Claims Examiner

2 weeks ago

Atlanta, United States Mindlance Full time

Job Title: Claims Examiner - Workers Compensation

Location: Remote

Job Length: 3 Months (Possibility of extension)

Manager’s Note:

· Alaska work comp license or a Property & Casualty adjuster’s license.

Job Overview:

  • Analyze complex or technically difficult workers' compensation claims to determine benefits due.
  • Work with high-exposure claims involving litigation and rehabilitation.
  • Ensure ongoing adjudication of claims within service expectations, industry best practices , and specific client service requirements.
  • Identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

· Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.

· Manages claims through well-developed action plans to an appropriate and timely resolution.

· Negotiates settlement of claims within designated authority.

· Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

· Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

· Prepares necessary state fillings within statutory limits.

· Manages the litigation process; ensures timely and cost effective claims resolution.

· Coordinates vendor referrals for additional investigation and/or litigation management.

· Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

· Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

· Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

· Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

· Ensures claim files are properly documented and claims coding is correct.

· Refers cases as appropriate to supervisor and management.

· Performs other duties as assigned.

· Supports the organization's quality program(s).

Skills & Knowledge

· Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

· Excellent oral and written communication, including presentation skills

· PC literate, including Microsoft Office products

· Analytical and interpretive skills

· Strong organizational skills

· Good interpersonal skills

· Excellent negotiation skills

· Ability to work in a team environment

· Ability to meet or exceed Service Expectations

Education:

· Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

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