Hybrid Workers' Comp Claims Examiner — Albuquerque

SDI Staffing; Albuquerque (NM); Hybrid; USD 88,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO

Job summary

SDI Staffing seeks an experienced Workers' Compensation Claims Examiner for a well-established insurance client in Albuquerque, NM. This is a full-time direct-hire, hybrid role (3 days remote, 2 days in office).

You will manage an average caseload of 130 workers’ compensation files, determine claim eligibility, conduct investigations, authorize treatment, administer benefits, and communicate with claimants, clients and providers.

Qualifications

• Bachelor's degree preferred.
• New Mexico Adjuster’s license required.
• Minimum of 5+ years of workers' compensation claims handling experience.
• Excellent written and verbal communication skills.
• Proficient in Word and Excel (preferred).
• Knowledge of self-insured claims handling (preferred).
• City, County and/or District claims handling experience (preferred).

Responsibilities

• Manages an average caseload of 130 workers’ compensation files, including complex claims.
• Initiates and conducts investigations.
• Determines compensability of claims and administers benefits per state law and guidelines.
• Develops and manages claims through action plans until resolution.
• Manages medical treatment and medical billing; authorizes as appropriate.
• Calculates and pays benefits and approves all claim payments.
• Refers cases to outside defense counsel as needed.
• Manages claim recoveries including deductible and subrogation.
• Communicates with clients, claimants, providers and vendors.
• Sets reserves within guidelines; completes diary system for reviews.

Skills

Strong communication

Excel

Word

Attention to detail

Education

Bachelor's degree in related field

Tools

Microsoft Word

Microsoft Excel

Job description

SDI Staffing seeks an experienced Workers' Compensation Claims Examiner for a well-established insurance client in Albuquerque, NM. This is a full-time direct-hire, hybrid role (3 days remote, 2 days in office).

You will manage an average caseload of 130 workers’ compensation files, determine claim eligibility, conduct investigations, authorize treatment, administer benefits, and communicate with claimants, clients and providers.