Job Details

Job Description:

• The Claims Examiner - Workers Compensation will be responsible for investigating, analyzing, and managing workers' compensation claims from initiation through resolution.
• The role includes evaluating claim exposure, coordinating investigations, managing litigation, processing benefits, and ensuring compliance with regulatory requirements while maintaining strong relationships with clients and claimants.

• Minimum 5 years of experience in claims management or workers' compensation claims handling.
• Strong understanding of insurance principles, claims management practices, and regulatory requirements.
• Experience investigating and resolving complex workers' compensation claims.
• Strong analytical, negotiation, and communication skills.
• Proficiency with Microsoft Office and general computer systems.

• Experience managing workers' compensation claims through investigation, evaluation, and resolution.
• Experience calculating claim reserves and managing reserve adequacy.
• Experience negotiating claim settlements within designated authority limits.
• Experience coordinating investigations, litigation, and vendor services.
• Experience managing claim recoveries including subrogation and benefit offsets.

• Investigate and analyze complex workers' compensation claims to determine exposure and resolution strategies.
• Develop and manage claim action plans to ensure timely and effective claim resolution.
• Calculate and maintain appropriate reserves throughout the lifecycle of the claim.
• Process and approve benefit payments and claim adjustments in accordance with policies and regulations.
• Prepare and submit required state filings within statutory deadlines.
• Manage litigation processes and coordinate with legal teams when necessary.
• Coordinate vendor services for investigations and litigation support.
• Implement cost containment strategies to reduce claim expenses.
• Manage claim recoveries including subrogation and applicable benefit offsets.
• Report claims to excess carriers and respond to related inquiries.
• Communicate claim status and updates to claimants and clients.
• Ensure claim files are accurately documented and coded.
• Refer complex cases to management when necessary and support organizational quality programs.

• Workers' compensation claims management.
• Claims investigation and analysis.
• Negotiation and settlement management.
• Litigation coordination and claims recovery management.
• Strong communication and documentation skills.

• Bachelor's degree from an accredited college or university is preferred.

• Professional certification relevant to workers' compensation or claims management.
• Knowledge of disability duration, medical management practices, and Social Security and Medicare procedures related to claims.
• Strong organizational, interpersonal, and presentation skills.