Claims Examiner

Position : Workers Compensation Claim Examiner

Location: Onsite: 675 Placentia Avenue, Brea, CA 92821

Duration: 03 months contract with strong possibility of extension

Shift Timing: Mon- Fri: (8 hrs/day & 40 hrs/week)

JOB ID- 37083021

Duties:

• Receives claim assignment, confirms policy coverages and directs acknowledgement of claims.
• Interprets and makes decisions using independent judgment on moderate difficulty claims and policy coverages and determines if coverages apply to claims submitted.
• Investigates, evaluates, negotiates and adjudicates first and third party claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required.
• Analyzes claims activity and prepares reports for clients/carriers and management.
• Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
• Make settlement decisions promptly and equitably and issues company drafts in payments for claims within authority limits.
• Develops subrogation and third party recovery potential and follows reclaim procedures.
• Analyzes claims activities and prepares reports for clients, carriers and/or management.
• Participates in claim reviews.

Required Skills:

• Ability to work independently while assimilating various technical subjects.
• Good verbal or written communication skills.
• Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
• Strong ability to identify, analyze and solve problems.
• Effective interpersonal skills to be capable of dealing with external sources and all levels of employees.

Education:

• Bachelor's degree or equivalent experience required.
• Comprehensive claims investigations/settling experience
• 1-3 years experience in Claims or similar organization