Claims Examiner Workers Compensation - Remote

• Job Type:Contract

Posted about 18 hours ago

Job Title: Claims Examiner Workers Compensation

Location: Sun Prairie, WI (100% Remote)

Claims Examiner Workers Compensation:

:

Candidate must have 4+years of relevant Claims handling experience of Workers Compensation.

QUALIFICATION:

• Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.
• Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

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:

• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Prepares necessary state fillings within statutory limits.
• 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.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Negotiates settlement of claims within designated authority.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

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.
• Ability to meet or exceed Service Expectations
• Good interpersonal skills
• Analytical and interpretive skills
• PC literate, including Microsoft Office products
• Strong organizational skills
• Ability to work in a team environment
• Excellent negotiation skills
• Excellent oral and written communication, including presentation skills

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About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With five 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.