Remote Healthcare Risk Management Jobs in Duluth, GA

This is a remote position.  This is a floater position.  The examiner will handle either, FL, NY, GA, CA, or TX claims and must have the appropriate adjuster's license.

POSITION SUMMARY: Responsible for the prompt review of policy information including all relevant endorsements and vehicle schedules to determine coverage for loss/damage/injury. Conduct and efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required. Recommendations regarding loss exposure and associated reserve and settlement strategy will be effectively communicated to the client.

DUTIES AND RESPONSIBILITIES:

The Claims Examiner (Float) is a versatile role designed to ensure continuity of operations within the claims department. This individual provides seamless coverage for permanent examiners during planned Paid Time Off (PTO), unexpected absences, or extended leaves of absence. The primary goal is to prevent backlogs claim and maintain service level agreements (SLAs) regardless of staffing fluctuations.

• Review, process and conclude assigned claims including investigation and evaluation complex Commercial Auto and General Liability Casualty Claims.
• Review and interpret policies, coverage determination.
• Oversee and direct outside investigative service providers and work closely with the client and client counsel and investigative services to advance the claim to conclusion.
• Maintain an ongoing diary.
• Continually assess exposure and evaluate for accurate reserves and settlement recommendation.
• Prepare Loss Reports providing thorough analysis of liability and damages.
• Where applicable, determine if subrogation and/or risk transfer exists and initiate recovery efforts at the direction of the client.
• Document all correspondence, reports, discussions and decisions in the claim file record.
• Provide outstanding service to the client.
• Assist Supervisors and Claim Department with requested tasks or special projects.
• Other duties as assigned.

Position is remote/working from home.

QUALIFICATIONS REQUIRED:

Education/Experience: High School Diploma or GED required; bachelor’s degree in related field (preferred) and a minimum of seven+ (7) years’ commercial auto and general liability casualty related experience; or equivalent combination of advanced education and experience.

Special Requirements:

• At least 10 years of Commercial Automobile and General Liability claims experience required
• Knowledge of claims handling concepts, practices, and techniques, including but not limited to coverage issues and product line knowledge.
• Demonstrated verbal and written communications skills.
• Demonstrated advanced analytical, decision-making and negotiation skills.
• Computer proficiency.

 Preferred Skills:

• Ability to communicate effectively and clearly, both orally and in writing.
• Ability to manage relationships in a fast-paced environment, while demonstrating problem solving and decision-making skills to work with customers.
• Good analytical abilities to review, exercise judgment and evaluate claims to make sound decisions with a minimal amount of supervision.
• Excellent customer service skills.
• An understanding of the litigation process and case valuation in multiple jurisdictions.
• Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
• An ability to handle assigned claims following company guidelines and industry best practices with a minimal amount of supervision.
• Time management skills, organizational skills and ability to prioritize issues and tasks.
• Ability to effectively operate computer equipment and applications.
• Independence, flexibility, and creativity.

Other Qualifications: 

• Multi state adjuster licensure within home state or designated state and/or the ability to obtain licenses through home state reciprocity or through state adjuster examinations. AICPCU industry designation

                             MENTAL AND PHYSICAL REQUIREMENTS

1.  MENTAL EFFORT

a.  Reasoning development:

          Follow one- or two-step instructions; routine, repetitive task.

          Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

          Follow written, verbal, or diagrammatic instructions; several concrete variables.

          Solve practical problems; variety of variables with limited standardization; interpret instructions.

 X      Logical or scientific thinking to solve problems; several abstract and concrete variables.

          Wide range of intellectual and practical problems; comprehend most obscure concepts.

b.  Mathematical development:

          Simple additional and subtraction; copying figures, counting, and recording.

          Add, subtract, multiply, and divide whole numbers.

 X      Arithmetic calculations involving fractions, decimals, and percentages.

          Arithmetic, algebraic, and geometric calculations.

          Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

          Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

c.       Language development:

          Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

          Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

          Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

          Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

 X       Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2.  PHYSICAL EFFORT

a.       Physical activity required to perform the job:

 X       Sedentary work:  Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.  Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

          Light work:

a.    Exerting up to 20 pounds of force occasionally

b.    Exerting up to 10 pounds frequently

c.    Exerting a negligible amount of force constantly to move objects

          (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

          Medium work:

a.    Exerting up to 50 pounds of force occasionally

b.    Exerting up to 20 pounds of force frequently

c.    Exerting up to 10 pounds of force constantly to move objects

          Heavy work:

a.    Exerting up to 100 pounds of force occasionally

b.    Exerting up to 50 pounds of force frequently

c.    Exerting up to 20 pounds of force constantly to move objects

          Very heavy work:

a.    Exerting in excess of 100 pounds of force occasionally

b.    Exerting in excess of 50 pounds of force constantly to move objects

c.    Exerting in excess of 20 pounds of force constantly to move objects

1. Visual requirements necessary to perform the job:

          Far vision:  clarity of vision at 20 feet or more

 X      Near vision:  clarity of vision at 20 inches or less

 X      Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet

          Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are

          Color vision:  ability to identify and distinguish colors

          Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point

2.  PHYSICAL EFFORT (cont.)

    FREQUENCY

c.        Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

       Climbing:      Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms.  Body agility is emphasized.  This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

       Balancing:     Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces.  This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

       Stooping:       Bending body downward and forward by bending spine at the waist.  This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

       Kneeling:       Bending legs at knee to come to a rest on knee or knees.

       Crouching:    Bending the body downward and forward by bending legs and spine.

       Crawling:      Moving about on hands and knees or hands and feet.

       Reaching:      Extending hand(s) and arm(s) in any direction.

        Standing:       Particularly for sustained periods of time.

       Walking:       Moving about on foot to accomplish tasks, particularly for long distances.

       Pushing:        Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

       Pulling:         Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

       Foot

       Motion:          Using feet to push pedals.

       Lifting:          Raising objects from a lower to a higher position or moving objects horizontally from position to position.  This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

 X    Fingering:     Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

 X    Grasping:      Applying pressure to an object with the fingers and palm.

Frequently

Occasionally

2.  PHYSICAL EFFORT (cont.)                  

      FREQUENCY

 X    Talking:         Expressing or exchanging ideas by means of the spoken word.  Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

 X    Hearing:        Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.

       Feeling:         Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

 X    Repetitive      Substantial movements (motions) of the wrists, hands,

       Motion:         and/or fingers.

Frequently

Frequently

Frequently

3.  WORKING CONDITIONS

Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. 

       WORKING CONDITION

           ENVIRONMENTAL

                     FACTOR

           NATURE/REASON

               OF EXPOSURE

                FREQUENCY

Dirt/Dust

Noise

Temperature extremes

Dampness

Vibrations

Equipment movement hazard

Chemicals/solvents

Electrical shock

Significant work pace/pressure

Odors/Fumes

Other (specify):