Overview

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

Level Experienced

Position Type Full Time

Job Shift Day

Category Insurance

POSITION SUMMARY:

Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires considerable interaction with clients, claimants on the phone, management, other Claims Examiners, external business partners, and internal staff.

DUTIES AND RESPONSIBILITIES:

• Effectively manages an average caseload of 130 Workers’ Compensation files, including very complex claims.*
• Initiates and conducts investigations in a timely manner.*
• Determines compensability of claims and administers benefits based upon state law and in accordance with established company guidelines.*
• Develops and manages claims through well-developed action plans and continues to work those plans to drive appropriate and timely claim resolution.*
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Calculates and pays benefits due and approves all claim payments.*
• Refers cases to outside defense counsel and directs/manages litigation activity as appropriate.*
• Manages claim recoveries of all types, including deductible and subrogation matters.*
• Communicates with clients, claimants, providers, and vendors regarding claims issues.*
• 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 claim status and ongoing work activity.*
• Communicates appropriate information promptly to clients to resolve claims efficiently, including injury trends or other safety-related concerns.*
• Adheres to all company policies and procedures.*
• Conducts file reviews independently.*
• Performs other duties as assigned.*

*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: Bachelor’s degree in related field (preferred); 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: 

• Certifications and/or licenses as required by State regulation.



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.