Workers Compensation Claims Examiner

Revel IT; California (MO); Remote; USD 75,000 - 110,000; Full time

Job summary

Revel IT is seeking a Workers' Compensation Claims Examiner with 3+ years of California WC experience for a remote role in California. The examiner analyzes complex claims, determines benefits, and handles subrogation and settlements in compliance with client requirements.

The role requires strong analytical, communication, and organizational skills, along with the ability to work independently in a remote environment and coordinate with internal teams and clients.

Qualifications

• Bachelor's degree preferred.
• Five (5) years of claims management experience or equivalent education/experience required.
• Subject matter expert of insurance principles and laws for workers' compensation.

Responsibilities

• Analyze and process complex workers' compensation claims to determine exposure and benefits.
• Negotiate settlements within designated authority.
• Calculate and assign reserves and monitor reserve adequacy.
• Ensure timely claim payments and adjustments consistent with policies.

Skills

Insurance knowledge

Communication skills

Analytical skills

Teamwork

Organization

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Workers Compensation Claims Examiner (3+ years of California WC experience) Work location: Remote in CA.

PRIMARY PURPOSE: 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.

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

Qualifications

• QUALIFICATION 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.

Required Skills

• 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
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations