Claims Examiner - Workers Compensation

Position: Claims Examiner - Workers Compensation

Duration: Project Starting With 3+ months of contract and after understanding of facility, Work environment of facility & bonding with manager the project it will go to FTE.

Location: Remote in California

Required Skills:

• 3+ years of California WC experience

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.
• ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required

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.