Job Description
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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