Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Roseville, CA/Remote location. 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 filings 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.
• 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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Requirements:

• Minimum 3 years of relevant CA WC claims experience is mandatory
• California WC Claims handling experience
• Must have OSIP certificate
• 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.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities