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Viggo Simmons
Workers Compensation Claims Examiner
Summary
Highly experienced Workers’ Compensation Claims Examiner with a proven track record of assessing over 1,000 claims annually. Skilled in investigating workplace accidents, evaluating medical expenses, negotiating settlements, and collaborating with insurance carriers, employers, and claimants. Expertise in administering complex claims, including those involving multiple injuries, permanent disabilities, and third-party liability. Proficient in claim investigation, subrogation, negotiation, Microsoft Office Suite, policy knowledge, and customer service.
Education
Bachelor’s Degree
August 2019
Skills
- Claim Investigation
- Subrogation
- Negotiation
- Microsoft Office Suite
- Policy Knowledge
- Customer Service
Work Experience
Workers Compensation Claims Examiner
- Collaborated with insurance carriers, employers, and claimants to provide guidance and facilitate claim resolution.
- Administered complex claims, including those involving multiple injuries, permanent disabilities, and thirdparty liability.
- Monitored claim status, tracked deadlines, and ensured compliance with legal and regulatory requirements.
- Prepared detailed claim reports, summaries, and correspondence to document findings and recommendations.
Workers Compensation Claims Examiner
- Assessed over 1,000 workers compensation claims annually, determining their validity and extent of coverage.
- Investigated workplace accidents and obtained statements from employees, supervisors, and medical professionals.
- Reviewed medical records and evaluated medical expenses to determine appropriate benefits.
- Negotiated settlements with claimants and their attorneys, resolving disputes and minimizing costs.
Accomplishments
- Consistently met or exceeded productivity targets by processing an average of 50 claims per day, ensuring accuracy and timely resolution.
- Developed and implemented a claims triage system that streamlined the claims intake process, resulting in a 30% reduction in processing time.
- Successfully negotiated favorable settlements for injured workers, resulting in cost savings for both the employer and insurer.
- Established and maintained strong relationships with medical providers and legal professionals, ensuring prompt and accurate medical examinations and legal advice.
- Developed and conducted training programs for new claims examiners, ensuring a consistent level of expertise and compliance with industry standards.
Awards
- Recognized for exceptional claims handling skills and accuracy, achieving a 98% approval rating on all claims processed.
- Recipient of the Claims Examiner of the Year award for consistently exceeding performance targets and providing exemplary customer service.
- Awarded the Excellence in Workers Compensation Claims Management award for implementing innovative strategies that resulted in a 20% reduction in claims costs.
Certificates
- Associate in Claims (AIC)
- Certified Workers’ Compensation Claims Professional (CWCCP)
- Certified Workers Compensation Professional (CWCP)
- Certified Claims Examiner (CCE)
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How To Write Resume For Workers Compensation Claims Examiner
- Highlight your experience in workers’ compensation claims handling and demonstrate your expertise in relevant laws and regulations.
- Showcase your skills in investigating accidents, evaluating medical expenses, and negotiating settlements.
- Emphasize your ability to effectively communicate with claimants, employers, and other stakeholders.
- Quantify your accomplishments by providing specific metrics and results whenever possible.
Essential Experience Highlights for a Strong Workers Compensation Claims Examiner Resume
- Assessed over 1,000 workers’ compensation claims annually, determining their validity and extent of coverage.
- Investigated workplace accidents and obtained statements from employees, supervisors, and medical professionals.
- Reviewed medical records and evaluated medical expenses to determine appropriate benefits.
- Negotiated settlements with claimants and their attorneys, resolving disputes and minimizing costs.
- Collaborated with insurance carriers, employers, and claimants to provide guidance and facilitate claim resolution.
- Administered complex claims, including those involving multiple injuries, permanent disabilities, and third-party liability.
- Monitored claim status, tracked deadlines, and ensured compliance with legal and regulatory requirements.
Frequently Asked Questions (FAQ’s) For Workers Compensation Claims Examiner
What is the primary role of a Workers’ Compensation Claims Examiner?
The primary role of a Workers’ Compensation Claims Examiner is to assess the validity and extent of coverage of workers’ compensation claims, investigate workplace accidents, review medical records, negotiate settlements, and collaborate with stakeholders to facilitate claim resolution.
What skills are essential for success as a Workers’ Compensation Claims Examiner?
Essential skills for success as a Workers’ Compensation Claims Examiner include claim investigation, subrogation, negotiation, Microsoft Office Suite proficiency, policy knowledge, customer service, and a strong understanding of workers’ compensation laws and regulations.
What are the key responsibilities of a Workers’ Compensation Claims Examiner?
Key responsibilities of a Workers’ Compensation Claims Examiner include assessing claims, investigating accidents, evaluating medical expenses, negotiating settlements, collaborating with stakeholders, administering complex claims, and ensuring compliance with legal and regulatory requirements.
What are the qualifications required to become a Workers’ Compensation Claims Examiner?
Qualifications required to become a Workers’ Compensation Claims Examiner typically include a Bachelor’s Degree, relevant experience in claims handling or insurance, and a strong understanding of workers’ compensation principles.
What is the job outlook for Workers’ Compensation Claims Examiners?
The job outlook for Workers’ Compensation Claims Examiners is expected to be positive, as there is an ongoing demand for qualified professionals in this field.
What are the potential career paths for Workers’ Compensation Claims Examiners?
Potential career paths for Workers’ Compensation Claims Examiners include moving into supervisory or managerial roles, specializing in complex claims or subrogation, or pursuing further education in risk management or insurance.
What is the earning potential for Workers’ Compensation Claims Examiners?
The earning potential for Workers’ Compensation Claims Examiners varies depending on experience, location, and employer. However, the median annual salary for Claims Examiners is around $65,000.