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Examiner Senior Workers Compensation Claims (Salary)

Company: York Risk Services Group
Location: Birmingham
Posted on: July 14, 2019

Job Description:

At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. That's why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

JOB SUMMARY:

The Senior Workers Compensation Claims Examiner investigates claims to determine an injured worker's entitlement to Workers' Compensation benefits. He/she administers indemnity and medical benefits for valid Workers' Compensation claims and manages a caseload of claims from inception to closing or settlement. He/she assists Unit Manager with mentoring new claims examiner and/or supervisory functions.

ESSENTIAL JOB RESPONSIBILITIES:


  • Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision on the claim
  • Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
  • Directs assistant to properly pay indemnity benefits payments and Awards. Issue state-mandated benefit notices within the required timeframes
  • Annotates, categorizes and addresses incoming mail on a daily basis
  • Responding to questions and requests from the client

    SUPERVISORY RESPONSIBILITIES:

    SUPERVISION RECEIVED:

    • This position reports to the Unit Manager

      SUPERVISION EXERCISED:

      • NA

        QUALIFICATIONS:

        EDUCATION:

        • BS / BA or Equivalent Work Experience

          EXPERIENCE:

          • 5 to 8 years

            SKILLS/ABILITIES:

            • Ability to prioritize multiple tasks and meet deadlines
            • Excellent written and verbal skills
            • Excellent customer service skills

              KNOWLEDGE:

              • Workers' Compensation law; policies and procedures
              • Medical and legal terminology, Integration with Medicare

                ROUTINE DECISIONS AND FORMAL POLICY SETTING:

                Decisions routinely made include:

                • Analyzes information gathered from all sources to determine whether to accept, delay or deny a claim.
                • Analyzes medical reports to determine whether benefits are due or make settlement recommendations to the client.
                • Determines when an activity check or sub rosa would be warranted based on red flags noted on the claim.

                  Policy setting:

                  • No formal responsibility; Policies associated with the job's purpose and essential responsibilities are set by others.

                    The intent of this job description is to describe the major duties and responsibilities performed by incumbents of this job. Incumbents may be required to perform job-related tasks other than those specifically presented in this description.

                    All duties and responsibilities are essential job functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.Apply Now!

Keywords: York Risk Services Group, Birmingham , Examiner Senior Workers Compensation Claims (Salary), Other , Birmingham, Alabama

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