Location: Remote or Onsite in Columbia, SC
Remote Senior Claims Examiner -- Preference will be given to candidates with experience working for an insurance carrier.
As a Senior Claims Examiner, you will be responding accurately, promptly, and courteously to all inquiries or complaints from internal and external customers (i.e. agents, insureds, company representatives, etc.) regarding the company's products or services. You will manage a pending caseload of moderate to the highest severity and complexity property and/or liability homeowner claims in a team environment. Ensures prompt, effective, and courteous handling of all claims to policyholders and claimants. Position may require evenings and weekends as business dictates.
Claim Assignment - Verifies policy information for accuracy to determine if coverage is applicable on new claims. Develops an investigative action plan to include resolution of coverage issues as required.
Claim Contact - Ensures that timely contact is made with insured and claimants as defined by established guidelines. Responds professionally and courteously when handling a claim. Contacts or interviews necessary parties to get additional information.
Investigation - Evaluates assigned claims on an ongoing basis and makes recommendations for further task assignments and other information as needed to facilitate final claim disposition. Interprets policy provisions to approve or deny payments. Determines when cases need to be elevated to a higher level. Presents information in a thorough manner and participates in their discussion when escalated.
Reserving - Ensures claims are adequately and timely reserved by adjusting reserves or providing reserve recommendations to ensure that reserve activities are consistent with established guidelines.
Processing - Reviews new claims, claim payments, reserves on computer system and corrects information as needed by inputting data in a concise, accurate and complete manner. Pays and processes claims within designated authority level. Resolves moderate to highest level of severity claims using high service oriented file handling techniques as defined by established guidelines.
Diary and File Review - Maintains a current diary on all assigned claims. Conducts periodic spot checks of claim files not being followed in a regular diary to ensure compliance with internal and external procedures and guidelines.
Training - Assists the claims supervisor/manager as needed in mentoring less experienced examiners. Assists in identifying training needs and aids in the development, administration, and evaluating of training programs.