Workers Compensation Claims Examiner

Responsibilities Manages all aspects of indemnity claims handling from inception to conclusion Initiates and conducts investigation in a timely manner Determines compensability of claims and administers benefits Develops and manages claims through well-developed action plans Manages medical treatment and medical billing Calculates and pays benefits due and approves all claim payments Manages claim recoveries of all types Communicates with clients, claimants, providers, and vendors regarding claims issues Computes and sets reserves within Company guidelines Settles and/or finalizes all claims Requirements Bachelor’s degree in related field (preferred) Five (5) or more years of related experience Technical knowledge of statutory regulations and medical terminology Analytical skills Excellent written and verbal communication skills Ability to independently and effectively manage very complex claims Proficient in Word and Excel (preferred) Knowledge of self-insured claims handling (preferred) City, County and/or District claims handling experience (preferred) Core Competencies Demonstrates expertise in managing indemnity claims from inception to conclusion, including investigation, compensability determination, and benefit administration. Proficient in statutory regulations and medical terminology, with strong analytical and communication skills to effectively handle complex claims. Hard Skills Claims Handling Benefit Calculation Reserve Computation Action Plan Development Medical Billing Management Soft Skills Analytical Skills Excellent Communication Skills Industry Keywords Statutory Regulations Medical Terminology City Claims Handling County Claims Handling District Claims Handling Tools & Technologies Microsoft Word Microsoft Excel #J-18808-Ljbffr