Current jobs related to Workers Compensation Claims Examiner - Atlanta - Association County Commissioners of GA
-
Workers Compensation Claims Examiner
4 weeks ago
Atlanta, Georgia, United States Rose International Full timeJob Title: Workers Compensation Claims ExaminerRose International is seeking a skilled Workers Compensation Claims Examiner to join our team. As a key member of our claims management team, you will play a critical role in analyzing and managing workers compensation claims to ensure timely and accurate benefits are provided to our clients.Key...
-
Senior Workers Compensation Claims Examiner
2 months ago
Atlanta, United States AIG Full timeAt AIG, we are reimagining the way we help customers to manage risk. Join us as a Senior Workers Compensation Claims Examiner to play your part in that transformation. Its an opportunity to grow your skills and experience as a valued member of the team. Our Claims teams are the proven problem solvers of choice for clients, delivering consistent technical...
-
Claims Examiner
5 days ago
Atlanta, United States ICONMA Full timeTo analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and...
-
Claims Examiner
2 days ago
Atlanta, United States ICONMA Full timeRequirements: Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams 3+ years of CA Workers Compensation claims experience California WC Claims handling experience OSIP certification
-
Claims Examiner Workers Compensation
4 weeks ago
Atlanta, United States Rose International Full timePrimary purpose: To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to...
-
Claims Examiner
3 weeks ago
Atlanta, United States Rose International Full timeTo analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...
-
Claims Examiner
4 weeks ago
Atlanta, United States Rose International Full timeTo analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...
-
Claims Examiner
2 days ago
Atlanta, Georgia, United States Rose International Full timeJob Title: Claims ExaminerWe are seeking a skilled Claims Examiner to join our team at Rose International. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due.Key Responsibilities:Analyze complex or technically difficult workers' compensation claims to determine benefits dueWork with high...
-
Claims Examiner Workers Compensation
1 month ago
Atlanta, United States Rose International Full timePrimary purpose:To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify...
-
Claims Examiner
2 days ago
Atlanta, United States Rose International Full timeDescription:To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify...
-
Claims Examiner
1 day ago
Atlanta, Georgia, United States ICONMA Full timeJob SummaryWe are seeking a skilled Claims Examiner to join our team at ICONMA. As a Claims Examiner, you will be responsible for calculating and paying benefits due, approving and making timely claim payments and adjustments, and settling claims.Key ResponsibilitiesCalculate and pay benefits due in a timely and accurate mannerApprove and make timely claim...
-
Claims Examiner
5 days ago
Atlanta, United States Rose International Full timeTo analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of...
-
Workers' Compensation Examiner
4 weeks ago
Atlanta, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...
-
Compensation Claims Specialist
2 weeks ago
Atlanta, Georgia, United States Sedgwick Claims Management Services Full timeJob SummaryWe are seeking a skilled Compensation Claims Specialist to join our team at Sedgwick Claims Management Services.Key ResponsibilitiesProcess low-level workers' compensation claims to determine benefits dueEnsure ongoing adjudication of claims within company standards and industry best practicesIdentify subrogation of claims and negotiate...
-
Claims Examiner
3 weeks ago
Atlanta, United States Rose International Full timeLooking for an experienced examiner to handle a heavy complex claims desk with mainly litigated claims. want someone who can move fast and is good at closing claims. At least 5 years of experience.This is one of our more complex desks on the team working for a prestigious client so I need someone who is reliable and has good...
-
Claims Examiner
2 days ago
Atlanta, Georgia, United States Rose International Full timeJob Title: Claims ExaminerWe are seeking a skilled Claims Examiner to join our team at Rose International. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and cost-effective...
-
Workers Compensation Claims Specialist
3 weeks ago
Atlanta, Georgia, United States RaceTrac Petroleum Full timeJob Description:RaceTrac Petroleum is seeking a highly skilled Workers Compensation Claims Specialist to join our team. As a key member of our organization, this individual will be responsible for supporting the company's Workers Compensation claims process.Key Responsibilities:Claims Investigation and Analysis: Conduct thorough investigations and analysis...
-
Claims Examiner
3 weeks ago
Atlanta, Georgia, United States Rose International Full timeJob SummaryRose International is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due. This role requires strong analytical and interpretive skills, as well as excellent oral and written communication skills.Key ResponsibilitiesAnalyze...
-
Claims Examiner
2 days ago
Atlanta, Georgia, United States Rose International Full timeJob SummaryWe are seeking a skilled Claims Adjuster to join our team at Rose International. As a Claims Adjuster, you will be responsible for analyzing and managing workers compensation claims, ensuring compliance with company standards and industry best practices.Key ResponsibilitiesAnalyze and manage workers compensation claims to determine benefits due...
-
Claims Adjuster
4 weeks ago
Atlanta, United States Rose International Full timePRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.SIP a plus- Must live in California. Position is remote but must live in CA.Min...
Workers Compensation Claims Examiner
4 months ago
Candidate selected to fill this position must have a permanent living address within the state of Georgia. The employee's telecommuting work location will be within a designated and approved workspace at the employee's home address.
General Definition of Work
Performs skilled technical work managing and resolving assigned lost time and complex medical only claims on behalf of the Association's insurance programs to ensure prompt determination of compensability, payment of entitled benefits, litigation management and effective claim resolution, and related work as apparent or assigned. Work is performed under the supervision of the Claims Supervisor.
Qualification Requirements
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
Position Responsibilities
- Supports the Association through the support of division or program staff and interaction with local governments and authorities; exhibits knowledge and general understanding of the programs and services offered by the Association, and provides outstanding customer support that reflects well on the entire Association.
- Initiates initial investigation for newly assigned insurance claims; confirms coverage of claim, contacts member, member representative, non-represented claimants, claimant's attorney and/or injured employees to obtain/provide information.
- Initiates compensability and/or liability determination through completion of statements, recorded statements, on-site investigations.
- Sets initial reserves for claims; performs proper and timely reserve evaluations and adjustments; reviews and approves bills for processing; reviews medical/rehabilitation notes; reviews and signs off daily check sheet; prepares and submits reports to excess carriers when loss is greater than one-half retention level.
- Establishes and maintains proper claim diary requirements of existing caseloads with documentation of action plans; ensures action plans are adhered to in a timely manner.
- Receives and responds to inquiries and requests for information from members, injured employees, vendors, case managers, legal representatives and medical providers.
- Completes Electronic Data Interchange (EDI) transmissions, state board filings and completes Centers for Medicare Services (CMS) requirements.
- Utilizes cost control measures regarding claims management when applicable including One Call Medical, Align, Telephonic Case Manager (TCM), Field Case Manager (FCM) and Surveillance; works at eliminating the payment of fines and penalties due to late and/or form filings.
- Occasional overnight travel required - less than 20 days per year - i.e. travel to mediations, hearings, depositions, account/member visits, and seminars.
Knowledge, Skills and Abilities
- Thorough knowledge of business English, spelling and arithmetic, standard office practices, procedures, equipment and administrative support techniques;
- Thorough knowledge of the workers' compensation system requirements and medical only claim administration;
- General knowledge of the laws, legal codes, court procedures, precedents, government regulations and agency rules regulating the workers compensation insurance industries; ability to make arithmetical calculations; ability to operate a variety of standard office equipment including personal computer and associated software;
- Ability to communicate ideas effectively in both oral and written formats; ability to type accurately at a reasonable rate of speed; ability to follow oral and written instructions; ability to read and understand detailed and complicated policies, procedures and materials that contain specialized words and phrases;
- Ability to establish and maintain effective working relationships with associates, claimants, attorneys, Nurse Case Managers, physicians, local government officials, customers and the general public.
Education and Experience
- Bachelor's degree with coursework in business administration, insurance, or related field and
- Moderate (1 - 3 years) of related experience in workers' compensation claim administration, or
- Equivalent combination of education and experience.
- AIC, ARM, and/or CPCU Professional Designations desired
Physical Requirements
- This work requires the occasional exertion of up to 10 pounds of force;
- Work regularly requires sitting, speaking or hearing, using hands to finger, handle or feel and reaching with hands and arms and occasionally requires standing, walking, climbing or balancing, stooping, kneeling, crouching or crawling, pushing or pulling, lifting and repetitive motions;
- Work has standard vision requirements; vocal communication is required for expressing or exchanging ideas by means of the spoken word; hearing is required to perceive information at normal spoken word levels;
- Work requires preparing and analyzing written or computer data, operating motor vehicles or equipment and observing general surroundings and activities;
- Requires light physical effort working almost exclusively with light weight materials (up to 25 pounds) or short periods in difficult work positions.
- Working conditions with absence of disagreeable conditions and little or no accident or health hazards; considerable mental effort and stress involved which could result in tension or anxiety.
Special Requirements
- Employee is required to have and maintain a high-speed, broadband internet connection at their work site that is sufficient to enable fast, consistent service to the membership. A minimum download speed of 25 Mbps is required. To ensure a consistent speed at this level, a 40MB internet connection is recommended. You may check your download speed at speedtest.net.
- Possession of or ability to acquire a Georgia Adjusters License issued through the State of Georgia Insurance Department within one year of employment.
- Valid driver's license in the State of Georgia.
