Claims Examiner- Workers Compensation (REMOTE - FL, GA, SC, AR, MS, TN, AL, NC exp required)
About the position Responsibilities • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution. • Coordinates vendor referrals for additional investigation and/or litigation management. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. Requirements • Bachelor's degree from an accredited college or university preferred. • Five (5) years of claims management experience or equivalent combination of education and experience required. • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to 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. Nice-to-haves • Professional certification as applicable to line of business preferred. Benefits • Flexible working hours. • Support for mental, physical, financial and professional needs. • Opportunities for career growth and skill sharpening. • Diversity and inclusion in the workplace. Apply tot his job Apply tot his job