Claims Examiner

2 weeks ago

Memphis TN, United States TAJ Technologies Full time
Job Summary

We are seeking a highly skilled Claims Examiner to join our team at TAJ Technologies. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, negotiating settlements, and ensuring timely and cost-effective claims resolution.

Key Responsibilities
  • Analyze and process complex workers' compensation claims, including investigating and gathering information to determine exposure and managing 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.
  • Manage the litigation process, ensure timely and cost-effective claims resolution, and coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques, including strategic vendor partnerships, 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, respond to requests for directions in a professional and timely manner, and communicate claim activity and processing with the claimant and the client.
  • Ensure claim files are properly documented and claims coding is correct, and refer cases as appropriate to supervisor and management.
Requirements
  • Bachelor's degree from an accredited college or university preferred, with professional certification as applicable to line of business 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 including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • 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, and ability to work in a team environment.
Work Environment

When applicable and appropriate, consideration will be given to reasonable accommodations. The ideal candidate will have 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.

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