Claims Examiner

3 weeks ago


Brea, California, United States ICONMA Full time
Job Summary

We are seeking a skilled Claims Examiner to join our team at ICONMA. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, managing claims through well-developed action plans, and ensuring timely and cost-effective claims resolution.

Key Responsibilities
  • Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
  • Manage claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiate settlement of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
  • Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
  • Prepare necessary state filings within statutory limits.
  • Manage the litigation process; ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manage 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.
Requirements
  • Five (5) years of claims management experience or equivalent combination of education and experience required.
  • Prior 4850 experience along with min 2 years of CA claims handling experience is required.
  • SIP is mandatory.

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