Workers Comp Claims Examiner

We are seeking a detail-oriented and experienced Senior Claims Examiner to join our dynamic team. In this role, you will be responsible for managing and evaluating complex claims, ensuring compliance with applicable laws and regulations, and providing exceptional customer service. The ideal candidate will possess a strong understanding of workers' compensation law and demonstrate excellent analytical skills to effectively assess claims and prevent fraud.

Responsibilities

• Review and analyze claims to determine eligibility and appropriate compensation based on established guidelines.
• Negotiate settlements with claimants and other stakeholders to achieve fair resolutions.
• Utilize financial software to track claims processing and maintain accurate records.
• Conduct thorough investigations into potential fraudulent claims, employing fraud prevention detection techniques.
• Provide exceptional customer service by addressing inquiries and concerns from claimants in a timely manner.
• Collaborate with legal teams to ensure compliance with workers' compensation laws and regulations.
• Maintain organized documentation of all claims activities, ensuring easy access for audits or reviews.
• Stay updated on industry trends, changes in legislation, and best practices related to workers' compensation.

Skills

• Strong knowledge of workers' compensation law and regulations.
• Excellent customer service skills with the ability to communicate effectively with diverse stakeholders.
• Proven negotiation skills to facilitate settlements in a professional manner.
• Exceptional organizational skills to manage multiple claims efficiently.
• Proficiency in financial software for tracking and managing claims data.
• Experience with auto estimating processes is a plus.
• Strong analytical skills to evaluate complex information and make informed decisions.
• Knowledge of fraud prevention detection methods is highly desirable.