WC Claims Examiner

Job Summary:

Investigate workers compensation claims as assigned by claims supervisor determine compensability of claim and liability based upon facts applicable negligence laws case law and statutes. Responsible for managing workers compensation claims as assigned by claims supervisor. Investigates claims. Determines the compensability of the claim and extent of liability. Communicates directly with clients employers injured workers physicians and attorneys to bring claims to a timely conclusion.

Essential Duties and Responsibilities: Other duties may be assigned.

• Interviews telephones or corresponds with claimant and witnesses consults police and hospital records.

• Documents all information from contacts with employers claimants physicians and attorneys into the claims management system and ensures that documentation is current.

• Reviews claims submissions for thoroughness and accuracy.

• Determines compensability of claims through information gathered and according to workers compensation statutes; makes recommendations as to compensability and coverage of claims.

• Provides guidance and advice to clients on direction of claims after all information has been gathered and analyzed.

• Ensures jurisdictional filings are complete and timely.

• Obtains pre-certification approval for specific treatments as needed.

• Reviews bills and medical notes; authorizes and codes bills.

• Attends seminars and meetings as needed to stay abreast of current industry knowledge.

• May attend mediations hearings trials or other legal proceedings.

• Processes medical -only workers compensation claims involving minor injuries and/or payment.

Qualifications:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required.

• Education and/or Experience: A High School degree or equivalent is required. At least two years college credit from a four-year college or university; or an Associates degree from a two-year college; or an Associate in Claims designation from the Insurance Institute of America is preferred. This position requires a minimum of two years of workers compensation claims handling experience client services skills and/or training.

• Certificates Licenses Registrations: Georgia Claims Adjuster license(s) as mandated by applicable state(s) are required. Current valid drivers license is required.

• Language Skills: The position requires the ability to read analyze and interpret common technical journals financial reports and legal document as well as the ability to respond to common inquiries or complaints from customers state agencies or members of the business community. The employee must have the ability to effectively present information to management employers boards of directors and other committees and have the ability to effectively interview claimants and other interested parties. The employee must have the ability to give presentations and attend client in-services. The employee must have the ability to communicate effectively through written correspondence.

• Mathematical Skills: Employee must have the ability to work with mathematical concepts and apply concepts such as percentages fractions rations and proportions to practical situations.

• Reasoning Ability: Employee must have the ability to define problems collect data establish facts and draw valid conclusions; ability to interpret a variety of technical instructions and deal with several variables; ability to effectively negotiate claim settlements.

Candidates should be comfortable with an on-site presence to support collaboration team leadership and cross-functional partnership.

Why Join Us:

At Acrisure were building more than a business were building a community where people can grow thrive and make an impact. Our benefits are designed to support every dimension of your life from your health and finances to your family and future.

Making a lasting impact on the communities it serves Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Childrens Hospital in Grand Rapids Michigan UPMC Childrens Hospital in Pittsburgh Pennsylvania and Blythedale Childrens Hospital in Valhalla New York.

Employee Benefits

We also offer our employees a comprehensive suite of benefits and perks including:

• Physical Wellness: Comprehensive medical insurance dental insurance and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.

• Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.

• Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.

• Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.

• and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.

Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race color religion sex national origin disability or protected veteran status. Applicants may request reasonable accommodation by contacting .

California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.

Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.

Welcome your new opportunity awaits you.