WC Claims Examiner

Berkley•Saint Paul, MN

2d•$65,000 - $77,000•Onsite

About The Position

This position involves performing workers’ compensation claims adjudication and investigation. The Claims Examiner will be responsible for all technical aspects of claim management for assigned claims, ensuring compliance with all established performance guidelines. This includes properly investigating and handling all types of workers’ compensation files, initiating return-to-work discussions, establishing timely and appropriate case reserves, investigating and managing subrogation, and negotiating settlements. The role also requires using an automated diary system for indemnity benefits and claim management, accurately calculating and paying wage loss and other benefits, assigning and monitoring rehabilitation, documenting all action plans, maintaining organized electronic files, interacting with clients and state agencies, addressing customer complaints, achieving performance outcomes, and providing cost containment.

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 established 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.