Job Title: Claims Examiner - Workers Compensation

Location: 100% Remote

Duration: 3 Months (Possibly Extension)

Requirements:

Manager's notes:

• Work address: 8855 Haven Ave., Rancho Cucamonga, CA 91730
• Job location: remote or onsite – we are open to either option.
• Any specific skill/ certification/ license: Self insured certificate, experience handling public entities and school districts is preferred but not required.
• Years of experience: at least 5 years handling Indem claims, new losses, complex issues and litigation
• Candidate should be local to CA only.

Description:

PRIMARY PURPOSE:

• To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

QUALIFICATION:

Education & Licensing

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Experience:

• Five (5) years of claims management experience or equivalent combination of education and experience required.