Role overview

Qualifications

3+ years of relevant experience
Bachelor’s degree from an accredited college or university preferred
Professional certification as applicable to line of business preferred
Excellent oral and written communication, including presentation skills

Responsibilities

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; ensures timely and cost effective claims resolution

Key facts

Remote from: California (USA)
Full time
Senior (5-10 years)
Insurance Claims Examiner
English

Hard skills

Cost Containment Workers' Compensation Insurance Law Litigation Management Professional Technical Training Medical Management

Other skills

Negotiation
Communication
Social Skills
Organizational Skills
Analytical Skills
Teamwork

About the company

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge

IndustryManagement Consulting

Company size1001 - 5000

Links

Website LinkedIn See all jobs

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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.

Requirements:

Years of experience: 3+ years of relevant experience
Bachelor’s degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
Experience 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

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities