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Examiner Claims Workers Compensation

Posted about 1 month ago

Terrific Opportunity!
Title: Examiner Claims Workers Compensation
Location: Phoenix, AZ 85029
Term: 3 Months Contract

Day-to-Day Responsibilities:
  • Reviews, examines, investigates, analyzes and resolves workers’ compensation claims
  • Develops strategic action plans to bring claims to prompt and equitable resolution
  • Identifies key interested parties and obtains recorded statements as necessary
  • Assesses witnesses’ credibility
  • Analyzes and resolves conflicts in the evidence.
  • Determines claim compensability based on witness statements and other evidence
  • Establishes appropriate reserve levels based on his/her estimate of financial exposure and updates reserves upon receipt of new information within the even greater financial authority afforded to Senior Workers Compensation Claims Examiners
  • Accepts or delays claims and makes recommendations to the manager regarding claim denials
  • Accurately determines average weekly wages and workers’ compensation benefit rates and pays benefits timely
  • Directs Claims Assistant(s) to issue notices and makes payments in accordance with state-mandated requirements
  • Interacts with injured employees to ensure awareness and understanding of the workers’ compensation process, requirements and statutory benefits
  • Coordinates medical treatment for injured employees and interacts with medical providers regarding employee’s medical history and job requirements
  • Assesses subrogation potential and pursues reimbursement
  • Negotiates claim settlements within established limits
  • Weighs the costs and benefits of going to trial versus entering into a settlement and chooses the most effective option
  • Presents the settlement recommendations to the client(s) if required
  • Independently resolves liens without defense attorney involvement
  • Serves as a liaison between medical providers, claimants, legal professionals, and clients
  • Informs clients of injured employees’ work restrictions and coordinates appropriate accommodations
  • Reviews medical reports to ensure that the appropriate American Medical Association (AMA) guidelines have been applied when rating permanent impairment
  • Communicates with defense attorneys and clients on litigated cases and develops strategies for claim resolution

Litigation Management:
  • Decides when to retain counsel
  • Develops litigation strategy with counsel
  • Supervises the litigation process
  • Prepares or reviews legal documents for submission to the Workers’ Compensation Board
  • Manages all discovery requests by the defense attorney
  • Attends and participates in hearings when requested
  • Audits incoming invoices and/or bills for accuracy and appropriateness
  • Processes treatment requests in line with applicable state mandated Utilization Review standards.
  • Coordinates with field investigators when conducting compensability, subrogation or subrosa investigations
  • Prepares claim status reports and presents to clients
  • Complies with excess insurance reporting requirements and seeks reimbursement where appropriate
  • Seeks reimbursement from codefendants or subsequent injury funds
  • Identifies and reports all suspected fraudulent activity to the appropriate authorities and/or state agencies
  • Complies with Medicare Set Aside obligations
  • Stays abreast of applicable laws, new trends, pending legislation and case law related to workers’ compensation
  • Manages outgoing payments in a timely manner
  • Maintains the required continuing education hours where applicable
  • Effectively manages client and other communications and maintains claim notes and status reports timely and accurately
  • Annotates, categorizes and addresses incoming mail and/or facsimiles on a daily basis
  • Performs other related duties as required

Is this a good fit? (Requirements):
  • BS/BA or Equivalent Work Experience
  • Professional certification and/or adjusting license as required by the State(s)
  • 2 to 5 years of relevant experience

If this sounds like the perfect fit, Apply Today!