Claims Examiner - Workers Compensation

Job Description

Job Description

BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation in Remote .

Position Title : Claims Examiner - Workers Compensation

Location : Remote (CA)

Anticipated Start Date : ASAP

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration : Duration : 3+ Months of Contract with possible extension,

Monday to Friday : 8.00AM to 5.00PM

Job Type : FULL TIME (>

40 HRS WEEKLY) / TEMP TO HIRE , ON-SITE

Pay Range : $30 / Hr - $33 / Hr

Please note that actual compen0073ation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.

g., benefits, paid time off, per diem, etc.).

Requirements :

• To analyze complex 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 within service expectations, industry best practices and specific client service requirements;

and to identify subrogation of claims and negotiate settlements.

Job Description :

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim;

manages claims through well-developed action plans to an appropriate and timely resolution.

Negotiates settlement of claims within designated authority.

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

Prepares necessary state fillings within statutory limits.

Manages the litigation process; ensures timely and cost-effective claims resolution.

Coordinates vendor referrals for additional investigation and / or litigation management.

Uses appropriate cost containment techniques including strategic 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 Social Security and Medicare offsets.

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

Communicates claim activity and processing with the claimant and the client; maintains professional client 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 quality program(s).

Travels as required.

Qualification :

Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge :

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Service Expectations

Requirements : Manager's note :

Manager's note :

5 years of relevant experience

It’s remote role. Candidates should be within CA boundary.

Benefits :

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

Keywords : Claims, Liability

Claims, Liability

About BCforward :

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world.

Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years.

Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum.

As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information.

BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States.

The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position.

Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Company Description

About BCforward

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world.

Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years.

Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum.

As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information.

BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States.

The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position.

Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Company Description

About BCforward r nFounded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world.

Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

r nBCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years.

Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work. r nBCforward is an equal-opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

r nTo learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum.

As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information.

BCforward will only use this information to complete the recruitment process. r nThis posting is not an offer of employment.

All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position.

Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.