Claims Examiner - Workers Compensation

ObjectWin Technology; Long Beach (CA); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading company in workforce solutions seeks an experienced claims manager to oversee workers' compensation claims. The role involves analyzing complex claims, negotiating settlements, and ensuring compliance with regulations. Ideal candidates will have a background in indemnity or litigation, alongside strong analytical and negotiation skills.

Qualifications

• Five years of claims management experience required.
• Bachelor's degree from an accredited college preferred.
• Experience in indemnity or litigation is a must.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within designated authority.
• Manage litigation process ensuring timely claims resolution.

Skills

Negotiation skills

Analytical skills

Communication skills

Interpersonal skills

Organizational skills

Teamwork

Education

Bachelor's degree

Tools

Microsoft Office

Job description

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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
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.

QUALIFICATION
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

Manager's note:

SIP - preferred

Relevant years of experience: 10+ years of WC claims experience.

Onsite role - all 5 days office

Office location: 1st preference is Roseville and 2nd would be Long beach, CA.

Experience : Indemnity or litigation experience is must.

About the company

ObjectWin provides global workforce solutions,ObjectWin,Workforce Solutions,IT Solutions,Staffing and Staffing Industry to meet current and future business demands of our customers.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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