Claims Examiner - Workers Compensation - Remote / Telecommute

Job TitleJob Overview:Pay Range: $45.00hr - $50.00hrRequirement/Must Have:Five (5) years of claims management experience or equivalent combination of education and experience required.Professional certification as applicable to line of business preferred.Responsibilities:Analyzes and processes complex 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 within 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.Settles claims within designated authority level.Prepares necessary state fillings within statutory limits.Manages the litigation process to ensure 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.Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.Reports claims to the excess carrier and 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.Supports the organization’s quality program(s).Travels as required.Nice to Have:Bachelor’s degree from an accredited college or university preferred.Skills:Workers’ Compensation Claims Adjudication.Litigation Management.Subrogation Negotiation.Reserve Management.Cost Containment.Claim Recovery Processing.Qualification And Education:Bachelor’s degree from an accredited college or university preferred.Professional certification as applicable to line of business preferred.