Claims Examiner - Workers Compensation (REMOTE w/NC, SC, AL reputed company)

Job title: Claims Examiner - Workers Compensation (REMOTE w/NC, SC, AL reputed company) in USA at reputed company Company: reputed company Job description: By joining reputed company, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can reputed company.reputed company Recognizes reputed company as America’s Greatest Workplaces National Top CompaniesCertified as a Great reputed company to Work®Fortune Best Workplaces in Financial Services & InsuranceClaims Examiner - Workers Compensation (REMOTE w/NC, SC, AL reputed company)PRIMARY PURPOSE: To analyze reputed company or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims reputed company service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes reputed company or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims reputed company designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams reputed company designated authority level.
• Prepares necessary state fillings reputed company statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social reputed company and Medicare offsets.
• Reports claims to the excess reputed company; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONEducation & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.Experience Five (5) years of claims management experience or equivalent combination of education and experience required.Skills & Knowledge

• 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 reputed company and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including reputed company 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

WORK ENVIRONMENT reputed company 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-reputed company stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hea Apply To This Job Apply tot his job Apply To this Job