Overview

Salary Range $90,000.00 - $95,000.00 Salary

Level Experienced

Position Type Full Time

Job Shift Day

Category Insurance

SIP is required for this position.

POSITION SUMMARY:

At the direction of the Claims Supervisor and/or Manager, manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants, medical providers, attorneys, vendors, nurse and vocational case managers, and internal staff.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.*
• Initiates and conducts investigations in a timely manner.*
• Determines compensability of claims and administers benefits based upon state law and established best practices for claim handling.*
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Refers cases to outside defense counsel and participates in litigated matters.*
• Communicates with claimants, attorneys, providers, and vendors regarding claim issues.*
• Works in an organized and proactive manner.*
• Computes and sets reserves within company guidelines.*
• Settles and/or finalizes all claims and obtains authority as designated.*
• Maintains diary systems for case review and documents files to reflect status, work performed, and plans of action.*
• Communicates appropriate information promptly to clients to resolve claims efficiently, including injury trends or other safety-related concerns.*
• Conducts file reviews as scheduled by clients and management.*
• Identifies and reviews claims for apportionment assignment.*
• Identifies and investigates subrogation potential and pursues recovery.*
• Identifies claim standard criteria for excess reporting and reimbursement.*
• Assists with state audit and reporting responses.*
• Mentors less experienced Examiners.*
• Performs other duties as assigned, including management of other jurisdictional Workers’ Compensation claims.*
• Adheres to all company policies and procedures.*

*Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire

QUALIFICATIONS:

Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. 

Knowledge, Skills and Abilities:

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications: 

Licenses as required by Jurisdiction..   



Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan 
• Paid Holidays
• Paid Time Off.
• Referral bonus.

If you’re an experienced Workers’ Compensation professional looking for a dynamic claims environment with flexibility and career stability, we’d love to connect.