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Company

James River Insurance Company · 3 hours ago

Claims Examiner - Claims Specialist

Richmond, VA

Full-time

Remote

Entry Level

1+ years exp

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Responsibilities

Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service.

Conduct three point contacts

Determine compensability

Issue workers’ compensation benefits

Develop plans of action to resolution, coordinate return to work efforts and approved medical payments.

Investigates Subrogation and negotiate limited settlements within authority level.

Maintains contact with policyholders and injured workers.

Ensure claims files are appropriately documented.

Completes and files appropriate FROI and SROI’s as required by individual State Workers’ Compensation Statute and EDI reporting regulations.

Manages claims in accordance with Falls Lake Best Practices

Employs appropriate claims management techniques and direct intervention (referrals for nurse case management, independent medical examinations, utilization review) to manage each claim.

Makes decisions within delegated authority.

Have a general understanding of all legislative requirements and is able to take direction to meet those requirements in a prudent business manner.

Maintains a license for all states and products serviced as required.

Organize and update all reference material to reflect current legislation and regulatory compliance.

Comply with all quality control standards set by the company for the handling of claims.

Comply with all procedures set forth by the company for performing the job as it relates to the various components of claim administrative services.

Immediately notify Management of any unusual lawyer inquiries, insurance carrier inquiries, or department of insurance inquiries.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims handling processMedical terminologyAdjuster licenseNegotiating settlementsLiabilityCoverage issuesClaims Best PracticesComputer skillsMulti-jurisdictional claims

Required

Familiar with the claims handling process

Knowledge of medical terminology

Customer Service focused

Organizational skills

Time Management skills

Excellent oral and written communication skills

Attention to detail

Strong Computer Skills

Hands on Learner

Ability to multi-task

Team Attitude

Ability to successfully obtain the required state adjusters’ licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter

One to three years of claims handling experience

Experience in working with liability and coverage issues

Experience negotiating settlements with claimants and attorneys