SENIOR CLAIMS EXAMINER - RISK MANAGEMENT

Clark County School District•Las Vegas, NV

2d•Onsite

About The Position

The Senior Claims Examiner is responsible for managing and resolving complex workers' compensation claims. This role involves investigating claims, determining compensability, coordinating medical treatment, and negotiating settlements. The Senior Claims Examiner will also provide guidance and support to junior claims examiners and ensure compliance with all relevant laws and regulations.

Requirements

High school diploma or GED required.
Minimum of 5 years of experience in workers' compensation claims adjusting.
In-depth knowledge of workers' compensation laws and regulations.
Proven ability to manage complex and high-exposure claims.
Strong investigative, analytical, and problem-solving skills.
Excellent negotiation and communication skills.
Proficiency in claims management software and Microsoft Office Suite.
Ability to work independently and as part of a team.
Valid driver's license.

Nice To Haves

Associate's or Bachelor's degree in a related field.
Relevant professional certifications (e.g., adjuster's license, AIC, CPCU).
Experience with self-administered claims programs.

Responsibilities

Investigate and evaluate workers' compensation claims to determine compensability and liability.
Manage a caseload of complex and high-exposure claims.
Coordinate medical treatment and rehabilitation services for injured employees.
Negotiate settlements with claimants, attorneys, and other parties involved in claims.
Conduct thorough investigations, including gathering evidence, interviewing witnesses, and obtaining medical records.
Ensure compliance with all state workers' compensation laws and regulations.
Provide guidance, training, and support to junior claims examiners.
Prepare detailed reports on claim status, reserves, and settlement recommendations.
Collaborate with legal counsel, medical providers, and other stakeholders to facilitate claim resolution.
Identify and implement strategies to control claim costs and improve outcomes.