Claims Examiner

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Overview:

It is the responsibility of a workers' compensation claims adjuster to receive and organize all documents related to the employee and the injury in order to make a determination regarding the claim. Workers' compensation claims adjusters abide by company guidelines when making claim determinations.

Overview:

It is the responsibility of a workers' compensation claims adjuster to receive and organize all documents related to the employee and the injury in order to make a determination regarding the claim. Workers' compensation claims adjusters abide by company guidelines when making claim determinations.

This role requires excellent communication and customer service skills, strong motivation and works in a team environment.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsibilities:

• Investigates and maintains worker’s compensation claims. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, releases, statements or other documents) in the investigation of claims.
• Works toward the resolution of claims files, and attends arbitrations, mediations or trials as necessary. Takes full charge of claim from start to resolution.
• Will affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.
• Ensures that claims payments are issued in a timely and accurate manner.
• Ensures compliance of claims handling pursuant to all state, legal, statutory and regulatory bodies to comply with all company procedures and requirements.
• Maintains a diary to follow claim progress on all claims.
• Must obtain state adjusting licenses where required.

Qualifications:

• 3-5 years of experience handling worker’s compensation claims experience.
• State specific licensing, worker’s compensation
• Familiarity with state and federal workers’ compensation laws and regulations
• Multiple jurisdiction experience is preferred.
• Candidates will be required to have strong skills in customer service, verbal and written communications, time management, and organizational skills.
• Great attention to detail
• Must demonstrate an ability to work independently.
• Must demonstrate a strong knowledge of computers and software.
• Must have experience in adjusting in FL claims and other states is a plus

Communication

Skills:

Effective with making complex technical information and recommendations understandable and clear to audiences with varied levels of technical knowledge

Listens effectively

Clearly expresses ideas, recommendations, etc. in writing

Technical Expertise:

Complete understanding of all Microsoft Office applications relevant for their area and navigates large volumes of loss data and creates presentable summaries. Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of formulas and equations. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Reviews loss information to identify basic trends and recommendations. Handles multiple assignments and schedules accordingly in order of importance

Customer Service:

Responds timely and consistently with all communication

Builds credibility with internal and external customers

Creates customer satisfaction by demonstrating the value of risk management

Familiar with the company tools and is comfortable reviewing with all levels of management

Physical Capabilities:

Physical Work Demands:

• Seeing/General and Close Vision
• Hearing/Listening
• Clear Speech
  - Complete
• Touch:
  Dexterity, Hand, Finger, Repetitive Key Typing
• Lifting up to 10 pounds
• Pushing and Pulling
• Bending
• Sitting

Work Environment/Hours

• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• The noise level in the work environment is usually moderate.
• Team Environment
• Verbal Contact with Others
• Standard
  
  Work Hours:
  
  Mon-Fri,…