NEW JOB OPENING
CLAIMS EXAMINER - WORKERS COMPENSATION
IN Remote, USA!

Notes: -Min 3 years of experience with California worker's compensation claims 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.



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 claims 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 the 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 for 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.



Education & Licensing

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

• 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



WORK ENVIRONMENT

• When applicable and appropriate, consideration will be given to reasonable accommodations.

• **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.**