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
Manages claims through well-developed action plans to an appropriate and timely resolution
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
Ensures claim files are properly documented and claims coding is correct

Bachelor's degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
Five (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
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

Claims Examiner – Workers Compensation

Key skills