Worker's Compensation Claims Examiner

Job Description

Job Description

Workers' Compensation Claims Examiner - Washington, DC (#R10291)

• Location:  Washington, DC 20001
• Employment Type: Temporary / Full-Time
• Hourly Rate: $42 per hour

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Administers workers’ compensation claims from initial report through closure by investigating compensability, analyzing medical and employment evidence, making claim recommendations, coordinating services, maintaining claim records, and supporting hearings and settlements.

Why Join Us?

• Competitive Compensation: Earn $42 per hour providing essential claims examination services for the Public Sector Workers' Compensation Program.
• Comprehensive Benefits: Temporary, full-time position. No work on District holidays or administrative closure days.
• Work Schedule: Full-Time (FTE), Monday-Friday, 8:30 a.m. - 5:00 p.m. ET; up to 40 hours per week. No work on District holidays or administrative closure days.
• Professional Growth: Gain valuable experience in a collaborative, innovative, and supportive environment within a government office setting.
• Impactful Work: Contribute to a mission-driven organization dedicated to improving outcomes for injured workers through professional claims administration and case management.

Qualifications:

• Job Qualifications & Certifications:
• • Bachelor’s degree and at least two years of workers’ compensation claims adjusting experience; or eight years of progressively responsible claims-handling experience, including at least three years of workers’ compensation claims adjusting experience.
  • Knowledge of workers’ compensation laws, regulations, investigations, reserving, case management, and claim adjudication.
  • Ability to analyze medical evidence and make claim determinations.
  • Experience participating in hearings, mediations, or settlement conferences.
  • Knowledge of medical terminology and treatment review.
• Skills:
• • Workers’ compensation investigation, compensability analysis, reserving, adjudication, and caseload management.
  • Medical and claim-record analysis, factual findings, and written determinations.
  • Claims management systems and Microsoft Office applications.
  • Stakeholder coordination, hearings and mediation support, customer service, and written and verbal communication.
  • Confidential and sensitive information handling.

JOB DESCRIPTION:

• Receive, review, and process first reports of injury, notices of loss, and workers’ compensation claims under applicable laws, regulations, policies, and procedures.
• Investigate and evaluate claims to determine compensability and entitlement to medical and related benefits.
• Manage medical-only workers’ compensation claims from inception through closure.
• Collect and analyze medical records, employment records, witness statements, treatment plans, bills, and other claim evidence.
• Review medical evidence for treatment appropriateness, medical necessity, work restrictions, and return-to-work opportunities.
• Complete required claim contacts, including 24-hour four-point contacts with injured workers, supervisors, medical providers, and other stakeholders; document activity in the claims management system.
• Develop factual findings, claim analyses, and recommendations supporting determinations and benefit decisions.
• Coordinate with injured workers, agency representatives, healthcare providers, legal counsel, nurse case managers, and other stakeholders.
• Coordinate medical appointments, independent medical evaluations, transportation services, and medically necessary follow-up care.
• Assess maximum medical improvement, work capacity, and ongoing treatment needs using medical evidence and provider recommendations.
• Draft notices, correspondence, claim determinations, and adjudication documents.
• Maintain complete and timely claim files; research claim histories, laws, regulations, policies, and procedures.
• Manage assigned caseloads to meet performance standards, statutory requirements, and customer-service expectations.
• Participate in claim reviews, settlement discussions, mediations, hearings, and administrative proceedings; provide testimony or supporting documents when required.
• Protect confidential medical, financial, and employment information and provide professional customer service.
• Perform other related duties supporting the Public Sector Workers’ Compensation Program.

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