Workers Compensation Claims Examiner
Job Description
HOURS: Full-Time
DURATION: Direct Hire
WORKPLACE: Hybrid: 3 days remote and 2 days in office
PAY: $85,000 to $95,000
BENEFITS: Full comprehensive benefits package including medical, dental, vision, and PTO.
Responsibilities:
- Manage a caseload of 125 to 150 workers' compensation indemnity claims, including complex files.
- Handle workers' compensation claims from inception through conclusion within established authority and company guidelines.
- Investigate claims promptly and determine compensability in accordance with Pennsylvania and New Jersey workers' compensation laws.
- Administer indemnity benefits and manage medical treatment and medical billing.
- Refer claims to defense counsel and oversee litigation activities as appropriate.
- Communicate effectively with claimants, employers, medical providers, attorneys, vendors, and clients regarding claim status and resolution.
- Establish and maintain appropriate claim reserves within company authority guidelines.
- Negotiate, settle, and finalize claims while obtaining proper settlement authority.
- Maintain accurate claim documentation and diary management to ensure timely follow-up and file handling.
- Provide clients with timely updates, including injury trends and safety-related concerns.
- Partner with loss control staff when appropriate to support claim resolution.
- Conduct independent file reviews while ensuring compliance with company policies and procedures.
- Perform other duties as assigned.
- Bachelor's degree in a related field preferred.
- Minimum of 3+ years of workers' compensation claims handling experience or an equivalent combination of education and experience.
- Experience handling Pennsylvania and New Jersey workers' compensation claims is preferred.
- Strong knowledge of workers' compensation statutes, regulations, and medical terminology.
- Ability to independently manage a high-volume, complex workers' compensation caseload.
- Strong analytical, organizational, and decision-making skills.
- Excellent verbal and written communication skills with the ability to explain technical claim information clearly.
- Ability to build and maintain professional relationships with clients, claimants, attorneys, medical providers, and internal staff.
- Proficiency in Microsoft Word and Excel is preferred.
- Ability to work independently while managing multiple priorities in a fast-paced environment.
Meet Your Recruiter
Account Manager
Since joining SDI Staffing in 2022, Nancy has demonstrated a strong aptitude for talent acquisition and client relations. She initially started as a Recruiter and has successfully transitioned into the role of an Account Manager. She has a deep passion for aiding candidates in their career journeys and takes great satisfaction in collaborating with clients to secure ideal candidates to add to their teams. Nancy's extensive knowledge in both Personal and Commercial Lines insurance, particularly with captive carriers, enables her to provide exceptional service. She works closely with clients to understand their specific needs and consistently delivers the perfect match for their offices.
In her free time, Nancy enjoys working out, trying out new restaurants, and spending time with her family.