About This Role
This role involves managing workers' compensation claims from beginning to end, ensuring adherence to best practices and California state statutes. The Claims Examiner will work with various stakeholders including clients, injured workers, agents, vendors, and attorneys. The position is available for remote or in-office work.
Responsibilities
- Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards
- Prepare accurate and timely issuance of benefits notices and required reports within statutory limits
- Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits
- Ensure timely payment of benefits, bills and appropriate caseload and performance goals
- Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data
- Monitor, report, and assign claims for fraud potential and subrogation possibilities
- Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws
- Prepare and present claims summaries to clients during file reviews
- Train and direct Claims Assistants to meet goals and deadlines
- Review and approve priority payments and other documents from Claims Assistants
- Perform other duties as assigned
Requirements
- Three years of claims management experience
- Bachelor
- Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM
- Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims
- Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions
- Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits
- Strong skills with use of general office administration technology, including Microsoft Office Suite and related software
- Excellent verbal and written communication skills
- Excellent interpersonal and conflict resolution skills
- Excellent organizational skills and attention to detail
- Excellent interpersonal, negotiation, and conflict resolution skills
- Strong analytical and problem-solving skills
- Ability to act with integrity, professionalism, and confidentiality, at all times
Important Details
- Work format: remote or in office work
About the Company
