Workers' Compensation Claims Manager manages accountabilities in the administration of first and third party worker's compensation claims. Manages domestic and/or international claim management strategies critical to the organization's success. Being a Workers' Compensation Claims Manager is responsible for reporting, investigation, and analysis; litigation management; resolution/outcome management; and the delivery of claim information. Manages litigated and moderately complex claims and is entrusted with significant settlement authority. Additionally, Workers' Compensation Claims Manager creates and develops relationships with claims adjusters, insurers, outside legal counsel, and other claims related parties. Directs workers' compensation claims policies and procedures within the claim information analysis. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Workers' Compensation Claims Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Workers' Compensation Claims Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Job Title: Claims Examiner - Workers Compensation
Location: Memphis, TN (REMOTE)
Work Hours: TBA
Benefits: Medical Insurance, Dental Insurance, Vision Insurance, 401K
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Analyzes and processes complex or technically difficult workers' compensation 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.
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 fillings 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 but 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).
Travels as required.
QUALIFICATION
Education & Licensing
Experience
Skills & Knowledge