Associate Claims Examiner

Berkley•San Diego, CA

1d•$60,000 - $65,000

About The Position

The Associate Claims Examiner (ACE) utilizes general understanding of department’s operation and objectives. They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player. This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor’s direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification.

Requirements

2+ years of related administrative office work experience.
Strong written and verbal communication skills, attention to detail and deadline structures.
Ability to work both independently and collaboratively with all levels of staff.
Proficient with MS Office software and PC applications and systems.

Nice To Haves

Bachelor degree from an accredited college or university preferred
Baccalaureate degree from an accredited college or university preferred
Knowledge of workers’ compensation principles and policies equivalent preferred.

Responsibilities

Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods.
Issue Benefit Notices as required with regards to the start, changing and ending of benefits.
Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity.
Transmit Second Report of Information (SROI) to the State of California as required.
Gather and document information from medical providers on disability status of claimants.
Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made.
Refers cases as appropriate to management by setting an activity for review.
Maintains professional client relationships.
Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim.
Coordinate and process void, stop pay, and reissue Indemnity payments.
Offer and, if accepted, enroll claimants in our EFT program.
Attend Examiner Certification training as directed by Supervisor.
Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements.
Assist technical and operations with other duties as needed and as time allows.