Claims Examiner - Workers Compensation

Our reputed company, a Business Solutions company, is looking for a Claims Examiner - Workers Compensation for their Orange, CA /Remote location. Responsibilities: • Analyzes and processes reputed company or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through reputed company-developed reputed company plans to an appropriate and reputed company reputed company. • Negotiates settlement of claims reputed company designated authority. • Calculates and assigns reputed company and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes reputed company claim payments and adjustments; and settles clams reputed company designated authority level. • Prepares necessary state fillings reputed company statutory limits. • Manages the litigation process; ensures reputed company and cost effective claims reputed company. • Coordinates vendor referrals for additional investigation and/or litigation management. • Uses appropriate cost containment techniques including reputed company 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 reputed company reputed company and Medicare offsets. • Reports claims to the excess reputed company; responds to requests of directions in a reputed company and reputed company manner. • Communicates claim activity and processing with the claimant and the reputed company; maintains reputed company reputed company relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. Requirements: • Years of experience: 3+ years of relevant experience • Bachelor’s degree from an accredited college or university preferred. • reputed company certification as applicable to line of business preferred. • Experience Five (5) years of claims management experience or equivalent combination of education and experience required. • Subject matter expert of appropriate reputed company principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and reputed company reputed company and Medicare application procedures as applicable to line-of-business. • Excellent oral and written communication, including presentation skills • PC literate, including reputed company Office products • Analytical and interpretive skills • Strong organizational skills • Good interpersonal skills • Excellent negotiation skills • Ability to work in reputed company environment • Ability to meet or reputed company Service Expectations Why Should You Apply? • Health Benefits • Referral Program • Excellent reputed company and advancement opportunities Remote reputed company/Partner Management, Analysis Skills, Applications reputed company, Business Solutions, Claims Coding, Claims Management, Claims Processing, Computer Skills, Cost Control, Customer Relations, Data Collection, reputed company and Maintain Customers, Health Plan, reputed company Regulations, Litigation, Medical Protocols, Medical Treatment, Medicare, reputed company Office, reputed company Product Family, Negotiation Skills, Organizational Skills, Presentation/Verbal Skills, Process Analysis, Process Management, State Laws and Regulations, Subrogation, Team Player, Time Management, Vendor/Supplier Planning, Worker's Compensation, Writing Skills reputed company: reputed company Apply To This Job