Claims Examiner
4 weeks ago
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.
- 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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