Senior Claims Examiner, Workers' Compensation

Arthur J Gallagher & Co.-posted 10 days ago
Full-time • Mid Level
Remote • Rancho Cordova, CA
5,001-10,000 employees
Insurance Carriers and Related Activities
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Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability, Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you'll be joining a team that's passionate about helping individuals and organizations thrive. The Senior Claims Examiner will administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. This is a remote position located in California.

  • Maintain current diary.
  • Identify, prevent and mitigate potential penalties.
  • Update claim notes in computer.
  • Provide timely reporting of excess files to the Reinsurance Manager.
  • Report SIU/Fraud.
  • Identify and pursue subrogation.
  • Complete Rehab forms/benefit notices/SJDB/RTW form.
  • Refer all PRIME deletions only to office designee.
  • Update reserves no later than 30 days of receipt of information modifying the financial exposure of a claim.
  • Prepare for and attend file reviews.
  • Accept or deny delayed claims within 90 days.
  • Request settlement authorization/notification within 30 days of a final P&S report and prior to the MSC date.
  • Complete Stipulation and/or Compromise and Release paperwork.
  • Maintain 100% closing ratio on active accounts and reduce run off accounts by 25% annually.
  • Prepare legal referrals, provide direction to and monitor defense attorney.
  • Return all phone calls within 24 hours.
  • Complete instruction sheets for Assistant/Technician/Claims entry clerk.
  • Review mail daily.
  • Correct error report daily.
  • Maintain client/claimant satisfaction.
  • Update Unit Stat forms.
  • Oversee new set-ups, reserves and instruction sheets.
  • Prepare cover letters to AME/defense QME, AOE/COE evaluations.
  • Negotiate outstanding liens.
  • Make 3-point contact.
  • File Answer/Application.
  • Interaction with nurse on case management.
  • Other duties assigned.
  • High school diploma and 5 years related claims experience required.
  • Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
  • Extensive knowledge of accepted industry standards and practices.
  • Computer experience with related claims and business software.
  • Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
  • Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses.
  • Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation.
  • Bachelor's degree preferred.
  • Medical/dental/vision plans, which start from day one!
  • Life and accident insurance
  • 401(K) and Roth options
  • Tax-advantaged accounts (HSA, FSA)
  • Educational expense reimbursement
  • Paid parental leave
  • Digital mental health services (Talkspace)
  • Flexible work hours (availability varies by office and job function)
  • Training programs
  • Gallagher Thrive program - elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
  • Charitable matching gift program
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