Claims Examiner - Workers Compensation (Hourly) - Apidel Technologies

Description: Manager\'s note:

Any specific skill/certification/ license: License preferred but not required.

Years of experience: 3 or more

PRIMARY PURPOSE: To analyzecomplex or technically difficult workers\' compensation claims to determinebenefits due; to work with high exposure claims involving litigation andrehabilitation; to ensure ongoing adjudication of claims within serviceexpectations, industry best practices and specific client service requirements;and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS andRESPONSIBILITIES

Analyzes and processes complexor technically difficult workers\' compensation claims by investigating andgathering information to determine the exposure on the claim; manages claimsthrough well-developed action plans to an appropriate and timely resolution.

Negotiates settlement ofclaims within designated authority.

Calculates and assigns timelyand appropriate reserves to claims; manages reserve adequacy throughout thelife of the claim.

Calculates and pays benefitsdue; approves and makes timely claim payments and adjustments; and settlesclams within designated authority level.

Prepares necessary statefillings within statutory limits.

Manages the litigationprocess; ensures timely and cost effective claims resolution.

Coordinates vendor referralsfor additional investigation and/or litigation management.

Uses appropriate costcontainment techniques including strategic vendor partnerships to reduceoverall cost of claims for our clients.

Manages claim recoveries,including but not limited to: subrogation, Second Injury Fund excess recoveriesand Social Security and Medicare offsets.

Reports claims to the excesscarrier; responds to requests of directions in a professional and timelymanner.

Communicates claim activityand processing with the claimant and the client; maintains professional clientrelationships.

Ensures claim files areproperly documented and claims coding is correct.

Refers cases as appropriate tosupervisor and management.

ADDITIONAL FUNCTIONS andRESPONSIBILITIES

Performs other duties asassigned.

Supports the organization\'squality program(s).

Travels as required.

QUALIFICATION

Education & LicensingBachelor\'s degree from an accredited college or university preferred.Professional certification as applicable to line of business preferred.

Experience Five (5) years ofclaims management experience or equivalent combination of education andexperience required.

Skills & Knowledge

Subject matter expert ofappropriate insurance principles and laws for line-of-business handled,recoveries offsets and deductions, claim and disability duration, costcontainment principles including medical management practices and SocialSecurity and Medicare application procedures as applicable to line-of-business.

Excellent oral and writtencommunication, including presentation skills

PC literate, including MicrosoftOffice products

Analytical and interpretiveskills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a teamenvironment

Ability to meet or exceedService Expectations

WORK ENVIRONMENT

When applicable andappropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptualthinking ability; excellent judgment, troubleshooting, problem solving,analysis, and discretion; ability to handle work-related stress; ability to handlemultiple priorities simultaneously; and ability to meet deadlines

Physical: Computerkeyboarding, travel as required

Auditory/Visual: Hearing,vision and talking

NOTE: Credit securityclearance, confirmed via a background credit check, is required for thisposition.

The statements contained inthis document are intended to describe the general nature and level of workbeing performed by a colleague assigned to this description. They are notintended to constitute a comprehensive list of functions, duties, or localvariances. Management retains the discretion to add or to change the duties ofthe position at any time.

Requirements:

Manager\'s note:

Any specific skill/certification/ license: License preferred but not required.

Years of experience: 3 or more