Workers Compensation Claims Examiner at TEKsystems

Description:

The Workers Compensation Claims Examiner will be responsible for managing moderately complex claims, including high exposure and litigated claims. Responsibilities include determining benefits due; ensuring management of claims within internal claims management guidelines and in compliance with applicable laws; and identifying opportunities for, managing subrogation of claims, and negotiating settlements.

Skills:

Claim, insurance educational association

Top Skills Details:

Claim,insurance educational association

Additional Skills & Qualifications:

Position Expectations Thoroughly investigate workers’ compensation claims by timely contacting injured workers, medical providers, and employer representatives/witnesses and documenting investigation efforts and findings within claim management guidelines. Determine if claims are valid under applicable workers’ compensation statutes. Communicate with medical providers to develop and authorize appropriate treatment plans. Review and analyze medical bills to confirm charges and treatment are related to the work injury and in accordance with the treatment plan. Ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes. Calculate and assign appropriate reserves to claims and manage reserve adequacy throughout the life of the claim. Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and Social Security and Medicare offsets. Prepare required state filings within applicable time limits. Oversee and work with outside counsel to provide information and strategic direction as needed for litigation and/or settlement negotiations. Ability to maintain on-going education credits in a multiple state. Strong understanding of workers’ compensation laws and regulations as well as workers’ compensation claim principles and application. Strong verbal and written communication and negotiation skills. Ability to work positively and collaboratively in a team environment; must always use good judgment. Excellent time management and organizational skills High level of attention to detail while working in a fast-paced environment Frequent use of computers, telephones, and other standard office equipment Must Have: CERTIFIEA Certificate and California Self Insured Certificate required.

Experience Level:

Intermediate Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.