7 Claims Examiner - Workers Compensation Jobs in Brea, CA
Cynet Systems is Hiring a Claims Examiner - Workers Compensation Near Brea, CA
Pay Range $40hr - $ 46hr
- nalyzes 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.
- 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.
- 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.
- nalytical and interpretive skills.
- Strong organizational skills.
- Good interpersonal skills.
- Excellent negotiation skills.
- bility to work in a team environment.
- bility to meet or exceed Service Expectations.
- When applicable and appropriate, consideration will be given to reasonable accommodations.
Job Summary
Full Time
$80k-103k (estimate)
05/07/2024
05/20/2024
cynetsystems.com
ARCOLA, VA
500 - 1,000
2010
ASHWANI MAYUR
$50M - $200M
IT Outsourcing & Consulting
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The following is the career advancement route for Claims Examiner - Workers Compensation positions, which can be used as a reference in future career path planning. As a Claims Examiner - Workers Compensation, it can be promoted into senior positions as a Claims Examiner IV that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Claims Examiner - Workers Compensation. You can explore the career advancement for a Claims Examiner - Workers Compensation below and select your interested title to get hiring information.
