Administers benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. Reserves, manages and brings Workers’ Compensation claims to an equitable conclusion within the Company standards and best practices guidelines. Communicates effectively with other Company departments. Maintains a good working relationship with insureds, employers, agents and other employees. Works more independently than a Claims Examiner and handles more complex cases and a higher caseload.
• Creates and adjusts reserves in a timely manner to ensure reserving activities consistent with company policies.
• Communicates with insureds to obtain information necessary for processing claims.
• Confers with legal counsel on claims requiring litigation.
• Attends depositions and hearings as often as workload allows.
• Contacts and/or interview claimants, doctors, medical specialists, or employers to get additional information.
• Examines claims investigated by outside adjusters, further investigating questionable claims to determine whether to authorize payments.
• Investigates, evaluates and settles claims, applying technical knowledge and human relations skills to ensure fair and prompt management of cases.
• Pursues subrogation vigorously.
• Participates in claim reviews and service calls with insureds and prospective insureds.
• Manages and approve payment of benefits within designated authority level.
• Presents cases and participate in their discussion at claim committee meetings.
• Reports overpayments, underpayments and other irregularities.
• Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law.
High school diploma or general education degree (GED). Bachelor's degree from four-year college or university preferred.
Requires a minimum of 2-4 years of work-related skill and knowledge. All Examiners must receive certification that meets the minimum standards of training, experience and skill. Strong understanding of laws and jurisdictional restraints to manage injuries. WCCA and WCCP helpful. State Workers Compensation License is required in some branches.