Claims Examiner - Workers Compensation
The Judge Group Inc.

Job Info

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Location: Brea, CA
Salary: $30.00 USD Hourly - $45.00 USD Hourly
Description: Our client is currently seeking a Claims Examiner - Workers Compensation in California (Remote)

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.

Education & Licensing:

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. 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.

Requirements:

• At least 3 or more years of experience
• Must reside in CA - remote in CA
• Agile work schedule (may consider remote)
• SIP is not mandatory, but preferred
• Experience on JURIS definitely preferred.

Contact: r.singh@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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