Claims Examiner jobs in Pennsylvania
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 Adjuster/Examiner Liability
- Sedgwick Claims Management Services Inc.
-
King of Prussia, PA
OTHER
- Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace® Forbes Best-in-State Employer Claims Adjuster/Examiner Liability PRIMARY PURPOSE: To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. Assesses liability and resolves claims within evaluation. Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. Manages subrogation of claims and negotiates settlements. Communicates claim action with claimant and client. Ensures claim files are properly documented and claims coding is correct. May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. Maintains professional client relationships. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATION Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience Four (4) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge 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 WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is 67K-86K. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Taking care of people is at the heart of everything we do. Caring counts Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us.
- 4 Days Ago
Claims Examiner
- Capital Blue Cross
-
Harrisburg, PA
FULL_TIME
- Position DescriptionThis position is responsible for the coding and total processing of claims and triaging claim adjustments generated by our providers and subscribers or requested via Customer Servi...
- 3 Days Ago
Claims Examiner
- Erie Insurance Group
-
Erie, PA
FULL_TIME
- Division Or Field OfficeClaims DivisionDepartment of Position: Corporate Claims DepartmentWork FromERIE's FootprintSalary Range$95,478.00 - $152,516.00 *salary range is for this level and may vary bas...
- 23 Days Ago
Surety Claims Examiner (Remote)
- Intact Insurance Specialty Solutions
-
Blue Bell, PA
FULL_TIME
- Job DescriptionWe currently have an opportunity for a Claims Examiner to join our Surety Claims team in our New York City, NY; Blue Bell, PA; Southfield, MI; Plymouth, MN offices or remotely nationwid...
- 1 Day Ago
Claims Examiner (Remote)
- Intact Insurance Specialty Solutions
-
Blue Bell, PA
FULL_TIME
- Job DescriptionWe currently have an opportunity for a Claims Examiner to join our Surety Claims team in our New York City, NY; Blue Bell, PA; Southfield, MI; Plymouth, MN offices or remotely nationwid...
- 14 Days Ago
Senior Claims Examiner
- Berkshire Hathaway Specialty Insurance
-
Plymouth Meeting, PA
FULL_TIME
- Who are we? A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outs...
- 16 Days Ago
Claims Examiner jobs at Popular Companies
Claims Examiner
- Manpower
-
El Segundo, CA
- Our client, Legal Industry is seeking a Claims Examiner to join their team. As a Legal Claims Examiner you will be part ...
- 6/11/2024 12:00:00 AM
Claims Examiner
- US Tech Solutions, Inc.
-
Atlanta, GA
- Job Title: Claims Examiner Location: Remote Duration: 06 months contract (C2H) Job Description: Responsibilities: • Inve...
- 6/11/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Folsom, CA
- The Claims Examiner is responsible for ensuring claims are coded and processed correctly and for meeting production requ...
- 6/10/2024 12:00:00 AM
Claims Examiner
- Hire Up Staffing Services
-
Fresno, CA
- Hire UP Staffing is seeking an experienced Medical Claims Examiner for well established client in Fresno, CA. This posit...
- 6/10/2024 12:00:00 AM
CLAIMS EXAMINER
- San Bernardino City Unified
-
San Bernardino, CA
- Comments and Other Information To review the job description, please use the following link. https://www.schooljobs.com/...
- 6/10/2024 12:00:00 AM
Claims Examiner
- SILAC Insurance Company
-
Salt Lake City, UT
- Headquartered in Salt Lake City, Utah, SILAC Insurance Company is one of the fastest-growing insurance companies in the ...
- 6/9/2024 12:00:00 AM
Claims Examiner
- E-Solutions
-
Whittier, CA
- POSITION SUMMARY: The claims examiner reports directly to the claims manager. They are primarily responsible for the pro...
- 6/8/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Sacramento, CA
- Day to Day: The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting p...
- 6/7/2024 12:00:00 AM
About Pennsylvania
Pennsylvania (/ˌpɛnsɪlˈveɪniə/ (listen) PEN-sil-VAY-nee-ə), officially the Commonwealth of Pennsylvania, is a state located in the northeastern and Mid-Atlantic regions of the United States. The Appalachian Mountains run through its middle. The Commonwealth is bordered by Delaware to the southeast, Maryland to the south, West Virginia to the southwest, Ohio to the west, Lake Erie and the Canadian province of Ontario to the northwest, New York to the north, and New Jersey to the east.
Pennsylvania is the 33rd-largest state by area, and the 6th-most populous state according to the most recent of...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$48,006 to $63,660