Workers Compensation Claims Examiner

SUMMARY

Responsible for reviewing, adjudicating and managing low- and mid-level workers' compensation claims in accordance with company guidelines, statutory regulations and best practices. Manages claims through well-developed action plans to an appropriate and timely resolution.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Reviews and evaluates workers' compensation claims to determines compensability and benefits due on indemnity claims; Sets and manages reserve accounts, ensures that accurate levels are maintained and that documentation is on file with state agency; Develops and manages workers' compensation claims action plans and manages to resolution; Establishes and manages return-to-work plan; Identifies modified work opportunities to enable return to work; Coordinates claim action and processing with claimant and client; Approves claim payments, manages subrogation of claims and negotiates settlements; Develops effective working relationships with outside vendors and ensures professional client relationships; Communicates with injured workers, employers, doctors and attorneys; Composes medical examination assignments, letters and legal orders; Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims; Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information); Other duties as assigned.

QUALIFICATIONS

EDUCATION / EXPERIENCE

Bachelor's Degree in business or equivalent combination of education and experience Three (3) or more years of experience in workers' compensation field Certificates and/or licenses as required by State regulation

SKILLS

Excellent verbal and written communication skills Excellent presentation skills Excellent customer service skills Analytical skills with ability to interpret results Strong organizational skills Good interpersonal skills with ability to work in a team environment Proficient in Microsoft Office Products #LI-DR1 We are proud to provide comprehensive, high quality employee programs to meet employees' needs now and in the future, including a very competitive financial package. We encourage you to explore what we have to offer. Alliant Insurance Services, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment based on their qualifications and ability without regard to race, color, religion, sex (including pregnancy, childbirth, breastfeeding, sexual orientation, and gender identity), national origin, ancestry, physical or mental disability, medical condition, marital status, age, genetic information, or status as a protected veteran, in accordance with applicable federal, state, and local laws, including California law. Applicants are protected under Federal law from discrimination. If you need an accommodation to complete the application process or would like to review these materials in an alternative format, please reach out to View email address on click.appcast.io For more information on Alliant Insurance Service's benefits, please visit #J-18808-Ljbffr Alliant Insurance Services