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Claims Examiner - Workers Compensation

Posted about 1 month ago

  • Expiry Date: 19 August 2022
  • Referral: 212665@accuick.com

Job Description:

Keywords:

  • Workers Compensation, Claims Management, Claims Examiner 

Primary Purpose:

  • To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements

Essential Functions And Responsibilities:

  • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Negotiates settlement of claims within designated authority.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.

  • Prepares necessary state fillings within statutory limits.

  • Manages the litigation process; ensures timely and cost effective claims resolution.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

  • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management

Additional Functions And Responsibilities:

  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

  • Travels as required.

Qualification:

  • Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

  • Experience Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge:

  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Excellent negotiation skills

  • Ability to work in a team environment

  • Ability to meet or exceed Service Expectations

Work Environment:

  • When applicable and appropriate, consideration will be given to reasonable accommodations.

  • Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

  • Physical: Computer keyboarding, travel as required

  • Auditory/Visual: Hearing, vision and talking

Note:

  •  Credit security clearance, confirmed via a background credit check, is required for this position.

  • The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.

  • They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Manager's note:

  • Work address: Office is 4245 Meridian Parkway, Suite 110 Aurora, IL 60504

  • Job location: Can be remote

  • Any specific skill/ requirement: Must know Illinois jurisdiction

About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.