Workers' Compensation Claims Examiner
7 days ago
**Job Summary**
We are seeking a highly skilled Claims Examiner to join our team at TAJ Technologies Inc. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, determining benefits due, and ensuring timely and cost-effective resolution.
Key Responsibilities:
• Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and developing action plans for resolution.
• 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.
• Prepare necessary state filings within statutory limits and manage the litigation process to ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management and use appropriate cost containment techniques to reduce overall cost of claims.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier and respond to requests and directions in a professional and timely manner.
• Communicate claim activity and processing with the claimant and client, maintaining professional client relationships and ensuring claim files are properly documented and claims coding is correct.
Requirements:
• Bachelor's degree from an accredited college or university preferred, with professional certification as applicable to line of business.
• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Subject matter expert of appropriate insurance principles and laws, recoveries offsets and deductions, claim and disability duration, cost containment principles, and Social Security and Medicare application procedures.
• Excellent oral and written communication skills, including presentation skills, PC literacy, analytical and interpretive skills, strong organizational skills, good interpersonal skills, and excellent negotiation skills.
• Ability to work in a team environment, meet or exceed Service Expectations, and adapt to changing priorities and work-related stress.
Work Environment:
• The employee will work in a fast-paced office environment and travel as required.
• The employee will be required to work in a team environment and will be subject to the physical demands of the job, including computer keyboarding and auditory/visual requirements.
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