Job Description
Job Description
Two Workers' Comp Claims Examiners Needed in California: Two Locations
Our client, a large insurance company, has a need for two Workers' Compensation Claims Examiners in one of two locations.
One position is located in Roseville, CA (1st Pref) or Long Beach, CA (2nd Pref) (five days/week in the office)
One position is located in San Diego, CA (1st Pref); San Diego, in Rosedale (2nd Pref) and 3rd Pref would be Concord, CA. (Onsite or hybrid)
This is a direct-hire position. You will 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; and identify subrogation of claims and negotiate settlements.
Essential Functions & Responsibilities
- 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
- Settle clams within designated authority level.
- Prepare necessary state fillings within statutory limits
- Manage the litigation process and ensure timely and cost effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Manage claim recoveries, including: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Qualifications:
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- 7-10 years of claims management experience or equivalent combination of education and experience required.
- 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.
- SIP (Self-Insurance Program) experience is preferred
If you or anyone you know is interested, qualified and available send your resume to us for immediate consideration.
Company DescriptionLabPersonnel is not a general staffing firm, we specialize on recruitment in the Engineering, Food, Energy, Power, Oil & Gas, Chemical, Paints and Petroleum.
As market specialists in these areas we understand your market and product solutions in considerable depth. This knowledge plays a key role in the process that enables us to source the best candidates using the most time efficient methods.
Company Description
LabPersonnel is not a general staffing firm, we specialize on recruitment in the Engineering, Food, Energy, Power, Oil & Gas, Chemical, Paints and Petroleum.\r\n\r\nAs market specialists in these areas we understand your market and product solutions in considerable depth. This knowledge plays a key role in the process that enables us to source the best candidates using the most time efficient methods.