Senior Claims Examiner
Insight Global
Job Description
Day to Day:
Insight Global is looking for a Senior Claims Adjuster for one of our top Claims Management/Healthcare Management companies. This individual is going to be joining the Claims team consisting of 7 members and reporting to the Claims Supervisor. They will be responsible for 3-4 claims (100% litigated claims) a week, and all of these are coming from their end client, a staffing partner.
Responsibilities:
Receives claim, confirms policy coverage and acknowledgement of the claim
Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies
Establishes reserves and authorizes payments within reserving authority limits
Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim
Coordinates early return-to-work efforts with the appropriate parties.
Manages subrogation and litigation of claim as it applies
Manages potential claim recoveries of all types
Reports claims to the excess carrier when applicable
Communicates claim status with the customer and claimant
Adheres to client and carrier guidelines and participates in claims review as needed
Develops and maintains professional customer relationships
Complies with rules and regulations of applicable state
Additional projects and duties as assigned.
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form (https://airtable.com/app21VjYyxLDIX0ez/shrOg4IQS1J6dRiMo) . The EEOC "Know Your Rights" Poster is available here (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12ScreenRdr.pdf) .
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .
Skills and Requirements
Must Haves:
5+ years experience adjusting Indemnity Claims
Strong experience handling litigated claims
80% litigated claims
Comfortable communicating with the end client, brokers, attorneys, etc.
Able to travel to Irvine CA quarterly to meet with the client (travel paid for) Plusses:
Bilingual (English/Spanish)
Compensation:
$80-100K
Exact compensation may vary based on several factors, including skills, experience, and education.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law. null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.
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