What are the responsibilities and job description for the Workers' Compensation Claims Examiner position at TRINDEL?
Description and Details:
The Workers' Compensation Claims Examiner, under the direct supervision of the Trindel Director of Workers' Compensation ensures access to any and all benefits necessary to cure or relieve the effects of an occupational injury or illness. The Workers' Compensation Claims Examiner administers these benefits as required by the California Labor Code. Effectively works with injured member and medical provider to facilitate the member's recovery while mitigating risk. This is a highly dynamic and collaborative role that requires outstanding customer service and communication skills.
Duties/Responsibilities:
- Ensure timely and accurate liability decisions and benefit provisions
- Initiate "Three-Point Contact" with member county, injured employee and medical provider.
- Initiate, coordinate, and ensure early return-to-work efforts with worker and member. Proactively manage, finalize, and control an inventory of cases.
- Authorize medical treatment with pre-established authority level.
- Review, investigate, analyze, and adjust workers' compensation claims in accordance with current laws and regulations.
- Establish claims reserves and authorize payments with reserving authority limits.
- Review process of claims with members, providing a well-documented action plan and acting as a resource for claims questions and guidance.
- Review and process bills for payment in accordance with the established fee schedule and contractual agreements.
- Attend conferences and hearings as necessary to properly administer resolution of claims.
- Coordinate resolution of claims by preparing legal documents, including stipulations, and compromise and release settlements within authority limits.
- Coordinate with defense counsel on litigated claims, providing records and reports, as necessary.
- Consult with and monitors service providers, such as legal counsel, and medical and vocational counselors.
- Refer appropriate claims for potential subrogation recovery.
- Regularly handles private and proprietary information while maintaining strict confidentiality and protection from unauthorized disclosure.
- Stay apprised of current law changes, court rulings, and other related matters that might affect the handling of claims.
- Perform various routine clerical duties, utilizing standard office equipment to include: maintaining calendars; entering information into databases and spreadsheets; making photocopies; faxing documents; typing; and word processing.
- Will require overnight travel to attend training, meetings and claim file reviews.
- Ensure to keep Director of Workers' Compensation apprised of any and all claims requiring special attention, or that have extenuating circumstances.
- Perform other duties as assigned by the Director of Workers' Compensation.
- Perform all work in a safe and effective manner.
Required Skills/Abilities:
- Knowledge of claims administration, case management and cost containment solutions as applicable to Workers' Compensation rules in California including 4850.
- Excellent organizational skills and attention to detail.
- Strong analytical and problem-solving skills.
- Excellent oral and written communication skills.
- Demonstrated ethical conduct.
- Effective analytical, problem solving and interpretive skills.
- Proficient with Microsoft Office Suite and/or related software.
Education and Experience:
- Minimum of 5 years’ experience in administering occupational claims in California.
- California Self-Insurance Plans Administrator Certification (SIP) or ability to pass exam within first six months.
- Four-year degree in Occupational Health and Safety or related field desired.
- Other combinations of education and experience may be considered.
Job Type: Full-time
Pay: $65,000.00 - $97,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Application Question(s):
- Why would you like to work for Trindel?
- If selected for this position, when would you be available to begin work?
- This position is preferred to be in-office, full time in Weaverville, CA. Would you be open to relocating if selected, and if so, what would your timeline for relocation if applicable look like?
Work Location: Hybrid remote in Weaverville, CA 96093
Salary : $65,000 - $97,000