Claims Examiner I

Responsible for assigned indemnity cases from inception to resolution and assigning appropriate tasks to the Claims Assistant.

- Conduct 3-point contact within 24 hours

- Establish initial reserves within 24 hours and modify as appropriate based on fact findings during 3-point contact

- Authorize daily benefit payments based on medical facts and workers? compensation administrative laws

- Evaluate facts and develop a proactive plan of action to resolve claims expeditiously

- Manage legal process on litigated cases including, but not limited to, directing the appointed attorney, conduct witness interviews, and provide expert testimony

- Oversee vocational rehabilitation process to ensure proper dispersal of monies and guideline adherence

- Settle cases promptly and equitably based on medical facts and a cost-benefit analysis utilizing the Examiner?s past experience

- Manage diary system to assure timely benefit administration and superior claims management

- Maintain communication with clients and producers via telephone, written correspondence and occasional claim review meetings to resolve ongoing issues and disputes

Requirements:

College degree preferred or equivalent work experience.

Must have excellent communication skills, both written and oral, with a strong customer service perspective. Must have the ability to gather and present claim facts to vendors, clients and management.

Must have excellent organizational and problem-solving skills. Must have the ability to work independently and the ability to maintain a positive work atmosphere in an environment of rapidly changing priorities. This position description outlines the general nature of the position and it is not designed to include all duties and responsibilities performed by people assigned to this position.

Equal Opportunity Employer