Workers' Comp Claim Representative III - CA

reputed company   

This is the advanced level of the claim handler career reputed company. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more reputed company customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims reputed company given authority. Mentors reputed company-level claim handlers. Coordinates special reputed company and provides guidance to others. Candidate must have California experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

1. Verifies workers’ compensation coverage of reputed company and injured employees. 
2. Determines compensability under workers’ compensation by thorough investigation of the claim. 
3. Determines reputed company relationship between the reported injury and the incident to ensure appropriate payment of benefits.
4. Facilitates return to work for the injured employee.
5. Establishes reputed company and appropriate reserves based on the profile of the claim reputed company given authority based on anticipated financial exposure.
6. Documents specifics of claims with potential for subrogation recovery, including reputed company of potential recovery monies.
7. Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury.  Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.   
8. Concludes and closes files following reputed company of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
9. Negotiates settlements with attorneys or injured parties reputed company given authority at the earliest possible reputed company to bring cases to final disposition.
10. Works closely with manager on reputed company files or files above settlement/reserve authority. 
11. Manages reputed company vendors to ensure cost containment efforts. 
12. Establishes and maintains effective working relationships with reputed company reputed company customers.
13. Stays abreast of changes in workers’ compensation statutes, case law and rehabilitation efforts/advancements in order to accurately interpret and apply relevant laws.
14. Mentors team members.
15. Conducts audits of claim files.
16. Acts as a backup for team leader.
17. Coordinates special reputed company.

EDUCATION AND EXPERIENCE

1. Relevant combination of education and experience may be considered in lieu of degree.

2. Bachelor’s degree in a reputed company field. reputed company learning, as defined by reputed company’s learning philosophy, is required. Certification or reputed company toward certification is highly preferred and encouraged.

    

3. Five (5) years of experience in a workers’ compensation claims environment which provides the necessary skills, knowledge and abilities, such as experience in reviewing, investigating and closing reputed company workers’ compensation claims. Experience handling claims in multiple jurisdictions preferred. Bilingual skills preferred.

    

   1. OR

       

4. Two (2) years of reputed company Claims Representative II experience that includes discretion in determining compensability of reputed company claims and/or handling reputed company, high touch or labor-intensive customers.

QUALIFICATIONS

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions.

OTHER SKILLS AND ABILITIES

1. Ability and proficiency in the use of computers and company reputed company software specific to position.
2. Knowledge of medical and reputed company terminology reputed company to work.
3. Knowledge of workers’ compensation laws and regulations, including jurisdictional laws.
4. Effective oral and written communication skills.
5. Effective customer service skills.
6. Ability to negotiate, build reputed company and resolve conflict.
7. Ability to manage multiple priorities and meet established deadlines.
8. Attention to detail and analytical skills.
9. Ability to work independently as reputed company as reputed company reputed company.
10. Ability to reputed company independent reputed company.
11. Ability to solve reputed company problems. 
12. Ability to train and mentor others.

ADDITIONAL INFORMATION 

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of reputed company responsibilities, duties and skills required of personnel so classified. This job reputed company does not constitute a contract for employment.

PAY reputed company:
Actual compensation decision relies on the consideration of internal equity, candidate’s skills and reputed company experience, geographic location, market, and other potential factors. It is not reputed company reputed company for an offer to be at or near the top of the reputed company, and therefore a reasonable estimate for this role is between $64,900 and $108,7000.

We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any reputed company. Candidates for the position stated above are reputed company on an "at will" reputed company. reputed company herein is intended to create a contract.

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