REMOTE POSITION / CLAIMS PROCESSOR

Claims Examiner - Workers Compensation

Temporary

Full-time

Virtual/Remote?

Labor Category

Office

Finding a Remote job that fits your lifestyle isn't always easy. We're seeking a Claims Examiner - Workers Compensation to work at a premier client in California
Job Title: Claims Examiner - Workers Compensation
California (Fully Remote)
Shift: 1st
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
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.
approves and makes timely claim payments and adjustments; 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; Communicates claim activity and processing with the claimant and the client; Ensures claim files are properly documented and claims coding is correct.
Supports the organization's quality program(s).
Travels as required.
Bachelor's degree from an accredited college or university preferred. Five (5) years of claims management experience or equivalent combination of education and experience required.

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.
PC literate, including Microsoft Office products
excellent judgment, troubleshooting, problem solving, analysis, and discretion; 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. out, you're still in our network. Helping you discover what's next in your career is what we're all about, so let's get to work.
Apply to be a Claims Examiner-Workers Compensation today!
#As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.
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