Claims Examiner - Workers Compensation
BC Forward

Roseville, California

Posted in IT

This job has expired.

Job Info

Claims Examiner - Workers Compensation
BCforward is currently seeking for a highly motivated Claims Examiner - Workers Compensation at Roseville, CA 95678

Role: Claims Examiner - Workers Compensation
Location: Roseville, CA 95678
Expected Duration: 5 Months

To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

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.

Performs other duties as assigned. Supports the organization's quality program(s). Travels as required.

Bachelor's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.

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

When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
They are not intended to constitute a comprehensive list of functions, duties, or local variances.
Management retains the discretion to add or to change the duties of the position at any time.

High School Graduate/GED

Interested candidates please send resume in Word format Please reference job code 151530 when responding to this ad.

Recommended Skills

  • Subrogation
  • Claims
  • Workers' Compensation
  • Medicare
  • Social Security
  • Insurance

Get job alerts by email.Sign up now!

This job has expired.

More IT jobs

Computer World Services (CWS)Corporation
Falls Church, Virginia
Posted about 1 hour ago

Computer World Services (CWS)Corporation
Fairview Heights, Illinois
Posted about 1 hour ago

Computer World Services (CWS)Corporation
Fort Meade, Maryland
Posted about 1 hour ago

Job Alerts

Provide an email, zip code for jobs, and/or job category to subscribe to job alerts. Learn more now.

*By subscribing, you agree to our Terms and Privacy Policy.