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Lead Claims Specialist

2 months ago


Los Angeles, California, United States Keenan & Associates Full time

Company Overview
Keenan & Associates is a premier insurance brokerage and consulting firm dedicated to addressing the insurance requirements of healthcare institutions, public organizations, and educational districts in California.

Role Summary
The Senior Claims Examiner will oversee indemnity claims and manage intricate claim matters. This position requires a robust background in litigation management, lien resolution, and exceptional customer service skills to effectively resolve standard claims without the need for legal representation.

Key Responsibilities
1. Maintain an up-to-date diary for claims.
2. Identify, prevent, and mitigate potential penalties associated with claims.
3. Regularly update claim notes in the system.
4. Provide timely reporting of excess files to the Reinsurance Manager.
5. Report any instances of suspected fraud or special investigations.
6. Identify and pursue subrogation opportunities.
7. Complete necessary rehabilitation forms and benefit notices.
8. Refer PRIME deletions to the designated office personnel.
9. Update reserves within 30 days of receiving information that alters the financial exposure of a claim.
10. Prepare for and participate in file reviews.
11. Accept or deny delayed claims within a 90-day timeframe.
12. Request settlement authorization within 30 days of a final report.
13. Complete necessary stipulation and compromise paperwork.
14. Maintain a 100% closing ratio on active accounts and aim to reduce runoff accounts by 25% annually.
15. Prepare legal referrals and provide guidance to defense attorneys.
16. Ensure all phone calls are returned within 24 hours.
17. Create instruction sheets for assistants and claims entry clerks.
18. Review incoming mail daily and correct any errors promptly.
19. Ensure client and claimant satisfaction is maintained.
20. Update Unit Stat forms as necessary.
21. Oversee new setups, reserves, and instruction sheets.
22. Prepare cover letters for evaluations.
23. Negotiate outstanding liens.
24. Maintain three-point contact with relevant parties.
25. Interact with nursing staff on case management.
26. Perform other assigned duties as required.

Qualifications
- A minimum of five (5) years of experience as a Claims Examiner in California and possession of a Self-Insurance Certificate, or the ability to obtain one within one (1) year of employment.
- Preferred: Two (2) years of experience managing public entity claims.
- Strong verbal and written communication skills.
- Proficiency in Microsoft Office Suite, including Outlook, Excel, PowerPoint, and Word.

Benefits
We offer a competitive salary and a comprehensive benefits package, including:
- Generous paid time off policy.
- Health benefit options tailored to your needs.
- 401(k) plan with company matching.
- Wellness program support.
- Access to mental health resources.
- Opportunities for professional development.

Compensation
The target salary range for this position is between $75,000 and $95,000 annually, with actual compensation based on experience and qualifications.

Company Culture
Keenan & Associates is committed to fostering a diverse and inclusive workplace that values the unique experiences and contributions of all team members. Join us to engage in meaningful work and grow professionally.