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Claims Examiner – Workers’ Compensation; 2-month Project
Our client, a large Insurance Co, has a need for a Claims Examiner for Workers’ Comp. The Claims Examiner will analyze complex or technically difficult workers’ Compensation Claims for a dedicated client.
Essential Responsibilities:
- Analyze and process complex or technically difficult workers’ Compensation Claims.
- 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
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments.
- Settles claims within designated authority level and prepares and prepare necessary state filings within statutory limits and manages the litigation process
- Coordinate vendor referrals for additional investigation and/or litigation management
- Manage claim recoveries, including, but not limited to: subrogation, second Injury Fund excess recoveries and Social Security and Medicare offsets
- Report claims to the excess carrier
- Communicate claim activity and processing with the claimant and the client
- Ensure claims files are properly documented and claims coding is correct
Job Qualifications:
Education and Experience:
- Bachelor’s degree from accredited college/university preferred
- Professional certification applicable to line-of-business preferred
- 3+ years of Workers’ Compensation Lost Time Claims handling experience mandatory
- 5 years of claims mgmt. experience or equivalent combo of education and experience required
- State of Ohio Claims (WC) handling experience preferred
Skills:
- Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claims and disability duration, cost containment principles including medical management practices & Social Security & Medicare applications procedures
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
If you live in IL and are currently interested, qualified and available please send your resume to us for immediate consideration.
We are employment specialists who have worked in heath care and managed care industry for over a total of 25 years. We staff temp, temp to hire, and direct hire placements
