Claims Examiner/Senior Claims Examiner

Responsibilities

• Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure on the claim.
• Negotiates settlement of claims up to designated authority level and makes claims payments.
• Processes complex or technically difficult claims.
• Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
• Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
• Prepares necessary state filings within statutory limits.
• Actively manages the litigation process; ensures timely and cost-effective claims resolution.
• Captures vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
• Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
• Frequently communicates with all appropriate parties involved with the claim.
• Refers cases as appropriate to management.
• Maintains professional client relationships.
• Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications

• 2+ years claims management experience.
• Professional certification as applicable to workers’ compensation required.
• In depth knowledge of appropriate insurance principles and laws for workers’ compensation.
• Strong written and verbal communication skills.
• Strong organizational skills.
• Strong negotiation skills
• Strong analytical and interpretive skills.
• PC literate.
• Professional certification as applicable to workers’ compensation required.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms.

Benefits

• Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off.
• 401(k) and Profit-Sharing plans.

Pay

Base Salary Range: $65,000 – $115,000 annually

Schedule

Not specified