What are the responsibilities and job description for the Claims Examiner position at TotalMed Medfi?
Required Skills & Education
- Bachelor’s degree from an accredited college or university preferred
- Minimum of five (5) years of claims management experience or an equivalent combination of education and experience
- At least three (3) years of recent and relevant workers’ compensation experience as a Claims Examiner
- SIP certification is required for this Claims Examiner role
- Experience handling lost time claims required
- Must be able to pass a background check, including credit security clearance
Position Purpose
The Claims Examiner is responsible for analyzing complex or technically challenging workers’ compensation claims to determine appropriate benefits. This Claims Examiner role involves managing high-exposure claims, including those involving litigation and rehabilitation, while ensuring compliance with service expectations, industry best practices, and client-specific requirements. The Claims Examiner will also identify subrogation opportunities and negotiate settlements.
Key Responsibilities
- The Claims Examiner establishes and maintains accurate claim reserves throughout the life of each claim
- Calculates, approves, and issues timely benefit payments and claim adjustments
- Settles claims within designated authority levels as a Claims Examiner
- Prepares and submits state filings in compliance with statutory requirements
- Manages the litigation process to ensure timely and cost-effective claim resolution
- Coordinates vendor referrals for investigations and litigation support
- Applies cost-containment strategies, including use of preferred vendor partnerships
- Oversees claim recovery efforts, including subrogation, Second Injury Fund recoveries, and Social Security/Medicare offsets
- Reports claims to excess carriers and responds to inquiries promptly and professionally
- Communicates claim activity with claimants and clients while maintaining strong relationships as a Claims Examiner
- Ensures accurate claim documentation and coding
- Refers complex cases to leadership when appropriate
#INDPM
Pay: $50.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Education:
- Bachelor's (Required)
Experience:
- Claims Management: 5 years (Required)
Work Location: Hybrid remote in Rancho Cucamonga, CA 91730
Salary : $50