Title: Claims Examiner
Location: Lake Mary, FL 32746
Duration: Direct Hire
HIRING MANAGER NOTES:
· 5 years of Florida workers’ comp experience or longer
· Person should be licensed in FL
· Heavy Litigation experience
· Should have job stability
· Telecommute is an option however they will have to come onsite for training. Also, the candidate has to be in the state of FL.
To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
· Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
· Assesses liability and resolves claims within evaluation.
· Negotiates settlement of claims within designated authority.
· Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
· Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
· Prepares necessary state filings within statutory limits.
· Manages the litigation process; ensures timely and cost effective claims resolution.
· Coordinates vendor referrals for additional investigation and/or litigation management.
· Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
· Manages claim recoveries, including be not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
· Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
· Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
· Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management.
ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:
· Performs other duties as assigned.
· Supports the organization's quality program(s).
· Travel as required
Education & Licensing:
· Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
· Four (4) years of claims management experience or equivalent combination of education and experience required.