Workers Compensation Claims Examiner
2 days ago
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.
- 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.
- 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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