Plans Examiner jobs in Coventry, RI

Claims Examiner

This role is a Hybrid Role:

After 90 days (in good performance standing), three days in the office and two days out

Position Summary:

Investigates, evaluates, reserves, negotiates and settles assigned claims in accordance with Best Practices. Provides quality claim handling and superior customer service on assigned claims, while engaging in indemnity and expense management. Promptly manages claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, and disposition.

Responsibilities:

• Provides voice to voice contact within 24 hours of first report.
• Conducts timely coverage analysis and communication with insured based on application of policy information, facts or allegations of each case. Consults with Unit Manager on use of Claim Coverage Counsel.
• Investigates each claim through prompt contact with appropriate parties such as policyholders, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential. Records necessary statements.
• Identifies resources for specific activities required to properly investigate claims such as Subro, Fire or Fraud investigators and to other experts. Requests through Unit Manager and coordinates the results of their efforts and findings.
• Verifies the nature and extent of injury or property damage by obtaining and reviewing appropriate records and damages documentation.
• Maintains effective diary management system to ensure that all claims are handled timely. Evaluates liability and damages exposure, and establishes proper indemnity and expense reserves, at required time intervals.
• Utilizes evaluation documentation tools in accordance with department guidelines.
• Responsible for prompt, cost effective, and proper disposition of all claims within delegated authority.
• Negotiate disposition of claims with insured’s and claimants or their legal representatives. Recognizes and implements alternate means of resolution.
• Maintains and document claim file activities in accordance with established procedures.
• Attends depositions and mediations and all other legal proceedings, as needed.
• Protects organization's value by keeping information confidential.
• Maintains compliance with Claim Department's Best Practices.
• Provides quality customer service and ensures file quality
• Supports workload surges and/or Catastrophe operations as needed to include working significant overtime during designated CATs.
• Communicates with co-workers, management, clients, vendors, and others in a courteous and professional manner.
• Participates in special projects as assigned.
• Some overnight travel maybe required.
• Maintains the integrity of the company and products offered by complying with federal and state regulations as well as company policies and procedures.

Qualifications:

• Associate’s Degree required; Bachelor’s Degree preferred. A combination of education and significant directly related experience may be considered in lieu of degree.
• 620 Licensure required.
• One to three years of experience processing claims; property and casualty segment preferred.
• Experience with Xactware products preferred.
• Demonstrated ability to research, conduct proactive investigations and negotiate successful resolutions.
• Proficiency with Microsoft Office products required; internet research tools preferred.
• Demonstrated customer service focus / superior customer service skills.
• Excellent communication skills and ability to interact on a professional level with internal and external personnel
• Results driven with strong problem solving and analytical skills.
• Ability to work independently in a fast paced environment; meets deadlines, and manages changing priorities effectively.
• Detail-oriented and exceptionally organized
• Collaborative partner; ability to contribute to a positive work environment.

General Information:

All employees must pass a pre-employment background check. Other checks may be needed based on position: driving history, credit report, etc.

The preceding job description has been designed to indicate the general nature of work performed; the level of knowledge and skills typically required; and usual working conditions of this position. It is not designed to contain, or be interpreted as, a comprehensive listing of all requirements or responsibilities that may be required by employees in this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Heritage Insurance Holdings, Inc. is an Equal Opportunity, Affirmative Action Employer. We will not discriminate unlawfully against qualified applicants or employees with respect to any term or condition of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, marital status, place of birth, military service status, or other basis protected by law.