WC Claims Examiner

Berkley•Saint Paul, MN

7d•$55,000 - $65,000

About The Position

This role involves performing workers' compensation claims adjudication and investigation. The Claims Examiner is responsible for all technical aspects of claim management for assigned claims, ensuring compliance with established performance guidelines. The position requires handling various types of workers' compensation files, including lost time, litigation, and long-term exposure, within predetermined claim-handling guidelines. A key aspect of the role is to initiate return-to-work discussions with employers and facilitate the return-to-work for injured workers. The examiner will also establish timely and appropriate case reserves, investigate and manage subrogation, and negotiate settlements. Utilizing an automated diary system, the examiner will issue indemnity benefits and manage claims, accurately calculating and paying wage loss and other benefits. The role includes assigning rehabilitation, monitoring costs and outcomes, and documenting all action plans and evaluations for claim resolution. Maintaining organized electronic files, interacting with clients to improve communication and service, and communicating with state agencies, attorneys, and other providers are also essential. The Claims Examiner will address customer complaints and inquiries professionally, achieve specific performance outcomes related to quality and quantity of work, and provide cost containment for individual claims and overall account costs to ensure account profitability. Defining medical and rehabilitation payment parameters for staff may also be part of the responsibilities. Other functions may be assigned as needed.

Requirements

1 – 2 years minimum workers’ compensation claim processing experience.
Experience must include handling of medical-only, lost-time and litigated claims.
Demonstrated working knowledge of workers’ compensation administration rules/laws.
Good to excellent math and analytical ability.
Good to excellent oral and written communication skills.
Excellent customer service skills.

Responsibilities

Perform workers’ compensation claims adjudication and investigation.
Handle all technical aspects of claim management for assigned claims, ensuring compliance with performance guidelines.
Investigate and handle all types of workers’ compensation files including lost time, litigation and long-term exposure within predetermined claim-handling guidelines.
Initiate return-to-work discussions with the employer and effect return-to-work for the injured worker.
Establish timely and appropriate case reserves.
Investigate and manage subrogation and negotiate settlements.
Use 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 all action plans and evaluations for claim resolution.
Maintain organized electronic files.
Interact with clients to establish/improve communication and service capabilities.
Interact and communicate with state agencies, attorneys and other providers.
Address customer complaints and inquiries in an exemplary and professional manner.
Achieve specific performance outcomes related to quality and quantity of work as established by management.
Provide cost containment for individual claim and overall claim costs for account to achieve account profitability.
Define medical and rehabilitation payment parameters staff.
May perform other functions as assigned.