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Claims Management Professional
2 months ago
Position Level
Experienced
Job Type
Full Time
Education Requirement
High School Diploma or GED
Salary
$90,000 - $95,000 per year
Work Environment
Hybrid
Key Responsibilities:
As a Claims Examiner III, you will:
- Conduct thorough investigations and evaluations of moderately complex to complex claims.
- Assess coverage, compensability, and liability while establishing appropriate reserves.
- Communicate effectively with injured workers, client representatives, and medical professionals to facilitate understanding of the claims process.
- Coordinate with disability examiners to manage non-occupational benefits.
- Issue necessary notices in compliance with legal requirements and stay updated on relevant regulations.
- Maintain accurate reserving practices throughout the claim lifecycle.
- Identify and pursue subrogation opportunities.
- Ensure compliance with reporting requirements.
- Manage medical treatment coordination for injured employees.
- Understand Medicare reporting obligations in relation to Workers' Compensation claims.
- Facilitate return-to-work initiatives through modified job duties.
- Oversee all medical aspects of claims with a focus on resolution.
- Refer claims for specialized management as needed.
- Monitor the quality of work performed by external vendors.
- Act as a liaison among medical providers, employees, legal teams, and clients.
- Handle claims in litigation with regular communication with legal counsel.
- Maintain precise records in the claims management system.
- Present clear action plans for claim resolution.
- Engage with clients to review ongoing claims.
- Control expenses associated with Workers' Compensation claims.
- Provide mentorship to junior claims examiners.
- Perform additional duties as assigned.
Required:
- High School Diploma or GED; Bachelor's degree in a related field is preferred.
- Three to five years of experience in Workers' Compensation claims administration.
- SIP certification.
- Experience with complex and litigated Workers' Compensation claims.
- Licensure in multiple states is advantageous.
- Bilingual in Spanish is a plus.
- Ability to thrive in a fast-paced environment.
- Strong analytical and problem-solving skills.
- Excellent communication skills, both verbal and written.
- Proficient in Microsoft Office and claims administration software.
- Ability to manage multiple priorities effectively.
- Team-oriented with good interpersonal skills.
- Comprehensive medical, dental, and vision insurance.
- 401(k) retirement plan.
- Paid holidays and time off.
Refer to the detailed checklist for specific mental and physical requirements necessary for this role.