Workers Compensation Claims Examiner II

Workers Compensation Claims Examiner II

Hybrid Dallas - Irving, TX 75038

Under general supervision, manages workers' compensation indemnity claims of moderate to complex difficulty from inception through resolution within assigned authority limits and established company and client guidelines. Exercises independent judgment in routine and complex claims handling and seek supervisory guidance on unusual, high-exposure, or sensitive matters.

Manages a caseload of approximately 150180 workers' compensation claims of moderate to complex difficulty.

Calculates and establishes reserves and authorizes payments and settlements within assigned authority limits, which are lower than those assigned to Claims Examiner III.

Identifies and escalates claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding assigned authority.

Refers claims to defense counsel as appropriate and monitors litigation activities, consulting with the supervisor on significant legal developments and settlement strategy.

Education/Experience: Bachelor's degree in related field (preferred); and three (3) to five (5) years related experience; or equivalent combination of education and experience.

Technical knowledge of statutory regulations and medical terminology.

Analytical skills.

Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.

Ability to interact with people at all levels in the business environment.

Ability to independently and effectively manage very complex claims.

Proficient in Word and Excel (preferred).

Certification and/or or license as required by State regulation.

Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts.

Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application.

Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Light work: Exerting up to 20 pounds of force occasionally.

Far vision: clarity of vision at 20 feet or more. Near vision: clarity of vision at 20 inches or less. Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet. Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are. Color vision: ability to identify and distinguish colors. Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point.

Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. Stooping: Bending body downward and forward by bending spine at the waist. Kneeling: Bending legs at knee to come to a rest on knee or knees. Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. Reaching: Extending hand(s) and arm(s) in any direction. Standing: Particularly for sustained periods of time. Walking: Moving about on foot to accomplish tasks, particularly for long distances. Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. Pulling: Using the upper extremities to extend force in order to drag, haul, or tug objects in a sustained motion. Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. Grasping: Applying pressure to an object with the fingers and palm. Talking: Expressing or exchanging ideas by means of the spoken word. Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. Repetitive Substantial movements (motions) of the wrists, hands, and/or fingers. Frequently Frequently Frequently

Dirt/Dust. Noise. Temperature extremes. Dampness. Vibrations. Equipment movement hazard. Chemicals/solvents. Electrical shock. Significant work pace/pressure. Odors/Fumes. Other (specify):