Job Description

Pay Rate: $30 - $33/Hour

OVERVIEW:

The Workers Compensation Claims Examiner will be responsible for managing moderately complex claims, including high exposure and litigated claims. Responsibilities include determining benefits due; ensuring management of claims within internal claims management guidelines and in compliance with applicable laws; and identifying

opportunities for, managing subrogation of claims, and negotiating settlements.

POSITION EXPECTATIONS:

• Thoroughly investigate workers’ compensation claims by timely contacting injured workers, medical providers, and employer representatives/witnesses and documenting investigation efforts and findings within claim management guidelines.
• Determine if claims are valid under applicable workers’ compensation statutes.
• Communicate with medical providers to develop and authorize appropriate treatment plans.
• Review and analyze medical bills to confirm charges and treatment are related to the work injury and in accordance with the treatment plan.
• Ensure payments for medical bills and income replacement are remitted on a timely basis in accordance with applicable fee schedules and statutes.
• Calculate and assign appropriate reserves to claims and manage reserve adequacy throughout the life of the claim.
• Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and Social Security and Medicare offsets.
• Prepare required state filings within applicable time limits.
• Oversee and work with outside counsel to provide information and strategic direction as needed for litigation and/or settlement negotiations.
• Ability to maintain on-going education credits in a multiple state.

EDUCATION AND EXPERIENCE:

• High school diploma or general education degree (GED) and two years of workers’ compensation claims handling experience required.
• Bachelor's degree from four-year college or university preferred.

CERTIFICATES, LICENSES, REGISTRATIONS:

IEA Certificate and California Self Insured Certificate required.

KNOWLEDGE AND SKILLS:

• Strong understanding of workers’ compensation laws and regulations as well as workers’ compensation claim principles and application.
• Strong verbal and written communication and negotiation skills.
• Ability to work positively and collaboratively in a team environment; must always use good judgment.
• Excellent time management and organizational skills
• High level of attention to detail while working in a fast-paced environment
• Frequent use of computers, telephones, and other standard office equipment

PHYSICAL REQUIREMENTS:

• Employees may need to regularly sit, walk, stand, speak, listen, and do computer keyboarding.

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