Claims Examiner I

Tokio Marine HCC - Cyber & Professional Lines Group; Los Angeles (CA); On-site; USD 47,000 - 70,000; Full time

Benefits offered by this job

401K match

PTO 20 days

Floating days

Parental leave

Learning culture

Growth opportunities

Job summary

TMHCC in Encino, CA is seeking a Claims Examiner I to resolve claims by investigating losses and analyzing data in line with policy terms and client guidelines.

This full-time position reports to a Claims Manager and offers a structured learning culture, competitive compensation, 20 days PTO plus floating days, and a 401(k) with a 6% match.

Candidates should have at least 2 years of related claims experience, strong written and verbal communication, and proficiency with Microsoft Office.

Qualifications

• 2 years of relevant and progressive claims or insurance experience
• Ability to apply basic knowledge of principles, practices, and procedures
• Good written and verbal communication skills with confidentiality, tact and diplomacy
• Good organizational and analytical skills; multitasking capability

Responsibilities

• Determine insurance coverage by examining claim information, policies, and records and interviewing claimants and providers
• Maintain accurate systems by collecting, analyzing, and summarizing information
• Resolve questionable claims by investigation and comparing claims data with evidence
• Settle claims by determining liability and reaching agreements per policy provisions
• Coordinate benefits with other carriers to minimize losses for the client and company
• Contribute to phone support with prompt, accurate responses
• Record/update claims activity in bordereau for client reporting

Skills

Claims processing

Data analysis

Investigation

Customer service

Education

High School or GED

Tools

Microsoft Office

Job description

About TMHCC

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Every policy we write is special, enabling our clients to do amazing things. From insuring the crops that feed us to the rock concerts that entertain us, to rescuing international travelers in trouble.

Job Title: Claims Examiner I

Location: Encino, CA

Reports to: Claims Manager

Employment Type: Full time

About TMHCC

Tokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world. Every policy we write is special, enabling our clients to do amazing things. From insuring the crops that feed us to the rock concerts that entertain us, to rescuing international travelers in trouble.

What We Offer

• Competitive salary and employee benefit package
• Strong learning culture
• Growth perspectives
• 6% 401K match
• 20 days of PTO and 2 Floating Days
• Paid parental leave
• An opportunity to love what you do

Job Summary

Resolves claims by investigating losses through the collecting and analyzing of data according to policy application and client/underwriter guidelines.

Key Responsibilities

Relying on limited experience and knowledge, this role is responsible for accomplishing the following assignments. These assignments are varied in nature and frequently non-routine.

• Determine insurance coverage by examining claim information, policies, and other records and interview claimants and other providers.
• Maintain accurate system by collecting, analyzing, and summarizing information.
• Resolve questionable claims by investigation: comparing claims information with evidence.
• Settle claims by determining insurance carrier's liability, reaching agreement with claimant according to policy provisions.
• Coordinate benefits with other insurance carriers when possible to minimize loss ratios for the client and the company.
• Contribute to phone support by prompt and accurate answering.
• Record/update claims volume and activity in a bordereau for reporting as required by the client, director, or Accounting department.
• Maintain insurance product and the Company reputation by complying with claims guidelines and unfair claims settlement limitations.
• Maintain professional and technical knowledge by attending educational workshops and establishing professional networks.
• Perform special projects as required.
• Contribute to the team effort by accomplishing related tasks as needed.

Competencies

Planning

• Follow work plans, established timelines, and pre-defined goals for assigned work.
• Meet commitments on deadlines.

Communication

• Develop strong customer focus and high service level relationship with clients.

Cost Management

• Perform work thoroughly in a cost-efficient manner and at a high productivity level.
• Utilize company resources effectively.

Business Controls and Policies

• Comply with all corporate policies and procedures.
• Take all reasonable steps to safeguard company assets against waste, loss, unauthorized use and misappropriation.
• Report any breakdown in controls to a supervisor or manager.

People Management

• No people management responsibility
• May assist in orienting and training less experienced employees.

Position Knowledge, Skills, And Requirements

Education

Min/Preferred: Minimum High School or GED

Experience

Years of Experience

2 Years Relevant and progressive claims or insurance experience in area of specialization

Other

• Possess and have ability to apply basic knowledge of principles, practices, and procedures
• Good written and verbal communication skills with an emphasis on confidentiality, tact, and diplomacy
• Good organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
• Superlative customer service skills Basic calculator knowledge

Pay Transparency: The pay range for this position is $46,600-$69,800 which includes geographic adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting. The hired applicant will be offered pay within the entire range based on the candidate’s geographic location, qualifications, work experience, education, and/or skill level. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws.

California → Use CA Fair Chance language.

124 The Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC 1033(e)), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.

As an insurance company, we comply with certain federal, state and local laws such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC 1033(e)), which restricts our ability to employ individuals with certain types of criminal convictions. Where not restricted by law and for criminal history not covered by this law, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law.

You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if the Company is concerned about a conviction that is directly related to the job, you will be given the chance to explain the circumstances surrounding the conviction or challenge the accuracy of the background report. The Company will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, such as the Violent Crime Control and Law Enforcement Act of 1994 (18 USC 1033(e)), which restricts financial institutions and insurers such as TMHCC from employing individuals with certain types of criminal convictions. Where the hiring and employment of individuals is not restricted by the foregoing, the Company will consider qualified applicants with arrest or conviction history in compliance with applicable law such as the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance, the San Diego Fair Chance Ordinance, and the San Francisco Fair Chance Ordinance.

Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on opportunity with confidence. That philosophy defines our way of thinking, unites us as a team, and differentiates us from our competitors. We are much more than just an insurance company; we are a good company.

Equal Opportunity Employer

TMHCC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national origin, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable local laws, regulations and ordinances.

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