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Penser North America’s Self Insured
Workers Compensation department, located in Lacey, Washington has an opening
for a Claims Examiner. This is a non-union, salaried, administrative, full time
position for self-insured Workers compensation claims handling at this Third
• 2 year college degree or equivalent experience
• 3-5 years Workers Compensation claims experience
• Must possess working knowledge of applicable workers Comp laws, rules and regulations.
• Strong investigative, decision making and problem solving abilities.
• Excellent oral and written communications skills.
• Superior analytical and negotiation skills.
• Computer proficiency with basic claims system and Microsoft Office.
• Washington Self Insurance certification is preferred.
• Detail oriented, organized individual with the ability to work in team environment
• Ability to multi-task, meet tight deadline and shift priority workloads
• High degree of integrity and confidentiality required
• Must be self-motivated, detail oriented and able to maintain current diaries
• Familiarity with medical codes,
terminology, medical aid rules and fee schedule
• Ability to set and adjust reserves, monitor and manage third party claims, and vocational rehabilitation claims
KEY RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO:
•Investigate, evaluate, and adjudicate Workers compensation claims to their conclusion.
• Coordinates referrals and manage, Nurse Case managers, Vocational rehab, and attorneys
• Calculate time loss and ensure timely and accurate delivery of benefits to injured workers.
• Review provider billing for payment, investigate and respond to inquiries from providers.
• Maintain communication with injured workers, employers, medical providers.
• Manage litigated cases, answer legal requests, attend hearings, and mediations.
• Manages claim recoveries, including Second Injury Fund, excess recoveries and Social Security offsets
• Reports claims to the excess carrier; responds to requests for information in a professional and timely manner
• Maintain correct and adequate documentation of claim management in claim system.
SALARY: Salary will be commensurate with experience qualifications.
CorVel is a national provider of industry-leading workers' compensation solutions for employers, third party administrators, insurance companies, and government agencies. Our continual investments in technology and human capital enable us to deliver the most innovative, integrated solutions. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities.
Manage within company standards and best practices complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim.
- Receives claim, confirms coverage and acknowledgement of the claim
- Determine validity and compensability of the claim by investigating and gathering information regarding the claim and the file necessary documentation with the State of Washington
- Establish reserves and authorize payments within reserving authority limits
- Develop and manage well documented action plan with the case manager, attorney, supervisor and client to reduce overall cost of the claim
- Coordinating early return-to-work efforts with the case manager and employer
- Negotiates settlements when necessary
- Actively manage the litigation process
- Identifies potential subrogation claims
- Communicate claim status with the customer and claimant
- Adhere to client guidelines and participate in claims review as needed
- Develops and maintains professional customer relationships
Education, Knowledge & Skills
- Excellent oral and written communication skills
- Effective analytical and interpretive skills
- Strong organizational skills
- Great interpersonal skills
- Ability to work in a team environment and independently
- Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation for the State of Washington
- Thorough knowledge of appropriate insurance principles and laws for workers' compensation recoveries and offsets
- Five years of Workers' Compensation claims management experience preferred
- Washington State Experience required