Senior Workers Compensation Claims Examiner
Reports to the Vice President and Senior Vice President, Claims
Summary and Purpose
Investigate, manage and resolve claims in a timely, unbiased and informed manner in compliance with policies, state laws and regulatory performance standards.
• Knowledge of policy documents for coverage verification.
• Provide account servicing support on claim issues to policyholders to include travel as required.
• Investigate, determine compensability and manage time loss claims consistent with jurisdictional requirements.
• In-Person meetings with injured workers, employers, and medical providers
• When necessary, assign investigators, attorneys, medical consultants and others to facilitate claim determinations and plan of action.
• Follow up with claimants, policyholders and medical providers to monitor progress.
• Answer questions regarding the status of pending claims from claimants, policyholders and medical providers.
• Consult with attorneys regarding litigation management, settlement strategy and claim resolution.
• Manage the most complex claims.
• Assist clerical staff in completion of workers' compensation forms in conformance with jurisdictional requirements.
• Maintain electronic and paper files necessary for documentation of the claim file to include coding, contacts, financial data and plan of action.
• Review reserves for appropriateness and file timely reports on all serious loss claims as required by policy and regulatory standards.
• Work with management to develop ANIC policies when necessitated by statutory/regulatory changes.
• Provide mentoring and leadership to the claims department.
• Provide direction, assistance, and supervision to assigned clerical and adjusting staff.
• Develop curriculum and present training programs for claims adjusters and claims department.
• Promote the team approach to case and account management.
• Perform other duties as assigned.
• High school graduate
• Two years of college preferred
• 10 years of Workers’ Compensation adjusting experience
• In-depth knowledge of Workers’ Compensation laws
• Knowledge of medical and legal terminology and procedures
• Mentoring and leadership experience
• General computer skills
Bilingual (Spanish and English) Major Plus
• Excellent written and verbal communication skills
• Strong interpersonal skills
• Effective negotiation skills
• Ability to prioritize workload to meet deadlines
• Ability to work well in a team environment