Senior Workers Compensation Claims Examiner

Berkley•Irving, TX

About The Position

Under limited supervision, the Senior Workers Compensation Claims Examiner will review, evaluate, negotiate and processes WC Claims of moderate/severe/catastrophic complexity, provide recommendations and strategies for resolution, and litigation management as appropriate. Collaborate with internal and external clients, and often interact with agents, claimants, and policyholders.

Requirements

4-year college degree preferred.
Work experience in the WC Claims arena of at least 5 years of end to end claims handling.
Must have extensive understanding of WC Statutory benefits and state regulatory requirements in multiple jurisdictions, with the capacity to learn new jurisdictions as needed.
Working knowledge of Excel, Word, and general computer skills.
Adjuster license required in area of adjusting specialty.
Demonstrates strong written and oral communications skills.
Ability to draft communications that are clear, concise, complete and professional.
Negotiation skills mandatory, and ability to interact with all levels of the organization.
Demonstrates organizational skills while working on multiple projects.

Nice To Haves

Ideal candidate will work from the Walnut Creek office at least 3 days a week.

Responsibilities

Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure on claims, handling multiple jurisdictions.
Calculate and assign timely and appropriate reserves on claims and monitor reserve adequacy throughout the life of the claim.
Develop and manage claims updating action plans as the claim progresses and bring the claim to an appropriate and timely resolution.
Accurately calculate and timely pay benefits due pertaining to the jurisdictional guidelines.
Operate within designated authority level and time constraints pertaining to payments and settlements.
File appropriate forms per jurisdictional protocol, within statutory limits.
Actively manage and guide the litigation process, ensuring timely and cost-effective claims resolution.
Participate in claim reviews, which may require limited travel, and timely production of claim reports.
Coordinate vendor referrals for additional investigation and/or litigation management.
Use appropriate cost containment techniques including strategic vendor partnerships to mitigate overall cost of claims.
Manage claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
Frequently collaborate with all appropriate parties involved with the claim, and clearly document that collaboration.
Maintain professional internal and external client relationships.
Actively execute timely and appropriate claims activities to ensure consistent delivery of quality claims services.
Proactively manage all litigated claims by clearly documenting the litigation plan and budget, retaining competent counsel, communicating with counsel on a regular basis and clearly documenting the litigation action plan and strategy.