Experienced Claims Examiner

This posting is scheduled to close on December 4th at 12:59pm. If a sufficient number of qualified applications are received this posting may close early. Apply today!

About the job:

The Claims Examiner is a highly professional and customer-focused position responsible for the independent management of a diverse caseload of workers compensation claims encompassing both indemnity and medical-only files. This role is expected to execute end-to-end claim strategy from initial investigation to timely resolution ensuring all activities adhere rigorously to MSF Claim Guidelines and industry Best Claim Practices. While operating with defined settlement and reserve authority the Claims Examiner progresses in subject matter expertise and autonomy taking on increasingly complex cases advanced strategic functions and mentorship opportunities as experience grows.

Required Skills

What you will do:

• Claim Adjudication and Financial Management: Investigates evaluates negotiates and resolves all assigned claims executing a documented strategy to achieve timely resolution in full accordance with Montana Code Annotated (MCA) established guidelines and industry Best Claim Practices. Calculates and authorizes medical and indemnity benefits within assigned limits and according to Montana Code Annotated Analyzes liability issues and complex risk exposure to properly set maintain and annually update claim reserves. Proactively manages the daily claim diary to ensure continuous progression and maintains thorough documentation by obtaining all pertinent claim file documents and utilizing internal reports to track expenditures.
• Expert Resource and Complex Case Coordination: Coordinates directs and manages the strategic assignment of necessary expert resources for claim management including legal counsel nurse case management vocational rehabilitation and primary care providers. Investigates and evaluates all potential catastrophic claims. Participates in large loss and catastrophic claim meetings to review case progression advise on strategy review reserve adequacy and recommend resources ensuring all plans of action are documented and presented to designated claim experts.
• Stakeholder Relations and Compliance: Maintains excellent stakeholder communication and customer relations demanding prompt responses to injured worker and policyholder inquiries and adequately explaining the workers compensation claim process in lay terms. Establishes and maintains productive working relationships with internal staff and external partners (attorneys medical providers and vendors). Ensures strict compliance including the appropriate handling of confidential information according to MSF policies and continuously seeking and applying claim management feedback in support of continuous improvement.
• Professional Development and Collaboration: Actively participate in professional meetings assigned tasks and MSF projects. This includes demonstrating professional communication behaviors and customer service skills with both internal and external customers. You may also be assigned other responsibilities by Claims Leadership or Executive Leadership.
  
  

Claims Examiner II Advanced Responsibilities (Above CE I)

• Mentorship and Strategic Guidance: Provides mentorship and oversight offering claim expertise policy oversight coaching and strategic guidance to lower-level claim examiners and peers either as part of a formal program or informally as requested by the Claims Manager. This requires the ability to present feedback and strategic recommendations in a positive and constructive manner.
• Strategic Account Management: Identifies policyholder trend analysis and mitigation opportunities and performs necessary activities to address negative claim trending and meet policyholder needs regarding claim and/or policy management. Establishes and maintains positive working relationships with assigned accounts and manages customer relations at a higher strategic level.
• Advanced Litigation and Project Involvement: Provides crucial litigation support by attending mediations depositions and court appearances and assisting in the development of mediation and litigation management for their own files and those of junior staff. Leads company-wide project efforts requiring participation in assigned initiatives tasks and projects with an emphasis on achieving team and organizational goals. Lastly the examiner proficiently runs and utilizes advanced position-specific reporting to analyze claim data for performance monitoring and strategic planning.

Required Experience

What you will need (minimum qualifications):

To be considered for this role youll need to meet the following criteria:

• High School diploma or GED and two (2) years of workers compensation indemnity work experience to include a minimum of one year of Montana workers compensation indemnity work experience
  • OR a graduate of MSF Claims Examiner Training Program
• Must have current active Montana Claims Examiner Certification.
  • OR if currently holding a similar certification in another state must obtain Montana Workers Compensation Certification within 6 months of hire.
• Must reside in the state of Montana

Preferred

• Bachelors degree
• Relevant designations and certifications
• Complete of one of the AIC or AINS course series