Claims Examiner - Healthcare
Job title: Claims Examiner - Healthcare in Atlanta, GA at Core Specialty Insurance Services, Inc.
Company: Core Specialty Insurance Services, Inc.
Job description: -As the Healthcare Claims Examiner, you will directly handle Healthcare Claims.Key Accountabilities/Deliverables:
- Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.
- Provide oversight on claims portfolios within the primary casualty book. Maintain direct contact with insureds, agents, and brokers.
- Provide oversight on claims portfolios handled by TPAs within the excess casualty book.
- Engage in rigorous ALAE control and management, by competently selecting, instructing, and managing 3rd party vendors, as appropriate.
- Gather and analyse information necessary to make an accurate evaluation of the claim by delivering effective resolution of claims, make decision within established authority levels and identifying settlement issues.
- Establish reserves pursuant to established reserving protocols and reserve authority procedures.
- Successfully and proactively resolve complex and/or high exposure claims, promptly limiting exposure to the Company. Substantial involvement in mediation negotiations will be required.
- Adhere to the Panel Counsel Program and all Litigation Management Guidelines.
- Meet all Reporting Requirements by completing reports timely and accurately, including Large Loss Reports, etc.
- Liaise and attend meetings with the underwriting team regarding claim trends and other areas of interest.
- Work with external customers to address questions, resolve problems and maintain rapport.
- Occasional domestic travel may be required to attend mediations and / or trials.
- Undertaking general office administrative duties as and when required.
- Proactively expanding and maintaining awareness of the current market/industry and attend continuing educations programs when available.
- In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require.
- Must possess a general understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims.
- Must possess a general understanding of policy language/coverages applicable to US Specialty Healthcare.
- Must understand medical terminology.
- Computer skills – good working knowledge of Windows 10. MS Office, Excel and basic computer setup/troubleshooting.
- Previous experience with an electronic (paperless) claim system.
- College degree required.
- Must be licensed as a claims adjuster in their home state – multi-state licensure is preferred.
- A minimum of 5 years of claims adjusting or legal experience is required. A background in US Healthcare Professional/General Liability is preferred.
- A prior history of employment as a Healthcare professional or Medical Malpractice attorney is a plus.
- Must have experience handling Primary and Excess claims. Additional experience handling Reinsurance is preferred.
- Ability to travel for meetings, mediations and trials as required.
- Ability to negotiate and be persuasive.
- Possess strong communication and writing skills.
- Must be detail oriented and organized.
- Must possess the ability to work independently and as a team member.
- Must be a self-starter and possess problem solving skills.
- Must be able to manage pending caseloads, additional projects and meet all deadlines as set by management