Claims Examiner

4 weeks ago

Melville, United States Experis Full time

Experis IT ManpowerGroup has partnered with a leading Insurance Co in the Melville NY area for a Claims Examiner - Workers Compensation role to assist their team. This is an Onsite role.

Industry: Insurance Co
Title: Claims Examiner - Workers Compensation
Location:  ONSITE – Melville NY
Duration: 2+ months
Pay: $41 per hour.

Job Description

To analyze complex or technically difficult workers' compensation claims to determine benefits due. This role involves managing high-exposure claims that may involve litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Additionally, the position includes identifying subrogation opportunities and negotiating settlements.

What You’ll Do

  • Claims Analysis and Processing
  • Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure.
  • Manage claims through well-developed action plans to achieve appropriate and timely resolutions.
  • Settlement Negotiation
  • Negotiate settlements of claims within designated authority.
  • Reserve Management
  • Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the claim's life.
  • Benefits Calculation and Payment
  • Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
  • State Filings
  • Prepare necessary state filings within statutory limits.
  • Litigation Management
  • Manage the litigation process to ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Cost Containment
  • Utilize appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claims costs for clients.
  • Claim Recoveries Management
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Excess Carrier Reporting
  • Report claims to the excess carrier and respond to requests for direction in a professional and timely manner.
  • Communication
  • Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
  • Documentation
  • Ensure claim files are properly documented and claims coding is accurate.
  • Referral
  • Refer cases as appropriate to supervisor and management.
  • Perform other duties as assigned.
  • Support the organization's quality programs.
  • Travel as required.  
You will need to have:
Qualifications
Education & Licensing
  • Bachelor's degree from an accredited college or university preferred.
  • Professional certification applicable to the line of business preferred.
Experience
  • Five (5) years of claims management experience or an equivalent combination of education and experience required.
Skills & Knowledge
  • Subject matter expert in appropriate insurance principles and laws for the line of business handled, including recoveries, offsets and deductions, claim and disability duration, and cost containment principles.
  • Excellent oral and written communication skills, including presentation abilities.
  • Proficient in Microsoft Office products.
  • Strong analytical and interpretive skills.
  • Strong organizational and interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work effectively in a team environment.
  • Ability to meet or exceed service expectations.

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