WC Sr. Claims Examiner

Berkley•Saint Paul, MN

9d•$80,000 - $110,000

About The Position

The WC Sr. Claims Examiner manages a caseload of incoming and complex workers’ compensation claims, including extended disability, litigation, employer’s liability, and assigned claims. The role is responsible for all technical aspects of claim management and for complying with established performance guidelines. The examiner works with injured workers, clients, legal counsel, and healthcare professionals to investigate and manage claims, coordinate medical treatment and disability, and support return to work.

Requirements

Demonstrated working knowledge of workers’ compensation administration rules and laws.
Ability to interface with clients, legal counsel, healthcare professionals, and others.
Excellent communication and presentation skills.
Good mathematical and analytical ability.
Excellent customer service skills.
Basic PC skills and working knowledge of the Windows environment.
Experience with a client/server-based claims processing system.
A BA/BS degree and three years of experience, including litigation, subrogation, and complex medical/legal issues; or two years of post-high-school education and five years of experience in workers’ compensation claims management.

Responsibilities

Investigate claims and make appropriate decisions regarding compensability and general claims management.
Document claim-handling activities and create and document action plans.
Establish appropriate case reserves.
Actively manage medical treatment and disability while assisting injured workers in returning to work.
Comply with established performance guidelines.
Identify loss trends and communicate them to a supervisor and/or clients.
Use an automated diary system to issue indemnity payments and manage claims.
Investigate and manage claim subrogation and negotiate settlements.
Manage Coverage B or conflict-of-interest cases as assigned.
Address customer complaints and inquiries professionally.
Participate in client claim reviews when scheduled or requested.
Perform other functions as assigned.