Claims Examiner - Workers Compensation - W2 Only
Posted Today by Apidel Technologies
Negotiable
Undetermined
Remote
Remote
Summary: The Claims Examiner for Workers Compensation is responsible for analyzing complex claims to determine benefits due, managing high exposure claims, and ensuring compliance with service expectations and industry best practices. This role involves negotiating settlements, managing litigation processes, and maintaining professional relationships with clients and claimants. The position requires a minimum of five years of relevant experience in California Workers Compensation and a strong understanding of insurance principles. This is a remote position based in California, offering a pay range of $48 to $53 per hour on a W2 basis.
Key Responsibilities:
- Analyze and process complex workers' compensation claims to determine exposure and manage claims to resolution.
- Negotiate settlements within designated authority.
- Calculate and assign reserves to claims and manage reserve adequacy.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process for timely claims resolution.
- Coordinate vendor referrals for investigation and litigation management.
- Implement cost containment techniques to reduce overall claims costs.
- Manage claim recoveries including subrogation and offsets.
- Communicate claim activity with claimants and clients.
- Ensure proper documentation and coding of claim files.
- Refer cases to supervisors and management as appropriate.
- Support the organization's quality programs.
Key Skills:
- SIP certification is mandatory.
- 5+ years of relevant California Workers Compensation experience.
- Bachelor's degree preferred; professional certification applicable to the line of business preferred.
- Subject matter expertise in insurance principles and laws.
- Excellent oral and written communication skills.
- PC literate, including proficiency in Microsoft Office products.
Salary (Rate): £53 hourly
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Detailed Description From Employer:
Position: Claims Examiner - Workers Compensation - W2 Only
Location: Remote in California
Pay Range: $48/hr to $53/hr on W2.
Required Skills:
- SIP is mandatory
- 5+ years of relevant California Workers Compensation 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:
- 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Qualifications:
- 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.