WC Claims Examiner

Berkley•Saint Paul, MN

4d•$52,000 - $55,000•Onsite

About The Position

This position involves investigating and handling various types of workers' compensation files, including lost time, litigation, and long-term exposure, within established claim-handling guidelines. The role requires initiating return-to-work discussions, establishing appropriate case reserves, and managing subrogation and settlements. The Claims Examiner will utilize an automated diary system for indemnity benefits and claim management, accurately calculate and pay wage loss benefits, and assign rehabilitation while monitoring costs and outcomes. Responsibilities also include documenting action plans, maintaining electronic files, interacting with clients, state agencies, attorneys, and other providers, addressing customer complaints professionally, and achieving performance outcomes related to quality and quantity of work. The role aims to provide cost containment for individual claims and overall account costs to ensure profitability and define medical and rehabilitation payment parameters. Additional 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

Properly 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