WC Sr. Claims Examiner

Responsibilities

• Responsible for managing a caseload consisting of incoming and more complex workers’ compensation cases including extended disability cases, litigation, employer’s liability claims, and assigned claims.
• Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines.
• Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files.
• Document claim handling activities; create and document action plans.
• Establish appropriate case reserves.
• Actively manage medical treatment and disability while assisting the injured worker to return to work.
• Comply with all performance guidelines.
• Identify loss trends and communicate to supervisor and/or clients.
• Use automated diary system to issue indemnity payments and for claims management.
• Investigate and manage claim subrogation and negotiate settlements.
• Manage coverage B or conflict of interest cases as assigned.
• Address customer complaints and inquiries in an exemplary and professional manner.
• Participate in client claim reviews when scheduled or requested.
• May perform other functions as assigned.

Qualifications

• Demonstrated working knowledge of workers’ compensation administration rules/laws.
• Excellent communication and presentation skills.
• Must be able to interface with clients, legal counsel, health care professionals, etc.
• Good math and analytical ability.
• Excellent customer service skills.
• Basic PC skills and a working knowledge of Windows environment.
• Experience with a client/server based claims processing system.
• Education BA/BS degree with three years’ experience.
• Experience must include litigation, subrogation and complex medical/legal issues; or two years post-high school education and five years’ experience in workers compensation claims management.

Requirements

• Occasional travel.

Benefits

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

• Health
• Dental
• Vision
• Life
• Disability
• Wellness
• Paid time off
• 401(k)
• Profit-sharing plans

Pay

Salary range: $90,000 - $100,000. 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.