California Workers Compensation Claims Specialist

1 week ago


Walnut Creek, California, United States RPS Full time
About the Role

We are seeking a highly skilled and experienced California Workers Compensation Claims Specialist to join our team at RPS. As a key member of our claims team, you will be responsible for overseeing workers' compensation claims in the State of California.

Key Responsibilities
  • Review new claims received from TPA on a daily basis
  • Complete Initial Claim Feedback Report within 48 hours of the TPA making 3 point contacts
  • Form a partnership and work closely with the TPA Claims Examiner to create claim summary reports for our members
  • Conduct quarterly claim reviews with Members, Brokers and Defense Attorneys
  • Maintain claim diary in CRM
  • Participate in quarterly litigation calls with defense attorney firms
  • Advise management regarding any financial impact of potential large loss claims
  • Assure that TPA is reporting claims to the Excess Carrier when the criteria is met
  • Communicate with Members, TPA, and Brokers in a professional, positive, and proactive manner
  • Ability to work and support other RPS Claims Analysts
  • Attend SIG Program Annual Meetings in person or telephonically when needed
  • Proficient using MicroSoft Office products such as Word, Excel, Outlook, etc.
  • Willing to travel as needed
  • Excellent presentation skills
Requirements
  • High school diploma and 3 years related claims experience required
  • Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements
  • Knowledge of accepted industry standards and practices
  • Computer experience with related claims and business software
Preferred
  • Bachelor's Degree preferred
Behaviors
  • Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges
  • Analytical skill necessary to make decisions and resolve issues inherent in handling of claims
  • Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation
About RPS

RPS is a leading provider of workers' compensation claims services. We are committed to delivering exceptional service to our clients and providing a positive and supportive work environment for our employees.

Benefits

We offer a comprehensive benefits package, including medical/dental/vision plans, life and accident insurance, 401(K) and Roth options, tax-advantaged accounts (HSA, FSA), educational expense reimbursement, paid parental leave, and more.

Equal Employment Opportunity

RPS is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and diverse work environment and are proud to be an affirmative action employer.



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