Claims Examiner

2 days ago


Atlanta, Georgia, United States Rose International Full time
Job Title: Claims Examiner

We are seeking a skilled Claims Examiner to join our team at Rose International. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and cost-effective resolutions.

Key Responsibilities:
  • 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 achieve timely and cost-effective resolutions.
  • Negotiate settlement of claims within designated authority.
  • 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.
  • Manage the litigation process to ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques 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 and respond to requests for directions in a professional and timely manner.
  • Communicate claim activity and processing with the claimant and the client, maintaining professional client relationships.
  • Ensure claim files are properly documented and claims coding is correct.
  • Refer cases as appropriate to supervisor and management.
Requirements:
  • Bachelor's degree from an accredited college or university preferred.
  • 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.
  • 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.

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