Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Long Beach, CA location. Responsibilities include analyzing and processing complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; managing claims through well-developed action plans to an appropriate and timely resolution.

Other responsibilities include negotiating settlement of claims within designated authority, calculating and assigning timely and appropriate reserves to claims, managing reserve adequacy throughout the life of the claim, calculating and paying benefits due, approving and making timely claim payments and adjustments, settling claims within designated authority level, preparing necessary state filings within statutory limits, managing the litigation process, ensuring timely and cost effective claims resolution, coordinating vendor referrals for additional investigation and/or litigation management, using appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients, managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets, reporting claims to the excess carrier, responding to requests of directions in a professional and timely manner, communicating claim activity and processing with the claimant and the client, maintaining professional client relationships, ensuring claim files are properly documented and claims coding is correct, referring cases as appropriate to supervisor and management, performing other duties as assigned, and supporting the organization's quality program(s).

Requirements include a Bachelor's degree from an accredited college or university 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, subject matter expertise 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 literacy including Microsoft Office products, analytical and interpretive skills, strong organizational skills, good interpersonal skills, excellent negotiation skills, and ability to work in a team environment.

Why should you apply? Health benefits, referral program, excellent growth and advancement opportunities.