Claims Examiner - Workers Compensation
Company: BCforward
Location: Orange
Posted on: June 21, 2022
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Job Description:
Claims Examiner - Workers CompensationBCforward is currently
seeking highly motivated Claims Examiner - Workers Compensation -
Remote only in CA. Job Title: Claims Examiner - Workers
Compensation Duration: 02 Months Contract Location: Orange, CA -
92868 Note: Remote but candidate must be in CA Job Description: *
Analyzes and processes complex or technically difficult workers'
compensation claims by investigating and gathering information to
determine the exposure on the claim; manages claims through
well-developed action plans to an appropriate and timely
resolution. * Negotiates settlement of claims within designated
authority. * Calculates and assigns timely and appropriate reserves
to claims; manages reserve adequacy throughout the life of the
claim. * Calculates and pays benefits due; approves and makes
timely claim payments and adjustments; and settles clams within
designated authority level. Prepares necessary state fillings
within statutory limits. * Manages the litigation process; ensures
timely and cost-effective claims resolution. * Coordinates vendor
referrals for additional investigation and/or litigation
management. * Uses appropriate cost containment techniques
including strategic vendor partnerships to reduce overall cost of
claims for our clients. * Manages claim recoveries, including but
not limited to subrogation, Second Injury Fund excess recoveries
and Social Security and Medicare offsets. * Reports claims to the
excess carrier; responds to requests of directions in a
professional and timely manner. * Communicates claim activity and
processing with the claimant and the client; maintains professional
client relationships. * Ensures claim files are properly documented
and claims coding is correct. Refers cases as appropriate to
supervisor and management. Additional Functions and
Responsibilities: * Performs other duties as assigned. * Supports
the organization's quality program(s). * Travels as required.
Education & Licensing: * Bachelor's degree from an accredited
college or university preferred. * Professional certification as
applicable to line of business preferred. Experience: * Five (5)
years of claims management experience or equivalent combination of
education and experience required. * Skills & Knowledge Subject
matter expert of appropriate insurance principles and laws for
line-of-business handled, recoveries offsets and deductions, claim
and disability duration, cost containment principles including
medical management practices and Social Security and Medicare
application procedures as applicable to line-of-business. *
Excellent oral and written communication, including presentation
skills PC literate, including Microsoft Office products Analytical
and interpretive skills Strong organizational skills Good
interpersonal skills * Excellent negotiation skills Ability to work
in a team environment Ability to meet or exceed Service
Expectations.Interested candidates please send resume in Word
format Please reference job code 179591 when responding to this
ad.
Keywords: BCforward, Orange , Claims Examiner - Workers Compensation, Other , Orange, California
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