WC Claims Examiner

Responsibilities

• Possibly investigate and handle all types of workers’ compensation files including lost time, litigation and long-term exposure within predetermined claim-handling guidelines.
• Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
• Establish timely and appropriate case reserves.
• Investigate and manage subrogation and negotiate settlements.
• Use automated diary system to issue indemnity benefits and provide claim management.
• Accurately calculate and pay wage loss and other benefits.
• Assign rehabilitation and monitor costs and outcomes.
• Document all action plans and evaluations for claim resolution.
• Maintain organized electronic files.
• Interact with clients to establish/improve communication and service capabilities.
• Interact and communicate with state agencies, attorneys and other providers.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Achieve specific performance outcomes related to quality and quantity of work as established by management.
• Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
• Define medical and rehabilitation payment parameters staff.

Qualifications

• May perform other functions as assigned.
• Minimum one-year work experience or post-high school education.
• Greatly preferred 1 – 2 years workers’ compensation claim processing experience.
• Preferred experience of handling of medical-only, lost-time and claims.
• Work experience should demonstrate organizational skills, time management skills, multi-tasking skills, verbal and written skills, and detail-orientation.
• Good to excellent math and analytical ability.
• Good to excellent oral and written communication skills.
• Excellent customer service skills.

Additional Company Details

The company offers a competitive compensation plan and robust benefits package for full time regular employees including:

• Base Salary Range: $52k-$55k
• Eligible to participate in annual discretionary bonus
• Benefits include: Health, dental, vision, dental, life, disability, wellness, paid time off, 401(k) and profit-sharing plans

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.