Description:
Primary Purpose:
• To analyze complex or technically difficult workers'' compensation claims to determine benefits due and provide guidance to examiners; 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.
• Approves and 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 management in accordance with client service instructions.
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
WORK ENVIRONMENT
• When applicable and appropriate, consideration will be given to reasonable accommodations.
RIGHT-TO-REPRESENT
I, _______________ on this day MM/DD/YY, give permission for Rose International to represent me for the position Claims Supervisor - Workers Compensation (1363131) located in Pasadena, California at $.../hour.
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Submission Comments:
- **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.**
I believe the best thing that Rose HR has going for it is the incredible responsiveness. Everyone is very quick to reply to any concerns, and contacts the contracted employees very quickly and efficiently.
Kevin, Consultant
I am very happy with the Rose International, and the professionalism of the employees.
Robin, Consultant
Thanks for the opportunity. If in the future I ever need a job, I would like to work for Rose International.
David, Consultant
I had a very positive experience working for Rose. The entire process is very efficient and easy.
Joanne, Consultant
I have been very pleased with my experience with Rose International. Everyone that I encountered was very helpful and courteous.
Stephanie, Consultant
EMPLOYEE COMMENTS