Claims Examiner - Workers Compensation - Remote / Telecommute

Cynet systems Inc; Toronto; Remote; CAD 60,000 - 80,000; Full time

Job summary

A leading insurance firm in Toronto is seeking an experienced Workers’ Compensation Claims Specialist to analyze, manage, and resolve complex claims. The ideal candidate will have over 5 years of claims management experience and strong knowledge of insurance principles. This role involves investigating claims, negotiating settlements, and maintaining professional communication with clients. Competitive compensation and benefits offered.

Qualifications

• 5+ years of claims management experience or an equivalent combination of education and experience.
• Professional certification in claims or insurance preferred.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Manage claims through action plans for timely resolution.
• Negotiate claim settlements within designated authority levels.
• Calculate and assign accurate reserves to claims.
• Approve and issue claim payments and adjustments.
• Prepare and submit necessary state filings.
• Manage the litigation process for cost-effective resolutions.
• Coordinate vendor referrals for investigations.
• Apply cost-containment techniques to reduce claim costs.
• Report claims to excess carriers and respond promptly.

Skills

Strong knowledge of insurance principles

Proficient in Microsoft Office applications

Excellent oral and written communication skills

Strong analytical skills

Effective negotiation abilities

Education

Bachelor's degree from an accredited college

Job description

Job Description

• We are seeking an experienced Workers’ Compensation Claims Specialist to analyze, manage, and resolve complex workers’ compensation claims.
• The role involves conducting detailed investigations, determining exposure, managing reserves, and negotiating settlements in compliance with company policies and state regulations.

Responsibilities

• Analyze and process complex or technically challenging workers' compensation claims by investigating and gathering necessary information to determine claim exposure.
• Manage claims through well-developed action plans ensuring appropriate and timely resolution.
• Negotiate claim settlements within designated authority levels.
• Calculate and assign accurate reserves to claims; maintain reserve adequacy throughout the claim lifecycle.
• Approve, calculate, and issue timely claim payments and adjustments.
• Prepare and submit necessary state filings within statutory deadlines.
• Manage the litigation process, ensuring timely and cost-effective resolutions.
• Coordinate vendor referrals for additional investigations or litigation management.
• Apply cost-containment techniques, including vendor partnerships, to reduce claim costs.
• Manage claim recoveries such as subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets.
• Report claims to excess carriers and respond promptly to requests or directions.
• Maintain professional communication with claimants and clients regarding claim activity.
• Ensure all claim files are accurately documented and coded.
• Refer cases to supervisors or management when appropriate.
• Perform other duties as assigned and support the organization’s quality programs.

Experience

• 5+ years of claims management experience or an equivalent combination of education and experience.

Skills

• Strong knowledge of insurance principles, laws, claim recoveries, cost containment, and disability duration management.
• Proficient in Microsoft Office applications.
• Excellent oral and written communication skills.
• Strong analytical, organizational, and interpersonal skills.
• Effective negotiation and problem-solving abilities.
• Ability to work in a team-oriented environment and meet service expectations.

Qualification And Education

• Bachelor’s degree from an accredited college or university preferred.
• Professional certification in claims or insurance (preferred).