Sr. WC Claims Examiner

Acrisure • Brentwood, TN

1d • Onsite

About The Position

Sr. Claims Examiner is responsible for managing workers’ compensation claims as assigned by claims supervisor. Investigates claims. Determines the compensability of the claim and extent of liability. Communicates directly with clients, employers, injured workers, physicians, and attorneys to bring claims to a timely conclusion. Essential Duties and Responsibilities include the following. Other duties may be assigned: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Interviews, telephones, or corresponds with claimant and witnesses, consults police and hospital records. Contacts physicians to obtain medical diagnoses and projected treatment plans. Monitors medical progress of claimants and coordinates follow-up treatments; reports to employers including any restrictions that may be imposed on claimants’ return to work. Documents all information from contacts with employers, claimants, physicians, and attorneys into the claims’ management system and ensures that documentation is current. Calculates and sets reserves through a reserve worksheet including the nature and scope of claims; adjusts reserves to reflect ultimate known exposures. Issues medical, indemnity, legal and expense payments Prepares reports for excess carriers and requests reimbursement when needed. Sets reminders to follow-up on tasks through diaries on the system; reviews and completes diaries daily. Maintains physical files for claim-related documents such as medical information, legal reports, and other correspondence. Reviews claims’ submissions for thoroughness and accuracy. Determines compensability of claims through information gathered and according to workers’ compensation statutes; makes recommendations as to compensability and coverage of claims. Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed. Ensures jurisdictional filings are complete and timely. Obtains pre-certification approval for specific treatments as needed. Reviews bills and medical notes; authorizes and codes bills. Attends seminars and meetings as needed to stay abreast of current industry knowledge. May attend mediations, hearings, trials, or other legal proceedings.

Requirements

• High School diploma or equivalent (required)
• Minimum of Five (5) years’ experience handling complex workers’ compensation lost -time claims
• Multi-line experience (required)
• Experienced Workers Comp Claim Adjuster / with active licensing
• Strong organizational skills, attention to details and the ability to multi-task and prioritize works.
• Strong verbal, presentation, and written communication skills
• Strong computer skills including proficiency in Microsoft Word, Excel and Outlook
• Self -motivated and customer focused.
• Attention to details and accuracy in documentation.
• Maintain detailed and accurate records of claims.
• Ability to establish and maintain good working relationships and rapport with others.

Nice To Haves

• Bilingual (Spanish) a plus

Responsibilities

• Interviews, telephones, or corresponds with claimant and witnesses, consults police and hospital records.
• Contacts physicians to obtain medical diagnoses and projected treatment plans.
• Monitors medical progress of claimants and coordinates follow-up treatments; reports to employers including any restrictions that may be imposed on claimants’ return to work.
• Documents all information from contacts with employers, claimants, physicians, and attorneys into the claims’ management system and ensures that documentation is current.
• Calculates and sets reserves through a reserve worksheet including the nature and scope of claims; adjusts reserves to reflect ultimate known exposures.
• Issues medical, indemnity, legal and expense payments
• Prepares reports for excess carriers and requests reimbursement when needed.
• Sets reminders to follow-up on tasks through diaries on the system; reviews and completes diaries daily.
• Maintains physical files for claim-related documents such as medical information, legal reports, and other correspondence.
• Reviews claims’ submissions for thoroughness and accuracy.
• Determines compensability of claims through information gathered and according to workers’ compensation statutes; makes recommendations as to compensability and coverage of claims.
• Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed.
• Ensures jurisdictional filings are complete and timely.
• Obtains pre-certification approval for specific treatments as needed.
• Reviews bills and medical notes; authorizes and codes bills.
• Attends seminars and meetings as needed to stay abreast of current industry knowledge.
• May attend mediations, hearings, trials, or other legal proceedings.

Benefits

• Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED