Claims Examiner - Workers Compensation - Remote / Telecommute

Job Description:

Pay Range: $45hr - $50hr
• The Claims Examiner - Workers Compensation is responsible for analyzing and managing complex workers' compensation claims from investigation through resolution.
• This role involves evaluating claim exposure, negotiating settlements, managing reserves, coordinating litigation and vendor services, and ensuring compliance with statutory and regulatory requirements.
• The position requires strong analytical, negotiation, and communication skills to deliver timely and cost-effective claim outcomes.
Responsibilities:
• nalyze and process complex or technically challenging workers' compensation claims.
• Investigate and gather relevant information to determine claim exposure.
• Develop and execute action plans to achieve timely and appropriate claim resolution.
• Negotiate settlements within designated authority levels.
• Establish, calculate, and manage claim reserves throughout the lifecycle of the claim.
• Calculate and pay benefits due, approve claim payments and adjustments, and settle claims within authority limits.
• Prepare and submit required state filings within statutory deadlines.
• Manage the litigation process to ensure timely and cost-effective resolutions.
• Coordinate vendor referrals for investigations and litigation management.
• pply cost containment strategies to reduce overall claim expenses.
• Manage claim recoveries including subrogation and applicable offsets.
• Report claims to excess carriers and respond to requests in a professional and timely manner.
• Communicate claim activity and updates with claimants and clients while maintaining professional relationships.
• Ensure claim files are accurately documented and properly coded.
• Refer cases to supervisors or management as appropriate.
• Support quality programs and perform additional duties as assigned.
• Travel as required.
Requirement/Must Have:
• Strong knowledge of workers' compensation insurance principles and applicable laws.
• Expertise in claim evaluation, reserve management, and settlement negotiation.
• Knowledge of cost containment and medical management practices.
• Understanding of claim recoveries, offsets, and regulatory filing requirements.
• Proficiency in Microsoft Office applications.
• Strong analytical, organizational, and interpersonal skills.
• Excellent written and verbal communication skills.
• bility to work effectively in a team environment.
Experience:
• Claims management experience in workers' compensation or related line of business.
• Experience handling complex or litigated claims.
Skills:
• Claims investigation and evaluation.
• Negotiation and settlement management.
• Litigation coordination.
• nalytical and interpretive decision-making.
• Client communication and relationship management.
Qualification And Education:
• Bachelor's degree preferred.
• Professional certification relevant to workers' compensation or claims management preferred.

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