Workers Compensation Claims Examiner

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

Our client, a well-established organization in the insurance industry, is seeking an experienced Workers' Compensation Claims Examiner to join their team. Candidates must reside in Albuquerque, NM!

HOURS: Full-Time DURATION: Direct Hire WORKPLACE: Hybrid: 3 days remote and 2 days in office PAY: $88,000 to $90,000 BENEFITS: Full comprehensive benefits package including medical, dental, vision, and PTO.

Responsibilities

• Effectively manages an average caseload of 130 workers’ compensation files, including very complex claims.
• Initiates and conducts investigation in a timely manner.
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
• Develops and manages claims through well-developed action plans; continues to work the action plan to stay on task and to bring the claim to an appropriate and timely resolution.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Calculates and pays benefits due and approves all claim payments.
• Refers cases to outside defense counsel.
• Directs and manages as appropriate.
• Manages claim recoveries of all types, including deductible and subrogation.
• Communicates with clients, claimants, providers and vendors regarding claims issues.
• Computes and set reserves within Company guidelines.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
• Conducts file reviews independently.
• Other duties as assigned.

Qualifications

• Bachelor's degree in a related field preferred.
• New Mexico Adjuster’s license is required.
• Minimum of 5+ years of workers' compensation claims handling experience or an equivalent combination of education and experience.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Proficient in Word and Excel (preferred).
• Knowledge of self-insured claims handling (preferred).
• City, County and/or District claims handling experience (preferred).