eTeam
Claims Examiner - Workers Compensation
eTeam, Pasadena, CA, United States
Job Title: Claims Examiner - Workers Compensation
Location: 100% Remote
Duration: 3 Months (Possible Extension)
Description:
Manager's note:
PRIMARY PURPOSE:
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
QUALIFICATION:
Education & Licensing
Experience:
Location: 100% Remote
Duration: 3 Months (Possible Extension)
Description:
Manager's note:
- Workers Compensation Claims Examiner (3+ years of California WC experience)
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:
- 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.
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.