Claims Examiner - Workers Compensation

Claims Examiner - Workers CompensationPrimary Purpose: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.Essential Functions and 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; and settles claims within designated authority level.Prepares necessary state filings within statutory limits.Manages the litigation process; ensures 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 for our clients.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; 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.Additional Functions and Responsibilities:Performs other duties as assigned.Supports the organization's quality program(s).Travels as required.Qualification:Education & Licensing:Bachelor's degree from an accredited college or university preferred.Professional certification as applicable to line of business preferred.Experience:Five (5) years of claims management experience or equivalent combination of education and experience required.Skills:Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.Excellent oral and written communication, including presentation skills.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.Work Environment:When applicable and appropriate, consideration will be given to reasonable accommodations.Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.Physical: Computer keyboarding, travel as required.Auditory/Visual: Hearing, vision and talking.Note: Credit security clearance, confirmed via a background credit check, is required for this position.