Claims Examiner - Perm
The Judge Group Inc.

Sandy Springs, Georgia


Location: Sandy Springs, GA
Description:
Role: Claims Examiner

Location: Atlanta, GA - Remote Opportunity

Fulltime Opportunity

Minimum Degree Required: Bachelor's Degree

Responsibilities:

  • WC position 6 years minimum experience, handling lost time claims.
  • Resident State Adjusters license in addition to any other experience they have handling the southeast states. NC, SC, GA, VA, AL, TN, MS, FLA.
  • Experience should include handling the claims from start to finish, to include investigating and determine compensability on IN claims, handling minor IN claims in addition to litigation, fatalities, Catastrophic Injury claims, etc. including completing reports to carrier and possibly the client. Can
  • Telecommute for candidate who has multiple state experience as indicated above.
  • Analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

NOTE:

Credit security clearance, confirmed via a background credit check, is required for this position.

  • Analyzes and manages complex or technically difficult 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.
  • Assesses liability and resolves claims within evaluation.
  • 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 filings 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 be 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.

EXPERIENCE:

  • Four (4) years of claims management experience or equivalent combination of education and experience required.

EDUCATION:

  • Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Contact: pkathuria@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com



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