Claims Examiner

1 week ago

Oakland, United States JT2 Integrated Resources Full time

JT2 has over two decades of experience in claims administration and has delivered consistent cost savings to clients while providing quality care to claimants. We partner with our clients to provide fully customized and innovative solutions that integrate claims administration with risk control solutions.

We are searching for highly motivated Claims Examiners to join our team Under supervision of the Claims Supervisor, the Claims Examiner will manage claims from inception to conclusion. The position requires an individual that adheres to best practices and State of California statutes to work directly with clients, injured workers, agents, vendors, and attorneys to resolve workers compensation claims.

This position is available for either remote or in office work.

Minimum Requirements

  • Three (3) years of claims management experience
  • Bachelors degree from an accredited college or university preferred.
  • Possession of a current Self-Insurance Plan (SIP) Certificate and insurance-related course work: CPCU, WCCA, WCCP, ARM.
  • Ability to administer any type of indemnity claim within the assigned caseload including those involving lost time, permanent disability residuals, and future medical claims.

Duties and Responsibilities

  • Ensure proper handling of claims from inception to conclusion per client service agreements and JT2 service standards.
  • Prepare accurate and timely issuance of benefits notices and required reports within statutory limits.
  • Reserve files in compliance with injury type; identify potential costs of medical care investigation and indemnity benefits.
  • Ensure timely payment of benefits, bills and appropriate caseload and performance goals.
  • Negotiate and prepare claims for settlement; provide manager/supervisor with complete and accurate settlement data.
  • Monitor, report, and assign claims for fraud potential and subrogation possibilities.
  • Monitor claims for pre-established criteria for case-management and vocational rehabilitation in accordance with State laws.
  • Prepare and present claims summaries to clients during file reviews.
  • Train and direct Claims Assistants to meet goals and deadlines.
  • Review and approve priority payments and other documents from Claims Assistants.
  • Performs other duties as assigned

Knowledge, Skills, and Abilities

  • Strong knowledge of workers' compensation policy, concepts and terminology and benefit provisions.
  • Strong knowledge of adjusting workers' compensation claims for municipalities and administering LC 4850 benefits.
  • Strong skills with use of general office administration technology, including Microsoft Office Suite and related software
  • Excellent verbal and written communication skills
  • Excellent interpersonal and conflict resolution skills
  • Excellent organizational skills and attention to detail
  • Excellent interpersonal, negotiation, and conflict resolution skills
  • Strong analytical and problem-solving skills
  • Ability to act with integrity, professionalism, and confidentiality, at all times

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.

JT2 Integrated Resources provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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