Claims Examiner - Workers Compensation - Remote / Telecommute

Job Title

Job Overview: Pay Range: $50.57hr - $53.57hr

Responsibilities

• Analyze and process complex workers compensation claims by investigating and gathering information to determine claim exposure.
• Manage claims through structured action plans to ensure timely resolution.
• Negotiate settlement of claims within designated authority limits.
• Calculate and assign appropriate reserves and manage reserve adequacy throughout claim lifecycle.
• Calculate and process claim payments, benefits, and adjustments.
• Prepare required state filings within statutory requirements.
• Manage litigation process ensuring timely and cost-effective resolution.
• Coordinate vendor referrals for investigation and litigation management.
• Apply cost containment strategies to reduce overall claim expenses.
• Manage claim recoveries including subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets.
• Report claims to excess carriers and respond to requests in a timely manner.
• Communicate claim status with claimants and clients while maintaining professional relationships.
• Ensure proper documentation and accurate claim coding.
• Refer cases to supervisor or management as required.
• Support quality programs and perform additional assigned duties.
• Travel as required.

Requirements/Must Have

• Bachelors degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• 5 years of claims management experience or equivalent combination of education and experience required.
• Strong understanding of insurance principles, laws, recoveries, offsets, and cost containment practices.
• Strong knowledge of claims handling, disability duration, and medical management practices.

Experience

• Experience in claims management or related insurance claims processing.
• Experience handling workers compensation claims preferred.

Should Have

• Excellent oral and written communication skills.
• Strong analytical and interpretive abilities.
• Strong organizational and interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment and meet service expectations.

Skills

• Microsoft Office tools.
• Claims management systems.
• Analytical and documentation skills.
• Insurance and workers compensation knowledge.

Qualification And Education

• Bachelors degree preferred in related field.
• Professional certification preferred.