Senior Workers' Compensation Claims Examiner

DecisionHR is a Professional Employer Organization (PEO) located in St Petersburg, FL. Since our inception in 1996, we have empowered our clients with industry-leading human resource solutions they need to drive their business. We assist our clients in the areas of payroll, worker's compensation, human resources, and benefits. We remove the administrative burden of running their business and allow our clients to focus on their revenue-producing activities. Our goal is to deliver customizable, practical workforce solutions that increase profits, reduce costs and liability, and attract, develop, and retain long-term employees.

Our Core values include:

Collaboration: working together is critical to achieving organizational goals.

Innovation: growth happens when we can absorb and implement new ideas that provide unique solutions and superior customer service.

Performance: we believe in providing our employees with the tools and support they need to grow, succeed, and make an impact.

Social Responsibility: we place charity and volunteer work at the core of our organization.

Trust: we build and maintain trust with our employees and clients by embodying integrity, transparency, and 'doing the right thing.'

Company Value Statements

In the performance of their respective tasks and duties, all employees are expected to demonstrate the following:

• Acting with the highest level of honesty, trust, character, and transparency.
• Making a unified effort to achieve the goals of the organization; embracing accountability for exceptional performance every day.
• Commitment to excellence in reaching our full potential as individuals and as an organization, surpassing the ordinary and the expectations of our stakeholders.
• Approaching every challenge with creative energy, discovering unique solutions to maximize success; focus on creating and delivering compelling customer value.
• Belief in the power of a diverse workforce and in creating a positive impact on both the environment and our community

Summary/Objective

Manage an inventory of high-exposure multi-jurisdictional claims ensuring the most advantageous and cost-effective outcome by working with our workers' compensation carrier/TPA, client companies, and technology to ensure claims are properly investigated, reserved, and managed to timely resolution. Provide client companies with consistent claim updates and Assist client companies in implementing strategies to reduce and mitigate risk.

Essential Functions

• Manages the administration of assigned worker's compensation claims.
• Responsible for reporting, investigation, coordination with TPA, and analysis of complex claims often with litigation; resolution/outcome management; and the delivery of claim information.
• Manages complex litigated and non-litigated claims and is entrusted with defined settlement authority.
• Creates and develops relationships with claims adjusters, insurers, outside legal counsel, and other claims-related parties.
• Maintain consistent and effective communication with our clients based on service needs, claim development and material changes. Provide clients with claim updates at appropriate times until the claim is closed.
• Investigate, evaluate, and manage an inventory of high-exposure and litigated claims.
• Intake first report of injury from clients and injured employees, conduct employer level investigation and process insurance claims to carrier for handling.
• Interview claimants and witnesses to gather pertinent information.
• Verify that coverage applies through an insurance policy.
• Evaluate remuneration to ascertain compensation amount and submit a wage statement to the carrier for calculation of average weekly wage amounts.
• Consult with clients and employees to obtain information required to complete an investigation of the claim.
• Collaborate with adjusters and/or defense attorneys to ensure proper claim decisions, reserve accuracy, financial accuracy, subrogation/recovery, investigation, medical management, litigation management, and action planning toward resolution.
• Complete settlement evaluations and work with the adjuster and defense counsel in negotiating the settlement.
• Collaborate with adjusters on the use of outside vendors to include legal, surveillance, case management etc.
• Coordinate Return to Work Program: To facilitate returning an injured employee to work as soon as practical to reduce compensation costs and minimize litigation potential.
• Review & maintain task diary in Salesforce to manage assigned claims.
• Assist client companies to increase their understanding of the claims process to reduce their exposure, and facilitate timely filing of claims and the return-to-work process.
• Other duties as assigned.

Required Education and Experience

• Five or more years experience handling Workers' Compensation claims with multi-state knowledge with a major insurer, insurance agency or broker, PEO, or as a private consultant.
• Comprehensive knowledge of Workers' Compensation laws, handling Workers' Compensation claims, and Workers' Compensation classifications and coding.

Preferred Education and Experience

• Bachelor's degree and PEO experience.

The preceding position description has been designed to indicate the general nature of the work performed; the level of knowledge and skills typically required; and the usual working conditions of this position. It is not designed to contain or be interpreted as a comprehensive, complete, or exclusive list of the duties of the position. Additional and different duties may be assigned from time to time. We are an E-Verify company.