Position Summary: Under supervision, resolves claims by investigating losses through the collecting and analyzing of data according to policy application and client/underwriter guidelines.
Relying on limited experience and knowledge, the Claims Examiner II is responsible for accomplishing the following assignments. These assignments are varied in nature and frequently non-routine.
- Determines Insurance coverage by examining claim information, policies and other records, interviews claimants and other providers.
- Maintains accurate system by collecting, analyzing and summarizing information.
- Resolves questionable claims by investigation: comparing claims information with evidence.
- Settles claims by determining insurance carriers liability, reaching agreement with claimant according to policy provisions.
- Coordinates benefits with other insurance carriers when possible to minimize loss ratios for the client and the company
- Contributes to Phone support by prompt and accurate answering.
- Records/updates claims volume and activity in a bordereau for reporting as required by the client, director, or accounting department
- Maintains Insurance Product and Company reputation by complying with claims guidelines and unfair claims settlement limitations.
- Maintains Professional and technical knowledge by attending educational workshops such as Covey 7 Habits, establish professional networks.
- Performs special projects as required
- Contributes to the team effort by accomplishing related tasks as needed.
- Follow work plans, established timelines, and pre-defined goals for assigned work.
- Meet commitments on deadlines.
- Develop strong customer focus and high service level relationship with clients.
- Perform work thoroughly in a cost efficient manner and at a high productivity level.
- Utilize company resources effectively.
Business Controls and Policies
- Comply with all corporate policies and procedures.
- Take all reasonable steps to safeguard company assets against waste, loss, unauthorized use and misappropriation.
- Report any breakdown in controls to a Supervisor or Manager.
- No people management responsibility
- May assist in orienting and training less experienced employees.
- High school diploma or equivalent
- Minimum of two years of relevant and progressive medical, claims or insurance experience in area of specialization
- Possess and have ability to apply basic knowledge of principles, practices, and procedures
- Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
- Good organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
- Intermediate proficiency and experience using Microsoft Office Package (Excel, Access, PowerPoint, Word)
- Superlative customer service skills
- Basic calculator knowledge.
- Ability to multi task
HCC Insurance Holdings, Inc. is a leading specialty insurer with offices in the United States, the United Kingdom, Spain and Ireland,...