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Claims Examiner - California

  • Location: Orange, California, 92868
  • Salary: 41.43
  • Job Type:Contract

Posted 16 days ago

Terrific Opportunity!
 
Title: Claims Examiner
Location: Orange, CA 92868
Term: 1 Month Contract


Day-to-Day Responsibilities:
 
  • Analyzes and manages complex or technically difficult 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.Assesses liability and resolves claims within evaluation
  • 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
  • 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 supervisor and management

Is this a good fit? (Requirements):
 
  • 4 years of claims management experience or equivalent combination of education and experience required
  • In-depth knowledge 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 procedure as applicable to line of business
  • 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
  • Bachelor's degree from an accredited college or university preferred
  • Professional certification as applicable to line of business preferred

If this sounds like the perfect fit, Apply Today!