TITLE: Claims Examiner - Workers Compensation (1305276 ) REMOTE
TERMS 4/1-7/2 -3 month contract Or longer
LOCATION: REMOTE IN CA AREA
HOURS: 8-5
Hourly Rate: $50.00 Hourly

Remote in CA

Must have updated CA Post Designation requirement

Description:

It would be awesome if we could find someone that has Juris and SIR experience but not required. Senior level with workers compensation experience 5 plus years.

Minimum of 5 years of Workers Compensation claims handling

SIP cert required (Self Insurance Plan)

Must be able to work 7.5 hours a day and 37.50 hours a week Mon-Friday

Spanish speaking preferred but not mandatory

Must have updated CA Post Designation requirement

Remote in CA

Above details should reflect in resume.

Requirements:

• Minimum of 5 years of Workers Compensation claims handling SIP cert required.
• Must be able to work 7.5 hours a day and 37.50 hours a week Mon-Friday
• Spanish speaking preferred but not mandatory remote in CA Must have updated CA Post Designation requirement 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.

QUALIFICATION

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.
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking

NOTE:

• Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Job Types: Full-time, Contract

Pay: $50.00 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Travel requirement:

• No travel

Work setting:

• In-person

Application Question(s):

• Do you live in the CA area?

Experience:

• Workers' compensation Examiner: 5 years (Required)

License/Certification:

• SIP Certification (Required)

Ability to Relocate:

• Brea, CA: Relocate before starting work (Required)

Work Location: In person