Claims Examiner
1 week ago
We are seeking a highly skilled Claims Examiner to join our team at Rose International. As a Claims Examiner, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and accurate resolution of claims, and providing exceptional customer service to our clients.
Key Responsibilities- Analyze and process complex workers' compensation claims, including investigating and gathering information to determine claim exposure.
- Manage claims through well-developed action plans to achieve timely and appropriate resolution.
- Negotiate settlements of claims within designated authority levels.
- Calculate and assign timely and appropriate reserves to claims, ensuring reserve adequacy throughout the claim's life cycle.
- Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority levels.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process, ensuring timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for our clients.
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
- Report claims to excess carriers and respond to requests for directions in a professional and timely manner.
- Communicate claim activity and processing with claimants and clients, maintaining professional client relationships.
- Ensure claim files are properly documented and claims coding is accurate.
- Refer cases to supervisors and management as necessary.
- Bachelor's degree from an accredited college or university preferred.
- Three years of claims management experience or equivalent combination of education and experience required.
- Valid NY Adjuster's License required.
- Subject matter expert in 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, 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.
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.
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