Workers Compensation Claims Examiner

Our client, a well-established organization in the insurance industry, is seeking an experienced Workers' Compensation Claims Examiner to join their team. Candidates must reside in Albuquerque, NM! HOURS: Full-Time DURATION: Direct Hire WORKPLACE: Hybrid: 3 days remote and 2 days in office PAY: $88,000 to $90,000 BENEFITS: Full comprehensive benefits package including medical, dental, vision, and PTO. Responsibilities Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims. Initiates and conducts investigation in a timely manner. Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines. Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution. Manages medical treatment and medical billing, authorizing as appropriate. Calculates and pays benefits due and approves all claim payments. Refers cases to outside defense counsel. Directs and manages as appropriate. Manages claim recoveries of all types, including deductible and subrogation. Communicates with clients, claimants, providers and vendors regarding claims issues. Computes and set reserves within Company guidelines. Settles and/or finalizes all claims and obtains authority as designated. Maintains diary system for case review and documents file to reflect the status and work being performed on the file. Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns. Conducts file reviews independently. Other duties as assigned. Qualifications Bachelor's degree in a related field preferred. New Mexico Adjuster’s license is required. Minimum of 5+ years of workers' compensation claims handling experience or an equivalent combination of education and experience. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Proficient in Word and Excel (preferred). Knowledge of self-insured claims handling (preferred). City, County and/or District claims handling experience (preferred). #J-18808-Ljbffr