Job Description
Intermediate Claims Examiner
Reports to: Lead, Claims; Travel requirements: Some travel required; Office hours: 8:30 AM – 4:30 PM.
Key Responsibilities
- Review initial claim documentation, apply legal/claims analysis and set/amend reserves.
- Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions.
- Ensure required information/evidence is collected & preserved, authorize mediation & pre‑trial expenses.
- Conduct/control negotiations with plaintiff counsel, mediators, pre‑trial judges, and claimants.
- Make settlement decisions up to the posted reserve of assigned claims, authorize settlement payments; handle specialty claims as assigned.
- Policy interpretation.
- Situational analysis and recommendations for actions on non‑claim matters.
- Provide advice regarding general risk management queries and/or referral to Healthcare Safety and Risk Management Department.
- Work with...