Sr Claim Examiner- WC

Crawford • Las Vegas, NV

1d

About The Position

Investigates and settles advanced, large-loss, and complex workers’ compensation claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims, reviewing coverage, determining liability and compensability, gathering information, arranging property damage appraisals, and settling claims using claims best practices. Evaluates and sets reserves using independent judgment. Assists supervisors and company attorneys with litigation preparation and conducts training and mentoring for new hires.

Requirements

• Bachelor's degree or equivalent experience.
• Four to eight years of technical claims investigation and settling experience in Claims or a similar organization.
• Workers Compensation (WC) Adjuster License, as required by jurisdictional requirements.
• Ability to work independently while assimilating various technical subjects.
• Strong written and oral communication, negotiation, and presentation skills.
• Advanced analytical and problem-solving skills, including the ability to manage and prioritize multiple projects.
• Advanced interpersonal skills to interact effectively with internal and external clients at all levels.

Nice To Haves

• Industry designations preferred but not required, such as IIA, AIC, AEI, and/or CPCU.

Responsibilities

• Interpret and make decisions using independent judgment on complex and unusual policy coverage, determining whether coverage applies to submitted claims.
• Manage all aspects of investigative activity on complex claims.
• Direct discovery and litigation strategy with legal counsel.
• Analyze claims activity and prepare reports for clients, carriers, and management.
• Establish reserves using independent judgment and expertise, and authorize payments within the scope of authority.
• Settle claims cost-effectively, promptly, and equitably, ensuring timely issuance of disbursements and company drafts within authority limits.
• Develop subrogation and third-party recovery potential and follow reclaim procedures.
• Participate in claim reviews.
• Assist supervisors and company attorneys in preparing cases for litigation.
• Conduct training and mentor new hires.

What This Job Offers

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