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Claims Examiner
2 months ago
Rose International is seeking a skilled Claims Examiner to join our team. 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- Claims Analysis: Investigate and gather information to determine the exposure on complex claims, manage claims through well-developed action plans to an appropriate and timely resolution.
- Negotiation and Settlement: Negotiate settlement of claims within designated authority, calculate and assign timely and appropriate reserves to claims, and manage reserve adequacy throughout the life of the claim.
- Benefits Calculation and Payment: Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
- Litigation Management: Manage the litigation process, ensure timely and cost-effective claims resolution, and coordinate vendor referrals for additional investigation and/or litigation management.
- Cost Containment: Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce the overall cost of claims for our clients.
- Claim Recoveries: Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
- Client Communication: Communicate claim activity and processing with the claimant and the client, maintain professional client relationships, and ensure claim files are properly documented and claims coding is correct.
- Education and Licensing: Bachelor's degree from an accredited college or university preferred, professional certification as applicable to the line of business preferred, and NY License required.
- Experience: At least 2-3 years of claims management experience or equivalent combination of education and experience required.
- Skills and Knowledge: 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.
