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Career Field
Claims
Insurance Discipline
All
Relocation Assistance
Not Available
Job Duration
Full Time
Salary Offered
Open
Summary Investigate, evaluate, negotiate and resolve claims. Satisfy customer needs and ensure file quality.
Critical Responsibilities -Provide voice-to-voice contact within 24 hours of first report -Handle low to high complex cases. Settlement authority will vary. -Obtain facts to evaluate coverage, negligence, medical necessity and causation/damages. -Recognize subrogation opportunities. -Establish and maintain appropriate claim and expense reserves. -Assure cost-effective resolution. -Achieve timely and optimal payout results on file inventory. Provide quality customer service and control payout. -Comply with state specific regulations. -Recognize and forward appropriate files to SIU. -Manage deductibles and wages. -Recognize additional coverage issues (i.e. OBEL & XPIP) as well as jurisdictional issues. -Manage medical payout and return-to-work strategies through IMEs and Peer Reviews. -Understand medical terminology and standard medical procedures, as required of line for business. -Perform any other duties as required.
Qualifications / Competencies: -Customer Focus/ Communication -Strong negotiation and customer service skills -Business Knowledge / System Management -File Management -Medical terminology knowledge is helpful. -Strong organization and time management skills. -Problem Solving / Decision Making. -College degree or comparable work experience. -Florida State 620 license within one year from hire date.
