What are the responsibilities and job description for the Workers Compensation Claims Examiner position at Mary Kraft HR?
Job Profile
Job Title
Workers Compensation Claims Examiner
Location
Remote
Hire Type
Contingent
Hourly
$40
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 – Liability to analyze and process complex general liability claims related to workers’ compensation. The ideal candidate will determine benefits due, manage high-exposure claims (including those involving litigation and rehabilitation), and identify subrogation opportunities while negotiating settlements in accordance with industry best practices and company standards.
Role & Responsibility:
Tasks That Will Lead To Your Success
- Analyze and process complex general liability claims by investigating and gathering necessary information to determine claim exposure.
- Develop and manage comprehensive action plans to ensure timely and appropriate claim resolution.
- Assess liability and resolve claims in accordance with evaluation criteria.
- Negotiate settlements within designated authority and calculate, assign, and monitor reserves throughout the life of each claim.
- Approve and process claim payments and adjustments, ensuring adherence to established guidelines.
- Prepare and submit state filings within statutory limits and manage the litigation process on claims that require legal action.
- Coordinate with external vendors, including independent adjusters, to support claim investigations and litigation management.
- Utilize cost containment strategies, including strategic vendor partnerships, to reduce overall claim costs.
- Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets.
- Report significant claims to excess carriers and communicate claim activities and decisions with claimants, clients, and relevant stakeholders.
- Ensure all claim files are accurately documented and coded, and refer cases to supervisors as needed.
- Perform other duties as assigned and support the organization’s quality programs.
- Travel as required to meet business needs.
Skills & Experience:
Qualifications That Will Help You Thrive
- Bachelor’s degree from an accredited college or university is preferred.
- Professional certification as applicable to the line of business is a plus.
- Mandatory: Must hold an active license.
- A minimum of 5 years of claims management experience, or an equivalent combination of education and experience, is required.
- At least 3-5 years of relevant workers’ compensation claims handling experience in multiple Southeastern states is necessary.
- Product liability experience is a plus but not required.
- In-depth understanding of insurance principles and laws, recoveries, offsets, deductions, and claim/disability duration relevant to workers’ compensation.
- Knowledge of cost containment principles, including medical management practices and Social Security/Medicare application procedures.
- Excellent oral and written communication skills, including the ability to present findings clearly and professionally.
- Strong analytical, interpretive, and organizational skills with a proven ability to manage multiple priorities and work under pressure.
- Proficiency in Microsoft Office products and other relevant software tools.
- Exceptional interpersonal and negotiation skills and a demonstrated ability to work effectively in a team environment.
Salary : $29 - $39
