Claims Examiner – Workers Compensation

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Evaluate and manage intricate or technically challenging workers' compensation claims by conducting investigations and gathering information to ascertain claim exposure.

• Oversee claims using action plans to ensure timely and suitable resolutions.

• Negotiate claim settlements within the established authority.

• Calculate and assign timely and appropriate reserves while ensuring reserve adequacy.

• Calculate and disburse benefits, authorize claim payments and adjustments, and resolve claims within authorized limits.

• Prepare necessary state filings within statutory deadlines.

• Oversee litigation to guarantee prompt and cost-effective claim resolutions.

• Coordinate vendor referrals for investigative and litigation management.

• Implement cost-containment strategies and cultivate strategic vendor partnerships.

• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and offsets from Social Security and Medicare.

• Report claims to excess carriers and respond to direction requests.

• Maintain communication about claim activities with claimants and clients while fostering professional client relationships.

• Ensure claim files are thoroughly documented and claim coding is accurate.

• Refer cases to supervisors and management as necessary.

• Perform other assigned tasks and support organizational quality initiatives.

• Travel as necessary.

⛳️ Requirements

• A minimum of five (5) years of claims management experience or an equivalent combination of education and experience is required.

• Subject matter expertise in insurance principles and regulations relevant to the applicable line of business.

• Knowledge of recoveries, offsets and deductions, claim and disability duration, along with cost-containment strategies.

• Familiarity with medical management practices and procedures related to Social Security and Medicare as applicable.

• Exceptional oral and written communication skills, including the ability to present effectively.

• Proficiency in PC applications, including Microsoft Office software.

• Strong analytical and interpretive abilities.

• Excellent organizational skills.

• Good interpersonal abilities.

• Outstanding negotiation skills.

• Capability to work within a team environment.

• Ability to meet or surpass service expectations.

• Skills to handle multiple priorities, deadlines, work-related stress, troubleshooting, problem-solving, analysis, and discretion.

• Competence in computer keyboarding.

• Professional certification relevant to the line of business is preferred.

• A bachelor's degree from an accredited college or university is preferred.

🏝️ Benefits

• Work-life balance.

• Supportive culture.

• Reasonable accommodations when applicable and appropriate.

• Equal Opportunity Employer.

• Drug-Free Workplace.