Sr Claim Examiner- WC

TalentBurst
Brea, CA, United States
Full-time

33897371

Sr Claim Examiner- WC

Location : 675 Placentia Avenue, Suite 350, Brea CA 92821

Hybrid role & California required License and Spanish is a Plus ( Speak, Read )

Duration : 3 Months

Description :

Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted

Manages all aspects of investigative activity on complex claims

Directs the discovery and litigation strategy with legal counsel

  • Analyzes claims activity and prepares reports for clients / carriers and management
  • Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements
  • Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits
  • Develops subrogation and third party recovery potential and follows reclaim procedures
  • Analyzes claims activities and prepares reports for clients, carriers and / or management

Participates in claim reviews.

Skills : Ability to work independently while assimilating various technical subjects

  • Strong written and oral communication, negotiation and presentation skills
  • Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.

Education : Bachelor's degree or equivalent experience

Technical claims investigations / settling experience with 4-8 years experience in Claims or similar organization

Workers Compensation (WC) Adjuster License required according to jurisdictional requirements

Preferred : - Industry designations such as IIA, AIC, AEI and / or CPCU

8 hours ago
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