from customers.</li><li>Sets up digital files and maintains detailed technical notes on claim progression.</li><li>Reviews and audits damage estimates using CCC ONE or similar appraisal platforms to ensure repair accuracy.</li><li>Corresponds with customers, vendors, body shops, and PDR (Paintless Dent Repair) technicians regarding claim status and coverage.</li><li>Negotiates labor rates and service costs with providers to ensure the most cost-effective remedy is utilized.</li><li>Coordinates with inspection centers and appraisers on complex or problem claims.</li><li>Initiates professional approval and denial letters based on contract specificities.</li><li>Inputs claim check requests for administrative approval.</li><li>Interacts professionally and courteously with customers.</li></ul>Education and Experience:<ul><li>1-4 years of related experience in automotive damage appraisal, body shop estimating, or claims adjudication.</li><li>Proficiency in CCC ONE is highly preferred.</li><li>Equivalent combinations of education and technical field experience will be considered.</li></ul>Benefits: ECP offers competitive Benefits: Comprehensive Health Insurance Coverage, Dental, Vision, Life Insurance, 401(k) Matching, and Paid Time off.About ECP: Since 1969, ECP Brands have been seen on over 45 million vehicles. Over 14 thousand automobile dealers and carwash operators use ECP products, programs and services. Our heritage has been in the manufacturing, packaging and distribution of protective coatings, detailing, prep, carwash and service chemicals and supplies, and in providing the administration of product warranties and financial services programs to produce aftermarket sales opportunities and cost savings for automobile dealers and related businesses.ECP is proud to be an Equal Opportunity Employer. All employees and applicants will receive consideration for employment without regard to age, color, disability, gender, national origin, race, religion, sexual orientation, gender identity, protected veteran status, or any other classification protected by federal, state, or local law. ECP participates in the E-Verify process for all new hires.Job Type: Full-timePay: $45,000.00 - $55,000.00 per yearBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Experience:<ul><li>Automotive claims : 1 year (Preferred)</li><li>Customer Service: 1 year (Preferred)</li></ul>Work Location: In person

Automotive Claims Representative I

Dealer Loyalty Protection

Dealer Loyalty Protection is a leading player in the automotive industry, renowned for its commitment to quality and customer satisfaction. We are seeking a dynamic and detail-oriented Automotive Warranty Claims Adjusters to join our team. As an integral part of our operations, you will play a crucial role in upholding our reputation for excellence.Responsibilities:&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Review and process incoming warranty claims from customers, dealerships, and service centers.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Evaluate claims based on policy terms, technical specifications, and industry standards.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Collaborate with technical experts and assessors to determine the validity of claims.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Maintain accurate documentation of claims, decisions, and communication.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Communicate effectively with customers, dealerships, and service centers regarding claim status, approvals, and rejections.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Ensure compliance with company policies, legal regulations, and warranty guidelines.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Analyze trends in warranty claims to identify potential issues and suggest improvements.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Provide exceptional customer service by addressing inquiries and concerns professionally.Qualifications:&bull;&ensp;&ensp;&ensp;&ensp;&ensp;High school diploma or equivalent; bachelor&rsquo;s degree in a related field is a plus.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Proven experience in automotive warranty claims processing or a related role.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Strong analytical skills to assess claims accurately and make informed decisions.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Excellent communication skills, both written and verbal.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Detail-oriented with the ability to manage multiple tasks efficiently.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Proficiency in using relevant software and databases for claims management.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Ability to work independently and as part of a collaborative team.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Customer-focused mindset and a commitment to resolving issues promptly.Benefits:&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Competitive wages.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Comprehensive benefits package, including health, dental, and retirement plans.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Opportunities for career growth and professional development.&bull;&ensp;&ensp;&ensp;&ensp;&ensp;Supportive work environment that values teamwork and innovation..If you are a motivated individual with a passion for automobiles and a knack for resolving complex warranty claims, we encourage you to apply. Join our team and contribute to our legacy of delivering top-notch automotive solutions and customer satisfaction.Job Type: Full-timePay: $20.00 - $23.00 per hourBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Professional development assistance</li><li>Vision insurance</li></ul>Ability to Commute:<ul><li>Mahwah, NJ 07430 (Required)</li></ul>Ability to Relocate:<ul><li>Mahwah, NJ 07430: Relocate before starting work (Required)</li></ul>Work Location: In person

Automotive Warranty Claims Adjuster

TRISTAR

<div><div>POSITION SUMMARY: Responsible for the prompt review of policy information to determine coverage for loss/damage/injury. Conduct an 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:
<ul><li>Review and interpret coverage, process, and conclude assigned claims including investigation and evaluation of Auto and/or General Liability Casualty Claims in multiple jurisdictions. Claims may be litigated or non-litigated.</li><li>
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.</li><li>
Maintain an ongoing diary.</li><li>
Continually assess exposure and evaluate accurate reserves and settlement recommendation.</li><li>
Prepare Loss Reports providing thorough analysis of coverage, liability, and damages.</li><li>
Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts in the direction of the client.</li><li>
Document all correspondence, reports, discussions, and decisions in the claim file record.</li><li>
Provide outstanding service to the client.</li></ul></div><div></div>
Position is remote/working from home.
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required; bachelor&rsquo;s degree in related field (preferred) and three years auto and general liability casualty related experience; or equivalent combination of advanced education and experience.
Special Requirements:
<ul><li>At least three years of Automobile and General Liability claims experience required.</li><li>
Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues, litigation management and product line knowledge.</li><li>
Demonstrated verbal and written communications skills.</li><li>
Demonstrated advanced analytical, decision-making and negotiation skills.</li><li>
Computer proficiency.</li></ul>
Preferred Skills:
<ul><li>Ability to communicate effectively and clearly, both orally and in writing.</li><li>
Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.</li><li>
Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.</li><li>
Excellent customer service skills.</li><li>
An understanding of the litigation process and case valuation in multiple jurisdictions.</li><li>
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.</li><li>
An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.</li><li>
Time management skills, organizational skills, and ability to prioritize issues and tasks.</li><li>
Ability to effectively operate computer equipment and applications.</li><li>
Independence, flexibility, and creativity.</li></ul>
Other Qualifications:
<ul><li>Multiple Adjuster licenses are preferred but candidate must have a New York State Adjuster License.</li></ul>
Mental and Physical Requirements:
<div><div>MENTAL AND PHYSICAL REQUIREMENTS</div><div><div> 
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
Solve practical problems; variety of variables with limited standardization; interpret instructions.
X Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.</div></div><div><div> 
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.</div></div><div><div> 
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.</div></div><div><div> 
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects 
</div></div> 
<div><div><ul><li>Visual requirements necessary to perform the job:</li></ul>
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
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
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
c. Physical activity necessary to perform the job and frequency (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 required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, 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.
Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
Kneeling: Bending legs at knee to come to a rest on knee or knees.
Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
Reaching: Extending hand(s) and arm(s) in any direction.
Standing: Particularly for sustained periods of time.
Walking: Moving about on foot to accomplish tasks, particularly for long distances.
Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm. 
</div><div>Frequently
Occasionally
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.</div><div> 
Frequently
Frequently
Frequently 
</div></div> 
<div><div>3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 
</div></div> 
<div><div>WORKING CONDITION
ENVIRONMENTAL
FACTOR</div><div> 
NATURE/REASON
OF EXPOSURE</div><div> 
FREQUENCY</div></div><div> 
Dirt/Dust 
</div> 
<div>Noise 
</div> 
<div>Temperature extremes 
</div> 
<div>Dampness 
</div> 
<div>Vibrations 
</div> 
<div>Equipment movement hazard 
</div> 
<div>Chemicals/solvents 
</div> 
<div>Electrical shock 
</div> 
<div>Significant work pace/pressure 
</div> 
<div>Odors/Fumes 
</div> 
<div><div>Other (specify):</div></div></div></div>

Commercial Auto & GL Claims Examiner III _ Temp

Ultimate Staffing

<div>
 
 We are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. The ideal candidate has strong working knowledge of
 
 ICD‑9 and ICD‑10 diagnosis coding
 
 and healthcare billing standards.
 
 
 
 Key Responsibilities:
 
 
 <ul>
 <li>
 Review and process medical claims for completeness, accuracy, and compliance
 </li>
 <li>
 Apply ICD‑9 and ICD‑10 codes to evaluate claim validity
 </li>
 <li>
 Identify coding discrepancies, overpayments, and potential fraud or abuse
 </li>
 <li>
 Ensure claims adhere to payer policies, CMS guidelines, and regulatory requirements
 </li>
 <li>
 Document determinations and communicate findings as needed
 </li>
 </ul>
 
 
 Qualifications:
 
 
 <ul>
 <li>
 Proven experience as a Medical Claims Examiner or similar role
 </li>
 <li>
 Strong knowledge of
 
 ICD‑9 and ICD‑10 coding
 
 </li>
 <li>
 Familiarity with CPT, HCPCS, and medical billing guidelines
 </li>
 <li>
 Attention to detail and strong analytical skills
 </li>
 <li>
 Proficiency with claims processing systems and MS Office
 </li>
 </ul>
 
 
 Preferred:
 
 
 <ul>
 <li>
 CPC, CCS, or related certification
 </li>
 <li>
 Experience with Medicare, Medicaid, or commercial insurance claims
 
 </li>
 </ul>
 
 
 
 
 Desired Skills and Experience
 
 
 
 We are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. The ideal candidate has strong working knowledge of ICD‑9 and ICD‑10 diagnosis coding and healthcare billing standards.
 
 Key Responsibilities:
 
 
 Review and process medical claims for completeness, accuracy, and compliance
 
 Apply ICD‑9 and ICD‑10 codes to evaluate claim validity
 
 Identify coding discrepancies, overpayments, and potential fraud or abuse
 
 Ensure claims adhere to payer policies, CMS guidelines, and regulatory requirements
 
 Document determinations and communicate findings as needed
 
 
 Qualifications:
 
 
 Proven experience as a Medical Claims Examiner or similar role
 
 Strong knowledge of ICD‑9 and ICD‑10 coding
 
 Familiarity with CPT, HCPCS, and medical billing guidelines
 
 Attention to detail and strong analytical skills
 
 Proficiency with claims processing systems and MS Office
 
 
 Preferred:
 
 
 CPC, CCS, or related certification
 
 Experience with Medicare, Medicaid, or commercial insurance claims
 
 
 
 
 All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.
 
 
</div>

Medical Claims Examiner

Benecard Services Inc.

<div><div><div><div><div><div>The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</div><div></div><div> 
This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week and is a Union position.</div><div></div><div> 
Key Responsibilities</div><ul><li>
Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li>
Process complex or high-dollar claims requiring supervisory overrides</li><li>
Distribute daily claim workloads and support operational workflow efficiency</li><li>
Prepare and maintain documentation for internal and external audits</li><li>
Ensure compliance with prompt pay regulations and timely filing requirements</li><li>
Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li>
Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li>
Support monthly claims reporting and departmental performance tracking</li><li>
Collaborate with leadership to meet monthly productivity and accuracy goals</li><li>
Respond promptly and professionally to internal and external communications</li><li>
Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><div></div><div> 
Required Qualifications:</div><ul><li>
5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li>
Strong knowledge of Medicaid and Medicare claim processing</li><li>
Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li>
Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li>
Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li>
In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li>
Familiarity with appeals and reconsideration processes for government payers</li><li>
Experience researching and resolving claim denials and timely filing issues</li><li>
Working knowledge of AS400 or similar claims processing systems</li><li>
Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li>
Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><div></div><div> 
Preferred Qualifications:</div><ul><li>
Previous leadership experience would be preferred</li><li>
Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li>
Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li>
Experience supporting or participating in claims audits or compliance reviews</li></ul><div></div><div> 
Why Join Us?</div><ul><li>
Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li>
Opportunity to specialize in eye care and vision insurance claims</li><li>
Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul> 
National Vision Administrators
For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.
Website: http://www.e-nva.com
We are an equal opportunity employer</div></div></div></div> 
Monday - Friday 8:30am - 5:00pm</div>

Claims Examiner

ELITE

<div>POSITION DETAILS 
<div><div><div><div>Position Title:</div> <div>Senior Claims Examiner</div>
</div> 
<div><div>Department:</div> <div>Workers&rsquo; Compensation California</div>
</div> 
<div><div>Reports To:</div> <div>Claims Supervisor</div>
</div> 
</div></div> 
POSITION SUMMARY 
COMPANY has an immediate need for a Senior Claims Examiner to support our workers compensation offices and can be located anywhere in the state of California. The schedule for this position is Monday-Friday at 37.5 hours a week. 
 
The Senior Claims Examiner will adjust workers&rsquo; compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers&rsquo; compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. 
 
PRIMARY RESPONSIBILITIES 
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: 
<ul><li>Establish contact with employer to review issues</li>
<li>Respond to inquiries from the employer, employee, doctors, and attorneys</li>
<li>Establish and maintain appropriate reserves</li>
<li>Review legal correspondence and medical reports</li>
<li>Evaluate and approve medical procedures and treatment</li>
<li>Administer benefits and ensure appropriateness of all payments</li>
<li>Investigate coverage, liability, and monetary value of claim</li>
<li>Review medical and legal bills for appropriateness</li>
<li>Discuss appropriateness of medical treatment with medical case manager</li>
<li>Determine compensability</li>
<li>Monitor and assist litigation</li>
<li>Negotiate settlement of claim, liens, rehabilitation plans, etc.</li>
<li>Prepare and present reports to clients</li>
<li>Appropriately close claims</li>
<li>Help resolve client billing and payment inquiries
</li><li>Investigate complaints from injured workers</li>
<li>Document and code the claim files and claims system with all relevant information</li>
<li>Maintain and update action plans within specified time frames</li>
<li>Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks</li>
<li>Contact with employers, employees, attorneys, doctors, vendors, and other parties</li>
<li>Provide customer service and support to clients and claimants</li>
<li>Work collaboratively with attorneys to draft settlements and assist with litigation strategies</li>
<li>Negotiate settlements</li>
<li>Authorize and negotiate cost of medical treatment and supplies</li>
<li>Internal communication with staff</li>
<li>Prepare professional, well written correspondence and other communications</li>
</ul>
 
ESSENTIAL POSITION REQUIREMENTS
 
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. 
<ul><li>High School Diploma or equivalent (GED) required for all positions
<ul><li>AA/AS or BA/BS preferred but not required</li>
</ul></li><li>Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained</li>
<li>Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)</li>
<li>3+ years recent workers compensation claims handling experience required</li>
<li>At least 5 years of workers compensation claims experience preferred</li>
<li>Solid knowledge of workers compensation laws, policies, and procedures&rsquo;</li>
<li>Completion of IEA or equivalent courses</li>
<li>Proficiency in determining case value and negotiating settlements</li>
<li>Understanding of medical and legal terminology</li>
<li>Mathematical calculating skills</li>
</ul><ul><li>Well-developed verbal and written communication skills with strong attention to detail</li>
<li>Excellent organizational skills and ability to multi-task</li>
<li>Ability to type quickly, accurately and for prolonged periods</li>
<li>Proficient in Microsoft Office Suite
<ul><li>Ability to learn additional computer programs</li>
</ul></li><li>Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution</li>
<li>Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization</li>
<li>Seeks to include innovative strategies and methods to provide a high level of commitment to service and results</li>
<li>Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner</li>
<li>Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.</li>
<li>COMPANYs&rsquo; operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.</li>
<li>Must be able to reliably commute to meetings and events as required by this position</li>
</ul>
 
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. 
 
COMPANY is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.</div>

Workers Compensation Claims Examiner (California Jurisdiction)

Utica National Insurance Group

<div>The Company
At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected.

Utica National Insurance Group is an &quot;A&quot; rated $2.0B award-winning, nationally recognized property &amp; casualty insurance carrier.

Operating along the Eastern half of the United States, based in our Home Office in Central New York, with Regional Office locations including NYC, Dallas and Charlotte.

What you will do

The Property Large Loss Examiner will handle personal and commercial large loss claims and complex claims. With attention to customer service and skills in investigation and negotiation, the Examiner will meet the needs of our insureds and engage in timely claims resolution. As a more senior individual contributor role, this position will require broad technical knowledge at an advanced level. This role will be a hybrid position reporting to New Hartford, NY; Buffalo, NY; or Charlotte, NC.

Key responsibilities
<ul>
<li>Direct handling of both personal and commercial large loss claims with a high level of customer service.</li>
<li>Handles Property claims of a complex nature; performs claims investigations and handles matters requiring broad technical knowledge at an expert level.</li>
<li>Operates on an independent basis with little supervision; mitigates, negotiates and settles claims within assigned authority with a strong focus of overall claim resolution.</li>
<li>Assist in selection, and some oversight, of independent adjusters and coverage counsel.</li>
<li>Reviews court decisions, and coverage interpretations, and is required to have a broad knowledge and understanding of Property law and claim practices.</li>
<li>Responsible for reporting on large losses, litigation reports and reports to reinsurance as needed.</li>
<li>Assists in the development and training of claims personnel in Property department.</li>
<li>Performs other tasks as assigned.</li>
</ul>
What you need:
<ul>
<li>4 year college degree preferred or equivalent experience.</li>
<li>4-8 years of Property claims experience demonstrating expertise in underlying coverages, broad background in litigated matters and development.</li>
</ul>
Licensing

Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment. 


Salary range: $81,000 - $120,000

The final salary to be paid and position within the internal salary range is reflective of the employee&rsquo;s work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications. 


Benefits
We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:
<ul>
<li>Medical and Prescription Drug Benefit</li>
<li>Dental Benefit</li>
<li>Vision Benefit</li>
<li>Life Insurance and Disability Benefits</li>
<li>401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)</li>
<li>Health Savings Account (HSA)</li>
<li>Flexible Spending Accounts</li>
<li>Tuition Assistance, Training, and Professional Designations</li>
<li>Company-Paid Family Leave</li>
<li>Adoption/Surrogacy Assistance Benefit</li>
<li>Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance</li>
<li>Student Loan Refinancing Services</li>
<li>Care.com Membership with Back-up Care, Senior Solutions</li>
<li>Business Travel Accident Insurance</li>
<li>Matching Gifts program</li>
<li>Paid Volunteer Day</li>
<li>Employee Referral Award Program</li>
<li>Wellness programs</li>
<li>Personal Insurance Discount</li>
</ul>
Additional Information:

This position is a full time salaried, exempt (non overtime eligible) position.

Utica National is an Equal Opportunity Employer.

Apply now and find out what it&rsquo;s like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
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Property Large Loss Examiner (hybrid)

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