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Workers Compensation Claims Examiner

Location : Glendale, CA
Job Type : Temp/Contract
Hours : Full Time
Travel : No
Relocation : No

Job Description :

The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department.


 


ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:



  • Receives claim, confirms policy coverage and acknowledgement of the claim

  • Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies

  • Establishes reserves and authorizes payments within reserving authority limits

  • Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim

  • Coordinates early return-to-work efforts with the appropriate parties.

  • Manages subrogation and litigation of claim as it applies

  • Manages potential claim recoveries of all types

  • Reports claims to the excess carrier when applicable

  • Communicates claim status with the customer and claimant

  • Adheres to client and carrier guidelines and participates in claims review as needed



  • Develops and maintains professional customer relationships

  • Complies with rules and regulations of applicable state

  • Additional projects and duties as assigned.


 


Required Qualifications :

KNOWLEDGE & SKILLS:



  • Excellent written and verbal communication skills.

  • Ability to assist team members to develop knowledge and understanding of claims practice.

  • Ability to identify, analyze and solve problems.

  • Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets

  • Strong interpersonal, time management and organizational skills.

  • Ability to work both independently and within a team environment.

  • Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation.


EDUCATION/EXPERIENCE:



  • Bachelor's degree or a combination of education and related experience.

  • Minimum of 5 years’ industry experience and claim handling


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