Claims Examiner – Workers Compensation - Remote​/Telecommute

Job Description:

Pay Range: $47hr - $52hr

• The Claims Examiner will analyze, manage, and resolve complex workers’ compensation claims by conducting thorough investigations, evaluating exposure, and ensuring timely and accurate processing while maintaining compliance with applicable laws and service expectations.

• Ability to analyze and manage complex workers’ compensation claims.
• Strong negotiation and settlement skills.
• Knowledge of insurance principles, laws, and cost containment practices.
• Ability to manage litigation and vendor coordination.
• Strong communication and documentation skills.

• Five years of claims management experience or an equivalent combination of education and experience.

• Analyze and process complex workers’ compensation claims by investigating and gathering information to determine claim exposure and drive timely resolution.
• Negotiate claim settlements within designated authority.
• Calculate and assign appropriate reserves and manage reserve adequacy throughout the claim lifecycle.
• Calculate, approve, and issue benefit payments and claim adjustments in a timely manner.
• Prepare required state filings within statutory limits.
• Manage the litigation process to ensure timely and cost-effective resolution.
• Coordinate vendor referrals for investigation and litigation management.
• Apply cost containment techniques and manage vendor partnerships to reduce overall claim costs.
• Manage claim recoveries including subrogation, second injury fund recoveries, and Social Security and Medicare offsets.
• Report claims to excess carriers and respond to requests in a professional and timely manner.
• Communicate claim activity with claimants and clients while maintaining professional relationships.
• Ensure claim files are properly documented and coded.
• Refer cases to supervisors and management when appropriate.
• Perform additional duties as assigned, support quality programs, and travel as required.

• Subject matter expertise in insurance principles, laws, recoveries, offsets, and cost containment practices.
• Excellent oral and written communication skills.
• Proficiency in Microsoft Office applications.
• Strong analytical, interpretive, and organizational skills.
• Good interpersonal and negotiation skills.
• Ability to work in a team environment and meet service expectations.

• Bachelor’s degree from an accredited college or university preferred.
• Professional certification related to the line of business preferred.