Claims Examiner – Workers Compensation, Southeast Exp Preferred, Licensing: NC

Job Description • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution. • Coordinates vendor referrals for additional investigation and/or litigation management. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. • Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. • Performs other duties as assigned. • Supports the organization's quality program(s). • Travels as required. Requirements • Bachelor's degree from an accredited college or university preferred. • Five (5) years of claims management experience or equivalent combination of education and experience required. • Jurisdiction Knowledge Southeast States, North Carolina Licensing NC, reciprocals Benefits • Flexible work schedule. • Referral incentive program. • Opportunity to work in an agile environment. • Career development and promotional growth opportunities. • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. Apply To this Job