Job Brief
As a Workers Compensation Claims Examiner, you will be responsible for reviewing and assessing claims to ensure compliance with company policies and legal regulations. This role requires a detail-oriented professional with experience in claims management, strong analytical skills, and the ability to communicate effectively with various stakeholders. You will collaborate with legal counsel on complex claims and play a crucial role in settling insurance claims efficiently while maintaining high standards of service.
Responsibilities
- Review and analyze settled workers compensation claims to ensure adherence to company practices and industry regulations.
- Evaluate and approve claims payments and settlements based on thorough investigation and documentation.
- Confer with legal counsel on claims requiring litigation or complex legal considerations.
- Communicate with claimants, employers, and medical professionals to gather necessary information and resolve discrepancies.
- Maintain accurate records and documentation for all claims processed and ensure timely reporting.
- Assist in the development and implementation of claims processing policies and procedures to enhance efficiency.
- Stay updated on changes in workers compensation laws and regulations to ensure compliance and best practices.
- Provide excellent customer service while managing sensitive and confidential information.
Requirements
- Bachelor’s degree in Business Administration, Risk Management, or a related field preferred.
- Minimum of 2-5 years of experience in workers compensation claims examination or related insurance field.
- Strong analytical skills with attention to detail and the ability to interpret complex information.
- Proficiency in claims management software and familiarity with industry-standard tools.
- Excellent communication and interpersonal skills for effective collaboration with stakeholders.
- Knowledge of workers compensation laws and regulations at the state and federal levels.
- Certification such as Associate in Claims (AIC) or similar credentials is a plus.
Similar Job Titles
- Claims Adjuster
- Workers Compensation Specialist
- Insurance Claims Examiner
- Claims Analyst
- Insurance Claims Manager
- Risk Management Analyst
- Claims Supervisor
- Workers Compensation Administrator
