What are the responsibilities and job description for the Claims Examiner position at Mary Kraft HR?
Job Description
Job Description
Job Profile
Job Title
Workers Compensation Claims Examiner (1360552)
Location
Remote / Hybrid in San Diego CA
Hire Type
Contingent
Hourly
open
Work Model
Monday – Friday
Contact Phone
443 ) -345-3305
Contact Email
sean@marykraft.com
Nature & Scope : Positional Overview
Mary Kraft is seeking an experienced Workers Compensation Claims Examiner to analyze complex or technically difficult workers' compensation claims. The role involves managing high-exposure claims, including those with litigation and rehabilitation, ensuring adherence to industry best practices, service expectations, and specific client requirements. The examiner will also identify subrogation opportunities and negotiate settlements to achieve cost-effective resolutions.
Role & Responsibilit y :
Tasks That Will Lead To Your Success
- Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
- Manage claims through well-developed action plans, ensuring timely and appropriate resolutions.
- Negotiate settlement of claims within designated authority limits.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
- Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness.
- Prepare necessary state filings within statutory limits.
- Oversee the litigation process to ensure timely and cost-effective resolution of claims.
- Coordinate vendor referrals for additional investigation or litigation management.
- Implement cost-containment strategies, including partnerships with vendors, to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
- Report claims to excess carriers and respond to their inquiries in a timely and professional manner.
- Maintain communication with claimants and clients, fostering professional relationships.
- Ensure claims files are properly documented, with accurate coding.
- Refer complex cases to supervisors or management as needed.
Skills & Experience :
Qualifications That Will Help You Thrive
