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Claims Examiner
2 months ago
BCforward is seeking a highly skilled Claims Examiner - Workers Compensation to join our team. As a key member of our insurance claims team, you will be responsible for analyzing complex workers' compensation claims and ensuring timely and cost-effective resolution.
Key Responsibilities- Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
- Negotiate settlements within designated authority and calculate and assign timely and appropriate reserves to claims.
- Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
- Prepare necessary state filings within statutory limits and manage the litigation process to ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management and use cost containment techniques to reduce overall cost of claims for our clients.
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
- Report claims to the excess carrier and respond to requests for directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and client, maintaining professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Bachelor's degree from an accredited college or university preferred.
- Five (5) years of claims management experience or equivalent combination of education and experience required.
- 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, and Social Security and Medicare application procedures.
- 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.
When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision, and talking.
BenefitsBCforward offers all eligible employees a comprehensive benefits package, including major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
