Senior Claims Examiner

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

The Sr. Claims Examiner is responsible for the investigation and administration of St. Luke’s Health System Employee workers’ compensation claims.

What You’ll Do:

• Lead complex claim management - Oversee a portfolio of workers’ compensation claims, including sophisticated occupational disease cases requiring in-depth analysis of pre-existing medical conditions, environmental exposures, and causation.
• Drive compensability decisions - Conduct comprehensive investigations, leveraging policy interpretation, regulatory research, court rulings, and collaboration with employees, medical providers, employers, and legal counsel to make well-supported determinations.
• Own financial stewardship - Establish and proactively manage claim reserves, ensuring accurate forecasting and responsible cost management.
• Deliver exceptional case oversight - Maintain current, well-documented claim files through consistent communication and proactive follow-up with all stakeholders.
• Ensure accurate benefit administration - Calculate and issue time-loss and impairment benefits, file required state documentation in compliance with Idaho Workers’ Compensation Law, and authorize appropriate medical payments.
• Influence settlement strategy - Analyze exposure and provide thoughtful recommendations on lump sum settlements; negotiate settlements within delegated authority and in partnership with leadership.
• Maximize recovery opportunities - Identify and pursue third-party recovery opportunities to mitigate claim costs when applicable.
• Contribute to workplace safety insights - Partner with the Safety Officer to identify trends, serious injuries, and occupational disease patterns, helping drive preventative and corrective measures.

Qualifications:

• Bachelor's Degree or experience in lieu of
• 4 years' relevant experience
• Independent Adjuster's License