Claims Examiner - Workers Compensation

Job Duties

• Analyze complex or technically difficult workers' compensation claims to determine benefits due.
• Work with high exposure claims involving litigation and rehabilitation.
• Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
• Identify subrogation of claims and negotiate settlements.
• Investigate and gather information to determine the exposure on the claim.
• Manage claims through well-developed action plans to an appropriate and timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims.
• Manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due.
• Approve and make timely claim payments and adjustments.
• Settle claims within designated authority level.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process to ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Report claims to the excess carrier and respond to requests of directions in a professional and timely manner.
• Communicate claim activity and processing with the claimant and the client.
• Maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Supports the organization's quality program(s).
• Travels as required.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• 5 years of claims management experience or equivalent combination of education and experience required.
• 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.
• Candidate with prior/current CA Indemnity and Litigated Workers Compensation experience is required.
• Self-Insured Plans certification.

Benefits

• Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois.
• Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife.
• Vision Insurance: Synectics offers eligible employees vision insurance through VSP.
• 401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan.

Pay

Compensation is competitive and commensurate with experience.

Schedule

Full-time position with flexible working hours.