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Gallagher Re · 2 months ago

Senior Claims Examiner, Workers' Compensation

United States

Full-time

Remote

Senior Level

$60K/yr - $117K/yr

5+ years exp

Gallagher Re is a leading insurance brokerage and consulting firm that specializes in employee benefits and workers' compensation. The Senior Claims Examiner will administer indemnity claims and handle complex claim issues, utilizing strong litigation management and customer service skills to resolve claims effectively.

ConsultingInsuranceRisk Management

Responsibilities

Maintain current diary

Identify, prevent and mitigate potential penalties

Update claim notes in computer

Provide timely reporting of excess files to the Reinsurance Manager

Report SIU/Fraud

Identify and pursue subrogation

Complete Rehab forms/benefit notices/SJDB/RTW form

Refer all PRIME deletions only to office designee

Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim

Prepare for and attend file reviews

Accept or deny delayed claims within 90 days

Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date

Complete Stipulation and/or Compromise and Release paperwork

Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually

Prepare legal referrals, provide direction to and monitor defense attorney

Return all phone calls within 24 hours

Complete instruction sheets for Assistant/Technician/Claims entry clerk

Review mail daily

Correct error report daily

Maintain client/claimant satisfaction

Update Unit Stat forms

Oversee new set-ups, reserves and instruction sheets

Prepare cover letters to AME/defense QME, AOE/COE evaluations

Negotiate outstanding liens

Make 3-point contact

File Answer/Application

Interaction with nurse on case management

Other duties assigned

Qualification

Claims experienceLitigation managementLien resolutionCustomer serviceComputer software proficiencyHigh school diplomaCommunication skillsProblem-solving

Required

High school diploma and 5 years related claims experience required

Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements

Extensive knowledge of accepted industry standards and practices

Computer experience with related claims and business software