Workers' Compensation Claims Examiner

Our client is a leader in commercial and personal underwriting, with a reputation for earning customer confidence that extends around the world. With solid profitability and financial stability, our client was given the highest rating by A.M. Best, an A++ in a Category XV.

They are an innovative company ahead of its time. With a basic philosophy of establishing customer confidence and satisfaction in all aspects of its business, the Company continues to develop new products and services as it strives to contribute to the affluence, comfort and economic development of society by providing safety and protection.


Job Summary:
Workers' Compensation Claims Examiner is responsible for coverage verification, investigation, damage assessment, evaluation, negotiation and resolution of workers compensation claims. Accountable for proper payout and quality of claim files.

Essential Job Functions:

1. Contact and establish a rapport with customer, injured party or property owner to obtain information. Comply with 24-hour contact requirements.

2. Obtain all relevant facts to determine coverage and compensability on claims files.

3. Determine and analyze benefits owed under various state WC Acts.

4.Utilize and manage experts to determine facts and exposure, ensuring that the value of the service is greater than the cost.

5. Handle litigated claims, and work as a partner with the defense counsel to ensure that legal resources are used to obtain the best resolution on the claim.

6. Evaluate information to assess proper resolution of claims to determine appropriate and fair payout.

7. Negotiate settlement based upon strategies and plans that ensure appropriate fair settlement of the claims.

8. Provide customer satisfaction by establishing a rapport with customers and by resolving issues.

9. Comply with Quality Validation, TAACC instructions, Customer Service Manual, Information Security procedures and our client's SIU program.

10. Determine subrogation and subsequent injury fund potential of claims.

11. Utilize mediation, settlement conferences and alternate dispute resolution (ADR).

12. Communicate and work with both internal and external customers.

13. Establish and monitor indemnity and expense reserves on claim files.

Other Job Functions:

1. Other special projects as assigned.
2. Keep abreast of important developments in tort and insurance law.
3. Attend training sessions.

Taub & Associates/Taub's Temps is a mother/daughter, executive search firm and temporary agency. With a combined experience of over 45 years in placing personnel both temporarily and direct hire within our insurance industry, we maintain a close working relationship with our candidates as we perform the essential elements of successful searches. When you speak with anyone at Taub, you will feel like one of the family!
REQUIREMENTS
Qualifications For Position:

- Four-year college degree required
- FIVE years workers compensation claims experience required, including litigated claim handling – California-specific experience required!
- Ability to negotiate workers' compensation claims
- Computer knowledge, especially Microsoft Word and Excel

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