Claims Examiner, Credit
- High School diploma or equivalent required.
- At least 2 years of experience in PC required.
- At least 2 years experience in claims and/other related claims processes required.
- Knowledge of AS400 system experience preferred.
- Property License, 220, or 620, is preferred.
- Enters claim information and adjudicates claim by reviewing information and taking appropriate action to pay, request additional information or deny benefits based on coverage, provisions, and exclusions as outlined in the master policy certificate, including endorsement for eligibility and or liability.
- Investigates claims of a potentially fraudulent nature and reviews findings with management.
- Communicates with members, employers, accounts, and vendors to retrieve information to validate claims.
- Analyzes information and makes payments or adjustments as needed.
- Maintains appropriate claims related statistics and documentation to be provided to the legal department in the event of lawsuits, insurance department inquiries, SSAE16 audits, or other internal or external audits.
- Maintains an understanding of related state laws, anti-fraud compliance requirements, claims processes, product standards, production standards, company guidelines and service standards.
- Maintains tracking system by updating the computer system with claims numbers and verifies coverages.
- Identifies potential workflow improvements and impediments.
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