Workers Compensation Claims Examiner II

Job Description:

• Effectively manages a caseload of 150 or fewer workers’ compensation files
• Initiates and investigates promptly
• Determines compensability of claims and administers benefits based upon state law
• Manages medical treatment and medical billing, authorizing as appropriate
• Communicates with claimants, providers, and vendors regarding claims issues
• Computes and sets reserves within Company guidelines
• Maintains diary system for case review
• Communicates appropriate information promptly to the client to resolve claims efficiently
• Adheres to all Company policies and procedures
• Conducts file reviews as scheduled by the client and management

Requirements:

• High school diploma or GED required
• Bachelor’s degree in a related field (preferred)
• Three (3) or more years of related experience
• Technical knowledge of statutory regulations and medical terminology
• Analytical skills
• Excellent written and verbal communication skills
• Ability to interact with persons at all levels in the business environment
• Ability to independently and effectively manage fairly complex claims
• Proficient in Word and Excel (preferred)

Benefits:

• Medical, Dental and Vision insurance
• Life & Disability insurance
• 401(k) plan
• Paid holidays
• Paid time off
• Referral bonus