Date Posted: 10/10/2024
Hiring Organization: Rose International
Position Number: 472572
Job Title: Claims Examiner - Workers Compensation
Job Location: Remote, USA
Work Model: Remote
Employment Type: Temp to Hire
Estimated Duration (In months): 3
Min Hourly Rate($): 48.00
Max Hourly Rate($): 50.00
Must Have Skills/Attributes: Claims, Computer Literacy, Microsoft Office, Worker
Job Description
Remote in CA however, if the candidate is near San Diego or Roseville office, the client would like to have a hybrid role but not a deal breaker. Min 3 years of experience with CA claims mandatory. CA SIP preferred not mandatory
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.
Skills & Knowledge
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations
Work Environment
• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical: Computer keyboarding, travel as required
• Auditory/Visual: Hearing, vision and talking
• NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
• The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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.
Skills & Knowledge
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations - **Only those lawfully authorized to work in the designated country associated with the position will be considered.**
- **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**
Benefits:
For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.
California Pay Equity:
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.
If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.
Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).
Rose International has been great to me. I thank everyone there for all of their hard work; it has not gone unnoticed.
Melody, Consultant
I am very happy with the Rose International, and the professionalism of the employees.
Robin, Consultant
Each time I contacted Rose, I was completely satisfied with the great attention and customer service I received. Each person was extremely knowledgeable and patient with my concerns or questions.
Diana, Consultant
As a contractor, I have to say that Rose International was by far the best agency I have worked for.
Q'testdalir, Consultant
Rose is an assembly of people grounded in honesty, truth and dignity for all of its employees and contractors.
Samba, Consultant
EMPLOYEE COMMENTS