Claims Examiner, Workers Compensation
About The Position
In this role, you’ll manage claims from initial review through resolution. You’ll gather and evaluate information, develop claim strategies that meet legal requirements and client expectations, establish reserves, and collaborate with employers, employees, medical providers, attorneys, and other partners to achieve timely, cost-effective outcomes. You will be required to be in office 5 days a week during the training period, up to about 90 days. Thereafter, you will be required to be in office 3 days a week. This is an exempt position and candidates must live within a commutable distance to our Granite Bay, CA office.
Requirements
- High school diploma or G.E.D. required; Bachelor’s degree preferred
- Minimum one (1) years’ experience as a workers’ compensation examiner or equivalent
- SIP license required or achieved within 6 months of promotion or hire
- Knowledge of claims management techniques, including investigation, reserving, cost analysis, and case resolution techniques
- Strong customer focus with a strong sense of urgency and attention to detail
- Manage multiple simultaneous projects; working independently in a multi-tasking office setting
- Proficient with Microsoft Office and be able to learn and utilize specialty software systems and procedures
- Must have excellent verbal and written communication skills including the ability to proofread the work of self and others with a high degree of accuracy
- Meet ongoing training or experience requirements set forth in regulations California Code of Regulation (Article 20 of subchapter 3, chapter 5, Title 10) and (Section 2592.01[f])
Responsibilities
- Evaluate claims and determine course of action from inception to resolution timely and accurately
- Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
- Evaluate claims to determine appropriate use of independent medical evaluations for claims and/or refer to legal
- Evaluate all information to make appropriate determination on compensability and issue compensability decisions
- Manage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolution
- Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and probable exposure, including reporting to excess carrier, within authority level
- Evaluate and determine an appropriate negotiated settlement amount, within authority level
- Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
- Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
- Represent the company as needed in depositions, conferences, hearings and trials
- Travel may be required periodically, which may include overnight stays and/or transportation via airplane
- All other duties as assigned or as situation dictates
Benefits
- Health insurance
- Dental insurance
- Vision insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
