Claims Examiner
Position Summary
At Michigan Commercial Insurance Mutual a claims adjuster is responsible for all aspects of the claim handling while working with a panel of approved vendors.
At Michigan Commercial Insurance Mutual a claims adjuster is responsible for all aspects of the claim handling while working with a panel of approved vendors.
Principal Duties and Responsibilities
(These duties and responsibilities are judged to be "essential functions" in terms of the Americans With Disabilities Act or ADA.)
- Deliver compassionate timely service to injured workers and employers.
- Communicate timely with medical providers, employers, attorneys, and injured workers.
- Investigate and determine compensability for lost time and medical only claims, coordinate early return to work, determine and pay benefits owed, and document and update action plans to resolution of claims.
- Set reserves timely and accurately to UPC.
- Set appropriating EDI tasks for support staff to process EDI.
- Work in in fast-paced team environment and meet deadlines.
- File documents and note work activities in Image Right and Tropics.
- Familiarity with statutory rules and regulations of the jurisdiction.
The above statements are intended to describe the general nature and level of work being performed by a person in this position. They are not to be construed as an exhaustive list of all duties that may be performed by such a person.
Recommended Employment Qualifications
Education: This position requires an Associate’s degree (AA) or equivalent from a two-year college or technical school; or equivalent experience.
Certificate, Licenses, Registrations: Active Adjuster License MI, FL, WI, IN, IL or GA.
Other Knowledge, Skills and Abilities:
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)
Required:
- Ability to read, analyzes, and interpret general business periodicals, technical procedures, medical reports or governmental regulations.
- Ability to prepare Excel reports, business correspondence, and update procedure manuals.
- Ability to effectively present information and respond to questions from managers, insured’s, nurses, attorneys, and the general public.
- Extensive claim knowledge (statutes, rules and regulations).
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
- Ability to prioritize and change direction quickly.
- Ability to travel to agency organizations, policyholders, and other field assignments.
Physical Demands: While performing the duties of this job, the employee is regularly required to sit; use hands to handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms and stoop, kneel, crouch, or crawl. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. The noise level in the work environment is usually moderate.
The qualifications listed above are guidelines for selection purposes; alternative qualifications may be substituted if sufficient to perform the duties of the job.
