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Cynet Systems · 8 hours ago

Claims Examiner – Workers Compensation - Remote / Telecommute

United States

Full-time

Remote

Senior Level

$47/hr - $52/hr

5+ years exp

Cynet Systems is seeking a Claims Examiner to analyze, manage, and resolve complex workers’ compensation claims. The role involves conducting thorough investigations, evaluating exposure, and ensuring timely and accurate processing while maintaining compliance with applicable laws and service expectations.

EmploymentRecruitingStaffing Agency

Growth Opportunities

Responsibilities

Analyze and process complex workers’ compensation claims by investigating and gathering information to determine claim exposure and drive timely resolution

Negotiate claim settlements within designated authority

Calculate and assign appropriate reserves and manage reserve adequacy throughout the claim lifecycle

Calculate, approve, and issue benefit payments and claim adjustments in a timely manner

Prepare required state filings within statutory limits

Manage the litigation process to ensure timely and cost-effective resolution

Coordinate vendor referrals for investigation and litigation management

Apply cost containment techniques and manage vendor partnerships to reduce overall claim costs

Manage claim recoveries including subrogation, second injury fund recoveries, and Social Security and Medicare offsets

Report claims to excess carriers and respond to requests in a professional and timely manner

Communicate claim activity with claimants and clients while maintaining professional relationships

Ensure claim files are properly documented and coded

Refer cases to supervisors and management when appropriate

Perform additional duties as assigned, support quality programs, and travel as required

Qualification

Workers' compensation claimsInsurance principlesNegotiation skillsClaims management experienceMicrosoft OfficeAnalytical skillsCommunication skillsInterpersonal skillsOrganizational skills