Claims Examiner

Claims Examiner

Claims Examiner


Job Type: Full-Time
Location: Oklahoma City, OK
Last Updated: 08/05/2011




Job Description:

Investigate claims received to determine coverage; prepare denial letters and/or initiate process to transfer for claims processing if it is determined that coverage is in effect for specific policy/policies. Will require someone with the ability to handle a large number of incoming claims and respond within 48 hours of receiving claim to begin process of either denying or handling of claim. This position could be filled at our Oklahoma City, OK, Addison, TX, or Calabasas, CA office.



Responsibilities:



* Analyze and understand coverage and contracts to establish coverage and exposure

* Make determinations of coverage and begin process of denial or handling of claim

* Analyze policy, applicable exclusions and endorsements

* Investigate and analyze facts received to make coverage and liability determination

* Gather and analyze contracts / hold harmless agreements and waivers to establish coverage and liability.

* Properly follow process to close claim within 30 to 60 days from receipt of assignment, and review periodically

* Keep detailed notes of file activity in MIDCLAIM system and enter time and expense on files meeting that requirement

* Write clear, concise reports to file in a timely fashion as specified in department program manual

* Write coverage declinations and coverage denials in accordance with state specific department of insurance rules

* Follow company and departmental procedures relative to the program

* Exercise professionalism in all contacts with parties, treating them with respect

* Be diligent in responding to phone messages and correspondence.



Qualifications:



* Technical Writing Skills

* Computer skills, including Microsoft office and the ability to understand multiple computer systems

* Ability to keep electronic notes and time in proprietary claims system

* Organizational skills

* Investigative abilities

* High School diploma or GED

* License from Oklahoma Insurance Department - Casualty

* Minimum 1 year experience in the P&C Insurance arena.



As a leader in the property and casualty insurance industry with multiple locations, our clients choose Midlands Management Companies, a part of the PMA Companies, because we understand that excellent service begins with our employees. Our working relationships with clients are marked by professionalism, execution and accountability and our company culture is centered on teamwork. This combination creates a supportive work environment that encourages personal and professional growth.



We offer a very competitive compensation package including a 401(k) with dollar for dollar match on the first 6% of salary and much more!