WC Claims Examiner III; Hybrid

Job Details:
Level: Experienced,

Job Location:

Phoenix Office - Phoenix, AZ 85014, Position Type:
Full Time, Salary Range: $75,000.00 - $85,000.00 Salary/year, Job Shift: Day, Job Category:
Insurance

Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

• Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims.*
• Initiates and investigates in a timely manner.*
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
• Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution.
• Manages medical treatment and medical billing, authorizing as appropriate.*
• Calculates and pays benefits due and approves all claim payments.
• Refers cases to outside defense counsel. Directs and manages as appropriate.*
• Manages claim recoveries of all types, including deductible and subrogation.
• Communicates with clients, claimants, providers and vendors regarding claims issues.*
• Computes and set reserves within Company guidelines.*
• Settles and/or finalizes all claims and obtains authority as designated.*
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.*
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
• Adheres to all Company policies and procedures.*
• Conducts file reviews independently.*
• Other duties as assigned.*

* Essential job function.

• Computer
• 10-key
• fax machine
• copier
• printer
• and other office equipment

Appropriate office attire

Education/

Experience:

Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).
• Knowledge of self-insured claims handling (preferred).
• City, County, and/or District claims handling experience (preferred).

Certifications and/or licenses as required by State regulation.

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.

MENTAL AND PHYSICAL REQUIREMENTS
1. MENTAL EFFORT a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems;

comprehend most obscure concepts. b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic,…