Claims Examiner - Risk Management

Clark County School District•Las Vegas, NV

3d•Onsite

About The Position

The Claims Examiner is responsible for managing workers' compensation claims from inception to closure. This includes investigating claims, determining eligibility for benefits, coordinating medical treatment, and negotiating settlements. The role requires a thorough understanding of workers' compensation laws and regulations, as well as strong analytical and communication skills.

Requirements

High school diploma or GED required.
Minimum of three years of experience in workers' compensation claims handling.
Thorough knowledge of workers' compensation laws, regulations, and procedures.
Strong analytical and problem-solving skills.
Excellent written and verbal communication skills.
Proficiency in claims management software and Microsoft Office Suite.
Ability to manage a caseload effectively and prioritize tasks.
Must complete the full seven-year work history, including periods of unemployment, in the 'Experience and Credential' section of the application.

Nice To Haves

Associate's or Bachelor's degree in a related field.
Relevant professional certifications (e.g., adjuster license).

Responsibilities

Investigate and evaluate workers' compensation claims.
Determine compensability and eligibility for benefits based on applicable laws and policies.
Gather and review medical records, police reports, and other relevant documentation.
Communicate with claimants, medical providers, legal representatives, and other stakeholders.
Coordinate medical treatment and rehabilitation services for injured workers.
Negotiate settlements and authorize payments for benefits and medical expenses.
Maintain accurate and detailed claim files.
Ensure compliance with all relevant laws, regulations, and company policies.
Participate in claim reviews and audits.