Workers' Compensation Claims Examiner III - Rocklin, CA (Contract - Hybrid)

JOHNSON SERVICE GROUP; Rocklin (CA); Hybrid; USD 110,000 - 125,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Short-term disability

401(k) plan

Weekly pay

Job summary

JOHNSON SERVICE GROUP in Rocklin, CA seeks a Workers' Compensation Claims Examiner III for a contract-hybrid role. You will manage an inventory of complex claim files, perform rapid triage with claimant/employer/physician, and document case facts to determine compensability and disability payments.

Responsibilities include pursuing subrogation, collaborating with medical case managers to enable early return-to-work, reviewing rehabilitation plans, and ensuring compliance with statutes and

Qualifications

• Bachelor's degree required with seven years related experience or equivalent
• Minimum five years managing indemnity cases, complex or high risk
• SIP certificate is preferred or required as noted

Responsibilities

• Perform three-point contact on all new losses within 24 hours of receipt
• Document ongoing case facts and decisions to establish compensability and disability payments
• Form action plans for each indemnity claim and monitor progress toward closure
• Collaborate with medical case manager to maximize early return-to-work potential
• Initiate referrals to SIU for suspected fraud and pursue subrogation
• Review vocational rehabilitation plans and adjust reserves per authority levels
• Review medical bills for appropriateness prior to client payment and posting

Skills

Claims handling expertise

Subrogation experience

Legal knowledge

Return-to-work strategies

Education

Bachelor's degree (B.A.)

SIP certificate

Job description

Workers' Compensation Claims Examiner III - Rocklin, CA (Contract - Hybrid)Pay Rate: 55.55Location: Rocklin, CA - HybridSummary:Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues.Essential Duties and Responsibilities:Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.Initiate the referral to the SIU of cases with suspected fraud.Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.Assure that the claim file is handled totally in accordance with applicable statutes as well as in-force service contracts and company guidelines.Review and approve all vocational rehabilitation plans.Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.Review all medical bills for appropriateness prior to referral to our client company for payment and posting to the claim file.Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.Litigation management - Direct, manage, and control the litigation process.Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.Qualification Requirements:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Education and/or Experience:Bachelor's degree (B. A.) from four-year college or university; at least seven years related experience and/or training; or equivalent combination of education and experience. Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.**JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.**#D720