Medical Only Examiner, Workers' Compensation

Gallagher•Corona, CA

About The Position

Keenan, now part of Gallagher, is seeking a detail-oriented and customer-focused Medical Only Claims Examiner to join its Workers' Compensation Claims team. The role administers Medical Only workers' compensation claims, ensuring timely processing, accurate benefit administration, regulatory compliance, and service to clients and injured workers. It is suited to a claims professional who values accuracy, organization, and support throughout the claims process.

Requirements

Bachelor's degree.
A minimum of 3 years of claim handling experience in a brokerage firm or insurance industry.
Ability to multitask.
Effective written and verbal communication skills within all aspects of the job requirements.

Nice To Haves

California IEA class course completion.

Responsibilities

Process and administer Medical Only workers' compensation claims in accordance with company policies and procedures.
Perform data entry and establish new Medical Only claims.
Conduct claim investigations, including three-point contact when necessary, to verify injury details, compensability, and claim status.
Review and process DWC notices, correspondence, and required documentation.
Calculate and issue mileage reimbursements and other applicable benefits.
Verify lost time, waiting periods, and eligibility requirements.
Monitor and manage modified duty programs.
Maintain accurate claim notes and timely diary management.
Identify claims requiring escalation or conversion to Indemnity status and provide supporting documentation.
Refer diagnostic services and imaging requests for utilization review as required.
Process medical bills promptly to ensure compliance and avoid penalties or interest charges.
Review reserve levels and update financial exposure as claim information changes.
Investigate questionable claim circumstances and escalate concerns when appropriate.
Maintain claim closure performance and quality standards.
Return phone calls and respond to inquiries within established service standards.
Review incoming mail and electronic documents daily in a paperless environment.
Correct system exception reports and maintain accurate claim records.
Deliver exceptional service and maintain positive client and claimant relationships.
Perform other duties as assigned.