Claims Examiner jobs in Maine
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)
Recently Added Claims Examiner jobs
Long Term Disability Claims Examiner
- Reliance Matrix
-
South Portland, ME
FULL_TIME
-
Job Responsibilities And Requirements
The Claim Examiner II obtains and analyzes information to make claim decisions and payments on Long Term Disability “LTD” and Waiver of Premium “WOP” claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.
To learn more about the Claim Examiner II position, watch our exclusive employee video!
Duties and Responsibilities:- Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim.
- Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line.
- Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner.
- Conducts in-depth pre-existing condition or contestable investigations if applicable.
- Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, cost of living adjustments, etc.
- Develops and maintains on-line claim data (and paper file if applicable).
- Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
- Fully investigates and adjudicates a large volume simple to complex claims.
- Identifies and investigates change in Total Disability definition (any occ).
- Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit.
- Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium.
- Majority of work is not subject to supervisor review and approval.
- Independently manages assigned case load as outlined in LTD Key Measures
- Collaborates with team members and management in identifying and implementing improvement opportunities.
- Remains current with all corporate and disability management practices.
- Collaborates with team members and management in identifying and implementing improvement opportunities.
- Collaborates with management on claims with high degree of complexity.
- Any other job-related duty as deemed appropriate by management.
- or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*
- High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.
- 2 years experience processing long term disability claims.
- Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
- Experience working in confidential/protected identification environments.
- Knowledge of medical terminology.
- Good math and calculation skills.
- Proven ability to work well in a high-visibility, public-oriented environment.
- Customer Service: Promptly acknowledges customers' needs, both internal and external. Ensures customers' needs are handled in a timely and appropriate manner. Creates a positive impression.
- Communication/Relationship Skills: Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback. Communicate/respond appropriately to varied audiences/tasks. Exhibits teamwork, honors commitments.
- Problem Solving/Decision Making: Anticipates, analyzes and defines problems. Develops and assesses alternative solutions as necessary. Makes appropriate decisions in a timely manner. Analyzes impact of decisions.
- Productivity: Work is accomplished quickly and accurately. Takes responsibility for actions. Prioritizes work effectively and uses time efficiently. Accomplishes goals and objectives.
- Dependability: Makes/fulfills commitments. Consistently works independently, meets deadlines, and accepts responsibility for his/her actions. Adheres to all attendance requirements. Prompt, well prepared and ready to contribute.
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that creating a more diverse, equitable and inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you.
That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.
Our Benefits:- An annual performance bonus for all team members
- Generous 401(k) company match that is immediately vested
- A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
- Multiple options for dental and vision coverage
- Company provided Life & Disability Insurance to ensure financial protection when you need it most
- Family friendly benefits including Paid Parental Leave & Adoption Assistance
- Hybrid work arrangements for eligible roles
- Tuition Reimbursement and Continuing Professional Education
- Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program
- Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council
- Integrity
- Empowerment
- Compassion
- Collaboration
- Fun
Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.
- 5 Days Ago
ME - 1099 Property Claims Adjuster
- Copper Claims Services, Inc.
-
Portland, ME
FULL_TIME
- 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA. Copper Claims Services excels in providing custom claims solutions fo...
- 19 Days Ago
Field Roof Technician
- Hancock Claims Consultants
-
Portland, ME
CONTRACTOR
- CLIMB to New Heights…And live the American Dream. Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carriers...
- 5 Days Ago
Field Roof Technician
- Hancock Claims Consultants Technicians
-
Portland, ME
CONTRACTOR
- CLIMB to New Heights…And live the American Dream. Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carriers...
- 28 Days Ago
Field Roof Technician
- Hancock Claims Consultants Technicians
-
Augusta, ME
CONTRACTOR
- CLIMB to New Heights…And live the American Dream. Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carriers...
- 28 Days Ago
Paramedical Examiner
- APPS - American Para Professional Systems, Inc.
-
Fort Kent, ME
PART_TIME
- Part-time or Full-time.QualificationsGood phlebotomy skills .You must provide your own BP cuff, stethoscope, and portable scale. We provide kits and disposable supplies.We perform basic screening exam...
- 10 Days Ago
Claims Examiner jobs at Popular Companies
Claims Examiner
- US Tech Solutions, Inc.
-
Atlanta, GA
- Job Title: Claims Examiner Location: Remote Duration: 06 months contract (C2H) Job Description: Responsibilities: • Inve...
- 6/11/2024 12:00:00 AM
Claims Examiner
- Manpower
-
El Segundo, CA
- Our client, Legal Industry is seeking a Claims Examiner to join their team. As a Legal Claims Examiner you will be part ...
- 6/11/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Folsom, CA
- Insight Global is looking for a Claims Examiner for one of their insurance clients in Folsom, CA. This is a fully onsite...
- 6/10/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Folsom, CA
- The Claims Examiner is responsible for ensuring claims are coded and processed correctly and for meeting production requ...
- 6/10/2024 12:00:00 AM
Claims Examiner
- Capital Blue Cross
-
Harrisburg, PA
- Position Description: This position is responsible for the coding and total processing of claims and triaging claim adju...
- 6/9/2024 12:00:00 AM
Claims Examiner
- The Jonus Group
-
- Position Overview: As a Commercial Auto and General Liability Claims Adjuster, you will be responsible for managing comp...
- 6/8/2024 12:00:00 AM
Claims Examiner
- AIG
-
Cincinnati, OH
- This is a hybrid role in Cincinnati Ohio requiring 3 to 4 days in office. Who we are American International Group, Inc. ...
- 6/8/2024 12:00:00 AM
Claims Examiner
- JCW
-
- JCW is currently recruiting on behalf of a rapidly growing Property & Casualty Insurance Company who are looking to add ...
- 6/7/2024 12:00:00 AM
About Maine
To the south and east is the Atlantic Ocean and to the north and northeast is New Brunswick, a province of Canada. The Canadian province of Quebec is to the northwest. Maine is both the northernmost state in New England and the largest, accounting for almost half of the region's entire land area. Maine is the only state in the continental US to border only one other American state (New Hampshire to the South and West).
Maine is the easternmost state in the United States in both its extreme points and its geographic center. The town of Lubec is the easternmost organized settlement in the United...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$46,804 to $62,065