WC Sr. Claims Examiner

Job Title

Responsible for managing a caseload consisting of incoming and more complex workers' compensation cases including extended disability cases, litigation, employer's liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.

Responsibilities

Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files. Document claim handling activities; create and document action plans. Establish appropriate case reserves. Actively manage medical treatment and disability while assisting the injured worker to return to work. Comply with all performance guidelines. Identify loss trends and communicate to supervisor and/or clients. Use automated diary system to issue indemnity payments and for claims management. Investigate and manage claim subrogation and negotiate settlements. Manage coverage B or conflict of interest cases as assigned. Address customer complaints and inquiries in an exemplary and professional manner. Participate in client claim reviews when scheduled or requested. May perform other functions as assigned.

Qualifications

Demonstrated working knowledge of workers' compensation administration rules/laws. Excellent communication and presentation skills. Must be able to interface with clients, legal counsel, health care professionals, etc. Good math and analytical ability. Excellent customer service skills. Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.

Education BA/BS degree with three years' experience. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years' experience in workers compensation claims management.

Additional Company Details

The Company is an equal employment opportunity employer. We do not accept unsolicited resumes from third party recruiting agencies or firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees including: Base Salary Range: $65k-$85k 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: Occasional travel