Workers' Compensation Claims Lead Examiner (REMOTE)

Fairygodboss; San Dimas (CA); Remote; USD 57,100 - 116,100; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Wellness Program

Paid Volunteer Time Off

Job summary

Fairygodboss is seeking a Claims Lead Examiner in California. This role involves assisting the Claims Manager and reviewing workers' compensation claims. The ideal candidate will have 7-10 years of experience, strong communication skills, and the ability to manage high call volumes.

Responsibilities include monitoring claims, resolving partner complaints, and developing processes for improvement. Benefits include medical, dental, and retirement savings options, with a salary range of $57,100 to $116,100 annually.

Qualifications

• 7-10 years of workers compensation claims experience in client service.
• Comprehensive knowledge of CA workers compensation laws.
• Experience in evaluating claims reserves and settlements.

Responsibilities

• Assist Claims Manager in monitoring workers compensation program.
• Review and resolve complaints from business partners.
• Identify trends and develop corrective processes.

Skills

Professional communication

Research complex issues

Organizational skills

Interpersonal skills

Innovative best practices

Understanding of FMLA

Proficient in Office Suite

Education

Bachelor's degree or equivalent

Tools

Excel

Outlook

Word

Job description

ADP is hiring a Claims Lead Examiner.

RESPONSIBILITIES

• Assist Claims Manager in monitoring the workers compensation program within the ADPTS/PEO structure.
• Review and resolve complaints raised by exterior business partners.
• Identify and track trends with specificity that could be problematic and take steps along with Claims Manager to develop processes to correct.
• Review and provide concurrence to T.P.A. for reserves, settlements, and other items per Special Service Instructions.
• Consistently consult and collaborate with T.P.A. and internal and external business partners.
• Ability to read data specific dashboards to orchestrate evaluation and analysis of claims to meet department and company goals.
• Monitor and ensure qualitative claim handling through T.P.A. and other vendor partners.
• Resolve escalated complaints and/or concerns by clients, risk and safety, H.R. and other internal business partners.
• Promotes interactive process and early return to work programs.
• Perform regular reviews of claims by specified criteria on diary.
• Provide regular reviews and provide feedback and recommendations for resolution of claim files as needed.

REQUIRED SKILLS

• Possesses professional communication, both written and verbal to facilitate exceptional customer service and resolution for client complaints and issues.
• Possesses the ability to research complex issues with internal and external parties in a professional, empathetic manner.
• Ability to adhere to a daily schedule and organize yourself to deal with a high volume of inbound calls and emails requiring responses within a reasonable period of time.
• Excellent interpersonal and communication skills and the ability to work independently, discretely, handling information with confidentiality.
• Innovative and successful in implementing best practices for real, measurable results in performance, cost containment and overall efficiency.
• Understanding of basic leave processes/law, FMLA, and other related subjects.
• Proficient in the use of Excel, Outlook, Word and other Office suite programs.

TO SUCCEED IN THIS ROLE: Required Qualifications

• 7-10 years of workers compensation claims experience working in a client service/customer service environment rich with the use of state-of-the-art predictive modeling, and metrics, data analytic tools and HRIS and claims systems.
• Requires comprehensive knowledge of CA and western region state workers compensation administration, including applicable local, state and federal laws pertaining to WC insurance programs.
• Possesses experience evaluating and recommending approval of claims reserves and settlements, designated expenditures and recovery forfeitures as needed.
• Bachelor's degree or equivalent in experience.

BONUS POINTS FOR THESE: Preferred Qualifications

• Comprehensive knowledge of western region states with general insurance policy coverage and state case laws.
• Understands the ins and outs of workers compensation claims within a PEO environment.
• Familiarity and use of Risktrac and Origami.
• Southern CA area ideal.

#LI-KD1

#LI-Remote

Base salary offers for this position may vary based on factors such as location, skills, and relevant experience. Some positions may include additional compensation in the form of bonus, equity or commissions. We offer the following benefits: Medical, Dental, Vision, Life Insurance, Matched Retirement Savings, Wellness Program, Short-and Long-Term Disability, Charitable Contribution Match, Holidays, Personal Days & Vacation, Paid Volunteer Time Off, and more. The compensation for this role is $57,100.00 - $116,100.00 / Year

Diversity, Equity, Inclusion & Equal Employment Opportunity at ADP: ADP is committed to an inclusive, diverse and equitable workplace, and is further committed to providing equal employment opportunities regardless of any protected characteristic including: race, color, genetic information, creed, national origin, religion, sex, affectional or sexual orientation, gender identity or expression, lawful alien status, ancestry, age, marital status, protected veteran status or disability. Hiring decisions are based upon ADP's operating needs, and applicant merit including, but not limited to, qualifications, experience, ability, availability, cooperation, and job performance.

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