Description
We're looking for a Remote Claims Examiner- Workers Compensation , working in Insurance industry in Pasadena, California, 91107, United States .
Hit Apply below to send your application for consideration Ensure that your CV is up to date, and that you have read the job specs first.
Work location : Remote in CA
- Analyze complex or technically difficult workers' compensation claims to determine benefits due.
- Work with high exposure claims involving litigation and rehabilitation.
- Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
- Identify subrogation of claims and negotiate settlements.
- Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
- Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
- Prepare necessary state fillings within statutory limits.
- Manage the litigation process; ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and / or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manage claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Report claims to the excess carrier; respond to requests of directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- Support the organization's quality program(s).
- Perform other duties as assigned.
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Remote working / work at home options are available for this role.
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