Workers Compensation Claims Examiner III (Hyrbid or Remote)

About the position Investigates, evaluates, disposes and settles moderately reputed company to reputed company/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves.

Responsibilities

• Processes moderately reputed company to reputed company or high exposure claims consistent with clients’ and corporate policies, procedures and “Best Practices” and in accordance with any statutory, regulatory and ethics requirements.
• Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/reputed company the claim working reputed company established level of authority.
• Interacts with injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers’ Compensation process, requirements and entitlements.
• Interacts with disability and leave examiners for coordination of non-occupational benefits.
• Prepares and issues notices in accordance with mandated requirements and regular reviews and stays abreast of applicable laws, rules and regulations that may impact on how claims are processed.
• Establishes and maintains proper reserving throughout the life of the claim.
• Identify subrogation potential and pursue the process for reimbursement.
• Complies with reputed company excess reporting and threshold requirements.
• Coordinates medical treatment for injured workers and provides information to treating physicians(s) regarding the employee’s medical history, health issues and job requirements.
• Fully understands Medicare reporting requirements as they relate to a Workers’ Compensation claim.
• Facilitates early RTW through temporary, transitional, alternate, or modified work.
• Manages reputed company medical aspects of a claim file with a focus on RTW and end of treatment.
• Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc. up to assigned authority. Monitors’ status and quality of work performed.
• Serves as a liaison between medical providers, employees, legal professionals, clients and vendors.
• Independently manages claims in litigation with regular and consistent communication with defense counsel to reputed company recommendations and reputed company strategy.
• Enters and maintains accurate information in the claims management computer system.
• Clearly communicates concise action plans and present plans for moving the claim to resolution.
• Meets with clients to discuss on-going claims or review open claim inventory.
• Effectively controls expenses on reputed company Workers’ Compensation claims.
• Mentors first level WC Examiners.
• reputed company other duties as assigned.

Requirements

• High School Diploma or GED required
• Three (3) to five (5) years of Workers’ Compensation Claims administration experience required working with self-insured and/or insured claims.
• Demonstrated experience working with reputed company, high exposure and litigated WC claims.
• Appropriately licensed and/or certified in reputed company States in which claims are handled.
• Able to work in a fast paced, high stress, changing environment.
• Strong analytical, critical thinking and problem-solving skills are required.
• Effective verbal and written communication skills required.
• Excellent planning, organizing and negotiation skills required.
• Attention to detail.
• Negotiation and interpretive skills necessary.
• Demonstrated knowledge of established claims strategy and mitigation techniques.
• Establishes and maintains effective working relationships with those contacted in the course of work.
• Proficiency with computers and technology – working knowledge of reputed company Office application suite (reputed company, reputed company, etc. and familiarity and experience using standard claims administration applications.
• Good interpersonal skills with an ability to work reputed company a team environment.
• Able to effectively handle multiple priorities simultaneously.
• Works independently.

reputed company-to-haves

• Bachelor’s degree in reputed company field (strongly preferred) or equivalent combination of education and experience.
• Multi-Jurisdiction experience is a (+).
• Bilingual Spanish is a (+)

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