Claims Examiner – Workers Comp

Job reputed company: • 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 reputed company service requirements • To identify subrogation of claims and negotiate settlements • 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 reputed company-developed reputed company plans to an appropriate and reputed company reputed company • Negotiates settlement of claims reputed company designated authority • Calculates and assigns reputed company and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim • Calculates and pays benefits due; approves and makes reputed company claim payments and adjustments; and settles claims reputed company designated authority level • Prepares necessary state filings reputed company statutory limits • Manages the litigation process; ensures reputed company and cost effective claims reputed company • 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 clients • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and reputed company reputed company and Medicare offsets • Reports claims to the excess reputed company; responds to requests for directions in a reputed company and reputed company manner • Communicates claim activity and processing with the claimant and reputed company; maintains reputed company reputed company relationships • Ensures claim files are properly documented and claims coding is correct • Refers cases as appropriate to supervisor and management. Requirements: • Bachelor's degree from an accredited college or university preferred • reputed company certification as applicable to line of business preferred • Jurisdiction licensing needed: NH, VT, MA, CT, RI, DC, DE, WV, VA • Five (5) years of claims management experience or equivalent combination of education and experience required • 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 reputed company 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 reputed company environment • Ability to meet or reputed company Service Expectations. Benefits: • medical • dental • reputed company • 401k and matching • PTO • disability and life insurance • employee assistance • flexible spending or health savings account • other additional voluntary benefits Apply tot his job Apply To this Job