Workers Compensation Claims Examiner II
$50,000–$70,000 year
On-siteMilwaukee, Wisconsin, United States or Waukesha, Wisconsin, United States
Milwaukee, Wisconsin, United States or Waukesha, Wisconsin, United StatesOn-siteFull Time$50,000–$70,000 yearHigh School Or Equivalent
Full TimeHigh School Or Equivalent
Job Summary
Manage a caseload of approximately 110–130 workers' compensation files by reviewing assignments, conducting initial investigations, and gathering documentation from claimants, employers, and medical providers. Coordinate medical treatment, review billing for authorization, and prepare reserve recommendations within assigned authority levels. Communicate claim status and treatment coordination updates to claimants, clients, attorneys, and vendors while maintaining accurate file documentation. Escalate complex issues, litigation matters, or settlement recommendations outside assigned authority to supervisory staff. Participate in file reviews, team meetings, and training activities as requested by management.
Required Qualifications
- High school diploma or GED
- Bachelor's degree in a related field
- Three (3) or more years of related experience
- Technical knowledge of statutory regulations
- Medical terminology
- Analytical skills
- Excellent written and verbal communication skills
- Ability to interact with persons at all levels in the business environment
- Ability to independently and effectively manage fairly complex claims
- Reasoning development: Follow one- or two-step instructions; routine, repetitive task
- Reasoning development: Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables
- Reasoning development: Follow written, verbal, or diagrammatic instructions; several concrete variables
- Reasoning development: Solve practical problems; variety of variables with limited standardization; interpret instructions
- Mathematical development: Simple additional and subtraction; copying figures, counting, and recording
- Mathematical development: Add, subtract, multiply, and divide whole numbers
- Mathematical development: Arithmetic calculations involving fractions, decimals, and percentages
- Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing
- Language development: Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction
- Language development: Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants
- Language development: Ability to compose original correspondence, follow technical manuals, and have increased contact with people
- Near vision: clarity of vision at 20 inches or less
- Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
- Color vision: ability to identify and distinguish colors
- Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
- Stooping: Bending body downward and forward by bending spine at the waist
- Kneeling: Bending legs at knee to come to a rest on knee or knees
- Crouching: Bending the body downward and forward by bending legs and spine
- Reaching: Extending hand(s) and arm(s) in any direction
- Standing: Particularly for sustained periods of time
- Walking: Moving about on foot to accomplish tasks, particularly for long distances
- Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward
- Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion
- Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position
- Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling
- Grasping: Applying pressure to an object with the fingers and palm
- Talking: Expressing or exchanging ideas by means of the spoken word
- Hearing: Perceiving the nature of sounds with or without correction
- Repetitive Substantial movements (motions) of the wrists, hands, and/or fingers
Desired Qualifications
- Bachelor's degree in a related field (preferred)
- Proficient in Word and Excel (preferred)
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