WC Claims Examiner

Job Title

Workers' Compensation Claims Adjudication And Investigation

Responsibilities

To perform workers' compensation claims adjudication and investigation. Responsible for all technical aspects of claim management for assigned including compliance with all established performance guidelines.

• Properly investigate and handle all types of workers' compensation files including lost time, litigation and long-term exposure within predetermined claim-handling guidelines.
• Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
• Establish timely and appropriate case reserves
• Investigate and manage subrogation and negotiate settlements.
• Use automated diary system to issue indemnity benefits and provide claim management.
• Accurately calculate and pay wage loss and other benefits.
• Assign rehabilitation and monitor costs and outcomes.
• Document all action plans and evaluations for claim resolution.
• Maintain organized electronic files.
• Interact with clients to establish/improve communication and service capabilities.
• Interact and communicate with state agencies, attorneys and other providers.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Achieve specific performance outcomes related to quality and quantity of work as established by management.
• Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
• Define medical and rehabilitation payment parameters staff.
• May perform other functions as assigned

Qualifications

• 1 – 2 years minimum workers' compensation claim processing experience.
• Experience must include handling of medical-only, lost-time and litigated claims.
• Demonstrated working knowledge of workers' compensation administration rules/laws.
• Good to excellent math and analytical ability.
• Good to excellent oral and written communication skills.
• Excellent customer service skills.

Education

• College degree or relevant experience

Additional Company Details

The company offers a competitive compensation plan and robust benefits package for full time regular employees including: • Base Salary Range: $65k-$77k • Benefits include Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Additional Requirements

Travel: Occasionally

Sponsorship Details

Sponsorship not Offered for this Role