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Workers Compensation Claims Examiner - Las Vegas, NV

UnitedHealth Group

Las Vegas, NV
Job Code:
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Job Details

Workers Compensation Claims Examiner - Las Vegas, NV(Job Number:712659)

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Under minimal supervision, the Workers Compensation Claims Examiner, reviews, analyzes, investigates, makes compensability decisions, set appropriate reserves and approves the release of benefit payments up to authorized levels on initial, continued and reopened claims.

Primary Responsibilities:
  • Evaluates new and on-going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence
  • Investigates questionable claims
  • Determines needs for additional medical information
  • Determine appropriate benefit calculations and payments
  • Performs reviews to verify initial and continued existence of a disabling condition
  • Responds to telephone and written inquiries from claimants, attorneys, physicians and policyholders within statutory requirements
  • Identifies and forwards claims to specialized internal and external resources in areas such as medical exams, rehabilitation, investigations, subrogation and subsequent injury
  • Track time frames as mandated by statute and regulation
  • Respond to correspondence to include litigation compliance with decisions & orders
  • This level is responsible for independently reviewing simple to complex claims for adjudication purposes
  • Refers more complex claims to higher levels for review and direction
  • This level is responsible for administering simple to complex including catastrophic claims

Job Claim Operations
Primary Location US-NV-Las Vegas
Other Location 
Organization E&I Nevada-Utah-Idaho
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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