Claims Examiner Workers Compensation

Vytwo; Prosper (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

Vytwo is seeking a Claims Examiner for Workers Compensation to analyze complex claims and determine benefits due. The position requires at least 5 years of claims management experience and strong skills in negotiation and communication. Responsibilities include managing claims, negotiating settlements, and ensuring ongoing adjudication. A Bachelor's degree is preferred. This is a remote position with a duration of over 3 months.

Qualifications

• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Analyze complex or technically difficult workers' compensation claims.
• Negotiate settlement of claims within designated authority.
• Manage claims through well-developed action plans.

Skills

Claims management experience

Excellent oral and written communication

Negotiation skills

Analytical and interpretive skills

Organizational skills

PC literacy (Microsoft Office)

Ability to meet or exceed service expectations

Education

Bachelor's degree from an accredited college or university

Job description

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 claims within designated authority level.
• Prepares necessary state filings 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.