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 110–130 workers' compensation files by reviewing new assignments, completing initial claim setups, and investigating claims. Gather documentation from claimants, employers, and medical providers while applying state regulations to administer indemnity and medical benefits. Coordinate treatment plans, review medical billing for authorization, and prepare reserve recommendations for supervisory approval. Escalate complex issues, litigation matters, or settlement questions outside assigned authority levels. Maintain accurate file documentation and communicate professionally with all stakeholders regarding claim status and updates.
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
- Technical knowledge of 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
- Reasoning development: Logical or scientific thinking to solve problems; several abstract and concrete variables
- Reasoning development: Wide range of intellectual and practical problems; comprehend most obscure concepts
- 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
- Mathematical development: Arithmetic, algebraic, and geometric calculations
- 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
- Physical activity required to perform the job: Light work
- Physical activity required to perform the job: Exerting up to 20 pounds of force occasionally
- Physical activity required to perform the job: Exerting up to 10 pounds frequently
- Physical activity required to perform the job: Exerting a negligible amount of force constantly to move objects
- Visual requirements: Far vision: clarity of vision at 20 feet or more
- Visual requirements: Near vision: clarity of vision at 20 inches or less
- Visual requirements: Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Visual requirements: Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
- Visual requirements: Color vision: ability to identify and distinguish colors
- Visual requirements: 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
- Physical activity: Stooping
- Physical activity: Kneeling
- Physical activity: Crouching
- Physical activity: Reaching
- Physical activity: Standing
- Physical activity: Walking
- Physical activity: Pushing
- Physical activity: Pulling
- Physical activity: Lifting
- Physical activity: Fingering
- Physical activity: Grasping
- Physical activity: Talking
- Physical activity: Hearing
- Physical activity: Repetitive Substantial movements (motions) of the wrists, hands, and/or fingers
- Physical activity: Motion: Using feet to push pedals
- Physical activity: Climbing
- Physical activity: Balancing
- Physical activity: Crawling
- Working condition: Significant work pace/pressure
Desired Qualifications
- Bachelor's degree in a related field (preferred)
- Proficient in Word and Excel (preferred)
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