Workers Compensation Claims Examiner

2 days ago


Seattle, Washington, United States TalentBurst Full time
Job Title: Workers Compensation Claims Examiner

TalentBurst is seeking a skilled Workers Compensation Claims Examiner to join our team. As a key member of our claims team, you will be responsible for managing moderately complex claims, including high exposure and litigated claims.

Key Responsibilities:
  • Determine benefits due and ensure management of claims within internal claims management guidelines and in compliance with applicable laws.
  • Investigate workers' compensation claims by timely contacting injured workers, medical providers, and employer representatives/witnesses and documenting investigation efforts and findings.
  • Communicate with medical providers to develop and authorize appropriate treatment plans.
  • Review and analyze medical bills to confirm charges and treatment are related to the work injury and in accordance with the treatment plan.
  • Ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.
  • Calculate and assign appropriate reserves to claims and manage reserve adequacy throughout the life of the claim.
  • Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and Social Security and Medicare offsets.
  • Prepare required state filings within applicable time limits.
  • Oversee and work with outside counsel to provide information and strategic direction as needed for litigation and/or settlement negotiations.
Requirements:
  • High school diploma or general education degree (GED) and two years of workers' compensation claims handling experience required.
  • Bachelor's degree from four-year college or university preferred.
  • IEA Certificate and California Self Insured Certificate required.
Preferred Skills:
  • Strong understanding of workers' compensation laws and regulations as well as workers' compensation claim principles and application.
  • Strong verbal and written communication and negotiation skills.
  • Ability to work positively and collaboratively in a team environment.
  • Excellent time management and organizational skills.
  • High level of attention to detail while working in a fast-paced environment.


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