Claims Examiner

We are seeking a highly motivated Claims Examiner - Workers Compensation to join our team at BCforward. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due, working with high exposure claims involving litigation and rehabilitation, and ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

• Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
• Manage claims through well-developed action plans to an appropriate and timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
• 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.
• Manage the litigation process; ensure timely and cost-effective claims resolution.
• 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 but not limited to: 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.
• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.

• 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.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

BCforward 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.

We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and experienced Claims Examiner - Workers Compensation looking for a new challenge, please submit your resume in Word format, referencing the job code, to apply for this exciting opportunity.