Claims Examiner, Workers Compensation

BETA HEALTHCARE GROUP RISK MANAGEMENT; Roseville (CA); On-site; USD 75,000 - 90,000; Full time

Job summary

BETA Healthcare Group is hiring an experienced Claims Examiner for its Granite Bay, CA office. You will manage workers’ compensation claims from review to resolution, gather evidence and collaborate with employers, providers and attorneys to achieve timely, cost-effective outcomes.

The role requires in-office presence during training (up to 90 days), then a 3-days-a-week in-office schedule. Strong attention to detail and reliable communication are essential.

Qualifications

• High school diploma or GED required; Bachelor’s degree preferred.
• At least 1 year of workers’ compensation examiner or equivalent experience.
• SIP license required or to be obtained within 6 months of hire/promotion.
• Knowledge of claims management techniques, reserving, cost analysis, and case resolution.
• Strong customer focus with urgency and attention to detail.
• Ability to manage multiple projects independently in a busy office.
• Proficiency with Microsoft Office and capability to learn specialty software systems.

Responsibilities

• Evaluate claims from inception to resolution.
• Gather medical, legal and factual information to determine compensability.
• Develop claim strategies and establish reserves.
• Coordinate with employers, medical providers, attorneys and others to reach timely outcomes.
• Maintain diary, process payments and notices to move claims forward.

Skills

Customer focus

Attention to detail

Multitasking

Verbal and written communication

Independent work

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

Microsoft Office

Job description

Job DetailsLevel: ExperiencedJob Location: Granite Bay BETA office - Roseville, CA 95661Position Type: Full TimeEducation Level: 4 Year DegreeSalary Range: $75,000.00 - $90,000.00 Salary/yearTravel Percentage: NegligibleJob Shift: Day

Ready to take the next step in your Workers’ Compensation career? Join our fun, fast-paced team as a Claims Examiner and help us deliver great service to our members. If you’re organized, detail-oriented, goal-driven, and comfortable managing changing priorities, we’d love to hear from you!

ABOUT BETA HEALTHCARE GROUP:

BETA Healthcare Group (BETA) is the largest professional liability insurer of hospitals on the west coast, providing coverage to more than 600 hospitals and healthcare facilities and provides workers' compensation coverage for over 90,000 healthcare workers in California. BETA also has a long-established and growing commitment to physicians, providing medical professional liability coverage to nearly 7,700 physicians and more than 70 medical groups. Beyond primary liability and workers’ compensation coverage, BETA provides an entire suite of alternative risk and insurance services, including excess healthcare professional liability coverage, excess workers’ compensation coverage, third-party claims administration services, risk management consulting services and claims management consulting services. Whether with hospitals, medical groups, clinics or hospices, BETA has earned a reputation for financial strength, rate stability, quality service and breadth of coverage that is unparalleled in the industry.

ABOUT THE ROLE:

In this role, you’ll manage claims from initial review through resolution. You’ll gather and evaluate information, develop claim strategies that meet legal requirements and client expectations, establish reserves, and collaborate with employers, employees, medical providers, attorneys, and other partners to achieve timely, cost-effective outcomes. You will be required to be in office 5 days a week during the training period, up to about 90 days. Thereafter, you will be required to be in office 3 days a week. This is an exempt position and candidates must live within a commutable distance to our Granite Bay, CA office.

IN THIS ROLE YOU WILL:

• Evaluate claims and determine course of action from inception to resolution timely and accurately
• Gather and analyze information including medical, legal, and factual evidence to determine compensability of claim
• Evaluate claims to determine appropriate use of independent medical evaluations for claims and/or refer to legal
• Evaluate all information to make appropriate determination on compensability and issue compensability decisions
• Manage and direct action of diary, e-mail, mail, faxes, phone calls, payments, required benefit notices, etc. to move claim to the best financial outcome and timely resolution
• Evaluate and establish medical, legal, vocational rehabilitation, and indemnity reserves based on facts of case and probable exposure, including reporting to excess carrier, within authority level
• Evaluate and determine an appropriate negotiated settlement amount, within authority level
• Communicate, strategize and direct legal counsel regarding issues such as discovery, depositions, settlement value
• Provide superior claims processing and diary management as exhibited by appropriate reserves, timely payments, reports, contacts, closings and activity on the claim files
• Represent the company as needed in depositions, conferences, hearings and trials
• Travel may be required periodically, which may include overnight stays and/or transportation via airplane
• All other duties as assigned or as situation dictates

ESSENTIAL JOB REQUIREMENTS

• High school diploma or G.E.D. required; Bachelor’s degree preferred
• Minimum one (1) years’ experience as a workers’ compensation examiner or equivalent
• SIP license required or achieved within 6 months of promotion or hire
• Knowledge of claims management techniques, including investigation, reserving, cost analysis, and case resolution techniques
• Strong customer focus with a strong sense of urgency and attention to detail
• Manage multiple simultaneous projects; working independently in a multi-tasking office setting
• Proficient with Microsoft Office and be able to learn and utilize specialty software systems and procedures
• Must have excellent verbal and written communication skills including the ability to proofread the work of self and others with a high degree of accuracy
• Meet ongoing training or experience requirements set forth in regulations California Code of Regulation (Article 20 of subchapter 3, chapter 5, Title 10) and (Section 2592.01[f])

Hiring base salary range: Up to $75,000-90,000 annually depending on experience

Note the amount listed is the base pay range; additional compensation may be available for this position.