[Hiring] Claims Examiner - Workers Compensation @eTeam

Role Description

The primary purpose of this role is to analyze complex or technically difficult workers' compensation claims to determine benefits due. Responsibilities include:

• Analyzing and processing complex claims by investigating and gathering information to determine exposure.
• Negotiating settlement of claims within designated authority.
• Calculating and assigning timely and appropriate reserves to claims; managing reserve adequacy throughout the life of the claim.
• Calculating and paying benefits due; approving and making timely claim payments and adjustments.
• Preparing necessary state filings within statutory limits.
• Managing the litigation process; ensuring timely and cost-effective claims resolution.
• Coordinating vendor referrals for additional investigation and/or litigation management.
• Using appropriate cost containment techniques to reduce overall cost of claims for clients.
• Managing claim recoveries, including subrogation and Social Security and Medicare offsets.
• Reporting claims to the excess carrier; responding to requests in a professional and timely manner.
• Communicating claim activity and processing with claimants and clients; maintaining professional relationships.
• Ensuring claim files are properly documented and claims coding is correct.
• Referring cases as appropriate to supervisor and management.
• Performing other duties as assigned.
• Supporting the organization's quality program(s).
• Traveling as required.

Qualifications

• 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.

Requirements

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled.
• Excellent oral and written communication skills, 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.
• Ability to meet or exceed Service Expectations.

Company Description