Cynet Systems ยท 1 month ago
Claims Examiner - Workers Compensation - Remote / Telecommute
United States
Full-time
Remote
Senior Level
$35/hr - $40/hr
5+ years expCynet Systems is a company specializing in claims management, and they are seeking a Claims Examiner for Workers Compensation. The role involves analyzing and processing complex claims, negotiating settlements, and managing the claims lifecycle to ensure timely and cost-effective resolutions.
EmploymentRecruitingStaffing Agency
Responsibilities
Analyzes and processes complex workers' compensation claims
Investigates claims and determines exposure
Develops and executes action plans to ensure timely claim resolution
Negotiates claim settlements within designated authority
Assigns and manages reserves throughout the claim lifecycle
Calculates and pays benefits and approves adjustments
Prepares required state filings within statutory limits
Manages the litigation process to ensure cost-effective claim resolution
Coordinates vendor referrals for investigations and litigation management
Uses cost containment techniques to reduce overall claim costs
Manages claim recoveries including subrogation and fund recoveries
Reports claims to excess carriers and responds to inquiries promptly
Maintains communication with claimants and clients
Ensures proper documentation and coding of claim files
Refers cases to supervisors or management as needed
Supports the organization's quality programs
Performs other duties as assigned
Travels as required
Qualification
Required
Five years of claims management experience or an equivalent combination of education and experience
Strong knowledge of insurance principles, laws, recoveries, offsets, and claim duration
Understanding of cost containment principles and medical management practices
Knowledge of Social Security and Medicare procedures relevant to the line of business
Excellent oral and written communication skills
Proficiency in Microsoft Office
Strong analytical and interpretive skills
Strong organizational and interpersonal skills
Excellent negotiation skills
Ability to work effectively in a team environment
Ability to meet or exceed service expectations
Preferred
Bachelor's degree preferred
Professional certification applicable to the line of business preferred
Bachelor's degree preferred
Professional certifications relevant to the role preferred
Company
Cynet Systems
Headquartered in Washington DC Metro Area, Cynet Systems is a top talent supplier for companies across North America.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ashwani (Ash) M.
Partner and Co-CEO
Nikhil "Nick" Budhiraja
Founder / Co-CEO
Company data provided by crunchbase