Claims Representative

Claims Representative - Workers Compensation

BCforward is currently seeking a highly motivated Claims Representative - Workers Compensation for an opportunity in California, CA -Remote

Position Title: Claims Representative - Workers Compensation

Location: California, CA- Remote

Anticipated Start Date: 10/14/2024

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: 2 Months

Job Type: [FULL TIME (>=30 HRS WEEKLY], [CONTRACT], [REMOTE]

Pay Range: [$42.00] - [$45.00]

Please note that actual compensation 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.).

Job Description: Workers' Compensation Claims Examiner

**PRIMARY PURPOSE:**
To analyze complex or technically challenging workers' compensation claims, determine benefits due, and manage high-exposure claims involving litigation and rehabilitation. This role ensures ongoing adjudication of claims meets service expectations, industry best practices, and specific client requirements while identifying subrogation opportunities and negotiating 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:**
- Perform other duties as assigned.
- Support the organization's quality programs.
- Travel as required.

**Education & Licensing:**
- Bachelor's degree from an accredited college or university preferred.
- Professional certification relevant to the line of business preferred (e.g., SIP Certification).

**Experience:**
- Minimum of five (5) years of claims management experience or equivalent combination of education and experience required, specifically in California workers' compensation.

**Skills & Knowledge:**
- Subject matter expertise in relevant insurance principles and laws, recovery offsets, claim duration, and cost containment.
- Excellent oral and written communication skills, including presentation abilities.
- Proficient in Microsoft Office and other relevant software.
- Strong analytical and interpretive skills.
- Excellent organizational and interpersonal skills.
- Exceptional negotiation skills and ability to work collaboratively in a team environment.
- Ability to meet or exceed service expectations.

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking

**NOTE: **

Manager's note: -Self Insurance Plans (SIP ) Certificate. Work location: Possibly remote but only in CA. Ideal is if we had someone close to the office that could come in one day a week with the rest of the team to help answer questions and training

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.

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.

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.

Interested candidates please send resume in Word format Please reference job code 229950 when responding to this ad.

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Salary Details

This salary was provided in the Job Posting.

$42-$45

Hourly Salary

Job Snapshot

Employee Type
Contractor

Location
Concord, NH (Onsite)

Job Type
Customer Service, Health Care, Insurance

Experience
Not Specified

Date Posted
10/04/2024

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