Claims Examiner - Workers Compensation

Retail Industry•Dallas, TX

22h•Remote

About The Position

This role involves analyzing complex or technically difficult workers' compensation claims to determine benefits due. The Claims Examiner will work with high exposure claims involving litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. A key aspect of the role is identifying subrogation of claims and negotiating settlements.

Requirements

Work comp claims handling experience is needed; loss time.
Minimum 3+ years of relevant WC experience required.
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

Nice To Haves

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

Responsibilities

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.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
Prepares necessary state filings 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 including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
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.