Claims Examiner Jobs

About The Position

Requirements

• Three (3) or more years related experience; or equivalent combination of education and experience.
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Certifications and/or licenses as required by State regulation.

Nice To Haves

• Bachelor’s degree in related field
• Proficient in Word and Excel

Responsibilities

• Effectively manages a caseload of 150 to 180 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel.
• Directs and manages as appropriate.
• Communicates with claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines.
• Settles and/or finalize all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Adheres to all Company policies and procedures.
• Conducts file reviews independently.
• Other duties as assigned.

Benefits

• Medical, Dental & Vision Insurance
• Life & Disability Insurance
• 401(k) plan
• Paid time off
• Paid holidays
• Referral bonus