Claims Examiner

7 days ago


Atlanta, Georgia, United States Rose International Full time
Only candidates authorized to work in the country associated with the position will be considered.

Kindly note that all start dates and duration are approximations and subject to adjustment based on client needs.

Job Title: Workers' Compensation Claims Analyst
Company: Undisclosed

PRIMARY OBJECTIVE:
  • Analyze intricate workers' compensation claims to determine eligible benefits.
  • Manage high-risk claims involving litigation and rehabilitation.
  • Ensure timely claims processing, adhering to industry standards and client specifications.
  • Identify opportunities for claims subrogation and negotiate settlements.

KEY RESPONSIBILITIES:
  • Investigate and process complex claims to assess exposure and develop action plans.
  • Negotiate claim settlements within approved limits.
  • Allocate reserves and manage claim adequacy.
  • Calculate and disburse benefits accurately.
  • Handle necessary state filings within legal limits.
  • Oversee litigation process for efficient claims resolution.
  • Coordinate external vendors for investigation and litigation support.
  • Implement cost containment strategies to reduce claims expenses.
  • Manage claim recoveries, including subrogation and offsets.
  • Collaborate with excess carriers and respond promptly to requests.
  • Maintain transparent communication with claimants and clients.
  • Ensure accurate documentation and coding of claim files.
  • Escalate cases to management when necessary.

ADDITIONAL REQUIREMENTS:
  • Perform assigned duties effectively.
  • Support quality assurance initiatives.
  • Travel as needed.

QUALIFICATIONS:
  • Bachelor's degree preferred; relevant professional certifications advantageous.
  • Minimum five years of claims management experience.
  • Expertise in insurance principles, laws, and cost containment strategies.
  • Strong communication, analytical, organizational, and negotiation skills.
  • Proficient in Microsoft Office and collaborative teamwork.

BENEFITS:

Details about employment benefits available for this role can be found on our website.


California Pay Equity:

For information on California pay equity laws, please refer to the State of California Department of Industrial Relations website.


Rose International is an Equal Opportunity Employer. Our recruitment process complies with Fair Chance Ordinances in San Francisco and Los Angeles, California.


For any questions or assistance with the application process, please reach out to our HR Department.


Rose International participates in the Employment Verification Program (E-Verify) with the U.S. Department of Homeland Security.


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