Workers Compensation Claims Examiner

1 month ago

Concord, New Hampshire, United States Mary Kraft HR Full time
Job Description

Mary Kraft HR is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically challenging workers' compensation claims to determine benefits due. The role involves managing high-exposure claims, including those involving litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

Key Responsibilities
  • Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
  • Develop and manage claims through well-structured action plans to reach appropriate and timely resolutions.
  • Negotiate settlements of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the claim's lifecycle.
  • Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness.
  • Prepare necessary state filings within statutory limits.
  • Manage the litigation process to ensure timely and cost-effective resolution of claims.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Implement cost-containment strategies, including strategic vendor partnerships, to reduce overall claim costs.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Report claims to excess carriers and respond to their inquiries in a timely and professional manner.
  • Maintain communication with claimants and clients, fostering professional relationships.
  • Ensure claims files are properly documented, with accurate coding.
  • Refer complex cases to supervisors or management as needed.
Requirements
  • Bachelor's degree from an accredited college or university is preferred.
  • Professional certification applicable to the line of business is preferred but not required.
  • Minimum of 3 years of experience in workers' compensation claims handling or an equivalent combination of education and experience.
  • Expertise in insurance principles and laws, claim and disability duration, and medical management practices.
  • Knowledge of Social Security and Medicare application procedures and recovery processes.
  • Excellent oral and written communication skills, including presentation abilities.
  • Proficiency in Microsoft Office and general PC literacy.
  • Strong analytical, interpretive, and problem-solving skills.
  • Strong organizational skills and the ability to manage multiple priorities effectively.
  • Excellent negotiation skills.
  • Ability to work collaboratively in a team environment and meet or exceed service expectations.

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