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Workers Comp Claims Examiner
2 months ago
Adecco is assisting one of their top clients with their search for a Workers Comp Claims Examiner in CaliforniaPay Rate: $45/hrRemote in California1 yr contractAnalyze 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.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 ordinates 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 municates 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.QUALIFICATIONSEducation & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.Experience (5) 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.Excellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsGood interpersonal skillsExcellent negotiation skillsAbility to work in a team environmentWorkers Compensation Claims Examiner (3+ years of California WC experience)Work location: Remote in CA.Must have SIP Certification
Pay Details: $45.00 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.
