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- Work with high-exposure claims involving litigation and rehabilitation.
- Ensure ongoing adjudication of claims within service expectations, industry best practices , and specific client service requirements.
- Identify subrogation of claims and negotiate settlements.
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Claims Examiner - Atlanta, United States - Mindlance
Description
Job Title: Claims Examiner - Workers Compensation
Location: Remote
Job Length: 3 Months (Possibility of extension)
Manager's Note:
· Alaska work comp license or a Property & Casualty adjuster's license.
Job Overview:
ESSENTIAL FUNCTIONS and 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; and settles clams within designated authority level.
· Prepares necessary state fillings within statutory limits.
· Manages the litigation process; ensures 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 for our clients.
· 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; 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.
· Performs other duties as assigned.
· Supports the organization's quality program(s).
Skills & Knowledge
· 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 Social Security and Medicare application procedures as applicable to line-of-business.
· Excellent oral and written communication, including presentation skills
· PC literate, including Microsoft Office products
· Analytical and interpretive skills
· Strong organizational skills
· Good interpersonal skills
· Excellent negotiation skills
· Ability to work in a team environment
· Ability to meet or exceed Service Expectations
Education:
· Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
