Workers Compensation Claims Examiner, remote in CA | 1064795

Revel-IT-1; California (MO); Hybrid; USD 75,000 - 95,000; Full time

Job summary

Revel IT is seeking a Workers' Compensation Claims Examiner to work remotely in California. The role requires 3+ years of California WC experience and 5+ years in claims management, handling complex and high-exposure claims with litigation and rehabilitation aspects.

You will adjudicate benefits, manage subrogation, and coordinate with clients while ensuring compliance with statutory filing and cost-containment practices.

Qualifications

• Bachelor's degree preferred; professional certification as applicable to line of business preferred.
• Five (5) years of claims management experience or equivalent combination of education and experience.

Responsibilities

• Analyzes and processes complex workers' compensation claims by gathering information to determine exposure.
• Negotiates settlements within designated authority.
• Calculates reserves and manages reserve adequacy throughout claims.
• Monitors payments and adjustments; settles claims within authority.
• Ensures state fillings are prepared within statutory limits.
• Oversees litigation process and coordinates vendor referrals.

Skills

Communication

Negotiation

Analytical

Teamwork

MS Office

Education

Bachelor's degree

Professional certification

Tools

Claims software

Microsoft Office Suite

Job description

Workers Compensation Claims Examiner, remote in CA | 1064795

• 3+ years of California WC experience

OUR GOAL: Treat our consultants and clients the way we would like others to treat us.

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.

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

QUALIFICATION

• 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

Reference:1064795

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Revel IT is an Equal Opportunity Employer. Revel IT does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.