Claims Examiner Workers Compensation - Remote / Telecommute

Cynet Systems Inc; San Antonio (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company seeks a Claims Manager to oversee complex workers' compensation claims. The role involves investigating claims, negotiating settlements, managing litigation processes, and maintaining client relationships. Ideal candidates will have a Bachelor's degree and a minimum of five years' experience in claims management, demonstrating excellent negotiation and analytical skills.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Five years of claims management experience or equivalent combination of education and experience required.

Responsibilities

• Analyzes and processes complex workers' compensation claims.
• Negotiates settlement of claims within designated authority.
• Manages the litigation process and ensures timely resolution.

Skills

Negotiation

Analytical Skills

Communication

Organizational Skills

Interpersonal Skills

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Job Description:

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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Qualification:

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

Experience:

• Five years of claims management experience or equivalent combination of education and experience required.

Skills and 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.
• 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.

Work Environment:

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesn
• Physical: Computer keyboarding, travel as requiredn
• Auditory/Visual: Hearing, vision and talkingn