Perform and deliver on routine and progressively more non-routine workers compensation and subrogation assignments independently in accordance with established procedures/guidelines.
Support workers compensation and subrogation liens being pursued by vendor.
Communicate with responsible parties, insured’s agents, vendors, and/or attorneys to obtain and/or provide a diverse range of needed information.
Evaluate subrogation potential and either triage to our internal team or submit claims to the appropriate vendor.
Support settlement negotiations for our vendor.
Escalate lien if settlements would reduce lien amount by more than 1/3.
Respond to requests, including but not limited to, pay histories, information updates, and other document requests from various parties.
Communicate with policy holders, vendors, attorneys, and agents on the status of pending subrogation matters, as required by statutes, regulations, and/or service standards.
Apply refund checks in claims systems and processes vendor expense payments within established authority.
Prepare for ASO checks to be sent employers with appropriate template letters.
Adhere to all applicable statutes and regulations as well as company protocols.

High School or GED
3
5+ Years of claims/liability experience in group insurance OR for candidates with an Associates degree or above, 0-1 year claims/liability experience directly aligned to the specific responsibilities directly aligns with the specific responsibilities for this role
Ability to interpret and apply common sense understanding to carry out a variety of instructions furnished in written, oral, or diagram form.
Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

Subrogation Claims Examiner

About this role