Claims Examiner III

Fortegra

(Jacksonville, Florida)
Full Time
Job Posting Details
About Fortegra
As a leading provider of credit protection, insurance, warranty, and specialty underwriting products, Fortegra™ offers consumers relief from life’s inevitable setbacks. No matter the issue – from a lost cell phone to car trouble, appliance failures to job loss – we deliver unequaled value without forcing your customers to jump through the hoops typically associated with traditional insurance and protection programs.
Summary
Primarily responsible for adjudicating, pending, investigating and/or denying claims by verifying submitted information against medical records, coverage issued, employer statements, and creditor information. Provides professional customer service to insureds, agents, and accounts. Enforces contractual requirements impartially and expeditiously. May identify claims of a potentially fraudulent nature and refer to management for review. Processes non file, mortgage, collateral protection damage, theft, skips, repossessions, personal property (dual and single interest), vendor’s single interest, salvage recovery, general agent claims, involuntary unemployment, un-collectible claims, General Agent, Accident Expense, L&A and Ordinary claims.
Responsibilities
* Reviews claims and determines appropriate actions, such as; pay, request additional information, or deny benefits based on the type of coverage, policy provisions and exclusions as defined in the insurance certificate, including endorsement(s) and master policy. * Investigates claims of a potentially fraudulent nature and reviews findings with management. * Communicates with insureds, employers, agents, and vendors to retrieve information to validate claims. * Analyzes information and makes payments or adjustments as needed. Works with subrogation on any possible at fault parties involved in collision claims and destruction of property. * Coordinates special projects as needed. Includes maintaining statistics and documentation to be provided to the legal department for lawsuits, insurance department inquiries, SAE 16 audits, internal and external company audits. * Maintains appropriate claims related statistics and documentation to be provided to the legal department in the event of lawsuits, insurance department inquiries, SAE 16 audits, or other internal or external audits. * Maintains an understanding of related state laws, anti-fraud compliance requirements, claims processes, product standards, production standards, and company guidelines. * Analyzes information on salvage recovery and processes Property Claims. * Meets or exceeds Quality and Production standards and maintains all claims within our Service Level Agreements. * Identifies potential workflow improvements and impediments
Ideal Candidate
* High School Diploma or equivalent work experience * 4-6 years of experience on PC or CRT. * 4-6 years experience with credit insurance claims and/or other related claims processes. * Knowledge of and experience with property, customer service, and fraud awareness training * AS400 system experience. * Bilingual skills a plus

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