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Vaco Nashville

Workers Compensation Claims Examiner

Industry: Insurance

Location: Eden Prairie, Minnesota

Date Posted: June 20, 2013

PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

1. Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. 2. Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. 3. Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract. 4. Manages subrogation of claims and negotiates settlements. 5. Communicates claim action with claimant and client. 6. Ensures claim files are properly documented and claims coding is correct. 7. Maintains professional client relationships.

QUALIFICATIONS:

Education & Licensing: Baccalaureate degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Experience: Four (4) years of claims management experience required.

Skills & Knowledge:

In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business. Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products
Analytical and interpretive skills Strong organizational skills
Excellent negotiating skills Good interpersonal skills

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