Claims Examiner

Job Title: Claims Examiner
Job Category: Finance and Accounting
Time Type: Full time
Minimum Clearance Required to Start: TS/SCI with Polygraph
Employee Type: Regular
Percentage of Travel Required: None
Type of Travel: None
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The Opportunity:
We are seeking a detail-oriented, pro-active, critical thinker to manage and review workers' comp claims as a Claims Examiner.
As a Claims Examiner, your duties will include investigating and processing insurance claims, negotiating settlements, and maintaining accurate claims records.
The ideal candidate should have a strong understanding of workers’ compensation policies and regulations, excellent investigative skills, and exceptional customer service skills
Responsibilities:
• Analyze and process complex claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Investigate and evaluate workers’ compensation claims to determine coverage, compensability, liability, and benefits owed.
• Conduct detailed reviews of medical records, employment records, and other documentation to assess claims.
• Handle claim settlements, reviews, and negotiations in a fair and ethical manner.
• Communicate effectively with injured employees, employers, medical providers, attorneys, and internal stakeholders to ensure the timely resolution of claims.
• Authorize treatment and payments within designated authority levels while ensuring compliance with organization’s policies and applicable state laws.
• Prepare and deliver reports documenting claim activity, reserve adequacy, and resolution strategies.
• Evaluate ongoing medical treatment plans and facilitate return-to-work options when feasible.
• Collaborate with legal teams as needed to support litigation and dispute resolution efforts.
• Maintain accurate and up-to-date claim records in accordance with organizational policies and compliance requirements.
• Ensure compliance with Department of Labor Federal Employees Compensation Action laws, regulations, and internal policies, meeting deadlines.
• Oversee case development, including medical examinations and specialty referrals, to resolve conflicts.
• Balance competing priorities in a limited-staff environment while meeting goals for timeliness, accuracy, customer service, and compliance
• Performs other related duties as assigned.
Qualifications:
Required:
• Bachelor’s degree or equivalent combination of education and 10+ years of relevant experience.
• Demonstrated ability to work independently and collaboratively in a team environment.
• Excellent written and verbal communication skills.
• Strong organizational skills with exceptional attention to detail.
• Strong negotiation and problem-solving skills.
• Proven ability to handle and maintain the confidentiality of sensitive information and materials.
• Extensive customer service experience with a strong focus on professionalism and responsiveness.
• Proficiency in Microsoft Office Suite or similar productivity software.
Desired:
• Knowledge of quantitative and qualitative research methods.
• Experience that can facilitate understanding of Intelligence Community mission and business processes.
• Experience with providing customer service support activities across organizational elements.
• Able to independently initiate, manage, execute and report tasks as identified by the government.
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What You Can Expect:
A culture of integrity.
At CACI, we place character and innovation at the center of everything we do. As a valued team member, you’ll be part of a high-performing group dedicated to our customer’s missions and driven by a higher purpose – to ensure the safety of our nation.
An environment of trust.
CACI values the unique contributions that every employee brings to our company and our customers - every day. You’ll have the autonomy to take the time you need through a unique flexible time off benefit and have access to robust learning resources to make your ambitions a reality.
A focus on continuous growth.
Together, we will advance our nation's most critical missions, build on our lengthy track record of business success, and find opportunities to break new ground — in your career and in our legacy.
Pay Range:
There are a host of factors that can influence final salary including, but not limited to, geographic location, Federal Government contract labor categories and contract wage rates, relevant prior work experience, specific skills and competencies, education, and certifications. Our employees value the flexibility at CACI that allows them to balance quality work and their personal lives. We offer competitive compensation, benefits and learning and development opportunities. Our broad and competitive mix of benefits options is designed to support and protect employees and their families. At CACI, you will receive comprehensive benefits such as; healthcare, wellness, financial, retirement, family support, continuing education, and time off benefits.
The proposed salary range for this position is:
$70,800 - $148,600
CACI is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, age, national origin, disability, status as a protected veteran, or any other protected characteristic.