Workers Comp Claims Examiner

Certifies, administers and finalizes basic to moderately complex workers compensation claims. Reviews coverage's and secures information to determine liability and compensability. Analyzes fact of loss and injury information to determine exposure potentials. Manages caseload effectively.

1. Administers and manages basic to moderately complex active claims within workers compensation policies and guidelines.

2. Certifies or denies claims based on investigations by examiners, other departments, medical documentation, application of state statutes and rules, or third party recommendations.

3. Develops and manages action plans to facilitate resolution of claims; coordinates return-to-work efforts.

4. Ensures claim files are properly documented and correctly coded.

5. Determines if treatment is reasonable for the allowed condition. Assists in identifying or scheduling claims for independent medical or functional capacity exams.

6. Reviews reserves, sets reserves, and determines if reserves are appropriate for claim. Ensures claim reporting to excess carrier.

7. Reviews, evaluates and negotiates settlement of claims up to designated authority level.

8. Processes claims including calculation and payment of benefits due, as well as approval and timely payment of claim and adjustments. Files necessary documentation with appropriate state agency.

9. Identifies subrogation opportunities.

10. Prepares strategy for the defense of denied claims and determines exposure potential for the settlement of claims. Works with legal counsel and assists with discovery.

11. Requests hearings and may attend trials and hearings as a representative of the company. Drafts and reviews motions or appeals as needed.

12. Participates in claim reviews.

13. High School diploma or equivalent required.

14. One to three years previous experience in Workers Compensation preferred.

15. Certification from a state recognized claims management program preferred.

16. Strong PC and Microsoft Office skills with proficiency in Word and Excel preferred.

17. Ability to learn and utilize claims management system required.

18. Strong oral and written communication skills required.

19. Excellent customer service skills required.

20. Ability to travel on a limited basis required.

We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws.