Job description
Workers' Compensation Claims Examiner
Remote, HI
*This is a Full time, Benefits Available, Work-From-Home flexible, DIRECT HIRE opportunity!*
*** MUST RESIDE IN HI ***
Workers' Compensation Claims Examiner Duties:
Workers' Compensation Claims Examiner Background:
Remote, HI
*This is a Full time, Benefits Available, Work-From-Home flexible, DIRECT HIRE opportunity!*
*** MUST RESIDE IN HI ***
Workers' Compensation Claims Examiner Duties:
- Effectively manages an active caseload of 150 workers’ compensation files, including fairly complex claims.
- Initiates and conducts claims investigation in a timely manner.
- Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.
- Manages medical treatment and medical billing, authorizing as appropriate.
- Communicates with claimants, providers and vendors regarding claims issues.
- Computes and set reserves within Company guidelines.
- Maintains diary system for case review and document file to reflect the status and work being performed on the file.
- Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.
- Adheres to all Company policies and procedures.
- Participates in file reviews, as needed.
- Other duties as assigned.
Workers' Compensation Claims Examiner Background:
- Valid HI Workers' Compensation Claims Adjuster License.
- High School Diploma/GED; Bachelor's degree preferred.
- 5 years of recent direct Workers' Compensation Claims processing experience.
- 5 years of recent Lost Time claims processing experience.
- Analytical skills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
- Ability to interact with persons at all levels in the business environment.
- Proficient in Word and Excel (preferred).
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