Workers Compensation Claims Examiner

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluate intricate or technically challenging workers' compensation claims to ascertain due benefits.

• Conduct investigations on claims and collect information to assess claim exposure.

• Oversee claims through action plans to ensure timely and appropriate resolutions.

• Negotiate claim settlements within the established authority limits.

• Calculate and allocate reserves, managing their adequacy throughout the claims lifecycle.

• Calculate and disburse benefits, authorize claim payments and adjustments, and close claims within authority.

• Prepare required state filings in adherence to statutory guidelines.

• Manage litigation processes to achieve timely and cost-effective resolutions.

• Coordinate vendor referrals for investigation and litigation management purposes.

• Implement cost containment strategies and foster strategic vendor partnerships.

• Oversee claim recoveries, which include subrogation, Second Injury Fund excess recoveries, and offsets from Social Security and Medicare.

• Report claims to excess carriers and fulfill requests for direction.

• Communicate claim progress and processing details to claimants and clients.

• Maintain professional relationships with clients.

• Ensure that claim files are thoroughly documented and that claims coding is accurate.

• Refer cases to supervisors and management when deemed necessary.

⛳️ Requirements

• A minimum of five (5) years of claims management experience or an equivalent combination of education and experience is required.

• Knowledge of California jurisdiction is mandatory.

• SIP certification is required or must be obtained within one (1) year of employment.

• A bachelor's degree from an accredited college or university is preferred.

• Professional certification relevant to the line of business is preferred.

• Proficient in analyzing and processing complex or technically challenging workers' compensation claims.

• Familiarity with claims investigation, reserves, benefit payments, settlements, litigation, subrogation, recoveries, and cost containment.

• Capable of preparing necessary state filings in compliance with statutory limits.

• Ability to effectively manage claims and litigation processes.

• Proficient in professional communication with claimants and clients.

• Ability to maintain well-documented claim files and ensure accurate claims coding.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunities for career development and promotional growth.

• Medical, dental, and vision benefits.

• 401(k) plan with matching contributions.

• Paid time off (PTO).

• Disability and life insurance.

• Employee assistance programs.

• Flexible spending or health savings accounts.

• Additional voluntary benefits.

• Work-life balance.

• Opportunities for professional development.

• Flexibility and autonomy regarding daily work, location, and career trajectory.