What are the responsibilities and job description for the Workers Compensation Claims Examiner position at Mary Kraft HR?
Job Description
Job Description
Job Profile
Job Title
Workers Compensation Claims Examiner (13 60902 )
Location
Remote
Hire Type
Contingent
Hourly
4 7-$50
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 challenging workers' compensation claims to determine benefits due. The role involves managing high-exposure claims, including those involving litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. The Claims Examiner will also identify subrogation opportunities and negotiate settlements.
Role & Responsibilit y :
Tasks That Will Lead To Your Success
- Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
- Develop and manage claims through well-structured action plans to reach appropriate and timely resolutions.
- Negotiate settlements of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the claim's lifecycle.
- Approve and process claim payments, adjustments, and benefits, ensuring accuracy and timeliness.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process to ensure timely and cost-effective resolution of claims.
- Coordinate vendor referrals for additional investigation and / or litigation management.
- Implement cost-containment strategies, including strategic vendor partnerships, to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund excess 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
Salary : $7 - $50
