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Adecco is assisting a local client recruiting for **Claims Examiner** opportunities **Remote** . This is an excellent opportunity to join a winning culture and get your foot in the door with a Company that acts as a claims administrator or claims adjuster. If **Claims Examiner** sounds like something you would be interested in, and you meet the qualifications listed below, apply now! Responsibilities for **Claims Examiner** include but are not limited to:

PRIMARY PURPOSE:

To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

• Assesses liability and resolves claims within evaluation.

• Negotiates settlement of claims within designated authority.

• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.

• Prepare necessary state filings within statutory limits.

• Manages the litigation process; ensures timely and cost-effective claims resolution.

• Coordinates vendor referrals for additional investigation and/or litigation management.

• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

• Reports claim the excess carrier; responds to requests of directions in a professional and timely manner.

• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

• Ensures claim files are properly documented and claims coding is correct.

• Refers cases as appropriate to supervisor and management.

Additional Functions and Responsibilities

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travel as required.

Qualification

• Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

• Experience Five (5) 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 accommodation.

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. Requirements:

Manager's note:

Claims Examiner General Liability Professional Liability

Work location: Remote across US.

FL (or any other reciprocal state) and/or NY licenses preferred.

Active licenses are mandatory.

Product liability is a plus but not a requirement.

Years of experience: 3-5 years of relevant experience

What's in this Mail Processor II position for you?

Pay: $31/hr.

Shift: 8 AM - 4:30 PM M-F

Dedicated Onboarding Specialist & Recruiter Access to Adecco’s Aspire Academy with thousands of free upskilling courses

This **Claims Examiner** is being recruited for by one of our Centralized Delivery Team and not your local Branch. For instant consideration for this **Claims Examiner** position and other opportunities with Adecco, apply today!

**Pay Details:** $31.00 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

Military connected talent encouraged to apply

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://uat.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

+ The California Fair Chance Act

+ Los Angeles City Fair Chance Ordinance

+ Los Angeles County Fair Chance Ordinance for Employers

+ San Francisco Fair Chance Ordinance

**Massachusetts Candidates Only:** It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.