Claims Examiner, PIP, No Fault

Job Description: • Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution. • Coordinates vendor referrals for additional investigation and/or litigation management. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. Requirements: • Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • Five (5) years of claims management experience or equivalent combination of education and experience required • New York experience preferred but not required • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business • Excellent oral and written communication, including presentation skills • PC literate, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Good interpersonal skills • Excellent negotiation skills • Ability to work in a team environment • Ability to meet or exceed Service Expectations Benefits: • medical • dental • vision • 401k and matching • PTO • disability and life insurance • employee assistance • flexible spending or health savings account • other additional voluntary benefits Apply tot his job Apply To this Job