Claims Examiner

4 weeks ago


Long Beach, California, United States Mary Kraft HR Full time
Job Title: Claims Examiner - Workers Compensation

Mary Kraft HR is seeking an experienced Claims Examiner to analyze and process complex workers' compensation claims. The ideal candidate will have a strong understanding of California Workers' Compensation laws and claim procedures.

Key Responsibilities:
  • Analyze and process complex workers' compensation claims by investigating and gathering necessary information.
  • Manage claims with well-developed action plans to ensure timely and appropriate resolution.
  • Negotiate settlements within designated authority.
  • Calculate and assign timely and appropriate reserves for each claim, and manage reserve adequacy throughout the claim lifecycle.
  • Process and approve benefits payments, adjustments, and settlements within established authority.
  • Prepare and submit state filings within the required statutory limits.
  • Manage the litigation process to ensure effective and cost-efficient claim resolution.
  • Coordinate vendor referrals for investigations or litigation management as needed.
  • Implement cost containment techniques, such as partnering with strategic vendors to minimize claim costs.
  • Manage claim recoveries, including subrogation and Second Injury Fund excess recoveries.
  • Report claims to excess carriers and respond to their requests professionally and promptly.
  • Maintain communication with claimants, clients, and other stakeholders to ensure claims are processed correctly and efficiently.
  • Ensure claim files are thoroughly documented and coded accurately.
  • Refer cases to supervisors or management when necessary.
Requirements:
  • High School Graduate or GED required.
  • Professional certification (OSIP) in California Workers' Compensation required.
  • Minimum of 3 years of experience handling California Workers' Compensation claims required.
  • Experience with complex or technically challenging claims preferred.
  • In-depth knowledge of California Workers' Compensation laws and claim procedures.
  • Strong negotiation and communication skills.
  • Proficiency with Microsoft Office and claims management software.
  • Analytical and problem-solving skills.
  • Ability to work both independently and as part of a team.
  • Strong organizational skills and attention to detail.
  • Ability to meet client service expectations and deadlines.


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