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Claims Examiner - Workers Compensation

ICONMA

Key Facts

Remote From: 
California (USA)
Full time
Senior (5-10 years)
English

Roles & Responsibilities

  • 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.
  • Excellent oral and written communication, including presentation skills.

Requirements:

  • Analyzes and processes complex or technically difficult workers' compensation claims.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims.
  • Manages the litigation process and ensures timely claims resolution.

Job description

Our client, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Orange, CA/Remote location.
 
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).
 
Requirements:
  • Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business 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.
  • Excellent oral and written communication, including presentation skills
  • 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
Work Environment
  • When applicable and appropriate, consideration will be given to reasonable accommodations.
  • Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
  • Physical: Computer keyboarding, travel as required
  • Auditory/Visual: Hearing, vision and talking
 
Why Should You Apply? #mcb
 
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