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Vaco Nashville

Liablility Claims Examiner

Industry: Insurance

Location: Seven Hills, Ohio

Date Posted: October 02, 2013

*Rhode Island experience requested. AUTO EXPERIENCE NEEDED*

ESSENTIAL FUNCTIONS and RESPONSIBILITIES: 1. Processes lower 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. 2. Processes claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
3. Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
4. Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract. 5. Manages subrogation of claims and negotiates settlements.
6. Communicates claim action/processing with claimant and client.
7. Ensures claim files are properly documented and claims coding is correct.
8. Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.
QUALIFICATIONS: Education & Licensing: Baccalaureate degree from an accredited college or university preferred. Licenses as required.

Experience: Two years of claims management experience or successful completion of Claims Examiner II training. Skills & Knowledge:
* Knowledge of ERISA regulations, offsets and deductions, disability duration, medical management practices and Social Security application procedures as applicable to line of business * Excellent oral, written, and presentation skills * PC literate, including Microsoft Office products
* Analytical and interpretive skills * Strong organizational skills
* Good interpersonal skills * Ability to work in a team environment

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