WC Claims Examiner

Berkley•Saint Paul, MN

About The Position

The WC Claims Examiner performs workers' compensation claims adjudication and investigation and is responsible for all technical aspects of assigned claim management, including compliance with established performance guidelines. The role handles claims ranging from medical-only and lost-time matters to litigated and long-term-exposure files, within predetermined claim-handling guidelines. It also works with employers to support return-to-work outcomes, manages reserves, benefits, subrogation, settlements, rehabilitation, and claim documentation, and provides professional service to clients and other involved parties. The position supports cost containment and account profitability while meeting management-established quality and productivity outcomes. The company is a member of W. R. Berkley Corporation; Berkley Risk provides program administration services and insurance operations for self-insured entities, including insurance and administrative options tailored to customers. The company states that it offers a competitive compensation plan and a robust benefits package for full-time regular employees. The salary range is $60,000–$80,000; actual salary is determined by factors including role scope, complexity and location, and the candidate's skills, education, training, credentials and experience.

Requirements

At least 1–2 years of workers' compensation claim-processing experience.
Experience handling medical-only, lost-time, and litigated claims.
Demonstrated 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

Perform workers' compensation claims adjudication and investigation.
Manage the technical aspects of assigned claims and comply with established performance guidelines.
Investigate and handle medical-only, lost-time, litigated, and long-term-exposure workers' compensation files within claim-handling guidelines.
Initiate return-to-work discussions with employers and help effect 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 and maintain organized electronic 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 management-established performance outcomes for work quality and quantity.
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.