Claims Examiner III

About the role

The position will be responsible for the resolution of high complexity and high exposure Workers Compensation claims in multiple jurisdictions. The position will have increased responsibility for decision making within their authority and work under general direction from their manager.

Job Responsibilities

• Confirms coverage of claims by reviewing policies and documents submitted in support of claims
• Analyzes coverage and communicates coverage positions
• Coordinates and directs investigation into loss facts and extent of damages
• Directs and monitors assignments to experts and outside counsel
• Evaluates information on coverage, compensability, and medical management to determine the extent of insured's exposure
• Sets reserves within authority or makes claim recommendations concerning reserve changes to manager
• Focus on driving claims to a resolution with a focus of returning the injured back to work
• Evaluate, Negotiate and settle claim when appropriate
• Prepares reports by collecting and summarizing information
• Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives
• Participates in special projects or assists other team members as requested
• Attend all state specific trainings as scheduled
• Travel to mediations, trials, and conferences as required

Qualifications & Skills

• Bachelor's degree in a business-related field preferred; equivalent insurance industry experience may be substituted.
• Insurance designation(s) preferred.
• Excellent written and verbal communication skills.
• Strong analytical, problem-solving, organizational, and time management skills.
• Ability to deliver outstanding customer service and work effectively in a team environment.
• Strong understanding of medical terminology preferred.
• Intermediate proficiency in Microsoft Office applications, including Excel, Outlook, PowerPoint, and Word.
• Demonstrated commitment to continuous improvement and professional development.
• Ability to analyze complex coverage, liability, compensability, and medical management issues and make sound claim decisions.
• Strong negotiation and decision-making skills.

Pay

The salary range for this position is $82,500 - $171,450. The posted salary range reflects the lowest and highest base salary applicable to this role across our U.S. locations. Individual offers are determined based on geographic location, experience, qualifications, internal equity, and other job-related factors. As a result, the salary offered for a specific location will fall within a narrower range than the overall range displayed in this posting. This position may also be eligible to participate in the Company's annual incentive plan.