Claims Examiner Workers Compensation

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.

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; settles clams within designated authority level
• Prepares necessary state filings within statutory limits
• Manages the litigation process; ensures timely and cost-effective claims resolution
• Coordinates vendor referrals for additional investigation and/or litigation management

Skills & Qualifications

• Professional certification as applicable to line of business preferred

Experience

• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.

Education

• Bachelor's degree from an accredited college or university preferred

Benefits

• Medical, dental vision, 401K on day one.
• PTO.
• Disability life insurance.
• Employee assistance program.