Claims Examiner

Job Title:

Claims Examiner Job Category:
Finance and Accounting Time Type:
Full time Minimum Clearance Required to Start: TS/SCI with Polygraph Employee Type:
Regular Percentage of

Travel Required:

None Type of Travel:
None*
*
* The Opportunity:

We are seeking a detail-oriented, pro-active, critical thinker to manage and review workers' comp claims as a Claims Examiner.

As a Claims Examiner, your duties will include investigating and processing insurance claims, negotiating settlements, and maintaining accurate claims records.

The ideal candidate should have a strong understanding of workers’ compensation policies and regulations, excellent investigative skills, and exceptional customer service skills

Responsibilities:
• Analyze and process complex claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Investigate and evaluate workers’ compensation claims to determine coverage, compensability, liability, and benefits owed.
• Conduct detailed reviews of medical records, employment records, and other documentation to assess claims.
• Handle claim settlements, reviews, and negotiations in a fair and ethical manner.
• Communicate effectively with injured employees, employers, medical providers, attorneys, and internal stakeholders to ensure the timely resolution of claims.
• Authorize treatment and payments within designated authority levels while ensuring compliance with organization’s policies and applicable state laws.
• Prepare and deliver reports documenting claim activity, reserve adequacy, and resolution strategies.
• Evaluate ongoing medical treatment plans and facilitate return-to-work options when feasible.
• Collaborate with legal teams as needed to support litigation and dispute resolution efforts.
• Maintain accurate and up-to-date claim records in accordance with organizational policies and compliance requirements.
• Ensure compliance with Department of Labor Federal Employees Compensation Action laws, regulations, and internal policies, meeting deadlines.
• Oversee case development, including medical examinations and specialty referrals, to resolve conflicts.
• Balance competing priorities in a limited-staff environment while meeting goals for timeliness, accuracy, customer service, and compliance
• Performs other related duties as assigned.

Qualifications:

Required:

• Bachelor’s degree with 3+yrs or equivalent combination of education and 5+ years of relevant experience.
• Demonstrated ability to work independently and collaboratively in a team environment.
• Excellent written and verbal communication skills.
• Strong organizational skills with exceptional attention to detail.
• Strong negotiation and problem-solving skills.
• Proven ability to handle and maintain the confidentiality of sensitive information and materials.
• Extensive customer service experience with a strong focus on professionalism and responsiveness.
• Proficiency in Microsoft Office Suite or similar productivity software.

Desired:
• Knowledge of quantitative and qualitative research methods.
• Experience that can facilitate understanding of Intelligence Community mission and business processes.
• Experience with providing customer service support activities across organizational elements.
• Able to independently initiate, manage, execute and report tasks as identified by the government.

-What You Can Expect: A culture of integrity.

At CACI, we place character and innovation at the center of everything we do. As a valued team member, you’ll be part of a high-performing group dedicated to our customer’s missions and driven by a higher purpose – to ensure the safety of our nation.

An environment of trust.

CACI values the unique…