Workers Comp Claims Examiner
About the position
The Workers Comp Claims Examiner role involves analyzing complex workers' compensation claims to determine benefits due, managing high exposure claims, and ensuring timely adjudication within service expectations. The position requires expertise in claims management, negotiation, and communication with claimants and clients, while also focusing on cost containment and compliance with statutory requirements.
Responsibilities
Ā Analyze complex or technically difficult workers' compensation claims to determine benefits due.
,
Ā Work with high exposure claims involving litigation and rehabilitation.
,
Ā Ensure ongoing adjudication of claims within service expectations and industry best practices.
,
Ā Identify subrogation of claims and negotiate settlements.
,
Ā Calculate and assign timely and appropriate reserves to claims.
,
Ā Manage reserve adequacy throughout the life of the claim.
,
Ā Calculate and pay benefits due; approve and make timely claim payments and adjustments.
,
Ā Prepare necessary state filings within statutory limits.
,
Ā Manage the litigation process; ensure timely and cost-effective claims resolution.
,
Ā Coordinate vendor referrals for additional investigation and/or litigation management.
,
Ā Use appropriate cost containment techniques to reduce overall cost of claims.
,
Ā Manage claim recoveries, including subrogation and offsets.
,
Ā Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
,
Ā Ensure claim files are properly documented and claims coding is correct.
,
Ā Refer cases as appropriate to supervisor and management.
Requirements
Ā Bachelor's degree from an accredited college or university preferred.
,
Ā Minimum of 5 years of claims management experience or equivalent combination of education and experience required.
,
Ā Subject matter expert in insurance principles and laws relevant to workers' compensation claims.
,
Ā Excellent oral and written communication skills, including presentation skills.
,
Ā PC literate, including proficiency in Microsoft Office products.
,
Ā Strong analytical and interpretive skills.
,
Ā Strong organizational skills.
,
Ā Good interpersonal skills.
,
Ā Excellent negotiation skills.
Nice-to-haves
Benefits
Ā Medical insurance
,
Ā Dental insurance
,
Ā Vision insurance
,
Ā Life insurance
,
Ā Short-term disability
,
Ā Additional voluntary benefits
,
Ā Employee Assistance Program (EAP)
,
Ā Commuter benefits
,
Ā 401K plan
,
Ā Paid Sick Leave
,
Ā Holiday pay
Apply Now
The Workers Comp Claims Examiner role involves analyzing complex workers' compensation claims to determine benefits due, managing high exposure claims, and ensuring timely adjudication within service expectations. The position requires expertise in claims management, negotiation, and communication with claimants and clients, while also focusing on cost containment and compliance with statutory requirements.
Responsibilities
Ā Analyze complex or technically difficult workers' compensation claims to determine benefits due.
,
Ā Work with high exposure claims involving litigation and rehabilitation.
,
Ā Ensure ongoing adjudication of claims within service expectations and industry best practices.
,
Ā Identify subrogation of claims and negotiate settlements.
,
Ā Calculate and assign timely and appropriate reserves to claims.
,
Ā Manage reserve adequacy throughout the life of the claim.
,
Ā Calculate and pay benefits due; approve and make timely claim payments and adjustments.
,
Ā Prepare necessary state filings within statutory limits.
,
Ā Manage the litigation process; ensure timely and cost-effective claims resolution.
,
Ā Coordinate vendor referrals for additional investigation and/or litigation management.
,
Ā Use appropriate cost containment techniques to reduce overall cost of claims.
,
Ā Manage claim recoveries, including subrogation and offsets.
,
Ā Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
,
Ā Ensure claim files are properly documented and claims coding is correct.
,
Ā Refer cases as appropriate to supervisor and management.
Requirements
Ā Bachelor's degree from an accredited college or university preferred.
,
Ā Minimum of 5 years of claims management experience or equivalent combination of education and experience required.
,
Ā Subject matter expert in insurance principles and laws relevant to workers' compensation claims.
,
Ā Excellent oral and written communication skills, including presentation skills.
,
Ā PC literate, including proficiency in Microsoft Office products.
,
Ā Strong analytical and interpretive skills.
,
Ā Strong organizational skills.
,
Ā Good interpersonal skills.
,
Ā Excellent negotiation skills.
Nice-to-haves
Benefits
Ā Medical insurance
,
Ā Dental insurance
,
Ā Vision insurance
,
Ā Life insurance
,
Ā Short-term disability
,
Ā Additional voluntary benefits
,
Ā Employee Assistance Program (EAP)
,
Ā Commuter benefits
,
Ā 401K plan
,
Ā Paid Sick Leave
,
Ā Holiday pay
Apply Now