What are the responsibilities and job description for the Claims Examiner position at ADP Workforce Now?
driasi is an ambitious, innovative and fast-paced company. We offer exceptional training and development programs, competitive pay, great benefits, all within an engaging, fun, and collaborative work environment. The staff in driasi has the unique opportunity to gain national knowledge and expertise in handling policies across various regions and territories. At driasi, we all work together to come up with big ideas and then bring them to life. We focus on our customers first, we bring our best, and we are stronger together.
driasi offers a full benefits package including:
- Health Insurance
- Company paid dental
- Company paid short and long term disability
- Company paid life insurance
- PTO
- 401(k)with company match
- Health club reimbursement
- Tuition reimbursement
- Wellness program
We are seeking an Experienced Senior Claims Examiner to join our team. The Senior Claims Examiner analyzes insurance claims to determine extent of insurance carrier's liability and settles claims with claimants in accordance with policy provisions: Compares data on claim application, death certificate, or physician's statement with policy file and other company records to ascertain completeness and validity of claim. Assists in carrier audits and monthly audits for examiners. Assist in the coordination of the claims team in relation to the assessment and payment of claims, reporting as required to support the department and the carrier needs and other tasks as required..
Functions:
4 Examines and analyzes claim form and other records to determine insurance coverage.
4 Interview/communicate with claimant, consults police reports and hospital records; to determine extent of company's liability, varying method of investigation according to type of insurance coverage.
4 Consult with Insurance Carriers or other professionals to best determine adjudication of a claim.
4 Assists in carrier audits and monthly audits for examiners as required by the management team.
4 Assists in preparing and sending annual carrier reporting.
4 Allocates workload for the claims department during absence of the Supervisor to ensure achievement of service standards.
4 Pay, pend or deny claims according to carrier guidelines and authority limits.
4 Works with the legal department or insurance carrier when settlement cannot be negotiated.
4 Generation of internal and/or client claims reporting.
4 All other duties as assigned by Management.
4 Gather documents for carrier audits.
4 Assists in monthly audits for examiners as per carrier guidelines.
4 Ability to lead, coach and train a team.
Education and/or Experiences
Associates degree from a community college and one to two years of experiences; or five to seven years related experience and/or training; or equivalent combination of education and experience. Must be proficient in Microsoft Office (Word, Excel, Outlook). Must have familiar with a variety of Life and Health Insurance concepts, practices and procedures as well as general insurance knowledge. Insurance Adjuster’s license or LOMA educational coursework preferred. Leadership, coaching and training experiences preferred.