Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Pennsylvania Lumbermens Mutual Insurance Company
Position: Claims Examiner Department: Claims
Reports To: Casualty Claims Manager
Position Summary: The purpose of this position is to facilitate, coordinate and expedite the immediate handling of all casualty claims, to control and critique large exposure cases and to resolve claims in a prompt, fair and equitable manner.
Essential Functions and Responsibilities:
Establish accurate reserves.
Determine verification of coverage.
Delegate settlement authority to adjustors.
Handle all complicated litigation and critique trial preparation with attorneys.
Attend mediation and settlement conferences.
Analyze insurance contracts.
Communicate with the public.
Maintain an appropriate diary date on files under direct supervision.
Ensure that a file is proceeding towards a prompt, fair and equitable claim settlement.
Direct responsibility for supervision of all subrogation and arbitration handling.
Knowledge and Skills:
10 years experience in casualty claims.
Knowledge of MSOffice.
Prior supervisory experience.
Basic knowledge of various applicable state law systems.
Strong litigation skills.
Above average reading comprehension and math skills.
Ability to deal with a variety of personalities.
Ability to handle difficult situations, including upset policyholders in a courteous and professional manner.
Experience controlling expenses.
Proficient negotiation skills.
Strong oral and written communication skills.
Strong analytic skills and ability to pay close attention to detail.
Strong customer service skills.
Ongoing training through the Insurance Institute of America.
College degree preferred.
Physical Requirements:
Ability to hear.
Ability to speak clearly.
Ability to sit for extended periods of time.
Job Type: Full-time
Pay: $70,000.00 - $90,000.00 per year
Benefits:
Schedule:
Work setting:
Experience:
Work Location: Hybrid remote in Philadelphia, PA 19103
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