Claims Examiner

Job Summary:

We are seeking a skilled Claims Examiner to join our team at Apidel Technologies. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, determining benefits due, and ensuring timely and cost-effective claims resolution.

Key Responsibilities:

• Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
• Negotiate settlement of claims 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 for our clients.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets, and report claims to the excess carrier.
• Communicate claim activity and processing with the claimant and the 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 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, 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, and analytical and interpretive skills.
• PC literate, including Microsoft Office products, and strong organizational skills.
• Good interpersonal skills, excellent negotiation skills, and ability to work in a team environment.

Work Environment:

When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability, excellent judgment, troubleshooting, problem solving, analysis, and discretion, ability to handle work-related stress, ability to handle multiple priorities simultaneously, and ability to meet deadlines. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision, and talking.