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Claims Management Professional

2 months ago


Concord, California, United States The Ladders Full time
Job Overview

Position Level
Experienced

Job Type
Full Time

Education Requirement
High School Diploma or GED

Salary
$90,000 - $95,000 per year

Work Environment
Hybrid

Key Responsibilities:

As a Claims Examiner III, you will:
  • Conduct thorough investigations and evaluations of moderately complex to complex claims.
  • Assess coverage, compensability, and liability while establishing appropriate reserves.
  • Communicate effectively with injured workers, client representatives, and medical professionals to facilitate understanding of the claims process.
  • Coordinate with disability examiners to manage non-occupational benefits.
  • Issue necessary notices in compliance with legal requirements and stay updated on relevant regulations.
  • Maintain accurate reserving practices throughout the claim lifecycle.
  • Identify and pursue subrogation opportunities.
  • Ensure compliance with reporting requirements.
  • Manage medical treatment coordination for injured employees.
  • Understand Medicare reporting obligations in relation to Workers' Compensation claims.
  • Facilitate return-to-work initiatives through modified job duties.
  • Oversee all medical aspects of claims with a focus on resolution.
  • Refer claims for specialized management as needed.
  • Monitor the quality of work performed by external vendors.
  • Act as a liaison among medical providers, employees, legal teams, and clients.
  • Handle claims in litigation with regular communication with legal counsel.
  • Maintain precise records in the claims management system.
  • Present clear action plans for claim resolution.
  • Engage with clients to review ongoing claims.
  • Control expenses associated with Workers' Compensation claims.
  • Provide mentorship to junior claims examiners.
  • Perform additional duties as assigned.
Qualifications:

Required:
  • High School Diploma or GED; Bachelor's degree in a related field is preferred.
  • Three to five years of experience in Workers' Compensation claims administration.
  • SIP certification.
Preferred Skills:
  • Experience with complex and litigated Workers' Compensation claims.
  • Licensure in multiple states is advantageous.
  • Bilingual in Spanish is a plus.
  • Ability to thrive in a fast-paced environment.
  • Strong analytical and problem-solving skills.
  • Excellent communication skills, both verbal and written.
  • Proficient in Microsoft Office and claims administration software.
  • Ability to manage multiple priorities effectively.
  • Team-oriented with good interpersonal skills.
Benefits:
  • Comprehensive medical, dental, and vision insurance.
  • 401(k) retirement plan.
  • Paid holidays and time off.
Mental and Physical Requirements:
Refer to the detailed checklist for specific mental and physical requirements necessary for this role.