Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
WHO WE ARE:
Harford Mutual Insurance Group is a growing, dynamic community partner located in Bel Air in Harford County, Maryland, offering a positive, diverse, and inclusive work environment with a rich company culture. We provide commercial property and casualty insurance products and services to a regional market. Founded in 1842 on the principles of mutuality for our business clients, our agents, and our company, we believe in insuring opportunity through mutual success® and invite our employees to continue that tradition with respect, integrity, exemplary service, and personal responsibility.
THE OPPORTUNITY
The Medical-Only Examiner works within specific limits and authority on low complexity claim assignments. They confirm coverage, contact the insured to confirm the incident, then collect medical bills and issue payment as quickly as possible. The claims handled by a medical only examiner are on a fast track basis and require limited investigation, with a goal of creating a positive experience for the policyholder and injured worker.
WHAT YOU’LL DO:
Receive, review and timely process claims.
• Proper claim coverage and file documentation.
• Enter and update claims in claim management system.
• Establish and update claim reserves promptly.
• Provide prompt claim acknowledgement to the policyholder.
• Contact medical providers promptly and request itemized billing statements and medical records.
• Resolve claims by issuing prompt payment, or denial of claim.
• Maintain claim diary and comply with departmental diary procedures.
• Comply with the Unfair Claims Practice laws in the handling of all claims.
• Respond to claims status inquiries.
• Continuing education on insurance and claims matters.
• Performs other duties or special projects as required or as assigned by a supervisor.
WHAT YOU’LL BRING:
WHO YOU ARE:
Physical Requirements:
The physical demands are minimal and typical of similar jobs in comparable organizations.
Americans with Disabilities Act (ADA):
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties of the position.
The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of Harford Mutual
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