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Claims Examiner - Workers Compensation

  • Location: Orange, Orange, California, 92868-5913
  • Salary: 45.96
  • Job Type:Contract

Posted about 1 month ago

Long term contract Opportunity!
 
Title: Claims Examiner - Workers Compensation
Location: Orange, CA 92868
Term: 4 Months Contract


Day-to-Day 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 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 supervisor and management.


Is this a good fit? (Requirements):
 

  • 5 years of claims management experience or equivalent combination of education and experience require
  • 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
  • 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


Preferred Skills:
 

  • 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!