WC Sr. Claims Examiner

Berkley•Minneapolis, MN

6d•$75,000 - $88,000

About The Position

Responsible for managing a caseload consisting of incoming and more complex workers’ compensation cases including extended disability cases, litigation, employer’s liability claims, and assigned claims. Responsible for all technical aspects of claim management for assigned files including compliance with all established performance guidelines. Investigate claims and make appropriate decisions regarding claim compensability and general claims management for assigned files. Document claim handling activities; create and document action plans. Establish appropriate case reserves. Actively manage medical treatment and disability while assisting the injured worker to return to work. Comply with all performance guidelines. Identify loss trends and communicate to supervisor and/or clients. Use automated diary system to issue indemnity payments and for claims management Investigate and manage claim subrogation and negotiate settlements. Manage coverage B or conflict of interest cases as assigned. Address customer complaints and inquiries in an exemplary and professional manner. Participate in client claim reviews when scheduled or requested May perform other functions as assigned

Requirements

Demonstrated working knowledge of workers’ compensation administration rules/laws in at least one of the following states: MN, IL or WI.
Excellent communication and presentation skills.
Must be able to interface with clients, legal counsel, health care professionals, etc.
Good math and analytical ability.
Excellent customer service skills.
Basic PC skills and a working knowledge of Windows environment. Experience with a client/server based claims processing system.
BA/BS degree with three years’ experience. Experience must include litigation, subrogation and complex medical/legal issues or two years post-high school education and five years’ experience in workers compensation claims management.

Responsibilities

Managing a caseload of workers’ compensation cases
Investigating claims and making decisions regarding claim compensability
Documenting claim handling activities and creating action plans
Establishing case reserves
Managing medical treatment and disability, assisting injured workers to return to work
Complying with performance guidelines
Identifying loss trends and communicating to supervisor/clients
Using automated diary system for indemnity payments and claims management
Investigating and managing claim subrogation and negotiating settlements
Managing coverage B or conflict of interest cases
Addressing customer complaints and inquiries
Participating in client claim reviews
Performing other functions as assigned