Indemnity Claims Examiner

Within company standards and best practices, manage complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim.

ESSENTIAL JOB DUTIES:

- Receive claim and acknowledgement of the claim
- Determine validity and compensability of the claim by investigating and gathering information regarding the claim
- Establish reserves and authorize payments within reserving authority limits
- Develop and manage well documented action plan with the case manager and outcomes manager to reduce overall cost of the claim
- Coordinating early return-to-work efforts with the case manager and employer
- Manages subrogation of the claim
- Negotiates settlements when necessary
- Actively manage the litigation process
- Manage potential claim recoveries of all types
- Communicate claim status with the customer and claimant
- Adhere to client and carrier guidelines and participate in claims review as needed
- Develop and maintains professional customer relationship
- Requires regular and consistent attendance

SKILLS:

REQUIRED:

- Excellent oral and written communication skills
- PC literate, including Microsoft Office (Word, Excel)
- Strong organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Knowledge of claims administration, case management and cost containment solution as applicable to Workers' Compensation
- Two (2) years of Workers' Compensation claims management experience required.
- Experience managing workers compensation claims from Cradle to grave - experienced in setting reserves, dealing with attorneys and negotiating settlements.