Workers Compensation Claims Examiner

Position Summary Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. Responsibilities Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims. Initiates and conducts investigations in a timely manner. Determines compensability of claims and administers benefits based upon state law and company guidelines. Manages medical treatment and billing, authorizing as appropriate. Refers cases to external defense counsel; directs and manages as appropriate. Communicates with claimants, providers, and vendors regarding claim issues. Computes and sets reserves within company guidelines; limits are larger than those for Claims Examiner I and II. Settles and/or finalizes all claims and obtains authority as designated. Maintains diary system for case review and documents file to reflect status and work performed. Communicates appropriate information promptly to the client to resolve claims efficiently, including injury trends or safety concerns. Adheres to all company policies and procedures. Conducts file reviews independently. Performs other duties as assigned. Equipment Operated/Used Computer, 10-key, fax machine, copier, printer, and other office equipment. Special Equipment or Clothing Appropriate office attire. Qualifications Education/Experience: Bachelor’s degree in a related field (preferred); three (3) or more years of related experience; or equivalent combination of education and experience. Knowledge, Skills and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficiency in Word and Excel (preferred). Other Qualifications: Certifications and/or licenses as required by state regulation. Benefits Medical, Dental & Vision Insurance Life & Disability Insurance 401(k) plan Paid time off Paid holidays Referral bonus #J-18808-Ljbffr