Workers Compensation Claims Examiner III (Hyrbid or Remote)

About the position Investigates, evaluates, disposes and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves. Responsibilities • Processes moderately complex to complex 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/close the claim working within 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 carrier 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 all 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 make recommendations and develop 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 all Workers’ Compensation claims. • Mentors first level WC Examiners. • All 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 complex, high exposure and litigated WC claims. • Appropriately licensed and/or certified in all 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 Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications. • Good interpersonal skills with an ability to work within a team environment. • Able to effectively handle multiple priorities simultaneously. • Works independently. Nice-to-haves • Bachelor’s degree in related field (strongly preferred) or equivalent combination of education and experience. • Multi-Jurisdiction experience is a (+). • Bilingual Spanish is a (+) Apply tot his job Apply To this Job