Senior Workers' Compensation Claims Examiner

Senior Workers’ Compensation Claims Examiner

Summit Administration Services is seeking a senior workers’ compensation claims examiner to join our team! As a workers’ compensation claims examiner, you will receive and organize all documents related to the employee and the injury to make a determination regarding the claim. Workers’ compensation claims examiners abide by client and company guidelines when making claim determinations. The role requires excellent communication and customer service skills, strong motivation and works in a team environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties.

About the company:

Summit Administration Services (Summit), located in Scottsdale, AZ is a fully licensed Third-Party Administrator for self-funded health plans and risk programs for Tribal Organizations, Rural School Districts, Municipalities, and Commercial clients. Many employers choose to self-fund their employee benefits and risk programs (health plans, wellness programs, dental, vision, workers’ compensation, etc.), acting as their own insurance providers. Third Party Administrators (TPAs) are employed to manage the plan's operations. Summit is a completely Independent TPA, and helps employers create innovative plans tailored to their employees' needs without having a big insurance company involved.

Summit specializes in creating programs for Native American Tribes, Hospitals, and Grant Schools. These entities range in size from 25 to over 18,000 lives and operate on tight budgets in very rural areas where access to healthcare is limited. Summit operates specialized programs that keep insurance costs low and provide first-class service to some of the most underserved communities. Over the 25+ years of working in Indian Country, Summit has delivered tens of millions of dollars in savings on healthcare costs.

Specific duties:

· Investigates and maintains Workers’ compensation claims by reviewing coverage and/or liability and securing information necessary to investigate the claim.

· Works toward claim resolution by taking full charge of claims from start to finish.

· Will affect settlements/reserves within prescribed limits and submits recommendations to supervisor on cases exceeding personal authority.

· Ensures that claim payments are issued timely and accurately.

· Ensures compliance of claims handling pursuant to all state, legal, statutory and regulatory bodies to comply with all company procedures and requirements.

· Maintains a diary of progress on all claims.

· Maintains daily contact with physicians, claimants and the Summit client to provide outstanding service, and assist all parties in navigation of the claim process.

Required skills:

· 3-5 years of experience handling time loss claims

· Familiarity with federal and state workers’ compensation laws and regulations

· Excellent verbal and written communication skills

· Strong organization and time management skills

· Great attention to detail

· Must demonstrate an ability to work independently

· Must demonstrate a strong knowledge of computers and software

· Native American Tribal experience is a plus.

Candidates are eligible for the following benefits:

· Vacation

· Personal Time Benefits

· Holidays

· Health Insurance

· Dental Insurance

· Vision Reimbursement

· Educational Assistance

· Life Insurance

· Long-Term Disability

· Simple IRA Savings Plan

· Flex Spending Account

· Health Reimbursement Account

Job Type: Full-time

Pay: From $57,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Vision insurance

Work Location: Hybrid remote in Scottsdale, AZ 85255