Why have FUN when you can have PhUN?!?! At Pharmacists Mutual, we've cultivated a unique culture centered around our employees and the goal of profitable results, all while putting our members at the heart of our mission and vision. If Relationships, Integrity, Citizenship, and Excellence align to your core values, you'll want to make us your employment home. All you have to do is knock. Smiles and opportunity are waiting inside just for you.
Pharmacists Mutual Insurance has an opening for a Claims Adjuster/Claims Examiner II or Senior Claims Examiner. This position will investigate, evaluate, reserve, negotiate and resolve assigned claims in accordance with Company guidelines. The Examiner will provide timely, professional claim handling and superior customer service. The examiner will independently make decisions related to the management, evaluation and resolution of third-party bodily injury, including property damage claims, to determine the proper valuation and resolution. The examiner will handle mid-to high-level severity claims involving attorney representation and litigation.
Essential functions may include, but are not limited to the following:
- Communicate regularly and effectively with policyholders to obtain claim information and provide updates.
- Perform timely coverage analysis based on policy information and facts or allegations of each case.
- Investigate each claim to determine the extent of liability, damages, and contribution potential.
- Take necessary statements (recorded); complete outside investigation as needed per case specifics.
- Maintain claim files and document activities in accordance with established protocols, guidelines, procedures, and metrics.
- Establish and maintain proper loss, indemnity and expense reserves.
- Recommend, attend, and/or present at roundtable discussions for collaboration of technical expertise.
- Manage the resolution of assigned claims by negotiating disposition of claims with insureds and claimants or their legal representatives.
- Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
- Manage the coordination of outside resources, including vendors, adjusters and attorneys.
- Identify potential fraud and assist in pursuing subrogation opportunities.
- Work with other examiners on team-based handling assignments.
- Provide consulting and training resources for internal sales and business partners.
Knowledge, Skills and Abilities
- Understand principles and practices of insurance claims examination.
- Understand policy and contract coverage.
- Demonstrate empathy to those who suffered a loss.
- Ability and flexibility to work longer hours when workload fluctuations occur.
- Ability to handle large volumes of work in a short period of time.
- Research and stay up-to-date with trends and changes in the claims/insurance industry.
- Appropriately deal with information that is considered personal and confidential.
- Obtain and use sensitive information discreetly and objectively, both internal and external.
- Communicate effectively with others (oral and written).
- Analyze complex issues and make critical decisions.
- Correct English usage, spelling, grammar, vocabulary and punctuation.
- Maintain records, prepare reports and conduct correspondence related to the work.
- Interpret and apply laws, rules and regulation, as well as policy and contract coverage.
- Determines when to escalate concerns to the appropriate level of management.
- Follow oral and written directions.
- Work effectively with others in a team environment.
- Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
- Establish and maintain effective working relationships with those contacted in the course of work.
- Excellent customer service skills.
- Ability to organize and prioritize work.
- Work independently and demonstrate drive and initiative.
- Ability to meet definite deadlines and deal with pressure situations.
- Collect, interpret, and input data efficiently and accurately.
- Use computer and related software effectively.
- Use Microsoft Office programs efficiently and effectively.
Experience and Education Qualifications:
Claims Examiner II
- High School Diploma or equivalent and 7 years of related experience; or
- Associate’s Degree or equivalent and 5 years of related experience; or
- Bachelor’s Degree and 3 years of related experience; or
- Master’s Degree
Senior Claims Examiner
- High School Diploma or equivalent and 10 years of related experience with at least 4 in insurance; or
- Associate’s Degree or equivalent and 8 years of related experience; and
- One of the following industry related certifications; AIC (Associate in Claims), ARM (Associate in Risk Management), ARe (Associate in
- Reinsurance), CLS (Claims Law Specialist), CLA (Claims Law Associate), or SCLA (Senior Claims Law Associate)
OR
- Bachelor’s Degree and 5 years of related experience; or
- Master’s Degree with 2 years of related experience
Special Requirements, Licenses and Certificates
- All levels - Texas Claims Adjuster License (or obtained within 6 months of hire)
Preferred Qualifications:
Licenses, Certifications or Designations
- One of the following industry related certifications; AIC (Associate in Claims), ARM (Associate in Risk Management), ARe (Associate in Reinsurance), CLS (Claims Law Specialist), CLA (Claims Law Associate), or SCLA (Senior Claims Law Associate)
