Claims Examiner (NE)

Dublin, Ohio
Not Specified
Apr 17, 2018
Jun 16, 2018
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

Analyze workers compensation claims in order to produce a plan of action that will yield the best financial outcome for the customer.

Initiate and implement workers compensation cost control strategies for a designated group of employers within preset guidelines. Cost control strategies include:
Claim documentation
Salary continuation
Light duty or transitional work
Lump sum settlement
Handicap reimbursement
Independent medical examinations
Awareness of BWC discount programs
Vocational rehabilitation
Demonstrate excellent oral and written communication skills with both internal and external customers on a daily basis.
Maintain customer satisfaction by frequently updating and educating employers on claim status and strategy. Occasional face-to-face meetings required.
Build relationships with attorneys, MCO personnel, and BWC personnel.
Explain specific claim issues to internal Rates Department staff so they can reply with an accurate actuarial analysis.
Delegate tasks to claim assistants with clear instructions.
Maintain accurate records regarding details of customer contact.
Handle time-sensitive documents, phone calls, and tasks accurately and efficiently.
Appeal BWC and IC orders within established timeframes.
Return phone calls and emails within one business day.
Complete daily tasks on system generated agenda.
Thoroughly prepare claims for hearing on a weekly basis.
Complete multiple action requests from Account Executives within one month.
Monitors and maintains compliance with federal laws and rules, workers compensation laws and rules, and BWC contract requirements as applicable to areas of responsibility
Identify areas for quality improvement and make recommendations to supervisor
May be required to perform other job-related tasks other than those specifically presented above

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