WC Claims Examiner

Berkley•Saint Paul, MN

6d•$60,000 - $80,000

About The Position

The WC Claims Examiner performs workers’ compensation claims adjudication and investigation, managing the technical aspects of assigned claims in accordance with established performance guidelines. The role handles medical-only, lost-time, litigated, and long-term exposure claims; coordinates return-to-work efforts; establishes reserves; manages subrogation and settlements; calculates and pays benefits; and documents claim plans and evaluations. The examiner also works with clients, state agencies, attorneys, injured workers, employers, and other providers to support service quality, claim resolution, and cost containment. The position may include other functions as assigned.

Requirements

At least 1–2 years of workers’ compensation claim processing experience.
Experience handling medical-only, lost-time, and litigated claims.
Working knowledge of workers’ compensation administration rules and laws.
Good to excellent mathematical and analytical ability.
Good to excellent oral and written communication skills.
Excellent customer service skills.
College degree or relevant experience.

Responsibilities

Investigate and handle workers’ compensation claims, including lost-time, litigated, and long-term exposure files, within established claim-handling guidelines.
Initiate return-to-work discussions with employers and facilitate return-to-work for injured workers.
Establish timely and appropriate case reserves.
Investigate and manage subrogation and negotiate settlements.
Use the automated diary system to issue indemnity benefits and provide claim management.
Accurately calculate and pay wage-loss and other benefits.
Assign rehabilitation and monitor costs and outcomes.
Document action plans and evaluations for claim resolution.
Maintain organized electronic claim files.
Interact with clients to establish or improve communication and service capabilities.
Communicate with state agencies, attorneys, and other providers.
Address customer complaints and inquiries professionally.
Meet performance outcomes for quality and quantity of work established by management.
Contain costs for individual claims and overall account claims to support account profitability.
Define medical and rehabilitation payment parameters for staff.
Perform other functions as assigned.