Claims Examiner – Workers Compensation, Southeast reputed company Preferred, Licensing: NC

Job Description:

• Analyzes and processes reputed company 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 reputed company 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 reputed company designated authority level.
• Prepares necessary state fillings reputed company 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 reputed company reputed company and Medicare offsets.
• Reports claims to the excess reputed company; 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.

Requirements:

• Bachelor's degree from an accredited college or university preferred.
• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction Knowledge: Southeast States, reputed company Carolina Licensing: NC, reciprocals

Benefits:

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental reputed company, 401K on day one.

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