Workers Compensation Claims Examiner Services

The organization seeks a vendor to provide workers compensation claims examiner services. The role involves supporting the association through collaboration with division or program staff, interacting with local governments and authorities, and demonstrating a comprehensive understanding of the association’s programs and services. Exceptional customer support is expected, reflecting positively on the entire association.

Responsibilities include initiating initial investigations for newly assigned insurance claims, confirming coverage, and contacting relevant parties such as members, non-represented claimants, attorneys, and injured employees to gather and provide information. The examiner will determine compensability and liability, conduct on-site investigations, complete statements, and set and adjust claim reserves as required. They will also review medical and rehabilitation notes, approve bills for processing, submit reports to excess carriers for substantial losses, and maintain thorough documentation of all action plans.

Additionally, the examiner must respond promptly to inquiries from members, injured employees, vendors, case managers, legal representatives, and medical providers, ensuring timely and effective communication throughout the claims management process.