Senior Claim Examiner I
About The Position
The Senior Claim Examiner manages complex and high-exposure workers’ compensation claims from start to resolution. The role investigates claims, determines compensability, sets reserves, negotiates settlements, and serves as a resource for junior examiners, including assisting with mentoring. It requires at least five years of workers’ compensation claims experience and strong technical knowledge. The broader Workers’ Compensation team description notes that these roles manage claim files, ensure compliance with state regulations, and deliver exceptional service. Responsibilities include investigating claims, evaluating medical bills and treatment, coordinating claim payments, responding to questions about pending claims, and consulting with attorneys on litigation management and resolution.
Requirements
- At least 5 years of workers’ compensation claims experience.
- Strong technical knowledge.
- Experience with Microsoft Office, including Word, Excel, and Outlook.
- Effective negotiation skills.
- Strong verbal and written communication skills.
- Ability to prioritize workload to meet deadlines.
- Ability to manage multiple tasks in a fast-paced environment.
Responsibilities
- Manage complex and high-exposure workers’ compensation claims from start to resolution.
- Investigate claims, determine compensability, set reserves, and negotiate settlements.
- Serve as a resource for junior examiners and assist with mentoring.
- Contact injured workers, medical providers, and employer representatives to investigate workers’ compensation claims.
- Determine whether claims are valid under applicable workers’ compensation statutes.
- Communicate with medical providers to develop and authorize appropriate treatment plans.
- Review and analyze medical bills to confirm charges and treatment are related to the workers’ compensation injury and comply with the treatment plan.
- Ensure medical bill and income-replacement payments are remitted timely in accordance with applicable fee schedules and statutes.
- Answer questions from claimants, policyholders, and medical providers about pending claim status.
- Consult with attorneys regarding litigation management, settlement strategy, and claim resolution.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
