Claims Examiner

CACI International • Chantilly, VA

8d • $70,800 - $148,600 • Onsite

About The Position

We are seeking a detail-oriented, pro-active, critical thinker to manage and review workers' comp claims as a Claims Examiner. As a Claims Examiner, your duties will include investigating and processing insurance claims, negotiating settlements, and maintaining accurate claims records. The ideal candidate should have a strong understanding of workers’ compensation policies and regulations, excellent investigative skills, and exceptional customer service skills.

Requirements

• Bachelor’s degree or equivalent combination of education and 10+ years of relevant experience.
• Demonstrated ability to work independently and collaboratively in a team environment.
• Excellent written and verbal communication skills.
• Strong organizational skills with exceptional attention to detail.
• Strong negotiation and problem-solving skills.
• Proven ability to handle and maintain the confidentiality of sensitive information and materials.
• Extensive customer service experience with a strong focus on professionalism and responsiveness.
• Proficiency in Microsoft Office Suite or similar productivity software.

Nice To Haves

• Knowledge of quantitative and qualitative research methods.
• Experience that can facilitate understanding of Intelligence Community mission and business processes.
• Experience with providing customer service support activities across organizational elements.
• Able to independently initiate, manage, execute and report tasks as identified by the government.

Responsibilities

• Analyze and process complex claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Investigate and evaluate workers’ compensation claims to determine coverage, compensability, liability, and benefits owed.
• Conduct detailed reviews of medical records, employment records, and other documentation to assess claims.
• Handle claim settlements, reviews, and negotiations in a fair and ethical manner.
• Communicate effectively with injured employees, employers, medical providers, attorneys, and internal stakeholders to ensure the timely resolution of claims.
• Authorize treatment and payments within designated authority levels while ensuring compliance with organization’s policies and applicable state laws.
• Prepare and deliver reports documenting claim activity, reserve adequacy, and resolution strategies.
• Evaluate ongoing medical treatment plans and facilitate return-to-work options when feasible.
• Collaborate with legal teams as needed to support litigation and dispute resolution efforts.
• Maintain accurate and up-to-date claim records in accordance with organizational policies and compliance requirements.
• Ensure compliance with Department of Labor Federal Employees Compensation Action laws, regulations, and internal policies, meeting deadlines.
• Oversee case development, including medical examinations and specialty referrals, to resolve conflicts.
• Balance competing priorities in a limited-staff environment while meeting goals for timeliness, accuracy, customer service, and compliance.
• Performs other related duties as assigned.

Benefits

• flexible time off benefit
• robust learning resources
• competitive compensation
• benefits and learning and development opportunities
• comprehensive benefits such as; healthcare, wellness, financial, retirement, family support, continuing education, and time off benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior