Claim Examiner- WC

Title:
Claim Examiner - WC

Location:

REMOTE

Duration: 3 months plus extensions

Receives claim assignment, confirms policy coverages and directs acknowledgement of claims. Interprets and makes decisions using independent judgment on moderate difficulty claims and policy coverages and determines if coverages apply to claims submitted.

Investigates, evaluates, negotiates and adjudicates first and third party claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required. Analyzes claims activity and prepares reports for clients/carriers and management.

Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost‑effective manner and ensuring timely issuance of disbursements. Make settlement decisions promptly and equitably and issue company drafts in payments for claims within authority limits.

Develops subrogation and third party recovery potential and follows reclaim procedures. Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.

Ability to work independently while assimilating various technical subjects.

Good verbal or written communication skills.

Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.

Strong ability to identify, analyze and solve problems.

Effective interpersonal skills to be capable of dealing with external sources and all levels of employees.

Bachelor's degree or equivalent experience required.

Comprehensive claims investigations/settling experience 1-3 years experience in Claims or similar organization.