Senior Claims Examiner III: Resolve, Negotiate & Decide

Markel Service; Henderson (NV); On-site; USD 82,000 - 171,000; Full time

Benefits offered by this job

Health, dental and vision insurance

401(k) with employer match

PTO, holidays and floating holidays

Employee Stock Purchase Plan

Parental leave

Job summary

Markel Service in Henderson, NV is seeking a claims examiner to review policies, analyze coverage, and coordinate investigations. You will direct experts and outside counsel, assess exposure, and recommend reserves while aiming to resolve claims and return injured workers to work.

The role requires strong communication, analytical skills, and a solid understanding of medical terminology, with proficiency in MS Office. Occasional travel to mediations and trials is expected.

Qualifications

• Bachelor's degree preferred; equivalent insurance industry experience may be substituted.
• California Claims Examiner Certification.
• Excellent written and verbal communication skills.
• Strong analytical, problem-solving, organizational, and time management skills.
• Ability to deliver outstanding customer service and work effectively in a team environment.
• Strong understanding of medical terminology preferred.
• Intermediate proficiency in Microsoft Office applications, including Excel, Outlook, and Word.
• Demonstrated commitment to continuous improvement and professional development.
• Ability to analyze complex coverage, liability, compensability, and medical management issues and make sound claim decisions.
• Strong negotiation and decision-making skills.

Responsibilities

• Confirms coverage of claims by reviewing policies and documents submitted in support of claims.
• Analyzes coverage and communicates coverage positions.
• Conducts, coordinates, and directs investigation into loss facts and extent of damages.
• Directs and monitors assignments to experts and outside counsel.
• Evaluates information on coverage, compensability, and medical management to determine the extent of insured's exposure.
• Sets reserves within authority or makes claim recommendations concerning reserve changes to manager.
• Focus on driving claims to a resolution with a focus of returning the injured back to work.
• Evaluate, Negotiate and settle claim when appropriate.
• Prepares reports by collecting and summarizing information.
• Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives.
• Participates in special projects or assists other team members as requested.
• Attend all state specific trainings as scheduled.
• Travel to mediations, trials, and conferences as required.

Skills

Communication skills

Analytical skills

Teamwork

Customer service

Negotiation

Medical terminology

MS Office proficiency

Education

Bachelor's degree in business-related field

California Claims Examiner Certification

Tools

Excel

Outlook

Word

Job description

Markel Service in Henderson, NV is seeking a claims examiner to review policies, analyze coverage, and coordinate investigations. You will direct experts and outside counsel, assess exposure, and recommend reserves while aiming to resolve claims and return injured workers to work.

The role requires strong communication, analytical skills, and a solid understanding of medical terminology, with proficiency in MS Office. Occasional travel to mediations and trials is expected.