Claims Examiner - Workers Compensation Jobs in USA, Remote | Rose International Job

Required Education:• High School Diploma or GED.Preferred Education:• Bachelor’s degree from an accredited college or university preferred. Required License• Workers Comp experience in Southeast state jurisdictions some or all AL, GA, FL, NC, SC, TNSkills & Knowledge• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the line of business.• Excellent oral and written communication, including presentation skills.• PC literate, including Microsoft Office products.• Analytical and interpretive skills.• Strong organizational skills.• Good interpersonal skills.• Excellent negotiation skills.• Ability to work in a team environment.• Ability to meet or exceed Service Expectations.To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high-exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements; and to identify subrogation of claims and negotiate settlements.Essential Functions and Responsibilities. • Manages workers' compensation claims, determining compensability and benefits due on long-term indemnity claims, monitors reserve accuracy, and files necessary documentation with the state agency.• Develops and manages workers' compensation claims' action plans to resolution, coordinates return-to-work efforts and approves claim payments.• Approves and processes assigned claims, determines benefits due, and manages action plan under the claim or client contract.• Manages subrogation of claims and negotiates settlements.• Communicates claim action with the claimant and the client.• Ensures claim files are properly documented and claims coding is correct.• May process complex lifetime medical and/or defined period medical claims, which include state and physician filings and decisions on appropriate treatments recommended by utilization review.• Maintains professional client relationships.Additional Functions and Responsibilities. • Performs other duties as assigned.• Supports the organization's quality program(s).• Travels as required.**Only those lawfully authorized to work in the designated country associated with the position will be considered.** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**



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