Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
Develops and updates a plan of action for the successful resolution of each claim.
Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
Reduces fraud through early identification and escalation.
Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

Minimum of High School Diploma or equivalent certificate required; Bachelor’s degree from four-year college or university is preferred
Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred
Exceptional interpersonal and customer service skills
Ability to manage and prioritize multiple assignments in a fast-paced environment
Strong organization skills to ensure tasks are completed within hard deadlines
Basic mathematical skills to calculate monetary reserves
To perform this job successfully, an individual should be proficient in the Microsoft Office Suite of applications and be proficient, or able to become proficient, on applicable databases, systems, and vendor software programs.

Claims Examiner – Trainee

Key skills