WC Sr. Claims Examiner

Berkley•Minneapolis, MN

3d•$90,000 - $100,000•Onsite

About The Position

This position is responsible for managing a caseload of incoming and complex workers' compensation cases, including extended disability cases, litigation, employer's liability claims, and assigned claims. The role involves all technical aspects of claim management, ensuring compliance with performance guidelines, investigating claims, making decisions on compensability, and managing medical treatment and disability to facilitate return to work. The examiner will also establish reserves, identify loss trends, manage subrogation, negotiate settlements, handle conflict of interest cases, address customer inquiries, and participate in client reviews.

Requirements

Demonstrated working knowledge of workers' compensation administration rules/laws.
Excellent communication and presentation skills.
Ability 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.

Nice To Haves

Experience must include litigation, subrogation and complex medical/legal issues.

Responsibilities

Manage a caseload of incoming and complex workers' compensation cases, including extended disability, litigation, and employer's liability claims.
Perform all technical aspects of claim management for assigned files, ensuring compliance with established performance guidelines.
Investigate claims and make appropriate decisions regarding claim 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, assisting injured workers in returning to work.
Comply with all performance guidelines.
Identify loss trends and communicate them to the 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.