Claims Examiner Trainee

RESPONSIBILITIES

• Completes classroom training introducing workers’ compensation claims handling strategies, medical terminology, and legal concepts.
• Learns skills such as investigative and persuasive communication, negotiation, decision-making, and strategic planning. Learns to review and interpret medical records.
• Conducts and directs the investigation of reported claims to determine coverage, compensability and severity and to gather all other relevant information, including making three-point contact telephone calls.
• Calculates appropriate reserves for each claim and ensures that reserves are adjusted as needed per authority guidelines.
• Develops and updates a plan of action for the successful resolution of each claim.
• Assigns appropriate tasks to a Claims Assistant and/or Claims Clerical Assistant and ensures they are performed correctly and efficiently.
• Reduces fraud through early identification and escalation.
• Communicates effectively with individuals outside the company, including clients, medical providers, and injured workers.
• Prepares timely and accurate settlement recommendations (within designated authority parameters) and effectively negotiates the settlement of claims.
• Ensures that the actions of all other professionals involved in managing a claim, including attorneys, nurse case managers, and investigators, are coordinated to achieve a successful resolution of the claim.

WHAT YOU'D BRING TO THE ROLE

• Minimum of High School Diploma or equivalent certificate required; Bachelor’s degree from four-year college or university is preferred
• Ability to communicate effectively verbally and in writing; Spanish Fluency ability preferred
• Exceptional interpersonal and customer service skills
• Ability to manage and prioritize multiple assignments in a fast-paced environment
• Strong organization skills to ensure tasks are completed within hard deadlines
• Basic mathematical skills to calculate monetary reserves
• Knowledge of Microsoft Word, Powerpoint, Excel, Outlook

WHY YOU SHOULD APPLY

• Unparalleled financial strength and stability
• Fantastic growth and advancement opportunities
• WFH Hybrid schedule
• Free gym in building
• Generous Paid Time Off and Holidays
• Excellent Benefits (Medical, Dental, Vision, 401k, etc)
• Health and Wellness Reimbursement
• Tuition Assistance Reimbursement
• Discounts across companies such as GEICO, See’s Candies, etc.