Claims Examiner - Workers Compensation - Remote / Telecommute

Job Overview

Pay Range: $50.00hr - $55.00hr

Requirement/Must Have

• Five 5+ years of claims management experience or equivalent combination of education and experience required.
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration.
• Knowledge of cost containment principles including medical management practices and Social Security and Medicare application procedures.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.
• Strong verbal and written communication skills.
• Excellent communication and presentation skills.

Responsibilities

• Analyzes and processes complex or technically difficult workers compensation claims by investigating and gathering information to determine the exposure on the claim.
• Manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments.
• Settles claims within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process to ensure timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier and responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client.
• Maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Supports the organizations quality program(s).
• Travels as required.

Nice to Have

• Professional certification as applicable to line of business preferred.

Skills

• Workers Compensation Claims Adjudication.
• Litigation Management.
• Subrogation.
• Reserve Management.
• Cost Containment.
• Microsoft Office.
• Negotiation.
• Analytical Skills.

Qualification And Education

• Bachelors degree from an accredited college or university preferred.