Workers Compensation Claims Examiner

SUMMARY
Responsible for reviewing, adjudicating and managing low- and mid-level workers' compensation claims in accordance with company guidelines, statutory regulations and best practices. Manages claims through well-developed action plans to an appropriate and timely resolution.
ESSENTIAL DUTIES AND RESPONSIBILITIES

Reviews and evaluates workers’ compensation claims to determines compensability and benefits due on indemnity claims;



Sets and manages reserve accounts, ensures that accurate levels are maintained and that documentation is on file with state agency;



Develops and manages workers’ compensation claims action plans and manages to resolution;



Establishes and manages return-to-work plan; Identifies modified work opportunities to enable return to work;



Coordinates claim action and processing with claimant and client;



Approves claim payments, manages subrogation of claims and negotiates settlements;



Develops effective working relationships with outside vendors and ensures professional client relationships;



Communicates with injured workers, employers, doctors and attorneys;



Composes medical examination assignments, letters and legal orders;



Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims;



Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information);



Other duties as assigned.


QUALIFICATIONS
EDUCATION / EXPERIENCE
Bachelor's Degree in business or equivalent combination of education and experience
Three (3) or more years of experience in workers’ compensation field
Certificates and/or licenses as required by State regulation

SKILLS
Excellent verbal and written communication skills
Excellent presentation skills
Excellent customer service skills
Analytical skills with ability to interpret results
Strong organizational skills
Good interpersonal skills with ability to work in a team environment
Proficient in Microsoft Office Products