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Claims Examiner - Workers Compensation

  • Location: Roseville, Placer, California, 95678-3567
  • Salary: 42.86
  • Job Type:Contract

Posted 12 days ago

Long term contract Opportunity!
 
Title: Claims Examiner - Workers Compensation
Location: Roseville, CA 95678
Term: 3 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.
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.


Is this a good fit? (Requirements):
 

  • 5 years of claims manPC 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 Expectationsagement 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
  • Must have California experience and certification to handle claims in California
  • Self-Insured Certification needed
  • 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!