Claims Examiner V
Fortegra Financial Corporation - Jacksonville, FL

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Job ID: LW 002
Job Description
Primarily responsible for providing professional customer service to insureds, agents, and accounts. To enforce contractual requirements impartially and expeditiously. Adjudicate, pend, investigate and/or deny claims by verifying submitted information to medical records, coverage issued, employer statement, and creditor information. Identify claims of a potentially fraudulent nature. Process non file, mortgage, collateral protection damage, and theft, skips, repossessions, personal property (dual and single interest), vendor's single interest, salvage recovery, general agent claims, involuntary unemployment, and un-collectible claims.
Primary Job Functions
Enters claim information and adjudicates claims by reviewing information and taking appropriate action to pay, request additional information or deny benefits based on coverage, provisions, and exclusions as outlined in the master policy certificate, including endorsement for eligibility and or liability.
• Investigates claims of a potentially fraudulent nature and reviews findings with management.
Communicates with insureds, employers, agents, and vendors to retrieve information to validate claims.
• Analyzes information and makes payments or adjustments as needed. Works with subrogation on any possible at fault parties involved in collision claims and destruction of property.
Coordinates special projects as needed. Includes maintaining statistics and documentation to be provided to the legal department for lawsuits, insurance department inquiries, SAS 70 audits, internal and external company audits.
Maintains appropriate claims related statistics and documentation to be provided to the legal department in the event of lawsuits, insurance department inquiries, SAS 70 audits, or other internal or external audits.
Maintains an understanding of related state laws, anti-fraud compliance requirements, claims processes, product standards, production standards, company guidelines and service standards.
Utilizes Collateral Protection Tracking System information to verify coverage.
Provides information to Team Leader to Collateral Protection System and notifies the Collateral Department if account is claiming a total loss.
Identifies potential workflow improvements and impediments.
Education and Skill Requirements
• 4-6 years of experience on PC or CRT.
4-6 years experience with Credit Insurance claims and/or other related claims processes.
Knowledge of and experience with Property and Credit Insurance, is a must.
Customer Service, and Fraud Awareness training, and AS400 system experience is a must.
Adjuster License or Agent License required (620, 220, or 520).

Employment Type:
Full time position with Benefits.

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