Workers' Claims Examiner

Overview

The Examiner is responsible for the oversight of Workers Compensation claims being handled by 3rd party TPAs. This will include the investigation, evaluation, negotiation and settlement of claims. This includes analyzing coverage, and ensure reserves are appropriate in accordance with the company guidelines. Examiners are required to understand and comply with Insurance Regulations, Statutes, and case law accordingly. The Examiners work closely with TPAs, other departments, vendors and defense counsel as needed throughout the claim process.

Depending on the level of complexity, claim values can range from a nominal amount to millions of dollars.

• P&C – Oversight of Multi state Workers Compensation Claims
• Handles Large Loss Reporting and Reinsurance Notifications.
• Reviews, interprets, summarizes and communicates concerns or opportunities related to the TPA claim handling.
• Oversight of files in excess of a million dollars or complex coverage issues.
• Provides day-to-day assistance to the management team as it relates to technical handling questions, research and file strategy.
• Completes targeted audits and other special projects.

• 8 years’ claims experience in handling Workers Compensation Claims.
• Maintain Continuing Education (CE) requirements for state licensing when appropriate.

• Bachelor’s degree in a related field or the equivalent years’ work experience.

• Claims Representative
• Sr. Claims Representative
• Claims Specialist
• Sr. Claims Specialist

Note:

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Salary range is $ 69,462. USD Annual