Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCforward is currently seeking a highly motivated Claims Examiner for an opportunity in Remote but limited to SE states (100% Remote).

Job Details:

Job Title: Claims Examiner - Workers Compensation

Work location: Remote but limited to SE states.

Duration: 3+ months contract and possibility of extension

Pay Rate: $40/hr on W2

Job Description:

Responsible for analyzing complex and technically challenging workers' compensation claims to determine benefits due, managing high-exposure claims involving litigation and rehabilitation, and ensuring the adjudication of claims in alignment with service expectations, industry best practices, and specific client requirements. This role also identifies subrogation opportunities and negotiates settlements.

Essential Functions and Responsibilities:

Claims Analysis & Management:

• Analyze and process complex or technically difficult WC claims by investigating and gathering necessary information to assess exposure.
• Develop and execute strategic action plans to drive claims toward appropriate and timely resolution.
• Calculate and assign timely and accurate reserves; monitor and adjust reserves throughout the claim lifecycle.

Benefits & Settlements:

• Calculate and pay benefits due, approve and process timely claim payments and adjustments.
• Negotiate claim settlements within designated authority limits.

Compliance & Documentation:

• Prepare and submit required state filings within statutory deadlines.
• Ensure claims are properly documented and coded accurately.
• Report claims to excess carriers and respond professionally to direction requests.

Litigation & Vendor Management:

• Manage litigation processes, ensuring cost-effective and timely claim resolution.
• Coordinate vendor referrals for further investigations or litigation support.
• Leverage cost containment strategies and vendor partnerships to minimize claim costs.

Recovery & Subrogation:

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

Client & Claimant Communication:

• Maintain ongoing communication regarding claim status and activities with claimants and clients.
• Foster and maintain professional client relationships.

Collaboration & Supervision:

• Refer cases to supervisors and management as needed.
• Support organizational quality programs.

Additional Responsibilities:

• Perform other related duties as assigned.
• Travel as required.

Qualifications:

Education & Licensing:

• Bachelor's degree from an accredited college or university preferred.
• Relevant professional certifications (as applicable to the line of business) preferred.

Experience:

• Minimum five (5) years of claims management experience, or an equivalent combination of education and experience.
• Florida Workers' Compensation experience is mandatory.
• At least 2 years of relevant WC lost time claims handling experience.

Skills and Knowledge:

• Expert knowledge of workers' compensation insurance principles, applicable laws, and claims processes.
• Strong understanding of claim recoveries, offsets, deductions, cost containment, medical management, and Social Security/Medicare application procedures.
• Excellent oral and written communication skills, including strong presentation abilities.
• Proficiency in Microsoft Office and general PC literacy.
• Strong analytical, interpretive, organizational, and negotiation skills.
• Exceptional interpersonal and teamwork capabilities.
• Ability to meet and exceed service expectations in a high-performance environment.

Work Environment and Physical Demands:

• Mental: Strong conceptual thinking, judgment, problem-solving, discretion, ability to manage stress and multiple priorities, and meet deadlines.
• Physical: Frequent computer use; travel as required.
• Auditory/Visual: Adequate hearing, vision, and verbal communication.
• Other: Credit security clearance, confirmed via background credit check, is required.

Interested candidates please send resume in Word format Please reference job code 236408 when responding to this ad.

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