Claims Examiner - Workers Compensation (80401 )

Job Description

Job Description

• Duration : 3-month W2 contract
• Location : Remote
• Pay rate : $45 / hr
• Any license / certification : CA licensed
• Years of experience : 4 or more years of relevant WC claims handling experience

PRIMARY PURPOSE :

• 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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• 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.

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Professional certification as applicable to line of business preferred.

ExperienceFive (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

NOTE :

• Credit security clearance, confirmed via a background credit check, is required for this position.
• The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
• They are not intended to constitute a comprehensive list of functions, duties, or local variances.
• Management retains the discretion to add or to change the duties of the position at any time.
• Manager's note :
• Job location : Remote or onsite
• Any license / certification : CA licensed
• Years of experience : 4 or more years of relevant WC claims handling experience

Company Description

• Come get Swoon’d!!
• Swoon handles the staffing need of over 80 Fortune 500 clients.
• We have won Best and Brightest Companies to Work for in the Nation Award 6 years in a row.
• Swoon was also awarded the Inc. 5000 Fastest Growing Private Companies in the US from 2016 2020.

Company Description

• Come get Swoon’d!! r n t
• Swoon handles the staffing need of over 80 Fortune 500 clients. r n t
• We have won Best and Brightest Companies to Work for in the Nation Award 6 years in a row. r n t
• Swoon was also awarded the Inc. 5000 Fastest Growing Private Companies in the US from 2016 2020.
30+ days ago