Elevator Examiner And Adjuster Job Description Sample
Elevator Mechanic 3866
The salary in the Department of Water and Power is $101,351 (flat-rated) and $108,283 (flat-rated).
For information regarding reciprocity between the City of Los Angeles departments and LADWP, go to http://per.lacity.org/Reciprocity_CityDepts_and_DWP.pdf.
Candidates from the eligible list are normally appointed to vacancies in the lower flat-rated positions.
Annual salary is at the start of the pay range. The current salary range is subject to change. Please confirm the starting salary with the hiring department before accepting a job offer.
An Elevator Mechanic does skilled electrical, electronic, mechanical, and hydraulic work in the maintenance and repair of passenger and freight elevators, escalators, and other vertical and horizontal transportation equipment, and their related equipment.
A Certificate as a Competent Conveyance (Elevator) Mechanic issued by the California Division of Occupational Safety and Health.
In addition to the regular City application, all applicants must complete an Elevator Mechanic Qualifications Questionnaire at the time of filing. The Elevator Mechanic Qualifications Questionnaire is located within the Supplemental Questions section of the City application. Applicants who fail to complete the Qualifications Questionnaire will not be considered further in this examination, and their application will not be processed.
A valid License to Act as a Journey level Elevator Mechanic issued by the City of Los Angeles Department of Building and Safety is required prior to appointment.
Experience in the maintenance and repair of selective-collective multi-programmed elevators and escalators is especially desired.
Proof of certification or a letter from the State of California indicating a certificate can be issued immediately upon hire (see below for more information) is required at the time of filing for the examination. This certification or letter must be attached to the online application BEFORE the application is submitted. If it is attached AFTER the online application has been submitted, it will not be available to the City and the applicant WILL NOT be credited with having submitted it. Applicants who fail to submit this documentation at the time of filing by attaching it to the online application will not be considered further in this examination.
a. If you do not currently possess a Competent Conveyance (Elevator) Mechanic certification issued by the State of California but have held one in the past, the State of California will not re-issue a Competent Conveyance (Elevator) Mechanic certification until you are re-employed as an Elevator Mechanic. As such, please contact the State office to request a review of your license status. If you are still in good standing, request a letter be written on your behalf indicating that a license can be re-issued immediately upon offer of employment. If hired, you must provide a copy of your certificate to the hiring department prior to your first day of employment.
b. If you have never possessed a Competent Conveyance (Elevator) Mechanic certificate issued by the State of California, please ensure you have submitted a new application to the State prior to requesting a review of your status and/or a letter on your behalf. If hired, you must provide a copy of your certificate to the hiring department prior to your first day of employment. The State of California elevator mechanic licensing office can be reached at (916) 274-5709 or online at http://www.dir.ca.gov/dosh/elevator/CCCM_App.pdf.
5.Information regarding the Journey-level Elevator Mechanic License issued by the City of Los Angeles Department of Building and Safety may be obtained online at http://www.ladbs.org.
6.Some positions may require a valid California driver's license. Candidates may not be eligible for appointment to these positions if their record within the last 36 months reflects three or more moving violations and/or at-fault accidents, or a conviction of a major moving violation (such as DUI).
WHERE TO APPLY & APPLICATION DEADLINE
Applications and Qualifications Questionnaires will only be accepted on-line. When you are viewing the on-line job bulletin of your choice, simply scroll to the top of the page and select the "Apply" icon. On-line job bulletins are also available at https://www.governmentjobs.com/careers/lacity.
Applicants are urged to apply early to ensure you have time to resolve any technical issues you may encounter.
The examination may close without prior notice at any time after a sufficient number of applications have been received. For administrative purposes, filing may close periodically and reopen the following day. In accordance with Civil Service Rule 4.2, all applicants who apply may not be tested in this examination. To meet anticipated hiring needs, only a limited number of qualified applicants will be invited to participate in the selection process in the following order: 1) Los Angeles City Promotional applicants who meet the minimum requirements. You must have received a regular appointment to a City position or be on a reserve list to apply for this examination as a promotional candidate; 2) Applicants currently employed by the City of Los Angeles on a part-time or exempt basis who meet the minimum requirements; 3) Remaining applicants who meet the minimum requirements in sufficient numbers to meet hiring needs in the order that applications were received. Applications submitted during the filing period will be kept on file in the event that additional applicants need to be tested to meet hiring needs.
Should a large number of qualified candidates file for this examination, each candidate's qualifications for the position of Elevator Mechanic may be evaluated based on the candidate's Qualifications Questionnaire. Those candidates considered possessing the greatest likelihood of successfully performing the duties of an Elevator Mechanic, based solely on the information submitted for qualifications review, will continue in the selection process.
Examination Weight: Interview . . . . . . . . . . . 100%
The examination will consist entirely of an evaluation by interview. In the interview, emphasis may be placed on the adequacy of the candidate's work experience and professional development as they have provided the background necessary to perform the duties of an Elevator Mechanic, including knowledge of: inspection, testing, maintenance, repair, and adjustment techniques and procedures used on conveyance equipment and components, including hydraulic elevator system components, electric elevator system components, escalator and moving walk system components, dumb waiter system components, dock ramps system components, and handicapped lift system components; the identification and proper use of tools common to the elevator mechanic trade; elevator and electrical safety rules, policies, and procedures, including California Code of Regulations – Title 24, California Division of Occupational Safety and Health (Cal/OSHA) Elevator Safety Orders, and the City of Los Angeles Elevator Safety Code; and the ability to read, interpret and use blueprints, diagrams and schematic drawings for the construction, installation and troubleshooting of conveyance equipment; communicate orally in a clear and effective manner for the purpose of explaining pertinent information to others; interact tactfully and effectively with coworkers, the general public, building operations personnel, and others; and other necessary skills, knowledge and abilities.
As part of their evaluation of each candidate's overall qualifications for the job, the interview panel members will consider the information in the candidate's Qualifications Questionnaire. Candidates may expect panel members to discuss this information during the interviews. Unsolicited supplemental information will not be submitted to the interview panel.
Candidates will be notified later by e-mail of the date, time, and location of the interview, which will be held in Los Angeles.
This examination is based on a validation study.
You may take the Elevator Mechanic examination only once every 365 days. If you have taken the Elevator Mechanic interview during an open filing period in the Personnel Department within the last 12 months, you may not file for this examination at this time.
Applications are accepted subject to review to ensure that minimum qualifications are met. Candidates may be disqualified at any time if it is determined that they do not possess the minimum qualifications stated on this bulletin.
Based on City policy, before being hired in one of these positions, you may be required to undergo a drug and alcohol-screening test.
As a covered entity under the Fair Employment and Housing Act and Title II of the Americans with Disabilities Act, the City of Los Angeles does not discriminate on the basis of disability and upon request, will provide reasonable accommodations to ensure equal access to its programs, services, and activities. To request a disability accommodation, please complete the Disability Accommodation Form within 14 calendar days of the submittal of the City application. The Disability Accommodation Form can be obtained at http://per.lacity.org/exams/verify_disability.pdf.
A final average score of 70% is required to be placed on the eligible list.
The promotional list will ordinarily be used ahead of the open competitive list. However, if open competitive candidates receive a higher score, without military credits, than the highest available promotional candidate, after adding seniority credit at the rate of 0.25 of a point for each year of continuous classified City service, the Civil Service Commission, upon request of the appointing authority, may approve certification of such open competitive candidates ahead of the promotional candidates.
You must have received a regular appointment to a City position or be on a reserve list to file on a promotional basis.
In conjunction with Civil Service Rules, applicants who have received a regular appointment to a City position or are on a reserve list will be considered Promotional candidates while all other applicants will be considered Open candidates.
Your rank on the eligible list may change as scores of candidates from other administrations of the examination are merged onto one list.
Your name may be removed from the open competitive list after 6 months.
In accordance with Civil Service Rule, Sec. 4.24, review periods may be combined. Candidates in the examination process may file protests as provided in Sec. 4.20, 4.22 and 4.23 as applicable and within the required time frame; however, the Personnel Department may respond to and resolve protests prior to the establishment of the eligible list.
If you receive and accept an offer of employment to a regular position with the City of Los Angeles, your employee benefit coverage (including health and dental coverage as well as life insurance) will commence approximately six weeks after your original regular appointment. Not all positions in the City receive benefit coverage; you should inquire regarding the availability of employee benefits prior to accepting a position.
THIS EXAMINATION IS TO BE GIVEN ON AN
INTERDEPARTMENTAL PROMOTIONAL AND OPEN COMPETITIVE BASIS
The City of Los Angeles does not discriminate on the basis of race, religion, national origin, sex, age, marital status, sexual orientation, gender identity, gender expression, disability, creed, color, ancestry, medical condition (cancer), or Acquired Immune Deficiency Syndrome.
AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
For additional information and FAQs regarding the City's hiring process, please go to: http://per.lacity.org/index.cfm?content=employmenttestingprocess
Claims Large Loss Adjuster
Responsible for investigating, evaluating and resolving complex injury claims in multiple jurisdictions. Focus will be on the accurate evaluation and timely settlement of both non litigated and litigated exposures. Must provide high levels of internal and external customer service while also taking into consideration the best interest of National General Insurance Company and its subsidiary companies. This position will be based remotely.
Essential Duties and Responsibilities:
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
Handle claim files and thoroughly document all activities using the claims system; maintain appropriate diaries and status notes using the claim system
Prepare Large Loss Reports (LLR) and elevate the claim exposures above adjuster authority, including appropriate reserve modification and settlement recommendations
Provide timely and concise verbal and written reporting to leadership as to claim exposures via LLR, LLC, and conference calls
Manage the company's indemnification and ALAE exposure by recognizing trends and proactively managing defense counsel including selection of appropriate experts at the appropriate time in the life of the claim file
Manage and partner with Panel Counsel and House Counsel to provide an appropriate defense in accordance with the Claims Handling Guidelines and Litigation Management Guidelines; assist with keeping counsel accountable to company guidelines and appropriate defense of all insureds
Handle assigned claims and other judgement matters according to company guidelines, good faith file handling requirements, and state legal and regulatory requirements in multiple jurisdictions
Complete all aspects of claim handling including complex coverage analysis, timely completion of liability investigations and accurate damages evaluations
Establish strategic negotiating positions when settling claims and/or lawsuits with claimants or attorneys
Set an example of claims handling excellence for the broader claims organization through accurate, timely, proactive, well-documented, creative defense and resolution of Large Loss Claims as defined in the Claims Handling Guidelines
Seek to become a subject matter expert in assigned venues through knowledge of state statutes, case law, defense and plaintiff's counsels, etc
Minimum Skills and Competencies:
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.
Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience
10+ years injury claims handling experience
5+ years handling high exposure, commercial or litigated claims
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Obtain and maintain adjuster license in required jurisdictions
Strong interpersonal skills and the ability to work effectively with a wide range of constituencies in a diverse area
Knowledge of claim systems and process payments
Must possess effective verbal and written communication skills
Must be able and willing to travel 20+ % of the time
Effective organization and time management skills with the ability to work under pressure and adhere to project deadlines
High degree of initiative, mature judgment and discretion
Proven skills with high exposure claims valued in excess of $100,000
5+ years of experience handling one or more of the following areas: extra-contractual matters, litigation management
Obtain and maintain appropriate licensing, educational and/or examination requirements (Adjuster License, MBA)
Successful completion of one or more professional designations: CPCU, AIC
Strong preference for California and other West Coast venue experience
- About National General Holdings:
National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.
National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!
Companies and Partners
Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.
In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:
Medical, Dental, Vision benefits
Life and Short/Long Term Disability Insurance
401k w/ Company Match
Company Paid Holidays & Generous Time-off policy
Employee Discount Program
Career Advancement and Development Opportunities
On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
On-site Fitness Center (Cleveland and Dallas offices)
Subsidized parking (Cleveland office)
National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.
In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.
Senior Claims Examiner - Workers Compensation
Excellence In Everything We Touch
Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices. Evaluates and sets reserves using independent judgment. Assists supervisor and company attorneys in preparing cases for litigations. Conducts training and mentors new hires.
Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted.
Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel.
Analyzes claims activity and prepares reports for clients/carriers and management.
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
Develops subrogation and third party recovery potential and follows reclaim procedures.
Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
Bachelor's degree or equivalent experience.
Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.
Ability to work independently while assimilating various technical subjects.
Strong written and oral communication, negotiation and presentation skills.
Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
- Industry designations such as IIA, AIC, AEI and/or CPCU
Think all TPAs are the same? Think again. With Broadspire, our leading global third-party administrator (TPA), Crawford & Company is the consultative outsourcing partner that adapts to businesses' needs and challenges at any point of the claims processing journey. We offer casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics.
As part of the One Crawford family, Broadspire brings together the best and brightest people in the industry to deliver smart, thoughtful solutions to our clients, and we are guided by our collective value system: RESTORE.
At Crawford, we:
Respect our culture of integrity and ethical behavior, while embracing the unique talents of the individual and encouraging an ownership mentality among everyone.
Are Empowered to advance the company mission and take ownership of our individual career progression.
Promote Sustainability through a corporate culture in which employees are good stewards of their communities.
Emphasize Training and an environment where employees continually seek and share knowledge and are engaged and satisfied with their work.
Are One Crawford, embracing a global mindset that's inclusive, agile, mission-focused, and customer-focused.
Give Recognition, participating in an environment where people are rewarded for jobs well done.
Embody an Entrepreneurial Spirit, sharing a passion to succeed, innovate, and outpace our competitors.
We believe in leading by example – at work and in our communities. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in mission, vision and values. Learn more at www.crawfordandcompany.com.
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries
On-going training opportunities through every stage of your career
Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
Claim Examiner I Health Plan
The Claim Examiner I for Baylor Scott and White Health (BSWH) is responsible for claims processing, research and adjudication to correctly apply benefit determinations on routine uncomplicated medical claims (CMS 1500 and UB04) and Rx claims in accordance with claim processing guidelines.
In addition, the Claim Examiner I for BSWH has the following responsibilities:
Processes and adjusts uncomplicated professional and facility and Rxclaims according to claims processing guidelines
Pends claims as directed by departmental policies and procedures, follows up for resolution and process pended claims immediately following a benefit / payment determination
Works claims inventory from assigned queues to ensure all claims process within established turnaround time as directed by department policy and procedures
Reviews all output reports to ensure accurate benefit and rider determinations
Completes reports to ensure prompt payment of claims
Coordinates win-scanning of claims related documents into members MACESS folder
Identifies and review problems systematic or procedural with Supervisor for timely follow-up and correction
Consistently meet /exceed productivity standards and accuracy standards for payment, procedural and financial
Performs follow-up and takes all necessary actions required to resolve all errors and findings assessed by the Quality Review Team
Performs task individually and as part of an assigned team
Maintains confidentiality regarding rules around HIPPA guidelines
May be required to work in excess of regular scheduled hours
Focuses on achieving departmental and organizations objectives
Complies with company policies and procedures, which includes punctuality as they relate to work time, lunch, and break period
The ideal candidate will possess the following knowledge, skills, and abilities:
Medical claims processing strongly preferred
Medical terminology, CPT, HCPCS, ICD9, ICD10, and coding preferred
Demonstrates effective data entry skills; ability to navigate within a computer / systems-without assistance
Experience in a windows-based computer environment
Excellent verbal and written communication skills
Excellent attention to detail
Excellent analytical and problem solving skills
Ability to prioritize and work within time frames to accomplish tasks
Excellent organizational skills
- Temple Health Plan
For more information on the facility, please click our Locations link.
- Claims Department
- Full Time Days
- Our competitive benefits package includes*:
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
- Note: Benefits may vary based upon position type and/or level.
H.S. Diploma/GED Equivalent
Subrogation Claims Examiner
At Berkley Entertainment, our team's industry experience and collaborative approach leads to great client solutions — and this is by design. We are here to assist with customizing products and services that are tailored to respond to each client's unique exposures.
Our business model is focused on you and providing peace of mind — the way we operate, the team we have built, current and planned future products, and the way we interact with clients — will meet or exceed your expectations.
Responsibilities will include reviewing workers' compensation, auto, liability and property claim files to determine if subrogation from any source is feasible. You will manage assigned claims with a value up to $50K, document and maintain claim files, pursue subrogation from adverse parties and negotiate settlements; strong knowledge of insurance/subrogation concepts, practices, procedures and techniques as well as negotiation, analytical and organizational skills required. Additionally, duties consist of developing a national subrogation network for frequency driven claims and inter-acting with various claim groups.
Able to work independently, be a self-starter, and communicate with clients.
Able to review, analyze and document a plan of action for subrogation recoveries and professionally negotiate a settlement with an adverse party.
Evaluate claims to determine third-party liability and reimbursement amounts.
Properly investigate and document all steps in the recovery process.
Use phone and written correspondence extensively to contact various parties throughout the subrogation recovery process.
Develop Subrogation Production Report.
Work with other members of the Claims group pre-and post-assumptions of the file for subrogation.
Filing intercompany arbitrations if necessary to seek recovery.
Minimum 3 years property/casualty claims handling and subrogation experience in workers' compensation recoveries.
Excellent communication, organizational, and customer service skills.
Exceptional telephone and negotiation skills.
Strong written and verbal skills needed; knowledge of Word and Excel required.
A high degree of motivation and team orientation.
Have and maintain state adjusting licenses as required.
Member of NASP is preferred.
Berkley Core Competencies
Customer Focus and Teamwork
Innovation and Initiative
Overview & Responsibilities
National Indemnity Company, a member of the Berkshire Hathaway group of insurance companies, has grown to possess tremendous financial strength under the direction of Warren Buffett, Chairman of Berkshire Hathaway Inc. We provide a challenging environment and a friendly atmosphere where the achievements of talented individuals are appreciated and rewarded.
We have an immediate opening for an experienced Claim Examiner. This individual will evaluate, manage and resolve claims reported under Company insurance policies within established authority and as required by applicable law.
Investigate, evaluate and settle or manage the defense of claims, including selection and oversight of independent adjusters and counsel and control of loss adjustment expenses, within established authority.
Identify, evaluate and determine, in consultation with Company counsel as necessary, respective rights and obligations of Company, Insured and third parties under all applicable insurance policies.
Establish and modify loss and expense reserves as information regarding claim develops.
Prepare accurate and timely case summaries, evaluations and reports; prepare, maintain and periodically review appropriate Claim Files and journals and all required electronic and other records, and provide information regarding claims as required.
Maintain current knowledge of insurance and claim management principles and practices through review of published opinions, trade periodicals and other professional literature and presentations.
Travel to represent Company in settlement conferences and other proceedings.
Perform other related duties as assigned or as situation dictates.
Bachelor degree in business or related field or equivalent, Law Degree preferred
Interpretation and application of insurance contracts
Insurance claim procedures, loss evaluation methods and claim resolution alternatives
3 to 5 years related work experience
Analyze data, apply knowledge and logic, and draw conclusions
Work well with others
Maintain strict confidentiality
Work independently within established authority
Casualty Claims Examiner (12M Ftc)
The primary purpose of this role is to produce a high quality work product on a portfolio of low value claims through immediate contact and the effective investigation, reserving and adjustment of claims incurred by insureds or third parties.
Specific duties/responsibilities are detailed in the individual's performance plan, based on the following key performance goals:
Manage a portfolio of liability claims in accordance with Chubb Best Practice Guidelines.
Analyse first report to determine nature of loss, coverage provided and scope of injury/damage.
Conduct investigations of all aspects of reported claims including potential fraud. Secure and/or file all supporting documentation and verify same for accuracy, relationship and completeness.
Establish accurate and timely reserves.
Provide exceptional service standards in line with Chubb Best Practice Guidelines
Maintain an active diary. Monitor same to achieve timely development of the file and timely disposition of the claim.
Promptly and properly document all developments on claim file.
Exercise good judgement in reaching final disposition of claim by evaluating nature of loss, liability, injury/damage, coverage provided and applicable limits.
Effectively negotiate compromise settlements where appropriate.
Effectively communicate with the following: claim department, customer services, loss control, underwriting departments, finance departments, brokers, insureds, service providers, third parties and/or their legal representatives.
Recognise and pursue subrogation where applicable.
Adhere to Insurance Contracts Act, the Insurance Code of Practice and all other relevant statutory rules and regulations.
Adhere to Chubb's legal, Regulatory and Internal compliance obligations.
Effectively control the use, work product and expense of outside vendors.
Any other duties as required by the Claims Manager.
Experience & Skills Required:
Relevant Tertiary or Insurance Industry Qualifications.
Minimum of 2 years liability claims experience
Broad knowledge of insurance industry and claims processes.
Written and verbal communication skills
Workflow management skills
Strong customer service focus
Proven team player
Performance is measured as detailed in the individual's annual goals. General areas of performance covered by the individual's annual goals are:
Specific performance measures may include:
Management of inventory.
Reserving timeliness and accuracy.
Coverage awareness and application.
Proper case value based on settlement or conclusion of case.
Volume of cases handled.
Adherence to department policies, procedures and practices.
Results of negotiations
Large Bank Examiner / Senior Large Bank Examiner - Credit Specialist
Large Bank Examiner / Senior Large Bank Examiner – Large Bank Dedicated Team
LSR Division – Supervision and Regulation Department
One of our Large Bank Teams is looking for a commissioned Safety and Soundness Examiner for a role that will primarily focus on general credit risk (corporate finance, mortgage, & counterparty), but will also include CECL, insurance, and sundry other areas as the need arises. The applicant will work closely with another dedicated team member who focuses on retail automotive risk. LSR roles are increasingly involved in financial (e.g., credit, liquidity, capital, & general budgeting) and operational modeling across disciplines for both daily and stress purposes. This role will evolve over 2019 and beyond to address different risks and supervisory responsibilities pursuant to dynamic dedicated team demands.
The Large Bank Supervision job family provides supervisory oversight of financial institutions that are greater than $50 billion in assets or are categorized as Financial Market Utilities. Members of the Large Bank Supervision job family provide supervisory oversight through continuous monitoring and examination activity by engaging with institutions' executives who have a deep knowledge of their functional or risk area.
Members of the Large Bank Supervision job family generally work within a dedicated team, and focus on and have a deep knowledge of a certain risk or functional discipline. The Large Bank Examiner uses in-depth knowledge to proactively identify risks through on- and off-site examination and monitoring activities to ensure the firm is operating in a safe and sound manner and in compliance with applicable laws and regulations. The individual also independently performs research and writes comprehensive analysis.
The level of work is generally considered intermediate and staff must be able to work under general supervision. This position has no direct reports and will report to a deputy central point of contact.
Principal Duties and Responsibilities
Participates in ongoing supervision efforts, such as horizontal / coordinated reviews, target reviews, and continuous monitoring of large or complex financial institutions
Presents and prepares quality and timely summary documents, such as reports of examination and conclusion memoranda, continuous monitoring documentation, risk assessments, and other supervisory correspondence and documentation for complex / high-risk institutions
Assesses the adequacy of risk management systems, policies and procedures, and compliance with laws and regulations
Leverages in-depth knowledge to develop supervisory strategies for complex / high-risk institutions
Develops examination / project plans, timelines, and milestones for complex institutions
Creates and provides focused and value-added reports, documents, and other correspondence to internal and external stakeholders
Builds relationships within the team, department, & division, and develops relationships with internal and external stakeholders, such as other Reserve Banks, the Board of Governors, and other regulatory agencies
Provides guidance, training, and constructive feedback to less experienced staff
Education and Experience
Large Bank Examiner Level
Bachelor`s degree or equivalent experience
Master's in Economics, Finance, or Business Administration preferred
Five plus years of direct work-related experience
Commissioning preferred, not required
Senior Large Bank Examiner Level
Bachelor's degree or equivalent experience
Master's in Economics, Finance, or Business Administration preferred
Seven plus years of direct work-related experience
Commissioning preferred, not required
Knowledge and Skills
Possesses the ability to understand risk-focused supervision and processes
Demonstrates intermediate to advanced analytical and problem solving skills
Demonstrates independent and critical thinking and decision making abilities, as well as have solid written and oral communication abilities
Possesses the ability to provide guidance and constructive feedback to less experienced staff
Possesses strong teamwork skills and the ability to build and work collaboratively within and across work teams
Demonstrates the ability to manage time and projects effectively by adjusting quickly to new and different priorities
Possesses a strong proficiency in Microsoft Office© products
Possesses general business acumen
Must be able to travel up to 30%, typically but not limited to Charlotte, NC and Detroit, MI
This position requires access to confidential supervisory information, which is limited to "Protected Individuals" as defined in the U.S. federal immigration law. Protected Individuals include, but are not limited to, U.S. citizens, U.S. nationals, U.S. permanent residents who are not yet eligible to apply for naturalization, and U.S. permanent residents who have applied for naturalization within six months of being eligible to do so.
As a condition of employment, Federal Reserve Bank of Chicago employees must comply with the Bank's ethics rules which generally prohibit employees, their spouses / domestic partners, and minor children from owning securities, such as stock, of banks or savings associations or their affiliates, such as bank holding companies and savings and loan holding companies. If you or your spouse / domestic partner or minor child own such securities, and would not be willing or able to divest them if you accepted an offer of Bank employment, you should raise this issue with the recruiter for this posting, who can provide you contact information for our ethics official if necessary.
Claims Examiner - Managed Care
The Claims Examiner is responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Processes claims according to all CMS and DMHC guidelines. Investigate and complete open or pended claims. Meet production and quality standards.
Essential Job Duties:
Meets productivity standards for number claims completed and for accuracy of entries.
Handles in a professional and confidential manner all correspondence.
Supports CSMNS core values, policies, and procedures.
Receives, and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.
Receives daily workflow via reports or work queue and incoming phone calls.
Researches claims for appropriate support documents.
Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied.
Responds and documents resolution of inquiries from internal departments.
Assists Finance with researching provider information to resolve outstanding or stale dated check issues.
Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases.
High school diploma required.
Three (3) plus years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and hospital related setting. Knowledge of general claims processing principles. Knowledge of CMS and UB coding. Experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims. Experience on an automated claims processing system (Epic Tapestry preferred). Ability to interpret Health Plans Division of Financial Responsibility for both IPA and Hospital Risk. Knowledge of medical terminology, CPT, HCPCS, Revenue Codes and ICD-10 codes. Working knowledge of coordination of benefits and Correct Coding Initiative edits. Knowledge and understanding of federal and state statutes, laws, rules and regulations. Flexible and detail oriented. Excellent verbal and written communication skills in the English language required.
Working Title: Claims Examiner - Managed Care
Department: MNS - Managed Care
Business Entity: Medical Network
Job Category: Patient Services
Job Specialty: Patient Relations
Position Type: Full-time
Shift Length: 8 hour shift
Shift Type: Day
Auto Claims Examiner
W. R. Berkley Corporation, founded in 1967, is one of the nation's premier commercial lines property casualty insurance providers. Founded in 2004, Berkley Environmental has underwriting and account executive units in seven regions. Berkley Environmental offers an array of coverages for virtually all classes traditionally known to have environmental liability exposures on both an admitted and non-admitted basis. We provide a comprehensive portfolio of commercial property casualty insurance, automobile liability and workers' compensation, along with claim services, providing expertise to meet the unique business needs of our customers. W.R. Berkley Corporation has reached a milestone and is celebrating 50 years.
This position is responsible for reviewing, investigating, evaluating, negotiating and the processing of first and third party commercial auto claims for our Environmental division which are generally larger and more complex with an authority level up to $100,000.
Complete coverage analysis
Conduct the necessary investigation, either by phone, or through independent adjusters, to determine coverage, liability and damages.
Evaluate, negotiate, and settle first party physical damage, third party property damage and severe and/or complex bodily injury claims within authority granted, or seek authority for those claims in excess of authority.
Resolve coverage disputes with insureds and agents
Prepare coverage opinion letters
Bachelors Degree Preferred
At least 7 years relevant industry auto claim handling experience
Multi state experience required
Skills and Competencies:
Strong negotiation skills
Some adjuster licenses required
Strong litigation skills
Berkley Core Competencies
Customer Focus and Teamwork
Innovation and Initiative
Making better hires starts with building better job descriptions
- Browse 100s of templates across 40+ industries
- Customize your template with your company info & job requirements
- Post it to 20+ job boards in seconds – for FREE!