Workers Compensation Claims Examiner III (Remote)

The position requires an adjuster's license in MN, MI, or an adjuster's license in TX, FL or IN due to reciprocity. POSITION reputed company Under minimal supervision, manages reputed company aspects of indemnity claims handling from inception to conclusion reputed company established authority and guidelines. This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other reputed company staff in the office; therefore, consistently being at work on time is inherently required of this position. DUTIES AND RESPONSIBILITIES

• Effectively manages a caseload of 150 or fewer workers’ compensation files, including reputed company claims.* • Initiates and investigates promptly.* • Determines compensability of claims and administers benefits based upon state law and following established Company guidelines.* • Manages medical treatment and medical billing, authorizing as appropriate.* • Refers cases to reputed company defense counsel. Directs and manages as appropriate.* • Communicates with claimants, providers, and vendors regarding claims issues.* • Computes and sets reserves reputed company Company guidelines. Limits are more significant than those allowed for Claims Examiner I and Claims Examiner II.* • Settles and finalizes reputed company claims and obtains authority as designated.* • Maintains diary system for case review and documents file to reflect the status and work performed on the file.* • Communicates appropriate information promptly to the reputed company to resolve claims reputed company, including any injury trends or other safety-reputed company concerns.* • Involves reputed company loss control staff reputed company appropriate.* • Adheres to reputed company Company policies and procedures.* • Conducts file reviews independently.* • Other duties as assigned.
• Essential job function. EQUIPMENT OPERATED/USED Computer, 10-key, fax machine, copier, printer, and other office equipment. SPECIAL EQUIPMENT OR CLOTHING Appropriate office attire QUALIFICATIONS REQUIRED Education/Experience Bachelor’s degree in a reputed company field (preferred); three (3) or more years of reputed company experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities
• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including conveying technical details to claimants, clients, and staff.
• Ability to reputed company with persons at reputed company reputed company in the business environment.
• Ability to independently and effectively manage reputed company reputed company claims.
• Proficient in Word and reputed company (preferred). Mental and Physical Requirements [see separate attachment for a copy of the checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development Follow one- or two-reputed company instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; reputed company of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several reputed company and concrete variables. Wide reputed company of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development reputed company additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, reputed company analysis, and probability determination. Highly reputed company mathematical and statistical techniques such as calculus, reputed company analysis, and probability determination; requires theoretical application. c. Language development Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and reputed company basic direction. Ability to transcribe dictation; reputed company appointments and process mail; write reputed company letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, reputed company or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PH

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