Claims Examiner - Workers Compensation

Position: Claims Examiner - Workers Compensation Duration: Project Starting With 3+ months of contract and after understanding of facility, Work environment of facility & bonding with manager the project it will go to FTE. Location: Remote in California   Required Skills: 3+ years of California WC experience   reputed company Purpose: To analyze reputed company 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 reputed company service expectations, industry best practices and specific reputed company service requirements; and to identify subrogation of claims and negotiate settlements.   Essential Functions and 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. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's reputed company program(s). Travels as required   QUALIFICATION Education & Licensing 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. Apply To This Job