Workers' Compensation Claims Examiner

Job Title Examine medical and other factual evidence for claims for benefits involving work-place injuries and/or illnesses for factual sufficiency and legal correctness to determine if the compensation claim and/or medical benefit claim meets the criteria outlined in established policies, procedures, or other guidelines. Prepare correspondence and maintain working relationships with claimants, witnesses, employers, physicians, medical providers, investigators, representatives, attorneys, and other sources to obtain missing or supplemental medical and employment documents, to clarify information, and to secure additional factual and medical information needed to adjudicate the claim. Provide technical assistance and advice to claimants and/or their representatives on eligibility for benefits. Review and evaluate a variety of evidentiary documents from a variety of sources submitted with or subsequent to the initial claim. Familiar with the appropriate program statute, regulations, and policies so that they can perform specialized adjudicatory functions required by the appropriate program's procedure manual to determine the amount of compensation to be paid, the duration of periodic compensation, and/or reimbursement for medical or other expenses. Respond in writing and/or via telephone, as appropriate, to received written correspondence, telephone messages, or inquiries via automated system. Apply knowledge of workers' compensation laws, regulations, and policies to develop and make determinations on the proper disposition of claims for assigned cases. Maintain and update claim data within appropriate applications to reflect the status and level of entitlement.