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Claims Examiner - Workers Compensation

Company: BCforward
Location: Orange
Posted on: June 21, 2022

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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