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Claims Examiner - Workers Compensation

Retail Industry

Dallas, Texas(remote)

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JOB DETAILS
SKILLS
Adjudication, Alliance/Partner Management, Analysis Skills, Applications Security, Best Practices, Business Services, Business Transformation, Claims Coding, Claims Management, Claims Processing, Cloud Computing, Computer Skills, Consulting, Cost Control, Customer Relations, Customer Support/Service, Data Collection, Develop and Maintain Customers, Enterprise Application Integration (EAI), Information Technology Consulting, Insurance Regulations, Interpersonal Skills, Licensing, Litigation, Medical Protocols, Medical Treatment, Medicare, Microsoft Office, Microsoft Product Family, Negotiation Skills, Organizational Skills, Presentation/Verbal Skills, Process Analysis, Process Management, Software Administration, Software Development, Software Engineering, State Laws and Regulations, Subrogation, System Integration (SI), Team Player, Time Management, Vendor/Supplier Planning, Worker's Compensation, Writing Skills, eBusiness
LOCATION
Dallas, Texas
POSTED
30+ days ago
Title: Claims Examiner - Workers Compensation (1431041)
Location: Remote
Duration: 03+ Months

Manager's notes:
Mandatory: Work comp claims handling experience is needed; loss time.
Minimum 3+years of relevant WC experience required.

PRIMARY PURPOSE:
To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
  • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; 
  • Manages claims through well-developed action plans to an appropriate and timely resolution. 
  • Negotiates settlement of claims within designated authority. 
  • Calculates and assigns timely and appropriate reserves to claims; 
  • Manages reserve adequacy throughout the life of the claim. 
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. 
  • Prepares necessary state fillings within statutory limits. 
  • Manages the litigation process; ensures timely and cost effective claims resolution. 
  • Coordinates vendor referrals for additional investigation and/or litigation management. 
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. 
  • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. 
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. 
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. 
  • Ensures claim files are properly documented and claims coding is correct. 
  • Refers cases as appropriate to supervisor and management. 

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

Experience
Five (5) years of claims management experience or equivalent combination of education and experience required. 

Skills & Knowledge 
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations
Compensation: $35.00 per hour

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.





About the Company

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Retail Industry