Workers Compensation Claims Examiner

Alliant Insurance Services • San Diego, CA

8d

About The Position

Responsible for reviewing, adjudicating and managing low- and mid-level workers' compensation claims in accordance with company guidelines, statutory regulations and best practices. Manages claims through well-developed action plans to an appropriate and timely resolution.

Requirements

• Bachelor's Degree in business or equivalent combination of education and experience
• Three (3) or more years of experience in workers’ compensation field
• Certificates and/or licenses as required by State regulation
• Excellent verbal and written communication skills
• Excellent presentation skills
• Excellent customer service skills
• Analytical skills with ability to interpret results
• Strong organizational skills
• Good interpersonal skills with ability to work in a team environment
• Proficient in Microsoft Office Products

Responsibilities

• Reviews and evaluates workers’ compensation claims to determines compensability and benefits due on indemnity claims
• Sets and manages reserve accounts, ensures that accurate levels are maintained and that documentation is on file with state agency
• Develops and manages workers’ compensation claims action plans and manages to resolution
• Establishes and manages return-to-work plan; Identifies modified work opportunities to enable return to work
• Coordinates claim action and processing with claimant and client
• Approves claim payments, manages subrogation of claims and negotiates settlements
• Develops effective working relationships with outside vendors and ensures professional client relationships
• Communicates with injured workers, employers, doctors and attorneys
• Composes medical examination assignments, letters and legal orders
• Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims
• Complies with agency management system data standards and data integrity (enters and maintains complete and accurate information)
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level