Claims Examiner jobs in Raleigh, NC
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)
Recently Added Claims Examiner jobs
Claims Examiner - Claims Specialist
- James River Group
-
Raleigh, NC
FULL_TIME
-
Falls Lake Insurance is the specialty admitted segment of James River Group Holdings, Ltd. James River Group received national recognition as a Top Workplaces USA winner in 2021, 2022, and 2023.
We are committed to providing a stable and rewarding work envirotnment supported by our Core Values and Guiding Principals: Integrity, Accountability, Innovation, Customer Service, Communication, and Teamwork.
James River Group Holdings, Ltd. is a Bermuda-based insurance holding company which owns and operates a group of specialty insurance and reinsurance companies. The Company operates in two specialty property and casualty insurance segments: Excess and Surplus Lines and Specialty Admitted Insurance. The Company ends to focus on accounts associated with small or medium-sized businesses in each of its segments. Each of the Company’s regulated insurance subsidiaries are rated “A-“ (Excellent) by A.M. Best Company.
Job Summary
The Claims Examiner, under direct supervision of the Claims Assistant Manager or Claims Manager, will handle lost time claims with a close period of indemnity benefits and non-complex medical injuries. Works on problems of limited to moderate scope where analysis of situations or data requires a review of a variety of factors. Exercises judgment within defined procedures and practices to determine appropriate action. Duties include: Review of claims to determine compensability, review of medical documentation, establishment of reserves, maintain diary within Best Practice Standards. The Claims Examiner will communicate with insureds, claimants and medical providers. The Claims Examiner will ensure that state claims handling requirements are met as well as compliance with our Claims Best Practices. The Claims Examiner is expected to learn and become proficient in the handling of commercial auto claims with limited to moderate period of disability.
Duties and Responsibilities- Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service.
- Conduct three point contacts
- Determine compensability
- Issue workers’ compensation benefits
- Develop plans of action to resolution, coordinate return to work efforts and approved medical payments.
- Investigates Subrogation and negotiate limited settlements within authority level.
- Maintains contact with policyholders and injured workers.
- Ensure claims files are appropriately documented.
- Completes and files appropriate FROI and SROI’s as required by individual State Workers’ Compensation Statute and EDI reporting regulations.
- Manages claims in accordance with Falls Lake Best Practices
- Employs appropriate claims management techniques and direct intervention (referrals for nurse case management, independent medical examinations, utilization review) to manage each claim.
- Makes decisions within delegated authority.
- Have a general understanding of all legislative requirements and is able to take direction to meet those requirements in a prudent business manner.
- Maintains a license for all states and products serviced as required.
- Organize and update all reference material to reflect current legislation and regulatory compliance.
- Comply with all quality control standards set by the company for the handling of claims. Comply with all procedures set forth by the company for performing the job as it relates to the various components of claim administrative services.
- Immediately notify Management of any unusual lawyer inquiries, insurance carrier inquiries, or department of insurance inquiries.
- Familiar with the claims handling process
- Knowledge of medical terminology
- Customer Service focused
- Organizational skills
- Time Management skills
- Excellent oral and written communication skills
- Attention to detail
- Strong Computer Skills
- Hands on Learner
- Ability to multi-task
- Team Attitude
- Ability to successfully obtain the required state adjusters’ licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter.
- Four-year college degree preferred
- One to three years of claims handling experience
- Experience in working with liability and coverage issues
- Experience negotiating settlements with claimants and attorneys
- Multi-jurisdictional claims experience preferred, may be required depending on type of claim
- Adjuster license and/or certifications preferred
#LI-Remote - 9 Days Ago
Claims Examiner - Claims Specialist
- JRGCLIENTCAREERSITE
-
Raleigh, NC
FULL_TIME
- Falls Lake Insurance is the specialty admitted segment of James River Group Holdings, Ltd. James River Group received national recognition as a Top Workplaces USA winner in 2021, 2022, and 2023. We ar...
- 10 Days Ago
Senior Commercial General Liability Claims Examiner
- King's Insurance Staffing
-
Durham, NC
FULL_TIME
- Our client, an A-rated Insurance Carrier, is seeking to add a Senior Commercial General Liability Claims Specialist to their North Carolina team. This person would be responsible for directly handling...
- 3 Days Ago
Title Examiner
- PSG Global Solutions
-
Halifax, NC
FULL_TIME
- Company DescriptionOne of the leading engineering firm across the US. Job DescriptionRight of Way Specialist Description:The Staff Right of Way Specialist will partner with senior staff in the facilit...
- 2 Months Ago
Property Desk Adjuster
- EAC Claims Solutions LLC
-
Durham, NC
CONTRACTOR
- At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and comp...
- 7 Days Ago
Property Desk Adjuster
- EAC Claims Solutions LLC
-
Nashville, NC
FULL_TIME
- At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and comp...
- 3 Days Ago
Filters
- Current Active Filter
- Raleigh, NC
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Claims Examiner jobs found in Raleigh, NC area
Life Insurance Agent
- Universal Benefits Marketing Firm,
-
Raleigh, NC
- Job Description Job Description It's time to take your success to the next level by joining Universal Benefits Marketing...
- 12/13/2024 12:00:00 AM
Remote Insurance Sales (Warm Leads + No Experience Needed)
- SFG - Peterson Agency
-
Raleigh, NC
- Job Description Job Description Ranked #9 on Forbes.com's "25 Companies Hiring The Most High-Paying Jobs In 2024," and l...
- 12/13/2024 12:00:00 AM
Entry Level Remote Sales
- Katz Legacy Financial
-
Raleigh, NC
- Job Description Job Description Are YOU tired of not getting paid what YOU’RE Worth? Do YOU want control of YOUR Income?...
- 12/12/2024 12:00:00 AM
Licensed Insurance Agent (100% Commission)
- Weyenberg Group
-
Raleigh, NC
- Job Description Job Description Remote or In-Person (Hybrid Position to Work from Home or Anywhere in the Country) Are y...
- 12/11/2024 12:00:00 AM
Leasing Consultant
- HHHunt
-
Raleigh, NC
- As a Leasing Consultant for HHHunt's Abberly Royal Creek apartments, you are passionate about being Customer Focused and...
- 12/11/2024 12:00:00 AM
Outside Sales Role *No Cold Calling, Flex Schedule, Training and Fresh Leads Provided*
- TAG
-
Raleigh, NC
- Job Description Job Description The Assurance Group is looking to hire and train new agents with the right skill set for...
- 12/11/2024 12:00:00 AM
Insurance Agent/Account Manager
- Craig Insurance Group
-
Raleigh, NC
- Job Description Job Description Local independent agency is seeking an organized and highly motivated insurance agent or...
- 12/10/2024 12:00:00 AM
Entry Level Insurance Representative
- Mortgage Protection Center
-
Raleigh, NC
- Job Description Job Description Seeking Business Minded Professionals Our Multi-Million Dollar company is seeking busine...
- 12/10/2024 12:00:00 AM
About Raleigh, North Carolina
According to the United States Census Bureau, Raleigh occupies a total area of 144.0 square miles (373.0 km2), of which 142 square miles (369 km2) is land and 0.97 square miles (2.5 km2), or 0.76%, is covered by water. The Neuse River flows through the northeast end of the city.
Raleigh is located in the northeast central region of North Carolina, where the Piedmont and Atlantic Coastal Plain regions meet. This area is known as the "fall line" because it marks the elevation inland at which waterfalls begin to appear in creeks and rivers. As a result, most of Raleigh features gently rolling hil...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$47,597 to $63,114
Raleigh, North Carolina area prices
were up 1.5% from a year ago
were up 1.5% from a year ago