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
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim
Manages claims through well-developed action plans to an appropriate and timely resolution
Negotiates settlement of claims within designated authority
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
Prepares necessary state fillings within statutory limits
Manages the litigation process; ensures timely and cost effective claims resolution
Coordinates vendor referrals for additional investigation and/or litigation management
Uses appropriate cost containment techniques to reduce overall cost of claims for clients
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
Ensures claim files are properly documented and claims coding is correct
Refers cases as appropriate to supervisor and management

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, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
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 I

Key skills