Workers Compensation Claims Examiner
6 days ago
At Mary Kraft HR, we are seeking a highly skilled Workers Compensation Claims Associate LB to join our team. As a key member of our claims team, you will be responsible for processing low-level workers' compensation claims, determining compensability and benefits due, and ensuring ongoing adjudication of claims within company standards and industry best practices.
Key Responsibilities:- Process low-level workers' compensation claims, determining compensability and benefits due for long-term indemnity claims.
- Monitor reserve accuracy and file necessary documentation with state agencies.
- Develop and coordinate action plans for the resolution of claims, including return-to-work efforts.
- Approve claim payments and process assigned claims according to company and client contracts.
- Administer subrogation of claims and negotiate settlements.
- Communicate claim actions with claimants and clients, ensuring clear updates on claim status.
- Ensure that claim files are properly documented, and claims coding is accurate.
- May process low-level lifetime medical and defined period medical claims, including state filings and physician decisions on appropriate treatments recommended by utilization review.
- Maintain professional client relationships and uphold service standards.
- Perform other duties as assigned.
- Support the organization's quality programs.
- Travel as required.
- Bachelor's degree from an accredited college or university preferred.
- No SIP certification required.
- Minimum of two (2) years of claims management experience or an equivalent combination of education and experience.
- Completion of Claims Representative training is acceptable.
- Developing knowledge of workers' compensation regulations, disability durations, offsets and deductions, and medical management practices.
- Understanding of Social Security and Medicare application procedures as applicable to the business line.
- Excellent oral and written communication skills, including presentation abilities.
- Proficiency in Microsoft Office and claims management software.
- Strong analytical, organizational, and problem-solving skills.
- Good interpersonal skills and the ability to work in a team environment.
- Ability to meet or exceed service expectations.
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